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The AMANews has a story about the fight between physician owned specialty hospitals and the general hospitals. In Oklahoma, an Orthopod opened a specialty hospital. The general hospital hired new Pods and instructed the hospital owned primary care physicians to change their referral patterns. Some MCOs also refused to contract with the specialty hospital, even though it gave better care and was cheaper since they had exclusive contracts with the general hospitals. The general hospitals believe the doctors are cherry picking and not providing emergency care. The doctors response is they would not have to do this if the hospitals were responsive to their requests. Some hospitals have given HMOs better rates if they won't contract with specialty hospitals. This does not pass the antitrust smell test. This was the decision in a South Dakota Supreme Court case that potentially would not have passed in most other states. In Indiana and Ohio the Hospital Association has gone to the legislature to prevent the referring of patients to physician owned hospitals. The AMA has responded by asking the OIG to investigate anti kickback charges against those hospitals. The AHA has responded by asking the OIG not to link staff privileges to anti kickback. They do not want staff privileges considered remuneration. The AHA couched their argument in the context of managed care instead of the true reason of the general versus the for profit specialty hospital and the restriction on privileges for economic reasons.
At a February 6-7, 2003 American Health Lawyers Assn. meeting, an attorney from a Pennsylvania firm espoused kicking physicians off medical staffs that are not "loyal". This means they do only a few procedures or admits at your hospital, they split their admission between more than one hospital or are involved financially with a competitor. This firm, that only really represents hospitals and systems obviously, is also associated with a large consulting business that gives seminars to medical staff executives. The problem here is the physicians work on trust and do not know about the options and duplicity of the consulting group and the law firm. The firms make a good living doing this and really do not care about the physician and their problems. When asked about their recommendation regarding having the medical staff executive committee removing the opposition, the attorney replied that the executive committee basically must be controlled by the hospital and can not be voted in each year or two by the staff. I believe the firm's policy would do more to injure hospital physician relationships than anything else I could think of and should be vigorously fought by all medical staffs. These people are the reason why the AMA has gone on record as advising all medical staffs to obtain their own (non-hospital paid) attorneys for all things that may be perceived as a conflict of interest, such as in all bylaws matters.
The law firm also just posted a 20 page letter to the OIG supporting their position. They used the advocacy approach to legal writing and forgot about the flip side. They also waited until the comment time for the OIG had passed prior to releasing the letter. This makes sure that no one may contradict their biased views. In their letter they continual mixed exclusive credentialing with economical credentialing, two very different but somewhat related concepts.
In Wisconsin the insurers are wary of a new heart hospital opening in the fall. They are afraid the costs they pay might increase. This is in spite of the promised lower cost of care by the hospital. This does not take into account the newer facilities and the known better potential for results when only one thing is done over and over again. If one looks behind the scenes, I am sure they will find the community hospitals pushing the insurers not to contract with the specialty hospital. A US Democratic Representative from Wisconsin states he will introduce legislation to prohibit physicians from referring to hospitals they own. There is no mention how much money the AHA is paying the Representative. Top
I will be happy when this no longer takes up the majority of space in this Recent News Section.
Alabama's largest malpractice insurer of hospitals and physicians, Reciprocal of America, was taken over by regulators. This puts all in jeopardy. The entities will remain covered until their policies come up for renewal. Reciprocal, under receivership, will continue to pay claims but not take any new policies.
In Florida, St. John's County physicians are planning a study day on medical malpractice. This means their offices will be closed and there will be no elective surgery. This will affect about 100 of the 170 area physicians. This followed a two day study of 800 Florida physicians a week earlier. The Manatee Medical Society physicians also went to the Tampa rally. The Tampa area had a walk out to protest the high cost of insurance. They had several hundred physicians present. It's a shame that the entire state physician population could not do this at once.
The Florida malpractice panel has called for the limits on non-economic damages as well as 60 other changes.
Some of the South Florida hospitals that are competing for physicians have dropped their requirements that all physicians must take ED call. This means that either the hospital will pay for the call or go uncovered in the high risk specialties for part of each week or month.
In the Coast area of Mississippi, five of the twelve surgeons who took leaves of absence have returned to work. One of the five will refuse to work the ED. All five now have insurance. The remaining seven still have no insurance and will remain off work. Two other physicians were hired by hospitals and are now covered under their hospital's policy. The surgeons went back to work after a bill cleared a legislative committee rapidly to form a pool to cover the uninsured physicians. The physician without insurance will have to move if the legislation is not approved.
The physicians of New Jersey walked out on February 3. Over 14,000 closed their office of at least three days some for a week and some until reform in enacted. The EDs were all crowded with patients, a scenario not unlike that would happen if physicians let the area. One patient was smart enough to call her insurer to take her daughter there. The insurer said no. That tells the story.
About eight thousand physicians held a rally on the steps of the Legislature. As this was going on, a potential deal was worked out. The deal is to make a state run fund to pay all amounts over a $300,000 pain and suffering amount. This fund would be paid into by the insurers at the rate of several dollars per insured patient and by a $15 per head charge to each physician and lawyer in the state. The physicians were not keen on the idea since the HMOs will just pass the amount on to the insureds raising the costs of medical insurance and the physicians would not see any reduction in their premiums.
