February 15, 2008 Recent News






The emergency room physicians at St. Mary's Hospital in St. Louis are now getting the same treatment as the ones did last week at St. Anthony's Hospital.  They will be removed as employees and replaced by a national firm who will employ them as independent contractors.  So far the physicians have not bolted as they did at St. Anthony's.        

The Palm Beach, Florida area continues to struggle with neurosurgeons.  The latest flight has to do with the three strike law passed by the Florida electorate three years ago.  Now you lose your license if you get three med mal cases against you.  The neurosurgeons are at high risk and there fore are either leaving the state or cutting back on their practices. Currently only 13 of the 22 neurosurgeons work on call and 18 are needed.  It is estimated that since new physicians are not coming and the older ones are retiring, that in three years there will be only 14 neurosurgeons left in the area of which only 7 will take call.  Until the three strike law is changed and the caps are more stringent there will continue to be an egress of physicians. 

To make matters worse, the area hospitals have rejected a plan to put the call schedules on line so the ambulances would know where to take patients with certain injuries.

Aetna and Cigna have agreed to pay physicians for email communications with their patients.  The insurers will pay office visit rates for simple follow-up care Until now many physicians who used email had the patient pay by credit card at the end of the session.   

In a personal affront to physicians, California Blue Cross is trying to backdoor the regulatory scheme of not being able to cancel policies retroactively.  They are now sending requests to physicians to review policy applications filled out by their patients for any inaccuracies.  The HMO states that this is voluntary on the part of physicians so no physician should fill out any form nor review the application.  This goes to the heart of the patient physician relationship.  The California Department of Insurance is now officially looking into the matter as well. As soon as the letters became public and a public embarrassment to the company, the insurer stopped sending them. 

New Jersey physicians are angered by the Aetna, Humana and Wellpoint policy that they will not pay for any general anesthesia for colonoscopies.  Aetna will only cover deeper anesthesia by an anesthesiologist on a case by case basis. Having gone through several colonoscopies in my life, I have to admit it is not the most pleasant thing but an experienced gastroenterologist can and will do the procedure under sedation with minimal effects and with good safety. This is like the time when Medicare stopped paying for an assistant surgeon for cataract removal or a pre-op stay in the hospital.  The hue and cry was tremendous but we lived through it and found that they were correct.  

Seven Iowa Orthopods are accused of taking money from manufacturers of artificial joints.  The largest amount was to a University of Iowa physician for $2.9 million.

About one or two years ago the physicians of Cincinnati were complaining about the poor pay they wer4e getting compared to their kin in other parts of the state.  They got a small raise and all was quiet for a while.  Now we know why.  Those physicians who could have left the area and no new physicians are coming into the area.     Top 


Peach Medical Center in Georgia will begin refusing to see non emergency patients in their ED.  The patient will be triaged and if no emergency exists the will be referred to a physician's office or an urgent care facility.  Those that wish to stay will have to pay a $100 deposit.  It should be interesting to see what happens when a Medicaid patient shows up.  They may not be charged.

In an interesting article in the AMANews regarding medical staff bylaws, the attorneys for the hospitals but who in my opinion pretend to be medical staff attorneys such as Horty Springer and Katten Munchin Roseman were at odds with those attorneys who represent medical staffs only.  The thing that came out of the article was that hospitals want to control physicians and that medical staffs should have their own attorneys who are not paid by the hospitals.  This is especially true for the bylaws issues that are discussed in the article such as economic credentialing.  Most physicians don't believe hospitals would do anything to hurt them.  They are wrong.  Economics trump good working relationships and is the reason that physicians, if they are able, should be on more than one hospital staff. 

The Wall Street Journal had an article on informed consent.  The writer states that hospital informed consent forms are not read by patients and they don't understand them.  That is probably true but the forms in hospitals are not informed consent forms.  Most forms are only to ask the patient if their physician has explained the procedure to them.  The hospital has no business getting informed consent, that is the duty of the physician performing the procedure.  CMS has now gotten into the act and have recently issued guidelines to hospitals to design patient friendly forms that describe alternatives and the problems of declining the offered procedure.  If the hospital does not get into the process where they have no business they may lose Medicare.  The VA is using an electronic consent process but they have minimal personal contact with a patient outside the hospital or clinic environment.  In private practice the informed consent is done in the physician office and the hospital only verifies that the physician has explained the procedure, not what the physician stated.  

The AHA has paid a lobbying group $240,000 to lobby Congress not to decrease payments to the members.  

