February 1, 2012 Recent News





GIGO.  Computers are only as good as the garbage fed into them.  Bronx-Lebanon Hospital found this out when it sent out bills to patients and put the invoice number where that amount owed was supposed to be.  One patient got a bill for $44.8 million.

After a local union accused El Camino Hospital in Palo Alto, California, of intimidation the union finally got certified.  It plans to make life miserable for the hospital.

Maine hospitals state they are owed $125 million by the state for treating Medicaid patients in the past.  The state does not add this into the budget but they are concerned about the money owed.  They just won't pay it.

CHW has changed its name to Dignity Health and broken away from the Catholic Church.  They want to be more inclusive and have both Catholic and non-Catholic hospitals in their fold.  They also will no longer be beholden to the Catholic teachings about birth control and abortion.   

Obamacare will soon pit hospital against hospital and against the 
AHA.  The Congress will be looking to reduce hospital payments to help pay for SGR reform.  The AHA has lamented the cuts saying untruthfully that it will result in the layoffs of over 200,000 people.  In fact the AHA had agreed to a much larger cut to support Obamacare.  Also the People's Republic of Massachusetts has found a loophole in the Obamacare law that allows only the hospitals of that state to get an additional $367 million in Medicare funding.  This money will come from the other hospitals in the country outside of the Republic.  The other hospitals gave asked the current administration to remove the loophole in their 2013 budget.    

Sometimes hospitals do things that are so idiotic that it amazes me that they can stay in existence. This one is by several Maryland systems including the University of Maryland.  They are recommending lawyers to patients that they have committed malpractice upon.  The question asked by a past president of the AHLA says it all, "Why would I want a referral from a hospital for an attorney at all?".  This seems like a major conflict of interest for the hospital to recommend lawyers that will take the case at a reduced rate and probably settle quickly at a reduced rate.          Top


Approximately 700 Southern California physicians affiliated with Providence Health have banded together to share quality, create guidelines and get feedback from their colleagues.  Providence is providing the electronic medical record and shared programs.  This is a physician led organization.

The American Academy of Gastroenterologists is warning its physicians to warn patients that the "free" preventative colonoscopy may not be free.  If any polyps are detected and removed that is not preventative and the patient will be billed.  also any follow-up visits are also not covered under the "free" preventative service.  There are now 34 "free" services and some may reveal further attention is needed.  Those are not free.  Physicians should consider when giving the "free" service to use an advanced beneficiary notice on Medicare patients and a similar notice to non-Medicare patients.

Two New Jersey groups of physician have formed their own ACOs.  The physicians are affiliated with a hospital but according to the article at NorthJersey.com the physician and not the hospitals will get any money saved.

The New York Times had a blog that reported a story out of the Archives of Internal Medicine that internists are referring more patients to specialists.  The referral pattern has doubled in the ten years between 1999 and 2009.  This may be a driver in the rising costs of medicine but it is better medicine than having physicians treating things they are not as good at treating.  Also, the 15 minute visit does not allow the primary physician to take the time to diagnose and treat potentially complicated issues. Occasionally the internist really takes on more than they should either due to financial pressure or habit.  I have a friend that has a severe unilateral tremor that is progressing and the internist has not referred him to a neurologist.  This is poor medicine bordering on malpractice.      Top


The People's Republic of Massachusetts has set out and accomplished it's goal of insuring most of it's residents.  To date about 94% of those between 19 and 64 years old are covered by insurance.  However, it comes a great cost to the Republic's workers who have seen their premiums continually raised to pay for the "have nots".

The Republic's Governor in his state of the Republic speech wants all insurers to pay globally.  This, he stated, would reduce costs and make the patients and the Republic pay less.  As of now about 20% of the Republics patients are covered by global fees or HMO style fees.  There is now less referrals to specialists and more patients stay in community hospitals instead of the expensive teaching hospitals. Global payments put primary physicians in charge of the patient and referrals.  If they go over their allotted amount of money the primary physician loses money.  This is an inherent conflict of interest that brought down the HMO industry years ago.  To date, it is unknown whether or not these payments save money.

The AP had a story printed in the Washington Post that stated truthfully EMRs are essentially worthless if they do not talk to one another.  Most do not.  Also EMRs are not being set up as quickly as the government would like.  Only 33% of physicians had an EMR in 2010.  The goal is to have all hospitals and physicians on EMR by 2014.  One of the problems with sharing is the financial disincentive.  If the ED physician relies on the test done a week ago by the PCP the hospital does not get paid if the ED physician does not reorder the test.  Also the privacy problem has not been solved.  Either it is not enough and information is stolen or there is too much and individuals can not interact with their physicians.

Could there be a conflict of interest?  Marilyn Tavenner, the new appointed but not confirmed head of HHS is being paid $160,000 a year for life by HCA for being a former executive with that business.  She will have to recuse herself from any matter that would affect her payment but not for any matter involving HCA.  She retired from the company six years ago.  It is probable that Ms. Tavenner will be confirmed by the Senate.

Wellpoint is starting a policy to pay primary care physicians about a 10% increase so they can spend more time and refer less.  They believe that if the primary physicians spend more time this will lead to less ED visits and hospitalizations.  They may be right if all insurers did this but if only one or two do it it will not lead to changes of behavior.  Aetna is paying its HMO primary care physician and additional $2 per patient per month in hopes for the same outcome as Wellpoint.  Wellpoint is also paying more money as a bonus of 20-30% of any saving they achieve if a physician has a care plan for a patient with a chronic disease.  The physician have to have longer hours to qualify for this including some form of 24 hour access for patients.  They also have to certified as a "medical home". To date there has been better patient satisfaction with the medical home concept but no money savings.        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.