February 1, 2008 Recent News




Electronic Medical Records


An article on Yahoo News stated that The Commonwealth Fund did a study on 3501 adults aged 19 or above and that 80% of Democrats, 52% of Republicans and 68% of Independents wanted mandatory health coverage.  The article did not state the questions asked or who would pay for it or how it would impact the cost of goods to both the US and foreign consumers.  The Democrats wanted employers to continue paying and the Republicans wanted individuals to pay the cost using the tax code. 

A study in the Wall Street Journal by three Northeast institutions decided that co-pays above $10 for mammography would deter a certain amount of older women, those between 65 and 69, from getting the test.  Some researchers felt it was due to the money and others felt there were other factors but no one asked any of the women why.  Another study designed to show the outcome wanted. 

Did anyone ever wonder what happens to the money in hospitals?  A story in the Courant states that ailing hospitals that are crying for more money to take care of the indigent are paying their CEOs almost one million dollars a year.  Maybe states should look at salaries when they consider to give more money to a hospital or not.  Several CEOs stated that their high salaries were not driving up healthcare costs.        

The audit of Medicare by the company that gets paid a percentage of what it says Medicare should recover, even if they are wrong, recovered about $250 million for the federal program last year. 

How much charity work should a hospital perform to remain a non profit and get the tax advantages?  In San Francisco five non profit hospitals took $79 million in tax breaks but only gave away $16 million in free care to the city's poor.  The worst offender was California Pacific which received almost $70 million in tax breaks and gave away a grand total of $5.2 million in charity care.  The other hospital with some work to do was Chinese Hospital which received over $3 million more than it gave.  California Pacific's answer is that the neighborhood they are in does not get the uninsured.  The hospital does do some other charity work that is not counted in the definition but is is peanuts compared to the tax incentives.  The spokesperson for the hospital also said that they only get what the public hospitals get for patient care.  Of course.  They should not get more.  It should be noted that California Pacific spent a whopping 0.7% of its budget on charity care and Chinese Hospital spent 0.6%.  Terrible numbers. 

In the twin city area of Minnesota a new online site allows patients to self diagnose and then go on the site to see the qualifications and price of different physicians to take care of the problem. To date, there is only a limited amount of diagnosis on line but the site hopes that will change.  The major provider groups have not yet joined en masse.  Providers who have joined are pitted against each other on price and not quality.  Those that use physicians to see patients may switch to nurses in order to reduce their prices.        Top


Aetna has announced a new wrinkle it its contracts with hospitals.  The new term calls for report "never" events to The Joint Commission state programs or patient safety organizations.  The contract goes on to state that the hospitals are not to charge for any related costs, are to take action to prevent future events and apologize to the patient and/or family.  It sounds like all are negotiable except the part where there will by no payments.  

The People's Republic of Massachusetts is not only strange in itself but it now spills over to its companies.  The People's Republic Blue Cross has proposed to stop paying for care at either a hospital or a physician on an as used basis but instead pay for a years care based on co-morbidities.  This is an HMO drawn out. The difference would be it would be one payment for all involved in the care be it hospital, primary care physician specialist or whomever.  It would be up to those involved to divvy up the money.  Blue Cross expects to halve the payouts in two years for those who accept this new idea and also increase their share of the market which they now own about half.  This of course would restrict patient choice to those who accept the system and make providers responsible for all costs above what is being paid even if they had nothing to do with the high costs.  There is no requirements for outliers.  To date no one is ready to assume the risks involved and sign on.

An article in the USA Today tells of employers dropping group health plans and instead giving employees a fixed amount a month to help them pick their own insurance.  The money goes to tax free HSA accounts.  There are those who like the idea nad those that don't.  The major drawback is that there are only three states who prohibit not giving insurance based on preexisting events.


A study by the University of Iowa of 338 physicians in teaching hospitals around the country shows that physicians in those positions do not report their errors.  Seventeen percent did not report minor errors and four percent did not report serious errors.  Only 38 % admitted to ever making an error.  This shows the reader how bad the study was since 100% have made errors.  I understand not reporting errors as long as there is a culture of an error equals a bad apple and the apple should be removed.  A better way is to prevent further errors by communication without making the physician go through hell.