In a surprise move, Detroit Medical Center has decreased payments to the Wayne State University physicians that provide care to the patients at the hospital.  There is a contract between the two entities for three years for Detroit to pay Wayne $19 million for the care of Medicaid patients.  This leave Wayne State only $7 million for the care of these patients.  It would seem that Wayne State has had its contract materially breached by Detroit and should sue them for the money or stop the collaboration between the two entities. This is confirmed by the Michigan Medicaid people who refuted Detroit Medical Center's assertions that the physicians are being paid twice for services rendered.  The Detroit Hospital is getting its information from the legal firm Foley & Lardner, who is being paid to have the information the hospital wants to hear.

Mercy Medical Center in Long Island, New York, is under scrutiny for the deaths of patients. One case was a double mistake, the day following a biopsy report that she had breast cancer the patient had a double mastectomy and then died.  The autopsy found no cancer in the breast and that was due to a lab mix-up.  There was no mention as to why the patient died.  However, several other patients died at the hospital after a hospital employee physician assistant had improperly inserted catheters, chest tubes and pacemakers into patients. 

In one of the worst falls in the nation, Cook County Hospital, now called Stroger after a politician, has gone downhill from one of the finest teaching hospitals in the country to the political hack that bears it's new name.  It has gotten so bad that the hospital almost lost its accreditation but after the usual last minute fixer up it retained its accreditation.       Top 


The stories of problems with electronic records keep coming.  In one of the latest is a stolen laptop containing psychological evaluations of 441 applicants for Californian police.  The laptop was stolen in Mexico.  The applicants have been notified that their raw information had been accessed and that this would not affect their job interviews.  The laptop was in a backpack that was stored in a trunk of a car of the psychologist.  The information was not encrypted.  I hope the psychologist has better skills in her profession than in her common sense.        Top   


Medicare Part D is working.  In 2008 the total amount of people using the system rose to 25.4 million, a 6.2% increase.  Along with the rise in users is a decrease in the projected cost to the government.  There are a total of 44 million in Medicare and of those about 17 million have stand alone drug plans and an additional 8 million are in the Advantage plans.  

The Rand Corporation has released an article very critical of California hospital pricing for the uninsured.  From 2001-2002 hospitals collected 18% more of their charges from the uninsured than from Medicare patients.  This has led to suits like the recently settled suit against Scripps.  The suits are making the hospitals give more discounts and advice to the uninsured.  There is also a 2007 law that requires hospitals to give discounted rates to the uninsured that make 350% of the federal poverty level.  It should be noted that the article describes the average which means that some are paying many times more than Medicare rates and some are paying nothing. 

Normally I never comment regarding pure medical matters but this is so grievous that I have to break my silence.  The American College of Preventive Medicine has recommended against either a rectal exam or a PSA test to detect early prostate cancer.  They state there has been no evidence that early detection saves lives.  They are worried by the anxiety a false positive test may be for a male and the discomfort of a biopsy with the huge complications of hematospermia, hemeturia or infection.  All are either insignificant or rare.  What they don't state is the true reason they are against the testing, money.  The majority of the people in this organization come from the HMO mindset to save money and not worry about the patient.  The organization, I can not call it a College, does not state when to diagnose the cancer but it certainly would save resources if it never was found until autopsy. They believe further studies are necessary to determine when to do screening in only the high risk population.  They are so wrong.  I wonder if the same is true for breast cancer and how the population would react to the same conclusions regarding mammography.  Mammography has the same false positive and false negative rate (65% sensitivity) as PSA and ultrasound.  The potential for infection etc. is the same in breast biopsies as in prostate biopsies.  The Europeans who used to believe in not screening now do screen for prostate cancer.  Their studies showed it made a difference.  In a second article researchers stated that watchful waiting is ok for "older" men defined as over 75.  I agree in general principle but only if the life expectancy is less than 10 years.  If the patient is over 75, has a high grade lesion and has an expected life of over 10 years, I believe they should be treated by whatever means the patient and physician agree upon.  

In Georgia, the Governor is suggesting a modest raise in the awful payments going to physicians.  The raise is not enough to keep physicians from dropping out of the program and possibly out o the state.  The governor proposes a 2.5% increase in fees that have not been raised since 2003.  Some of the physicians in the state still take the insurance and they are being swamped so they have no time for their regular patients.  They too will soon realize that they must stop taking this insurance. 

It seems that physicians are getting smarter.  More are having all patients sign arbitration agreements when they are first seen, as Kaiser has done for years.  Arbitration is faster and quieter than a law suit but it is not necessarily cheaper.   

British health care is back in the news.  The Health Secretary has sent letters to all FPs in England asking them to stay open longer to accommodate the patients.  The British Medical Assn. has already rejected a NHS plan to pay 12,000 pounds extra a year to those who stay open longer.  The physicians may individually bargain with the NHS.      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.