July 1, 2004 News





Economic Credentialing


The Mississippi Governor has signed into law tort reform  What it took to get this passed was not the pressure by the physicians but by businesses refusing to come to the state due to its liability laws.  (See Recent Legislative News, this edition).

In Texas, medical malpractice reform is working.  Due to the cap on non-economic damages fewer lawyers are taking fewer cases.  This will lead to decreases in premiums for the state's physicians.  The other good side benefit is with less malpractice cases, the plaintiff and defense bar may have to lay off attorneys.

In Maryland, the three adversaries in medical malpractice are working together to attempt to find common ground for more affordable med mal insurance.  To date, each has stuck to their predetermined ideologies. 

The AP has a story about the Florida physicians who practice bare.  They have been told to contact their bankruptcy attorney and not their defense attorney if sued.  The belief is that the negotiations then begin at zero and not the policy limits. In Florida the house, retirement plans, annuities, life insurance and salaries.  All else is usually given to the spouse in advance of any suit. The problem is you need to trust your spouse. 

The Palm Beach Post has reported that some doctors in their county will not stop at accidents nor help if a "code" is called in the hospital. If it is not their patient they call the ED physician to respond to the code. These doctors have dropped their malpractice coverage and are afraid of potential liability.  

In another story the Post states that about half of the hospitals in the county have no neurologists to see patients in the ED.  This is a direct result of the malpractice crisis in the state.  If a patient can get to a hospital and receive a head CT scan to determine if he is a candidate for "clot busters" within an hour, the chance for a good recovery is greatly improved.  The hospitals are making things worse by not allowing ED physicians and only neurologists to give the drug, mainly due to the cost.  Many hospitals are using internists to fill in for neurologists, a poor second choice.  The only way it will be rectified is if the state adopts meaningful malpractice reform or the hospitals start paying their physicians to take call.  (See story in Recent Legislation regarding Massachusetts.)

The Business Journal of Milwaukee has a story of the Illinois physicians leaving their state to go to Wisconsin.  The malpractice premiums are a small fraction there than in Illinois.  One of the largest malpractice carriers in Illinois has stopped writing policies in and around Chicago in the north and St. Louis in the south due to the litigation.  Of course, the legislature is Democratically controlled and therefore no significant malpractice reform will come forward.  Even if it does, unless there is a change in the state Supreme Court, the measure would be ruled unconstitutional by the Democratic Court.       Top


The Texas former partners, Baylor and Methodist Hospital are at odds over physicians.  Methodist has stated that the Department Chairs must be only at Methodist.  The remainder of the staff may go anywhere they wish and remain of the staff.  Methodist has formed a for-profit subsidiary that allows it to hire physicians.  About 1/3 of the Methodist physicians are also on the Baylor staff.

The Chief of Surgery at Methodist was the first person to resign at either hospital.  He will remain on the staff at Methodist and continue to do surgery there.  

In California, another hospital has been hit by the poorly thought out nurse ratio law.  At Providence Saint Joseph in southern California, approximately 90 people will be laid off due to financial difficulty caused largely by the law.  Those laundry workers, managers, secretaries, clerks, technicians and nurses in positions not covered by the law should call the union and thank them personally.

It is hard to believe but the poorly run King/Drew Hospital in Los Angeles has drawn praise from the local CMS head.  He praised the hospital for the work that has been accomplished but also said they have only met the minimum and thee is et no talk of excellence.  The LA Councilwoman in charge of the District said the major problem was lack of funding.  The county health director stated that studies have shown it is not the lack of funding but the lack of leadership that is the problem.

Modern Healthcare had an article regarding the nurse-patient ratios. stating that "As Calif. adjusts, backers seek to replicate success".  I believe the measure is not a success.  There can be no doubt that nurses are the vital cog in the care of hospitalized patients.  There also can be no doubt that the more nurses per patient, the better the outcome.  However, there must be a balance between numbers of nurses and the potential closures and layoffs of affiliated personnel at hospitals.  There also needs to be some common sense in the rules, which the California legislature nor the recent judge who decided that the ratios apply 24/7, lack.  With several hospitals closing, access to any type of care will be impacted.  I hope the other states that are considering the ratio will consider all sides of the argument. 

North Shore University Hospital in Long Island has notified 177 patients that they may have been exposed to HIV or hepatitis due to improperly disinfected endoscopes. To date none have tested positive.  Two employees had failed to test a disinfectant bath used to clean the scopes.  The hospital did not check the records of the employees on a daily or even weekly basis.  

