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Cigna is no fun. The idiots at the organization are calling their sanity into question. A physician in Auburn Maine writes a paid parody newsletter on line call Placebo Journal (you can Google it). He recently wrote an article called SICKNA Healthcare and was a parody on physician satisfaction. The survey used a logo similar to Cigna and signed W. E. Sucque fro the Medical Thievery and Health Policy Division. Dr. Douglas Farrago then stated that Cigna had put pressure n his hospital Sisters of Charity Health System to have the doctor cease and desist. They claim that the contract with St. Mary's bars physicians from any false or disparaging communication which would, or are likely to, interfere or otherwise damage any of Cigna's existing or potential contractual relationships. This, of course, goes against free speech and is probably illegal. The parody was also possibly true, which is an absolute defense against defamation. Dr. Farrago answered the Cigna threat with an article "A Day in the Life of an HMO Medical Director" and an advertisement called "Grand Theft HMO III: Medical Request Denied. Keep it up says the Urologist writer of this newsletter to Dr. Farrago.
Insurance companies are finding out the senior population will not go along with restrictions on their choice of physicians or hospitals. The study showed 44% of seniors versus 70% of 18-34 year olds were willing to trade choice for money. Most of the 44% were enrolled in HMOs. This is bad news for the senior HMO business since about 60% of seniors are in fee for service plans.
UnitedHealth is planning to do the same thing in Florida as they started in Missouri, measure performance. The standards are the Ambulatory Quality Alliance standards. This is to show the physicians are using evidence based medicine. The problem is, as all physicians know, the evidence keeps changing. Top
As usual, I start this section with a story about the worst hospital in the country, Drew/King in LA. In the latest fiasco after finding their consultants are billing for work not performed, they now find a need for $64 million for hospital repairs. These repairs are apparently needed to regain its accreditation which it rightfully lost earlier this year. The Board of Supes has not acted on the request since it is not convinced the hospital will remain open.
And now another Drew/King misadventure. The chief auditor for the Department of Health has claimed that the medical director, Roger Peeks, has possibly received kickbacks and falsely allowed illegal payment for a radiologist who slept at the hospital and was being paid $225 an hour for this time. The radiologist worked 20 hours a day, seven days a week for six months. Peeks has been accused to giving away public funds by allowing the payments to be made and by giving the radiologist a free room in the medical residents dorm. Peeks was supposed to disciplined for the use of payments according to the Board of Supes but Peeks states he never was. The outside consultants told the health department director not to discipline him since the investigation was ongoing.
The LA County Board of Supes is now considering Plan B. Turn the hospital over to someone else to run it. This would entail closing the hospital until new staff could be hired. The Supervisor in whose District the hospital resides has never sounder bright but now she sounds even dumber. She knows of instances where hospitals have contracted out portions of a hospital but not the entire hospital. What it means is that no more civil service and those who screw up can be fired. There is another possibility. The State just finished another seven day inspection of the hospital and may yet close the thing. They are trying to balance the public safety from a hospital that is dangerous while it's open versus having no hospital and have the patients transported to another institution.
All is not well in the People's Republic of Massachusetts. A representative of the State's Attorney General's office had to mediate a dispute at Hubbard Hospital in Webster. The hospital board is split over the administrators of the CEO. Prior to the running of the hospital Mr. Christopher Rich was a Salem collections lawyer. The 21 bed hospital was in financial straits prior to the new abrasive CEO coming on board and the hospital is now in the black. So far the board members that wants the CEO's ouster have resigned from the hospital board but remain on the System board.
Two separate groups of Kentucky investors have sued two southern Indiana counties for their rules regarding moratoriums of private hospitals. The moratoriums were the brainchild of the public hospitals in the area who were afraid of any competition. The suit was filed in federal court to get away from the local politics and for the antitrust concerns.
The AHA is back at crying wolf. They now state that the specialty hospitals are not allowing them to provide the needed EMTALA back up call. This is nonsense. EMTALA states that the hospital only has to provide back up call in those specialties it provides and there does not need to be a physician on call every day in every specialty. The hospital only has to make arrangements for transfers but they won't since they would lose money. This is a fiscal issue and not a patient care one.
