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Dr. David Kessler, the prior dean of Yale Medical School and Commissioner of the FDA under both the elder Bush and Clinton has been fired as the dean of the University of California San Francisco (UCSF) Medical School. This came on the heels of Dr. Kessler's whistleblowing on the schools poor financial condition. Dr. Kessler was asked to resign and not go public but he decided to stand up for his rights and was fired. Don't feel too sorry for Dr. Kessler as he retains his tenured professorship at the UCSF with a salary of $325,000 per year. Top
An article in the Fresno, California, Bee discusses a peer review problem in the Kaiser Fresno facility. It involves a perinatologist who has had complaints against him by nurses and physicians including the former chief of OB who has been reassigned over this and his friend who has since resigned from Kaiser. The California Medical Board is looking into the perinatologist. Part of the article quotes Richard Willner of the Center for Peer Review Justice as stating many times peer review is due to the collision of politics and personality. There have been law suits against the perinatologist but this is a high risk area and the case was settled by Kaiser although it was a case without evidence. Many of the hospital physicians are positive on him and anti the former OB chief. Top
The Indiana med mal premiums are heading south. The physicians will pay almost 20% less into the state fund that makes payments to med mal victims. Physicians in the state must have a $250,000 med mal policy and may voluntarily belong to the state pool for an additional $1 million in coverage. This is due to caps on med mal payments.
A new report shows the average Canadian physician that does fee for service gets a payment of $250,000 for fee for service treatments. This is amazing since there is almost no fee for service in the country.
The AMA has an article on the potential 10% cut in payments to physicians by CMS. They feel that if the physicians do stay with the program many will stop participating and accepting assignment and so be allowed an additional 15% in payment. There are drawbacks to becoming a non participating provider. Your full fee is 5% lower than the participating provider and you must collect the entire fee paid by Medicare plus the copay plus the additional 15% from the patient, according to the AMA article.
Part of the medical malpractice discussion is whether or not the patient received informed consent. CMS has formulated a "guideline" that allows the process of informed consent to occur as is now done in the physician's office and noted in the physician's medical record. Now the hospital consent form for most things only has the patient acknowledge that he/she was given informed consent. The new "guidelines" to surveyors are not written in stone. They impose no new requirements that are not required by statute or hospital regs. Therefore it behoove the hospital to make their regs as lax as possible or they will be delaying surgical or other procedures, upsetting physicians and patients and accomplishing very little. If the patient's hospital record states that the physician has given informed consent with the necessary ingredients that should be enough. There will be some hospital attorneys that will insist it is not and will create significant problems for all concerned. Maybe the hospital wants to write informed consent forms for all procedures and then give them to the physicians to use with their patients. That should not take too much effort and time away from patient care.
In a collateral to med mal there is a national story about how California has taken away the confidentiality of physicians in rehab programs. The issue of getting physicians to enter voluntarily rehab programs without confidentiality and the ability to continue to practice under supervision is glossed over. Top
A California employer health benefit survey done in 2007 shows that insurance premiums went up 8.3% as opposed to the national average of 6.1%. There is no mention as to why this is the case such as more state regulation in California. The HMO premiums went up 10% and the PPO premiums went up 8%. The actual premiums paid were about $100 less monthly for a single on an HMO and about $200 a month for a family coverage. Of course the old adage (truth) still holds, "You get what you pay for". The survey also showed that California employers provided coverage for twice the national average of same sex domestic partners at 70%.
In an interesting twist the health insurers main trade group, America's Health Insurance Plans, is suggesting that states cover the most costly individuals they would cover everyone else even with pre-existing conditions. This is an interesting concept since those with pre-existing conditions are also those who are likely to have high medical bills.
In a survey by the Health Care Advisory Board in 2007 it was found that the primary decision maker as to hospital selection was the combined physician and patient as opposed to the patient or the physician alone. The only area surveyed that did not follow the pattern was in oncology where the decision was made in 44% by the physician and in 43% by the combination. Top
The Washington Post has an article about how hard it is to find and retain physicians willing to take ED call. This relatively new phenomenon is directly related to several causes. The first is the potential for med mal claims. The second is the decrease or non payment for the care and the third and probably the most important is the change in physician attitude to more balance in their lives. The hospital bylaws usually require ED coverage for privileges but the hospitals realize they can not enforce the issue since more physicians do not use the hospital often and would be willing to give up their privileges at that hospital if the hospital pushed. This would cost the hospital money. Hospitals are attempting to alleviate the situation by paying physicians for call or for taking uninsured patients. This helps but does not relieve the med mal or the life issues.
Are hospitalists worth the money? The answer published in the New England Journal of Medicine says probably not. They did a rather large multihospital study on patients with pneumonia, heart failure, stroke, urinary tract infection and acute exacerbation of chronic lung disease. They looked at the patients in these hospitals that were cared for by hospitalists, internists and family practitioners. The end result was a slightly decrease length of stay with hospitalists but an increase in lab testing costs. This was about even when comparing hospitalists to internists but more compelling with the comparison to family practitioners. The death rates and readmission rates were not significantly different in the three groups. The study recognized the potential for bias in their study.
Aetna has joined Wellpoint and Humana in stopping payment for propofol ( the white milk of kindness). Medicare continues to allow its intermediary to pay for the drug on an individual basis. As one who has undergone multiple colonoscopy for screening, I agree it is usually not needed. The thing that is interesting is that almost all screening colonoscopies in the New York City area get their exams with the medication where it is 10% or less in the rest of the country. The drug has more dangers than the opiates that are usually used. With opiates there are reversals available where that is not true for propofol. In most areas of the country anesthesiologists are not required for the procedure but where propofol is used they are usually used to assist, an unnecessary expense. Aetna has but some exceptions on its restriction of the drug. Guess what? The anesthesiologists are not happy with the decision since the medical necessity leaves out in their minds the psychological. I agree but not to the extent of all those procedures needing the unneeded physician. The idea that biopsies or polyp removal can not be performed under opiate is nonsense since I have had several done without any pain. 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.