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TennCare has failed and is on the verge of bankruptcy. The zealots who favor this misguided approach now want to push a tax on medical goods and services. Currently TennCare is 24% of the state budget. In five years the percentage will reach 36%. The pro-TennCare people want the federal government to put in more money. The feds put in two dollars for each dollar spent by the state. The feds have also stated they will not put more money into the program that they would have put into a Medicaid program.
In another TennCare story, Maury Hospital in Columbia, Tennessee, has reached an agreement with the payor to provide more money. It was either that or no more TennCare patients at the hospital.
In Milwaukee the businesses got together and set up a payment plan to pay physicians a lower reimbursement schedule. The problem is only 20% of the physician were stupid enough to fall for the ruse. They were going to pay 150% of Medicare where physician are now getting about double Medicare rates. The plan is to start on January 1. I wonder how many of the employees will be happy to find their physicians are no longer to be used?
Aetna has formed the advisory committee it promised to do when it settled the lawsuit against it by the physicians. The committee will hear the medical community concerns and make recommendation about the insurer's business practices.
California has passed a law under the previous administration that reduces payments for Medicaid billings by five percent. There has been a proposal by the new governor for an additional 10% cut. This is not sitting well with those providing services. The physicians who are now treating these patients will probably thin their ranks. The pharmacies are threatening to stop filling Medicaid prescriptions since they will lose money. Walgreens has already stated they will stop filling prescriptions if the law goes into effect. Walgreens has 41% of the pharmacies in San Francisco. Some inner city pharmacies that have up to 90% of their clientele Medicaid patients will have to close entirely.
CalPERS, the largest consumer of healthcare in California, states that is will stop sending patients who charge more than the state average. The problem is that quality has no bearing and when one uses an average that means that half are above and half below. CalPERS has just eliminated half the hospitals in the state. This will be felt in Northern California and especially in the Sacramento area. The major hospitals in this area are all above the state average for charges and are now dickering with CalPERS to charge them less. When this happens other hospitals will then fall below the line since the line will move.
The Wall Street Journal has an article on good rationing of medical care. The rationing is to improve quality and rid the system of it's waste. The six rational rationing ideas are (1) computerization (2) evidence based medicine (3) payment that take into account quality, whatever that may be, (4) disease management, (5) ICU redesign with special monitors and (6) have patients pay for some of their care to involve them regarding which care has value.
The Columbus Business Journal had an article regarding the decreasing enrollments in HMOs and their increase in profits. In 2002 the enrollment fell 10.4% and in the first six months of 2003 an additional 6.3%. During this same time there was a combined profit increase of 2.4% and 3.1%. The reason is an 19% raise in premiums for commercial members. It is incomprehensible to me that employers will continue to pay these huge increases for a product that is only there to decrease costs. The major shift is to the PPO model, where it is discounted fee for service. Top
The Massachusetts medical board has finally begun to crackdown on the physicians who prey on others for their own sexual gratification. The only problem with the board's action is that is decades late.
CTnow.com has a story about states allowing physicians who graduated from some foreign medical schools to practice in their state. They use the story of an injured patient by a physician who graduated from Spartan health Sciences University, a Caribbean school that has poor credentials. Although the school is suspect it is the state medical board that is the culprit in this story. If the boards find the education to be deficient, they should not allow the person to practice in the state. Some states like Texas want to abrogate their responsibility to the feds, a cop-out of their responsibility. This should not surprise anyone who has looked at the Texas Medical Board. This board has now copied California and banned all graduates to certain schools.
The AMA News has a story about three physicians who lost their licenses and later had them reinstated. Two of the three physicians were drug addicts and were allowed to practice again after going through recovery and were spot checked for many years for relapses. The third one was questionable to begin with. He dated women and later these women became his patients. This is a technical violation but only that. The article does not discuss the physicians who are losing their licenses due to the incompetency of the medical board, as in Texas.