An article in the New York Times talks about nonprofit hospitals overcharging uninsured patients for their care and then going after them in court for the over inflated charges.  Who is leading the attack on the hospitals are the trial lawyers, who are always on the lookout for more ways to line their pockets.  They have filed suits as a coordinated action on the nonprofits in the hope that they can get a class action status.  Their goal, besides their own wealth, is to have these nonprofits create a trust to provide affordable healthcare for the uninsured.  According to the scavengers who want to take the money from the nonprofits for their own use, it is the duty of nonprofits to give affordable care to the uninsured. What some of the allegations state is that the care should be free not the same as that given to insured patients.  This is a societal issue and not a judicial one.  The nonprofits as well as the for profits could not stay in business if they had to give free care to those without insurance.  As a matter of fact, why would anyone buy insurance if they knew they could get their hospitalization for free.  I truly doubt that these do-gooder attorneys would do their trade for free. 

In hospital CEO news the beginning Milwaukee Heart Hospital CEO has resigned.  The problem stated is wanting more time with family.  The real problem is the lack of any contracts with insurers who are being told that if they sign contracts with the hospital they will lose the other hospital business.  

The other CEO is one not hired by the Board of Supes in LA to take over the political riddled King/Drew Hospital.  He was told he was not needed.  The idiots at the Board believe that the problems at the hospital are being handled.  They state they have corrected most of the problems identified by the state and feds but they still have the problem of the Board and their poor oversight.

The CEO of Putnam General Hospital resigned.  The hospital has about 40 suits against it for negligent credentialing of an orthopedic surgeon that the hospital hired.

HHS has subpoenaed documents from Maryland General Hospital.  This is the hospital that did HIV and hepatitis tests wrongly and then went after the personnel who blew the whistle on them. It is against the law to bill for tests you know are inaccurate. The hospital CEO and lab director have already left in disgrace.   

In one of the smartest moves I have heard in a long time, Porter Adventist Hospital in Denver, Colorado, has listened to and worked with their physicians to increase market share in the community.  The physician-designed plan focuses on oncology, surgery, cardiovascular and complex medical services.  The physicians also recommended locating services closer to patients and the hiring of specialized nursing to support the programs.  The hospital will update to a state of the art ED with on-site lab, x-ray and CT.  They also built new ORs for the specialty programs.  It is nice to see a hospital and physicians working together to solve common problems. 

In Butler County, Indiana, a hospital with a different concept is opening its second phase.  This fall a surgical hospital for outpatient surgery will open.  The hospital is building one section at a time.  Prior they opened a medical building with imaging and offices for specialists.  A second medical office building is starting and the possibility of a hospital down the line is on the drawing board.  They also have a linear accelerator, dialysis, two banks, a restaurant and a spa.       Top


As reported here in past editions CalPERS dropped 38 hospitals from its list that its HMO Blue Shield may negotiate with next year.  Many of those were rated highest in quality.  The high costs of the hospitals may be related to their high quality by their investments in technology and information systems. Sutter Health, the major recipient of CalPERS cost cutting has just been named the VHA leader in Community Health-Health Delivery System  

CalPERS, the third largest insurer in the country has risen its premiums over 11% for the next year.  This is the fourth year in a row it has double digit raises, but it is the lowest of the four years.  This is also after hit got rid of the high quality, high cost hospitals.  Of course, premiums throughout the country are expected to decrease for 2005.    

Some insurers never learn.  Aetna, by becoming more physician friendly an open, has become somewhat profitable.  Now they are attempting to undo their profitability by alienating the physicians and the patients.  The insurer is starting to get rid of physician specialists in their network limiting the choice of the patients.  The doctors they get rid of are not cost efficient.  Quality, of course, is not an issue. This is being done by a new product offered to employers that is cheaper than the standard product.     Top


At the June, 2004, AMA Organized Medical Staff Section (OMSS), Dr. Danae Powers, an anesthesiologist at Mt. Nittany Medical Center came after her as a disruptive physician because of her whistleblowing in the department.  In order to get rid of her the hospital made an exclusive contract and she left prior to serving her term as the elected chief of staff.  The OMSS did as the AMA usually does, nothing.  The AMA President's opinion was that an appeals process is an interesting concept.  Why people pay dues to that organization eludes me.

Dr. W. Harry Horner, an internist at Western State Hospital in Virginia, was fired in 2001 for whistleblowing on poor patient care.  He exhausted his administrative appeals and then went to court.  The lower court ruled for the physician but that was overturned by the Court of Appeal.  The state supreme court reinstated the doctor with full back pay.  Dr. Horner is returning to the hospital on August 1.  Virginia state law allows the immediate supervisor to make the final decision on these matters.  The supervisor went with the doctor but was overruled by the administration.  The Supreme Court said the law must be followed.        Top

Economic Credentialing

In a story regarding the Milwaukee, Wisconsin situation where Aurora Health is denying services to their physicians who invest in competing heart hospitals, a new phrase has emerged.  It is not economic credentialing, it conflict of interest credentialing.  It is the same wolf in different clothing.  The only smart thing said in the article was by the head of the ProHealth Care a parent company of two hospitals.  He stated that this all about a patient's right to know what incentives the physician has when the physician makes choices on the patient's behalf.  Full disclosure is an imperative.        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.