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An article discussing misdiagnosis focuses on the reasons physicians have not utilized computer systems for decision trees. The first reason is the inability to access web based platforms easily during patient encounters. The second is that it takes too long for rule based systems. The third reason given is the systems are expert and not reminder systems which ticks off the ego of the clinician. Apparently there is new technology which utilizes EHR in real time and instead of rule based is based on unstructured text. These may be helpful in the 10%-15% of misdiagnosed conditions. The question remains, is it worth the money?
Another article states that patients are more likely to have the wrong meds given and potential for harm when transferred to radiology. The is because of lack of communication on the handoff. The article doesn't state that many of the 12% of mistakes in the radiology suite could be averted by using a bar code system. Top
In two articles that seem to be related one talks about those in concierge practices and the other in how to work within an organization. The retainer or concierge article compared concierge and non-concierge practices. The results of the study showed fewer minorities in the practices of the concierge physicians, the concierge physicians going with their patients to the specialist appointments, more communication between physician and patient, more house calls. It also showed that 17% of the concierge physicians see some of their old patients on a non-retainer basis and 84% also provide charity care.
The next article is part one of tips for preparing for the future and working within organizations. The first one is to get together with your medical school classmates or your fellowship or residency mates and organize a seminar on the business of medicine. In virtually all communities there are speakers that would be happy to come to these seminars geared for the soon to be practicing physician. The next tip was to target a consumer based care which is now taking over the employer world. Make your office consumer friendly because you will need to compete with others. The patients will no longer be sent to you. The next tip involves access to capital so that you can market and get involved with the latest technology. Most capitol goes to multi-specialty and single specialty corporations. Look at your money. Is your money from salary or sweat and how will this change in the future with lowering reimbursement and rising costs? Most importantly, how does the money relate to life style? The next tip is, if possible, align with physician driven organizations. Look at the size as smaller groups can move more quickly to respond to changes. The fifth tip is consider working collaboratively with hospitals. If they won't, then consider others that will. The last tip in this part one is to think about the big picture. The future will be what? How will you fit in? How business savvy do you need to be?
The American College of Surgeons will not meet in Georgia until there is a change in the law regarding outpatient surgical centers. Georgia has a CON policy that allows single specialties to operate surgical centers without going via the CON process. General surgeons are not considered single specialty. This is the only state in the union that believes this. Atlanta was not allowed to bid on the annual ACS convention which brings almost 20,000 people to the city. The Georgia Hospital Association which want to keep the surgeons in the hospital are opposed to the ACS action.
The American College of Physicians is concerned that primary care is almost a dead field. This is due to insurers rushing the visits, rising expenses and no comparable rise in pay. Currently more primary care physicians are retiring than are graduating from medical school. The ACP wants to give primary physicians in charge of organizing a patient's care and more money for doing so. They want pay for more preventative measures instead of just in time interventions. About 3/4 of current internal medicine are going into the more lucrative sub specialties. Top
In Columbia, South Carolina there are two major hospitals. One is Providence owned by the "Sisters of Charity". The other is Palmetto. Palmetto wanted to build a cardiac hospital and this was fought via the CON process by Providence. Providence lost. The new hospital is 121 beds and is attached to a new office building owned by two physician groups. It is also attached to the Palmetto flagship hospital. This process started six years ago and the gentle "Sisters" but in a economic credentialing provision in their hospital that nobody with a financial interest in any other system could practice at Providence. This was not a charitable thing for the "Sisters of Charity" to do. It is my hope that they will lose many of their staff and patients to their competitors for their atrocious behavior.
How not to make nice with the physicians. Partners Healthcare, the parent of MGH and Brigham and Women's, is pushing the 300 physicians of the North Shore hospital and medical group to refer patients to them. If they don't send more patients they will be cut from any affiliation with Partners. Partners used the old saw that if the referrals are sent elsewhere they can not monitor the quality of their care (nor receive their money). The affiliation brings money to the physicians since Partners can negotiate higher contracts than the physician group can on its own. This happened after the smaller group developed an oncology program and a cardiology program with other facilities. Partners didn't like that and so the economic ultimatum.