A pathologist in Missouri writes internet prescriptions. His licenses have been removed in 13 states including his own (he occasionally does locums at various hospitals and has licenses in 27 states). He continues to write prescriptions since the server is in Pennsylvania where he still holds a valid license. He believes his location is immaterial and only the server site is important. His real living comes from doing private autopsies. He does between 50-100 a year at an average fee of $3500. Top
In the Tampa Bay, Florida area the new malpractice tort reform signed earlier this year has not lowered premiums enough to keep the doctors practicing. Several high risk specialists have left the state for areas where the malpractice climate is much more user friendly. One, an OB, used to pay $100,000 for $$250,000 of coverage. He now pay $15,000 for $1 million of coverage. Another, a general surgeon, is moving to Indiana where they have a malpractice law that is like California.
In Missouri leaders of medical, legal and the insurance industry have come together to attempt to resolve differences about the malpractice situation. At a meeting no one blinked but they agreed to continue to work toward a solution. The legislature is mired down in the usual politics and I am sure this meeting will lead to the same conclusions.
The Georgia legislature is back in session. The physicians versus the trial attorneys is back on the front burner.
In the Kansas City area a malpractice insurer, Reciprocal Alliance, went bankrupt. This means that those covered by the insurer are not scrambling for other coverage and those patients who sued and won may never get paid. The physicians will all go into personal bankruptcy if they had not incorporated to protect their personal assets.
The University of Miami takes a disproportional share of poor patients and is asking for relief of liability from the Florida legislature. Since the school is private it is not currently under the $200,000 cap afforded the state hospitals. They are requesting this for the government and non-pay patients, not for those with insurance. Top
In two stories juxtaposed in Modern Healthcare shows the mentality of this organization. The first tells how the profits have fallen 8.5% or $7.5 million in their core business. Their side businesses of consulting and education made money so the organization as a whole came out in the black. In 2001 the Joint made a record $14 million. They are using this money to pay for the new survey process. In the second story shows another way the Joint is using the money, bonuses to their executives. O'Leary got a 15% raise to $918,308. Massaro, an executive vice president got a 42% raise to $510,000. Others received raises as well but not as high a percentage. How many physicians are making that much money. Does it remind anyone of the salaries of the HMO execs? Top
Santa Paula Hospital is southern California has finally bought the farm. They have now given all their property including the land to Ventura County. This will allow the hospital to continue to operate but under the auspices of the County. The hospital had already closed its ICU and ED. The hospital will declare bankruptcy after the deal with the county is completed. This will rid the hospital of about 400 creditors. The hospital has also fired the chief nurse who continued to stand by her charges. The hospital also fired eight medical residents who were not part of official medical residency programs (I don't have the foggiest idea why they were there) and they transferred responsibility of the human resources to the county DHS headquarters. Following all of the above, the hospital closed, hopefully to be reborn later, at least six months later.
There will be a new specialty hospital built in Irvine, California, even though the deadline was missed. Why? Because they can. The law only states that any hospital built can not bill Medicare or Medicaid but can bill all others. The new neurological hospital will be able to do without those payments for a while.
The longest strike by nurses against a hospital in California history is now history. Nurses and Tenet Hospital in San Pablo have come to an agreement after 13 months. The new agreement calls for a 13% raise now and an additional 17% over the next three years. It also for the first time gives the nurses a pension plan where the hospital will contribute up to 8% of the pay without any nurse contribution into the fund. They will also get a small medical benefit. Most of the nurses worked at other hospitals part time during the strike so they received no benefits. Some of the nurses will not come back to the Tenet Hospital due to fear of its fiscal viability. Tenet is only the management company for the hospital that is rally a district hospital and the district owns the land and the buildings. Tenet may leave at any time with certain provisions.
The AHA has asked the federal government for a waiver from the rule requiring them to go after all needy uninsured patients for the full amount of their bill. If approved, the waiver would allow the use of discounted billing and perhaps better cooperation from those billed.
In Washington DC, the bidding for the Greater Southeast Hospital is over. The total of the four bids for the four hospitals up for grabs did not match the bid for all four hospitals combined as one bid. The winner is the same owner as now. Yep, the original owners who claimed bankruptcy have repurchased the four hospitals and are rid of the past debt by virtue of the bankruptcy proceedings. The other three hospitals are Hadley Memorial Hospital, a LTC facility in DC, Pacifica Hospital in Sun Valley, California and Michael Reese Hospital in Chicago.
