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A study just released by two Pennsylvania judges showed a decrease in the amount of $1 million verdicts. The problem is there is still a large discrepancy (about double) between Philadelphia and the remainder of the state as well as the surrounding states. The tort reforms that passed the House and are now in the Senate are aimed at reducing the non-economic damages. The trial lawyers are still in their old theme that the liability would be borne be the victims. What they are really saying is we make our living on the insurance money and do not want the golden calf killed. (See Legislation) In Florida, the medical association is thinking about placing a proposition on the November ballot that would limit punitive damages. Many states do not allow these damages in negligence cases only in those with intent. Again the trial lawyers would be vehemently opposed. They state, not believe, that the high awards keep the physicians accountable. Such hooey! The proposition route was tried in 1988 and failed mainly due to the lawyers heavily outspending the physicians. The Florida physicians are going to march on Feb. 20th at the state capitol against the high malpractice rates. Since the legislature is in the pocket of the trial lawyers, it won't make much of a difference. There needs to be a much more decisive action such as not doing elective surgery or seeing elective patients. This may hurt the pocketbook for several weeks but the rates will hurt it more and for a longer time. The march needs to be coordinated with a state proposition for the November ballot and this time but your money where your mouth is. Don't be overspent by the lawyers. Hire a good PR firm. In two stories in the Corpus Christi, Texas Caller the malpractice woes of the state are detailed. The first story discusses the legislature again looking at the problem. However, the state does not enforce the $5000 bond requirement to file a case. The law states the bond may be waived for poor patients but if waived they need an expert to agree that each defendant named committed malpractice. This expense comes out of the contingency fee attorney's pocket, so they try to talk the judge out of it. The attorneys also complain that the nasty insurance companies take the premium money and don't want to pay claims. The one thing I believe all doctor's agree upon is that their premiums should not be raised just because they get a notice to sue that never comes to fruition. The other story is how lawsuits hurt not better patient care. The article states how the Corpus Christi physicians are sending patients to San Antonio or Houston for care. Top A new study by the Commonwealth Fund showed that out of pocket costs for Medicare HMO patients rose by about 50% over three years. The sicker patients spent $2,088 last year in drug bills. Approximately 14% of seniors are enrolled in these plans. The average recipient in an HMO has an out of pocket expense for drugs at $1438 as opposed to the regular Medicare at $3142 per year. Could this be cherry picking with or without rationing of care? I truly do not understand why any are enrolled. If one looks at regular Medicare supplements there are 10 plans that go from A to J. The top layer have up to $3000 matched coverage for the recipients. Yes they are over $200 per month but the patient can get care in any hospital and with any physician in the United States, as well as emergency overseas coverage. Now that the HMOs have cut back their payments and benefits there is even less reason to join one of these rationing plans. The San Diego Trauma Centers will be examined. Palomar Hospital, part of the system, closed its trauma doors for several weeks due to a contract dispute with its physicians. The has led to the County re-evaluating the system as to the necessary funding necessary. The project will be complete in six months. That's better than the over ten years it has taken from the fall of the San Francisco Bay bridge after an earthquake to the groundbreaking for a new span. This is longer than it took to build 3000 miles of the Great Wall of China in 621 CE. Tacoma, Washington's Mary Bridge Children's Hospital Orthopedic surgeons refused to cover the ED. They did this by dropping off the hospital staff. CMS threatened the hospital with loss of Medicare certification for EMTALA violations. The hospital began to pay the Orthopods for call and the CMS dropped its case. The hospital is paying for on-call and more if the Orthopod actually has to show up. Top Blue Shield is playing follow the leader. They have copied PacifiCare in using a two tier system of hospitals for their insured. Health Net is soon to follow. The two tiers are only based on cost and not quality. They have dropped the only hospitals in Vallejo and Fairfield California to the second tier. The hospitals are now dropping Blue Shield entirely, so they will not have to go after the patient for the extra per diem payment. This could add up to over $700 per stay depending on length of stay and diagnosis. The only two hospitals in central Contra Costa, just across the river from Vallejo are also dropping Blue Shield. Blue Shield just sent me a letter stating that instead of the hospital one mile from my house or the one five miles away which are both on the best hospital in California list, I can go to one twenty miles away where it is a for profit and I have no physicians. It is easier to drop Blue Shield, and I will. PacifiCare has changed the rules in midstream. In Texas, they have began charging patients for hospitalization and chemotherapy medication, even though they were already on the medication when they switched policies. Not playing nice! Don't cry for me Harvard!! Harvard has lost their top cardiac surgeons to Mt. Sinai in New York City. The surgeons were paid a good salary and also promised research and operating room space. Harvard