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The feds have notified Washington Hospital in Washington, D.C., Sutter Memorial Hospital, Hartford Hospital and Bryan Med Center in Nebraska of the potential for loss of funds for their heart transplant program due to lack of enough cases. One need to do twelve cases a year to keep the funding. The hospitals have 30 days to respond as to why they failed to meet the amount of cases and how they intend in the future to comply. All have good outcomes. The Sutter surgical director for the program stated he was not concerned since the outcomes were so good. He also states that the rule to require hearts to go to hospitals within 500 miles is hurting the program. Sutter hopes to give more people artificial pumps to encourage them to have the transplants in Sacramento.
The University of California at San Diego has stopped its heart transplant program voluntarily since it was under investigation for not doing the required 12 transplants per year. They did 4 last year.
Blue Cross of California and finally begun paying the Community Hospital of Fresno higher rates for the Medicaid patients it was seeing. The way the hospital got the raise was to threaten to pull out of seeing the 140,000 members of the Health Plan. Top
The family practitioners in England working for the NHS are making about 106,000 Pounds per year. They are keeping an average of 48% for take home pay. The Health Secretary is not happy with the efficiency of the physicians. She stated that if she had known they would take home more of the income, the government would not have raised the amount of the pay. She also stated that if not paid to the physicians it could have been used for keeping the clinics open longer hours. The BMA states that the Secretary is actually wishing the patients were not getting the quality of care they are getting but a lower quality. The salaries are linked to quality.
The physicians of Washington are being rated by both Regence Blue Shield and UnitedHealth on their care. Those patients who go the approved physicians will pay a lower co-pay. The insurers base their ratings on claims data and only care about the cost, never the quality. Suits were filed by the AMA which caused the programs to go away but the suit is continuing.
Hooray for the urologists of Inova Fairfax Hospital. They will now be paid for all indigent patients they see in the ED. This is the first of many physician groups that will be paid for ED work at the hospital. the hospital is a dumping ground for other Inova hospitals that do not want to treat uninsured patients. Some of the urologists will not accept the deal and drop off the call list.
The gastroenterologists of Palms West Hospital in Loxahatchee, Florida, quit the hospital to get off the ED call roster. They wanted $1000 per day for coverage. The Palm Beach County area has 92 GI physicians but only 20 will see ED patients. This hospital is in a hard spot since it has already been cited for failure to care for an uninsured person with internal bleeding.
In Oregon the physicians are not covering the ED all the time. A recent study showed over half of the hospitals had no coverage for at least one specialty and mow 43% of hospital are paying physicians for call. Oregon also has over 30% of its physician over the age of fifty with good practices and not alot of incentive to take ED call.
In some specialties times have changed. The old paradigm that a cardiac surgeon was worth his weight in gold is no longer true. Those that are still coming out of the residencies are having a hard time finding a position. The Cardiologists have taken the commanding position with their stents. This has led to huge decline in the physicians vying for positions and an actual decrease in positions available in a residency situation. This will lead to a change as the boomers become seniors and the amount of surgeons are less. Top
Virginia passed a tort reform package in 2003. Until that was passed, physicians were bypassing the state to practice medicine. Since the reform there has been an easier time for hospitals to recruit physician to the area.
Florida is investigating why the med mal insurance companies are not returning more money to physicians since rates have about halved since the passage of reform. The state believes the premiums should be reduced by about 40%. Top
In an interesting turn of events the feds have used $500 million in reserve funds to decrease premiums for the federal retirees and employees who have fee for service plans. No funds were allocated for those with HMO plans. Therefore plans like Kaiser of Northern California are going to double digit increases. They are going up for this group 15% but the employee will have a 50% increase in their share of the premium. Blue Cross has an increase of 62% for the employee share of cost.
Tufts Health Plan in the People's Republic will restrict gastric surgery for the obese. They will now have the patients go on a yearlong diet and counseling and then do the procedure. This delays putting out money for an additional year. The plan is only interested in money and not the lives of their patients. After the year behavior modification those with a BMI under 40 would not be eligible for any procedure and those between 40 and 50 could only have the cheaper gastric banding procedure. When one looks at the rationale, it is fairly easy to see. The plan has lost almost 50% of its members in the last several years so its revenue is down. Another incidence of insurance companies making medical decisions instead of patients and physicians.
The Wall Street Journal has a report on a new industry. The hospitals and physicians are hiring companies and buying software systems to stop the insurers from denying claims. This is costing the medical industry about $20 Billion a year, half on the provider side and half on the insurer side to deny claims. This money could be going to patient care but is not due to the insurance industry attempting to show "they are paying appropriately". 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.