The JCAHO taketh and the JCAHO giveth back, depending on the political pressure. Four months ago the removed Southwest's accreditation. They have now given it back. The new inspection continued to find flaws in the recordkeeping and quality improvement, not important things. The spokesperson for the JCAHO stated that the usual wait for final approval is 45 days but this will go faster since everyone is watching, like the government.
In Valhalla, New York the Westchester Medical Center is in financial difficulty. The staff are being told to either take a pay cut or leave. The hospital is $16 million in the red since it became a public benefit hospital five yeas ago. The staff feels vulnerable. I wonder why?
In Garden City, New Jersey, the public health agency will lay off about 200 individuals with a total of about 600 in the offing. The agency blames the high costs of rising pension and health care fostered by the unions. The unions reject the premise, but would not take any decreases. This is the reason the unions are going the way of those laid off. They don't care about their constituents, only the money they bring monthly into the coffers, whether working or not. Top
The largest provider of chemotherapy in Louisiana has decided to close six centers. The remaining four offices are all in the New Orleans area and patients will need to travel to receive the therapy. The reason for the closure is money or lack of same. The new Medicare program will dramatically cut back on the amount to be paid for the drugs. The practice is also considering stopping the use of drugs that they would lose the most money by giving. Those would need then to be given in the more expensive setting, a hospital. This is only the first of many that will do the same thing at a greater cost to the patient in terms of travel and to the program for outpatient rates. Top
In one of the most interesting stories I have read recently, the Florida International University in Miami is graduating a new class of nurses. The difference is that these nurses are all foreign born physicians who can not practice in the US. HCA has helped fund the pilot program.
With the California nursing ratio law upon us, an article in the San Jose Business Journal states that some hospitals will not meet the law. The problem is the term continuous compliance. This means that if one nurse leaves the floor for any reason the hospital is not in continuous compliance and may be fined. At present the state needs about 5000 new nurses to meet the law and this will swell to 30,000 by 2006, an impossible task. The increased costs for the extra hiring will be passed on to the insurance companies who in turn will pass it on to the consumers and businesses of California. Top
A cardiologist in Chevy Chase, Maryland, is closing his office. Why would a busy physician do this? Because, he was going broke. He is working 10 hours a day for six days a week. He is making on a good year about $100,000 a year, not Swiss cheese but not good for a person with student debts, a family and the hours worked. He does pacemakers but not invasive cardiology, such as PTCA. He is the only cardiac electrophysiologist on staff at the hospital where he has privilege. They now must send patients out or get an itinerant in. His office was very efficient with voice recognition software, a claims software to immediately send out claims. He was rewarded by the usual low reimbursement and the typical three month wait for payment. He collects about 45% of billed charges. He will work for the FDA evaluating pacemakers and defibrillators. He will be paid almost $100,000 for 40 hours work.
Pain physicians are running scared states a story in the Washington Post. Those who treat the nations pain patients are being singled out by state and federal authorities for harassment and prosecution. The tension is between what the physicians believe is necessary and what the government believes is necessary. The pain physicians are now becoming organized and are going to hire a single attorney to defend them in their cases. This will make that attorney a formidable foe for the government lawyers. The other side effect of the persecution is the reduced number of physicians willing to treat pain patients with the medications they need.
A report by Yahoo states that those surgeons in the British Health Service charge their "Harley Street practices" patients the highest fees in the world. This will range from 22%-60% above those fees charged in the USA. The Health Service depends on these surgeons to cut the long waiting times for the regular patients. Canada just has the long waiting times. Top
The Pittsburgh Post Gazette Reporter, Steve Twedt, who wrote the articles on the hypocrisy of HCQIA in whistle blowing cases has another article. This one is on the Oregon Medical Association plan to investigate the Disruptive Physician concept in the state. One of the things that the Oregon physicians will look at is the bringing of peer review out of the hospital where politics may run rampant. I hope Mr. Twedt continues to bring this to the forefront. 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.