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Stanford University is deleting all of its HMO contracts as of the first of the year. Some say this is a irreversible decision. Others believe it's a negotiating ploy. Assuming the former approximately 50,000 people will need to either change insurances to continue with their same physicians or change providers. If most change providers there will not be enough physicians to treat them. Stanford is the middle of the still high price Silicon Valley and finding new physicians to move there is next to impossible. The current physicians are overloaded already and will not be able to take many more patients. The patients may have to travel either across the Bay or to San Jose to see physicians, a distance of 20-30 miles. That should be fun especially for the employers who will lose the employee for the entire work day for a routine appointment. If the employers don't like that, they may have to pay higher prices for their employers to join PPOs. Top
Palm Beach Hospitals Get Another Chance
Several months ago I reported on two Palm Beach hospitals owned by the same for-profit that was going to close one as not profitable. the community rebelled and the Florida attorney general stepped in. The hospitals were then sold to Tenet who just reopened them in the hope of making money. The believe that by using Tenet's purchasing power that dropped costs by 1/3 and their efficient billing procedures they can turn the two hospitals around. They also will push for employee satisfaction and outcome improvements. Here's hoping they can do it. Top
For the last decade or so, VBAC rates were important to how good a hospital was rated. Now the New England Journal of Medicine has reported on something that we all knew- VBAC means increased risks. The report showed an increase from 1.6% to 24% of uterine rupture in women with VBAC versus repeat C-Section. The report also stresses that women should be informed of the higher risk with VBAC when they make their choices. Top
Eli Lilly inadvertently released the email addresses of about 600 Prozac users. Normally the notice only goes to the individuals but this time somebody goofed. It sounds like instead of sending blind copies, they just sent copies. If HIPAA privacy rules would have been in place, the fine would have been 600 x $100 = $60,000. Of course, Lilly would not have to face the HIPAA fine since drug companies are not covered entities under HIPAA. Lilly has temporarily discontinued the service of reminding patients to take their weekly medication. Top
The University of Kentucky has seen the light. They are withdrawing their satellite clinics and their physicians. The axiom continues to hold. Hospitals and for-profits can not run clinics and do not know how to bill and manage staff. I would not be surprised to see no evidence that PHOs ever existed in another five years. Top
Red Cross Sucks the Life Blood
The Red Cross continues to raise the price of blood. The organization is in debt to the tune of $335 million and needs to raise the price of blood dramatically. They control about one half of the nation's blood supply and have made certain internal rules that many do not agree with. They will not transfuse blood from Europeans that may have been infected with Mad Cow Disease, They also do leukocyte reduction which may cause fevers in some and serious reactions in those seriously ill. The problem is that Mad Cow is rare and so is the problem of fevers, etc. The leukocyte reduction costs about $35 per unit and both rules reduce the supply or add to the cost. The cost for the blood that the hospitals now eat has gone from about $100 per unit to $180 per unit. Igor, they're bleeding us! Top
In a significant breach of privacy St. Elizabeth Memorial Medical Center in Illinois has probably inadvertently broke as many privacy laws as there are by allowing the release of medical records identifying a woman who had an abortion. the information went to an anti-abortion website and is now across the web. The woman has sued the hospital and the people responsible for the website. Illinois law prohibits willful and wanton disclosures by hospitals or their employees. I hope she gets enough to close down the site and to punish the hospital for allowing access to the information. Whether one agrees or disagrees with abortion the privacy of the individual person must be protected. Top
In the July 1, 2001 Recent News I spoke about the problems at LA County. The supervisors and the union are now doing what they do best, they are quarreling over who gets control of $40 million earmarked for retraining. The supes know they will be sued and lose big time for the people who have died from neglect but instead of going ahead with their elected responsibilities they are forming a committee to study other possible problems and not telling the union to go bye. What is wrong with the hospital administrators, physicians and nurses telling the Board what is wrong. They have been trying to do that for several years. Top
The Peoples Republic of Massachusetts is great for newsletters. There is probably no other state that comes up with more schemes that make people laugh and shake their heads. In the latest one a high school principal has put in a program to have teachers smell the pupil's clothes for cigarette smoke. If two teachers smell the smoke the child is suspended for one week. The teachers will have to discern how recent the smoke smell is and whether it came from the student or via second hand means. Now if the teachers can also teach reading, writing and 'rithmetic. Top
Aetna is planning to boost premiums about 20% in it's home state. The company will also go to "experience rating" for companies with HMO policies with 100 or more employees. This means that those companies that utilize medical services to a greater degree will be charged more than those who do not spend their premiums. Aetna and others already do this in other states and in their non-HMO products. Aetna will also get out of the HMO business in central Indiana, but keep their PPO program there.
In Houston employers are experiencing the highest rate increase in six years. There has been a 12% increase in the past year and more increases are on the horizon. The employers prio to 1999 saw a decrease in their payments with the HMOs making profits on "fat cutting". With no more fat to cut the insurers need to make up for lost time and increase shareholder dividends. The employers are answering by either decreasing benefits or increasing employee costs. they can do this since the tightening labor market is making jobs a premium.
When was the last time you heard of a hospital crying because they are too full. In Maryland, Upper Chesapeake Health eliminated 150 jobs because it was too full and losing $16 million. There ED, OB and admissions are all up significantly. This caused the costs to increase dramatically. The hospital can not increase the income side since the state has a cap on the amount that can be charged. Does this sound like the California energy fiasco where costs can increase but not revenue?