Hospitals are monitored for quality in the federal programs by quality improvement organizations (QIOs). JAMA has published an article from Johns Hopkins that stated hospitals in five states and DC that participated in the QIO programs showed no improvements. Medicare is now paying about $400 million per year for this quality improvement that may not exist. The study showed quality was improving in hospitals even if they did not participate in the QIO. The American Health Quality Association that represents the network of QIOs criticized the report for it's lack of length of time of the study and that it only went to 2002.
The Catholic Health System of Buffalo, New York, wants 60 physicians to work at any of its four hospitals. The System is offering two years of financial incentives to move to Buffalo. Currently the physicians are being paid well below the Medicare rate and can make up to 40% more elsewhere. Not a great incentive to go there nor is the location. Top
In the last edition of Medicalaw.net updates, I spoke about the AMA and their cutting off their nose to spite their face attitude of cutting free services. Now the AMA has come out with their profit statement. They almost doubled their profits in the last fiscal year with less dues and less membership. They did it by getting rid of staff and benefits which saved it $10 million and by increased revenue on its ancillary products such as books. It is interesting that dues only make up 18% of the total revenue of the organization. It is a good thing the profit is up since they have set a $20 million budget over three years for marketing. In September the AMA is going to trial over the firing of its head four years ago. Dr. Anderson wants $15 million for wrongful termination. Whatever the outcome, the AMA will have some egg on their face and less money in their pocketbook.
In something that should be no surprise, of the people making over $132,000 per year in the California state worker category 600 of the 2000 are physicians. This include state psychiatrists that are state mandated to be paid bonuses for enrolling and reenlisting. This also allowed for the nurses and others that worked overtime. The real unreported news is whether any physician was under the threshold. Employees of the Legislature and the University of California were not included in the survey.
The Sacramento Bee has a story about the two forgotten physicians from Redding, California who where accused but never proven to be doing unnecessary cardiac procedures. To date the FBI investigation has gone nowhere and both still have their licenses but are not practicing.
The physicians of Orange County, California are not happy campers. The State is attempting to save money by placing as many Medicare/Medicaid people as possible into HMOs. The State believes that all members should have a choice and if they decide to go to the HMO they will be seen by only several doctor groups. They do have the choice to stay private under Medicare/Medicaid but only if they elect to do so by October31. They can also change monthly. The physicians who do not belong to the several medical groups are afraid of the livihood. This is the potential for any physician who is dumb enough to have the majority of his/her patients with one insurer. Top
Terry Schiavo may be dead but the politicians will not let her be. Governor Bush of Florida has asked the state Attorney General to investigate a 911 call by her husband following her collapse many years ago. This has been investigated in the past and Mr. Schiavo cleared. This is pure politics and not in Governor Bush's favor. Top
Following the US Supreme Court decision on medical marijuana, Oregon has decided that the ruling does not apply to them. They have restarted issuing medical marijuana cards to those in need. Top
The Maryland physicians are finally getting some smarts. They are getting clobbered by the lack of med mal meaningful reform. The physicians are beginning to fight back by raising $1 million to elect physician friendly legislators, no matter their party. The money will also be used to target those in the legislature who are anti physician.
The Rhode Island legislature has failed to come up with a solution to their malpractice problem. The Governor and the medical groups all point the finger at the trial lawyers. The legislature had put their duty to reach a decision off to the combination of physicians and attorneys. They obviously couldn't agree so there is no law. The physicians mainly wanted a decrease in the interest rate of 12% now in place for pre-trial times. This allows plaintiffs to drag out cases for years. Rhode Island has the longest time to trial in the nation, six years. Part of that may be the insurers fault as they only use one firm to defend in the state and those attorneys are booked for months to years. Top
The AMA's policy making body has decided to push for state laws that would allow physicians to dispense medications when there is a need and no nearby pharmacist (within 30 miles) is willing to dispense the prescribed drugs. This is to counteract the "good conscience" refusals of pharmacists to dispense contraceptive medication or Plan B. It seems that some pharmacists are also refusing pain meds and psychotropic drugs, not returning the prescriptions to the patient and then lecturing the patient. Top
The Joint (JCAHO) has flunked its own self testing. It had sold software to its hospitals that it is supposed to accredit for between $500 and $1000 a year. The software is to be used to help with the paid accreditation. The problem is, besides the obvious conflict of interest, the software is like the organization, faulty. The hospitals would not publicly criticize the Joint, since their accredited lives depended on them. The Joint had forgotten to put in about 20% of the standards necessary to pass muster. The Joint called the error a glitch. One hospital called it an earthquake. 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.