An Eastern hospital consulting group has stated that prior to starting an economic credentialing program they should do PR to not be caught in defamation law suits. The hospitals and their boards should not talk about the harm they are causing the physicians. The consulting group does acknowledge the strong adverse publicity that will be generated by the physicians.
Although it is a legal case, I decided this would be a good
spot for the story. A physician group in Missouri is suing its hospital on
antitrust grounds. The Ferguson Medical
Group accuses Missouri Delta Medical Center of discriminating against the group
in peer review and call in order to obtain their patients. They seek
triple damages and attorney fees along with an end to the illegal
conduct.
In Lafayette, Indiana, Clarian Health is building a 150 bed hospital in partnership with a 138 physician group. The hospital will be the majority shareholder even though the medical group is bringing to the table their 61,000 member health plan and their surgery center. Clarian and the physician group both are affiliated with the University of Indiana in teaching the medical students. Top
It's nice to have Drew/King back. The LA Times has a story about the poor employees at the hospital. In the past two years, about 20% of the employees have been disciplined or fired. The problems is that the employees are still doing the same poor performance as took them to the national spotlight two years ago. The past county health director states that the employees see the consistency of the discipline will be more attuned to do the right thing.
The Providence Health System in Oregon had 300,000 patient records on a backup tape stolen from a minivan. The System said it was routine for managers to take patient records tapes home as a available backup. The records were home health and not hospital records but had patients names, addresses, social security numbers and all the health information. Providence did not notify the patients about the problem for three weeks. I wonder how much they will pay to the state and to the patients.
The attorneys who represented the poor folk of Tennessee in their losing fight against the State for putting TennCare recipients back on Medicaid got $1.3 million for their shenanigans. They went to the Court of Appeal twice. The second one was almost frivolous. Who is paying the fees? The same state who they sued. The firm was a late comer in the fight and charged about $450 an hour. The settlement with the state was for 5000 hours and ended at $350 per hour. The legislature is not happy and want the details which are not forthcoming.
UC Irvine, already in trouble for refusing livers for patients in need, now is in trouble for the same refusal of needed kidneys. They deserve to have all their programs shut down for letting people die who were registered with them. The patients who are presently registered with UCI should go to other hospitals to be put on their lists. They did not have and still do not have adequate numbers of physicians to perform the transplants.
UC Irvine is now under fire for making a special residency slot for a person whose father just gave $250,000 to the University. The resident was not chosen as part of the usual selection process. The resident is paid from a special fund controlled by the chief of radiology and is not connected to the money the father gave. The father is on the staff of UCI as a radiologist. When the young resident started the slot had not officially been approved by the ACGME.
The head of UCI has resigned over the problems at the University.
The feds are now getting into the nonprofit hospital debate on providing sufficient care to the uninsured. The IRS and the Senate are beginning the crackdown on 9nurement by the non profits. The hospitals are going to be sure their tax exempt bonds go to charitable purposes, they cannot have excessive compensation to their executives, and their community benefit will need to spelled out in detail. Community benefit includes an open hospital staff, full time ER, non emergency care to all in the community regardless of their ability to pay and the hospital serves the broad community via research or charity care. The hospitals have only themselves to blame or this added scrutiny.
Providence Health Systems of Oregon, the ones who just lost 366,000 patient records, combined with its sister organization Providence Services. They also settled with the Scruggs legal group the lawsuit against them for overcharging uninsured patients. The new settlement would be to charge the uninsured the same as the System gets from PPOs. To be eligible to this and other discounts the patients would need to be within a percentage of the national poverty level. Currently 43,000 people would be eligible for retroactive discounts but they only have to February 23 to apply. By the way the first class action law suit against Providence over their negligence in losing the medical records has been filed. Top
In California, MICRA continues to work. A physician owned mutual malpractice company CAP-MPT is dropping premiums slightly over 5% across the board. Top
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.