January 15, 2008 Recent News





The folks at San Francisco do not care about the law.  A federal judge has ruled against their city universal health plan.  While they appeal the ruling they are going ahead with the implementation of the plan but with the money available without the taxation of businesses.  The people covered would only be those who earn up to 300% of the federal poverty level, about $30,000.  The City as asked the 9th Circuit for an emergency stay in the ruling to allow the city to go ahead.  A three judge panel of the 9th Circuit has sided with the City to require employers to pay into a fund uninsured residents while the City goes ahead with its formal appeal.

Finally someone in the VA is thinking.  The VA has formed a partnership with Alameda Hospital for to treat vets starting February 1.  The hospital would treat East Bay Region inpatients until the end of 2008 with options to continue.  The hospital which is in dire financial straits can make about $9000 per patient and is expected to hospitalize about 84 patients in the eleven month period for a total of $756,000.  

California had banned Thimerosal as a preservative in vaccines for children.  Even without the drug, there has been a rise in autism.  This disproves the old wives tale about the link between the two.  The nuts at the National Autism Society are still grasping at straws for some link.  

In an interesting study France was the best nation in prevention of death from treatable illnesses.  The United states was dead last. They blame the US ranking on lack of access to healthcare due to lack of insurance.  The study was done by group in Britain, a country with full access and who ranked just above the US.   

If, as stated above, access is all important in prevention of deaths from treatable illness then Maryland is on the brink of disaster.  They are losing physicians to retirement without significant replacements from residents staying or movements of outside physicians into the state.  This goes with the predicted 10,000 nurse shortfall.  The low reimbursement rates and the high med mal premiums in the state are significant contributing factors.             Top 


A letter in the opinion page of the LA Times by a Cornell University oncolologic gynecologist accuses insurers of following a "playbook".  He states that his patients also die, as did the young girl that needed but was refused a liver transplant by Cigna.  He states that the insurers always states that they do not deny care on the payment for that care.  That is true but of course at the same time a lie.  The insurers continue to ask for more and more information until it is too late.  He also states that the insurers never give an explanation of the term "experimental".  The is no criteria or definitions.  He then goes to the heart of the problem.  He calls the experts that deny the care "any has-been, retired, unemployed failure with a medical license who is paid to deny care".  He certainly tells it like it is.   

UnitedHealth is losing market share.  Their response is to promise to be nicer to patients and physicians.  They have lost 315,000 members in the past year.  United will now give incentives for quality and patient advocacy over productivity.  Physicians have heard United's pleas before with no effect.   Of course UnitedHealth is also embroiled with the back dating scandal with it's prior CEO Wm. McGuire.  The physicians state that United is the lowest payor of all and they are not willing to negotiate.  They just settled a suit for $12 million for its poor payment record and claims losses.      Top


A cardiology group in Indianapolis, Cardiac & Vascular Surgery Associates, is in Chapter 11 bankruptcy.  They filed two weeks prior to losing a law suit filed in 1996 against them by their former partner.  The partner won $480,853 which will translate to over $1 million with interest.  They may now have to dissolve their business.  They obviously knew they were going to lose at trial and should look for a new attorney as well as look at possible legal malpractice against their attorney. 

Florida physicians want to charge more for copying medical records.  Currently they can charge $1 per page for the first 25 pages and $0.25 per page after.  They want to charge $1 per page for all pages.  Currently Florida ranks 29th in the country for copying fees.  The requested hike would raise it to the 10th highest.  The Florida Medical Board has tentatively agreed but the ruling is not yet final.  Hospitals in the state charge $1 per page for all pages.  The Florida trial attorneys think it is about them and having the physician put barriers to filing of med mal suits.  Ridiculous idea.  The Board wants a $25 maximum for what the state pays for files when investigating and that physicians waive copying fees for patients going to other physicians, if possible.  

The AMA and Aetna are fighting over out of network payments.  The AMA states that Aetna is in violation of the settlement reached last year in the Miami Federal Court.  Aetna is now reimbursing physicians who are seeing their HMO patients out of network at 125% of Medicare rates instead of usual and customary rates. The physicians often then balance bill the patients for the difference.  Aetna sends an EOB to the patient stating how much it has paid the physician for any involuntary medical care and states that if they get a bill from the physician to send it to Aetna.  Aetna will then try to work a settlement with the provider but the patient may still be on the hook. Aetna has already been fined over $9 million for its policy by New Jersey. 

A private practice 100 person physician group from the newly formed Western Reserve Hospital Partners have agreed to partner with Summa Health in building a new physician hospital in northern Summit County in Ohio.  This is being done to keep Cleveland Clinic out of the area and keep the patients local.    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.