is worried and well they should be. They pay their physicians below the median for salaries but when the cost of living is taken into account it is at the 25 percentile level. They blame the low salaries on the low reimbursement but are not willing to have the guts to drop out of managed care to force increased incomes. Top Cigna is following the Aetna model of a new insurance plan that allows employers to fund a certain amount of money into an account that is to be used for medical payments. After the fund is used up the employee will be responsible for possibly 20% of the remainder and Cigna would provide the other 80%. This gives the employee some control over the expenditures. If there is any money left at the end of the year it may be rolled over to the next year. If this sounds familiar , it is because it has been in existence for about five years but called a Medical Savings Account by the Feds. I have had one for years and love it. I get a IRA type tax deduction for the contribution and then pay a small amount for al large deductible policy as a safety net. Patient Physician Haggle The Wall Street Journal is reporting an increase in patients trying to haggle the cost of their medical care with their physicians. The patients have been doing this for years for cosmetic surgery and other conditions not covered by insurance. In the era of insurance will pay for all this has fallen off. It now returns but the patient needs to pay a significant, if not all, the bill upfront to get a significant discount. This is especially true with those patients who et a fixed amount each year to spend on health care. Top The three deaths in Minnesota following knee replacement surgery were not related. One was indeed from an infection in the prosthesis but the other two were heart attacks. This was when the State reasonably prohibited all knee surgery for one week until the cause could be probed. Top A Texas man is the first identified blood recipient in several years to have been infected with the AIDS virus via a transfusion. The patient had an emergency bypass surgery and required transfusions. One of the units was from a donor that had donated four times that year. The first three times his test was negative but the fourth was positive for HIV. The Bank retested the other three units and found no HIV but notified the hospitals and recommended the patients who received the donor's blood be tested. This one recipient was positive. The test being used is sensitive enough to tell if a donor had been infected 7-10 days earlier. The Bank believes this one did not have a high enough count to be detected. Top Golden State Physicians, a Sacramento IPA, had its radiologists refuse to do any more for the group. They haven't been paid. The IPA has hired two prior management companies that did not do what they stated they would-pay bills on time. The IPA has now hired a third management company and in all probability will be out of business in a short time. The Department of Managed Care has them on its watch list but has no power to de-certify them. MGMA has released the first comprehensive report on the comparison between salaried and independent physicians. Salaried physicians are losing about $89,000 per full time physician. Independent multi-specialist practices are making about $1000 per full time physician. This does not take into account the difference between salaried and productivity physicians. Those on straight salary are bringing in about $300,000 and those on productivity about $416,000 per year. The flip side is that hospital owned practices had about $58,000 less expenses per full time physician than their independent counterpart. This was due to group purchasing arrangements. Top The California Foundation has released a report stating that 46% of California physicians, primary and specialists, do not treat Medicaid (MediCal) beneficiaries. For those that did see the Medicaid patients half, only had 5% of their patients in the program. The study showed that most of the physicians taking the patients were either foreign medical graduates or non-board certified. Again, of those accepting the patients, 94% said the pay was inadequate and have more complex medical problems. The other major problem are the administrative hassles. I remember when I started practice I took all patients. As the physicians in my specialty took less MediCal patients, I ended up with more. This with the decreased payment and the increased paperwork required to take care of patients led me to drop the program after about ten years. I also refused to see those MediCal patients from physicians who never sent me anything but the MediCal patient. If they sent me some better paying patients I would see some of the MediCal patients for them. Now, there are no primary physicians or specialists or hospitals in my community who take MediCal. Top CVS Pharmacy mistakenly gave a 51 year old patient with diarrhea an opium tincture instead of camphorated tincture of opium, Paregoric. The pharmacy is blaming the physician for not using that name on the prescription. This was found on an autopsy toxicology test. The pharmacist is on administrative leave and a civil suit is in the works. Top The Feds raided a San Francisco medicinal marijuana club and confiscated a whole pound of the nasty weed and 630 plants. In other coincided raids a total of 6300 plants were taken. Medicinal marijuana is legal under California law but not under federal law. It is only the Feds that do the busts. It is understandable since there is nothing else going on of national importance. At the same time San Diego approved the implementation of a marijuana identification card to allow the possession of one ounce for medical purposes. Is this schizophrenic, or what? 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.
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Copyright 2000 Allan Tobias MD JD, Altoby@aol.com |