In Pennsylvania, liability issues still are holding the front lines. Pottstown Memorial Hospital is figuring out how to pay their 78% malpractice premium increase. At the same time the hospital's excess insurance coverage has not been renewed and no company is rushing to fill the breech for them or the other VHA institutions. Pottstown, in response to the malpractice crisis, has limited what types of procedures can be performed at the hospital. I would hope that Pottstown Hospital and the others in Pennsylvania publicize their plight to their community in order to pressure the state legislators to pass reform or not be re-elected.
Health Affairs has issued several studies of capitation in California and it's effects on medical groups. The first one looked at New York and California and found that both areas are decreasing their prepaid contracts. The second one examined 250 medical groups and finds that the groups are still fairly strong. This goes against the CMA report that shows IPAs in financial difficulty. Top
Connecticut Hospital Deal Worries Women
Hartford's St. Francis Hospital is planning on purchasing Essent Healthcare. The problem is the recent Catholic Bishop pronouncement that will forbid any sterilization or abortion procedures at Catholic hospitals. This is not usually a problem for vasectomies or abortions since they are not done in hospitals but in clinics or offices. It does effect the ability of women to obtain tubal ligations since they are many times performed post delivery. In a public meeting Essent representatives stated there would be no curtailment but a spokesperson for St. Francis would not comment, except to say that if the merger/sale does not go through there will be no hospital to worry about. Top
Everyone knows that the most sought after employees in the country now are nurses. Nursing schools are attempting to turn them out at a faster clip, however many nursing people would rather have no nurses than non-university trained nurses. The nurses who currently have a license are aging with few to take their place. The current nurses are also looking for better pay and working conditions. Many are doing nurse administrative positions such as utilization review and performance improvement. Now the Houston Business Journal reports that many nurses are becoming legal nurse consultants. They are helping to define the standard of care, analyzing records and testimony for both plaintiffs and defendants. Many are independent and work from their homes, a major improvement in their hours and locations. They also get a much higher pay than when they were in clinical nursing. Maybe the clinical nurses should be paid more and treated better, a novel idea. Top
In the Cincinnati area new physicians have a choice, they can work for hospitals or physician owned practices. Since most hospitals have already seen the light and are cutting loose their money losing physician groups, most new physicians are joining the physician owned groups. By joining these groups they have the one thing that hospital owned groups do not have, incentive to work hard. The private practice physicians are seeing about 32 patients a day where the hospital owned doctors are averaging 22 a day but will soon go to 26 per day. The hospital is losing about $60,000 per physician per year, small amount compared to some in the California market.
Speaking of losing money, General Health of Louisiana needed to sell facilities to pay for their HMO losses. They are selling their psychiatric hospital and two nursing homes. They owe $42 million and will get about $16 million from the sale. they hope to pay off the remainder in the next 5 years from their acute care hospital profits. their own physicians will be paid last. They are owed 13.6 million. Ain't being an owned doctor great?
Kaiser physicians in Colorado will be allowed to follow the law. Kaiser has deemed it allowable for their physicians to prescribe or not prescribe medical marijuana as their choice. Colorado has a medical marijuana statute that allows physicians to recommend marijuana to their patients.
Good old Palm Beach. They can not figure out the voting machines nor what they want to do with money losing hospitals but they know their physicians are rude. The senior citizens don't like the way they're treated. The patients feel rushed and ignored. The doctors don't answer questions and don't return phone calls. This is from 16% of 400 seniors polled by an organization formed to make the area a more senior friendly place. The County Medical Society is taking this seriously and is organizing a series of seminars for the physicians and their staff to become more consumer (they used to be patients) friendly.
Blue Cross of California has started something new, payments for patient satisfaction. The physician may receive up to a 10% bonus for meeting Blue Cross criteria for patient satisfaction. These criteria will be focus patient surveys, interviews with patients that leave a group to determine the reason for the departure and how quickly grievances are resolved. Other criteria are preventive care and how quickly the physicians tell the organization when a hospital releases a patient. This is not in response to the federal patient rights bill just passed by the Senate. It is refreshing to see a bonus for non-cost cutting measures.
Where have all the ethics gone? Why they're in Miami at the Dorado Resort. The state medical board physicians were invited to the resort to hear about how the pharmaceutical companies are unethically giving gifts and payments to physicians. Of course the $260 fee for the course may be waived for these hard working people. Top
USC Rejected Funds to Train Nurses
In May 2000 USC was $240,000 to help train emergency dialysis nurses. Several months later the first of three people died due to the lack of emergency dialysis nurses. The proposal came from nurses in a collective bargaining session and was turned down by hospital personnel. Under the proposal $60,000 would go for training and the rest for payment for those nurses filling in for the ones being cross trained. Instead of $260,000 the county is now putting up $2.5 million for training nurses in all specialized tasks including dialysis. Top
The doctors in Pennsylvania can not get any relief from the legislature on malpractice. The white hats are the insurance companies, believe it or not. Several of the companies are giving the physicians raises since their malpractice premiums are so high. I will guarantee that the increase in pay will not make up for the premiums being charged and will be taken away if tort reform comes in. The legislature has to get off the trial lawyers payroll and pass some meaningful tort reform. Their current public fund will not be phased out until 2007, way too late. Get some nerve docs and slow down or heal in until you get meaningful legislation. 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.