The Seattle Times reports about a group of 20 anesthesiologists that went to Northwest Hospital and demanded over $2 million more in payments.  The anesthesiologists were canned.  The CEO of the hospital, Bill Schneider, had told the anesthesiologists they were doing a lousy job and the anesthesiologists wanted him to apologize by asking for more money.  The hospital then opened negotiations back with the group and if there is no agreement the hospital will have a hard time scrambling for more qualified anesthesiologists.  The money was for taking call in Ob and at nite for free when others were being paid.  The anesthesiologists now state that maybe both sides overreacted.  Sounds like maybe a compromise may be reached.   

In a head in the sand approach, the head of the California Medical Board has stated he is willing to throw the baby out with the bath water.  The Board had a confidential program to help rehabilitate physicians from drug and alcohol abuse.  A report on the program showed it was not monitoring the physicians closely enough and some physicians were gaming the system.  Instead of tightening up the system, the Board is throwing out the whole system.  This means those with problems will not ask for help and will not be found until harm comes to a patient.  Those that are found to be abusing alcohol or drugs will now be prosecuted by the State AG office and have their licenses revoked, a good reason not to come forward.   

An article in the Chicago Tribune discusses the medical board in Wisconsin and their lack of discipline of physicians.  The article states that Wisconsin had 2400 complaints filed about physicians from 2002 to 2006 and only disciplined 213.  Of course Public Citizen, the holier than thou organization that only wants numbers not true discipline, piped in by ranking Wisconsin 46th in numbers.  The article intimates that the Board keeps secrets from the public but in fact it would harm the physician if unfounded complaints were open to public scrutiny.

In a classic model of how to do things wrong, St. Anthony's Medical Center in the Saint Louis area is changing their ER physician employments without the input of the group.  The physicians are currently employees of the hospital and are happy with the arrangement.  The hospital wants out of the employment business and wants the physicians either to band together as a group and then contract with the hospital or join a large group to contract with the hospital.  They have already lost three of their physicians to a competitor and another five will join them soon.  Stupid top management that wants to do things without input usually lose all.   

Bridges to Excellence made up of Verizon, GE and IBM are offering bonuses to primary care physicians to do appropriate screenings and following up on referrals, tracking tests and flagging abnormals as well as using guidelines for chronic conditions.  This can be from 2% to 6% of the regular payments from these companies for the screenings and an additional $125 per patient per year for each patient from each employer, up to $100,000 per year per practice.

Dr. Stephen Haffner of the University of Texas is a peer reviewer for the New England Journal of Medicine.  He screwed up by faxing an article sent to him to read regarding Avandia to the drug maker of the medicine Glaxo.  This was two weeks prior to the article being published in the Journal.  Dr. Haffner has received about $75,000 for being a paid consultant and speaker for Glaxo.  It will be interesting what if any punishment the physician received except for being removed from the Journal and Glaxo.         Top

Electronic Medical Records

The Palo Alto Medical Clinic, a large provider of medical services under the Sutter Health banner, has installed electronic medical records.  They hope to show the expensive toy is worthwhile by doing a study showing improved patient compliance leading to better outcomes.  Once this is shown they will ask insurers to increase payments to cover the system.  Of course the Congressional Budget Office recently showed that EMRs on their own would not significantly reduce overall health care costs.  Also in October, the Medical Records Institute found that 12% of those who had EMR had uninstalled them and an additional 7% are now uninstalling them.  Over 8% had gone back to paper.  The Palo Alto Group has a $60 fee that allows patients to email their physicians questions and information cutting out some visits.  After about 20 years of pushing EMR about 18% of hospitals or clinics have joined the movement and only about 25% of physicians are using some form of EMRs.  The cost is about $30,000 per physician but there is more in the annual updates etc.  Palo Alto, being a closed group, may be able to force the EMR on all their physicians and to pay for all the updates and upkeep.  I hope, as do they, that it really improves care and then insurers will pay for the extra cost.   

The New Jersey Blues have lost another computer with patient identification.  There was no medical information on this computer but 300,000 notices offering monitoring services have been mailed.  the information was password protected.     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.