The estimated price for retrofitting San Francisco hospitals is $1.6 billion. The hospitals are required by law to report the cost estimates and whether or not they will go forward with the improvements or close. Federal antitrust laws are also preventing the hospitals from discussing regionally how to best coordinate issues such as open space and transportation. UCSF will need $700-$800 million for their two hospitals since they are considering tearing down the structures and building a new 600 bed hospital by 2030. SFGH will cost an additional $474 million for another new inpatient building. The other hospital costs will be roughly $100 million for Kaiser and Seton with lesser amounts ranging from $1 million for Chinese to $52 million for St. Francis. The deadlines are 2008 for structural soundness and 2030 for all hospital systems to withstand a major earthquake.

The city may replace San Francisco General rather than do a seismic upgrade. This would require approval of the Board of Supervisors and the citizens for a taxpayer supported bond issue. A bond issue for $299 million for a rebuild of Laguna Honda was passed last year.                                                                  Top

Boston University had agreed to sell to a for-profit company their Framingham Study patient data. The deal was for $21 million for a partnership with a group of venture capitalists to study the data. The initial data was obtained via public funds and a controversy arose because of that. There will be continued use of the database but via the use of traditional funding grants.                                                             Top

The opening of the Mercy Carmichael trauma center has provided little to ease the chronic overcrowding in the Sacramento area emergency departments. Since the Sacramento area is chock full of HMOs and patients can not get to see their physicians on a prompt basis; the hospital emergency departments have been left to shoulder the burden. The new trauma center is losing money but it’s still early in the game. They are finding that patients that are injured in auto accidents, etc. are not paying until the court cases are resolved.                                                             Top

Pennsylvania, unlike many other states, has no malpractice caps. Twelve Frankford, PA orthopedic surgeons decided not to renew their malpractice insurance coverage after it hit $100,000 per year. This closed the trauma center for four days. The hospital is now helping to pay for the insurance. The physicians are going to the legislature to attempt to cap malpractice damages and bring down premiums. The plaintiff’s attorneys are of course fighting this intrusion on the patient’s "fundamental rights". Other physicians are also rebelling with about 1/3 of the Obs stopping deliveries. One group of Obs has applied for New Jersey licenses to possibly move their practice. Anybody remember 1975 and the Physician’s Crisis Committee which shut down hospitals and medical offices throughout the state. This led to a special session of the legislature and AB1xx, now MICRA, passed. This law has led to physician owned insurance companies and has kept malpractice premiums in the state at a tolerable level. This revolt was led by less than 10 physicians.                            Top

The Sacramento Business Times isn’t making life easy for those physicians who are leaving Sutter Group. In the latest case they fired the doctor on the pretense that he was soliciting staff and patients the day after he turned in his resignation. The physician states he was asked where he was going and told those that asked. Other physicians complained when bonuses due were not paid or not scheduling patients when notice was given. Sutter physicians that have left the womb are finding life isn’t bad on the outside. Two other physicians that left a year ago are getting referral from the area specialists and making the same amount of money as they did with Sutter but with only a tenth of the night call and more continuity with their hospitalized patients. They also see less patients per day then they did with Sutter and keep open spots for urgent patients thereby admitting less to the hospital. Sutter reports that they lost 12 PCPs this year and hired 20. Of course the ones that left are usually seasoned and the new ones are usually rookies. The patient’s at Sutter belong to the Group and are not told where the leaving physicians are practicing. Some patients are finding the physicians and, if able, are changing insurance to follow their physician.                                                          Top

The AMA tells of a group of physicians that are called the Traditional Practice Alliance around California who are weaning themselves off HMO and IPA contracts. They state they get paid better and have lower overhead to make the same amount of money seeing 25 patients as they did when they saw 60 patients per day. The patients are traditional Medicare, PPO and HMO point-of-service patients as well as those without insurance or HMO patients willing to pay out of pocket. Members are charged $300 yearly for which is used for background checks and joint advertisements. Referrals by group PCPs may be to group specialists but that is not required. There are sister groups in San Diego, Santa Monica, Orange County And East San Francisco Bay. The web site is www.indoc.org/.                                                           Top

Yes, Hillary is back. She will be on the Senate Health, Labor, and Pensions Committee. She will also be on the Environment and Public Works Committee. The New York Daily News states these assignments will allow her to continue the push for "HillaryCare", health care reform. Hopefully this time real physicians will be allowed to testify without secrecy.                                 Top

Blue Cross and Sutter have broken off negotiations and no further talks are scheduled. Originally, Blue Cross stated that the break-off was only for HMO patients. All HMO patients have been transferred to non Sutter physicians. Then Blue Cross said no to PPO patients as well. Now, Blue Cross, without talking to Sutter, gave a story to the press stating that PPO patients may go to "rural" Sutter hospitals i.e. without non-Sutter hospitals in close approximation. Blue Cross also states that they will pay Alta Bates, Summit, CPMC, and Marin General, all Sutter hospitals, rates comparable to other area rates. Since the hospitals have not agreed to the rates patients will have to pay out of pocket money to make up the difference between usual and customary price and Blue Cross’ payment. Both Gould Medical and Palo Alto Medical Group will also be paid comparable rates. Blue Cross also stated they would pay for any surgeries scheduled prior to January 31, pregnancies in the second and third trimester, and some patients in ongoing treatments. Also emergencies will be covered. CalPERS and DMHC are now becoming involved. CalPERS has said that in future contracts participating health plans will be required to disclose the status of negotiations and what to do if the contract is terminated. The Department of Managed Health Care states they may intervene in the dispute. Not mentioned in the story is that John Muir/Mt. Diablo Health is also affected and there is no contract between Blue Cross and the Muir physicians or Mt. Diablo Medical Center. What’s a poor patient to do?                     Top

A new Harris poll showed that people are satisfied with their health plan and the perception of poor HMO care is from the media or physicians. The poll showed that 51% preferred employer based health plans down from 56% a year earlier. Only 19% wanted government sponsored health care. The article did not state whether the respondents were users of plans or not nor how the users voted compared to the non-users.                         Top

A study by UC School for Public Health showed Kaiser with the fewest patient complaints. The study was by telephone of 1200 health insured adults in California. Kaiser best aspects were the lack of qualifications to be seen or referred. HMOs had the most complaints due to there rationing of care by restrictions of not receiving the most appropriate care, delays in receiving care and difficulty getting referrals to specialists. PPOs received the highest marks in providing the care a patient needs since they have the most hospitals and physicians that the patient may utilize. Kaiser also had faults that included not receiving the most appropriate care and delays in getting care.                               Top