By the end of the week many physicians had gone back to business as usual. There may be more job actions soon if the Legislature does not act soon. The original thought of only making the physicians, insurers and attorneys pay into a pool to cover higher awards went down in flames quickly. It did nothing to resolve the tort liability issues.
The Illinois physicians are poised for a work stoppage on February 26. This would involve almost all hospitals in the state and a large rally in Springfield, the state capitol. They hope to have over 10,000 physicians not do routine surgery or patient care that day.
In an interesting item, a liberal Democratic "retired" (voted out due to his anti-business and anti-death penalty stance) California Supreme Court Justice has stated that California's malpractice reform should be the model for the country. It was his opinion that it has worked and worked well. He stated that the beauty of the California system is that as the amount of damages goes up the patient receives a higher percentage and the attorney receives a smaller percentage of the award. It also allows for periodic payments so there may be better use of the resources.
The West Virginia physicians are at it again. They will go back on strike if the Senate doesn't change the bill that came out of committee. The offensive bill dropped a tax credit for malpractice insurance, and levied a tax on insurers and physicians to set up a fund for a mutual insurance company. The Governor also is against the bill. Even some Democrats have threatened to join with their Republican brethren to get meaningful reform.
The Doctors Company, a malpractice insurer in Nevada, has raised it rates 17%. This compares to the 25% increase by other companies. Almost no OBs are in Doctors.
Connecticut is having a physician walkout day on March 26. There will be a rally at the Capitol. This is in conjunction with Doctor's Day, an annual event at the Capitol. Many of the hospitals do not expect the event will have any impact on their operations. In other words they will not let their physicians exercise their First Amendment rights. Top
In 2000, KPC, a California IPA, went belly-up. The 8 million patient records have been in storage since then under an order of the court. The storage company has not been paid since this past summer and is now considering destroying the records. They still get 300-400 requests a month for records. There is no regulatory oversight over these records. The keeper of the records charges $21.50 to ship the records to a physician's office or a patient's home. Top
Eight cardiologists at Cedar Sinai in LA were summarily suspended after an outside review raised questions about the appropriateness of the medical necessity for the procedures. This HCA hospital has turned the report over to the appropriate government agencies. The analysis was done by a private agency and was led by a teaching Harvard cardiologist. The report recommended written standards to ensure procedures were medically necessary and a requirement of board certification. There are still forty five other cardiologists on staff. The report has not been made public. Top
Secretary Thompson is dismayed that only about 1/3 of American hospitals are considering the smallpox vaccine. He understand the questions over liability but wants the hospitals to move ahead anyway. The hospital attorneys are saying NO. He doesn't understand the great amount of people that don't believe him or the government regarding the danger. There has not been a case of smallpox in the world for over 30 years. The threat of the disease is far less than the potential injury to those receiving the vaccine and their patients.
During the first two weeks of inoculations only 687 people had been inoculated in the country. This is in contrast to the 250,000 doses shipped. In a great saying Dr. Paul Offit of Philadelphia stated" people are voting with their arms". In LA only 60 people were vaccinated after the county ordered 9200 vials. About 1/3 of the LA hospitals have decided not to participate.
In the University of Miami/Jackson Memorial Hospital only 89 people have volunteered for the vaccine. The hospital had ordered 1000 doses. In North Broward County with four major hospitals , there is no commitment. The state of Florida vaccinated 503 people on the first day of the state program. One had an allergic reaction, was treated and released. This is the same state that could punch voter cads.
Minnesota has started and had five people sign up.
Connecticut was the first state to begin vaccination and had three people sign up for the first day. Now two weeks later they have gotten 1000 to be vaccinated, less than the 6000 expected.
The People's Republic of Massachusetts started the program and 10 souls showed up.
The military has announce they have vaccinated 3665 troops. There have been some minor reactions such as itching or swollen lymph glands. There have been two serious reactions. One was vaccinia and the other encephalitis. Top
An article in the San Francisco Chronicle discussed the fleeing of physicians from all managed care and especially HMOs. The trend now is back to the future with the patient paying and getting whatever reimbursement they can from the insurer. The medical offices will help fill out the necessary paper work. The article also talked about the concierge practices with retainers and how this only will happen in affluent areas. It is the perception that if Medicare continues to ratchet down the payments, there will be access problems with these people as well.
At Province Healthcare Company the stock dropped almost 20% after it was noted that they lost 51 physicians last year. Each physician generated almost $250,000 per hospital. The system is now waking up and has hired a person just to deal with physician retention and hiring issues. He is to do this by CEO training, not an easy job. Top
The pharmacies in the People's Republic of Massachusetts are caving in. The big three, Walgreens, CVS and Brooks have agreed to take down their signs stating the $1.30 tax per prescription is by government fiat. They will pay the tax themselves and not charge their patients in the future as well as refunding the money they had collected. This allows the "lawmakers" a chance to wiggle out of their mess and not reduce their everybody gets everything free spending. Top
The February 13, 2003 New York times had an article regarding Canada's health care or lack of same. The system has long waiting times for radiation therapy of up to three months for breast cancer, not optimal therapy. There were also two month waits between a positive mammogram and a breast biopsy. The article goes on to discuss the "line jumping" by affluent and politicians or those connected to the politicians. A recent government survey showed 18% had difficulty seeing physicians or getting a test or surgery performed. This would also be true in the United States if one looked at the HMO population. 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.