July 15, 2012 Recent News
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Becker's Hospital reports on the money paid out by hospitals for call coverage and medical directorships. The main driver for call coverage increases over the average 8.8% increase between 2010 and 2011 is trauma. This can increase payments up to 22% higher for those physicians who must stay at the hospital. Medical directorships are about a median of $200 per hour and are continuing to increase but at a low percentage. Hospitals are also paying a large amount for exclusive services such as anesthesiology, which is just under $1 million per year. Since hospitals need all these services it is expected to see the amounts climb, especially after 2014, when Obamacare kicks in.
Dignity Health, used to be Catholic Healthcare West, has purchased Healthworks, an occupational medicine and urgent care chain. They have 172 sites nationwide. The above comes from The San Francisco business times.
Speaking of San Francisco the idiots in power there have struck again. After agreeing to a deal with California Pacific Medical Center to allow them to build a new earthquake safe building, they reneged. This is not unusual for the left wing zealots who run the city. they are controlled by the unions and the nurse's union has problems with Sutter Health, the owner of CPMC. Somebody inside the hospital, any guess which union the whistleblower works for, leaked old documents which stated the hospital was going to change the deal. The Board of Stupes got their nose in an uproar and now want more assurances and this means more delay. This leads to potential patient harm if another quake hits the city.
Following the Board of Stupes announcement, the San Francisco Business Times had an article about the announcement by CPMC. CPMC stated they will not renegotiate the deal.
Victorville Hospital in Victorville, California was originally supposed to be sold to Prime Health but the sale was blocked by the California Attorney General who listened to the unions who are fighting with Prime. The hospital is broke. A new buyer has come forward that the unions approve of so the hospital will be sold to KPC group.
Patients are complaining about Lee Memorial Hospital in Fort Meyers, Florida. They are getting charged extra money for seeing owned physicians in buildings owned by the hospital. This extra fee is paid by some insurances and not by others. The reason for the fee is a facility fee for seeing a owned physician in an owned facility. The people of the area are stuck as most of the primary care physicians and many of the specialists are owned by the hospital and it is the only hospital in the vicinity. The charges are about $60 per visit above any co-pay. They should be happy they do not live in the Palm Desert, California, area where Eisenhower Hospital charged $300 per visit at one time. However, there are excellent alternative hospitals in the area, so Eisenhower dropped the charges to $150 per visit. It is a wonder that anyone except Medicare patients goes to the facilities. Medicare pays the extra charge but does not penalize the physician. The physician fee is based on the total expenses including rent. Since they do not pay rent anymore they should get less money from the feds. CMS, like usual, doesn't care how they spend the taxpayer's money.
Hospitals realize the CPOE is dangerous and many mistakes have or could happen with the program. The reason for the errors is human where the physician orders the meds for the wrong patient. This is easier to do on CPOE than with writing a prescription. When one writes, the patient sees the name and can ask questions. When it is done electronically the patient is left out. They looked at New York's Montifiore Hospital where there was a large percentage of CPOE errors as manifested by retractions of an order and a reorder within short time periods. This can be largely corrected by the physician reentering patient identification. This took physician time to do and was not being done. This is another example of the potential for error in electronic records, especially where it is already causing significant time constraints on physicians. Top
Following the Supreme Court verdict on Obamacare, many are writing articles on the outcomes. One such article is a Practice Group article by the AHLA Teaching Hospitals. They state that since Medicaid is now optional these hospitals may be hit hard financially. Those hospitals that are Disproportionate Share Hospitals may be hit harder than any other. Those hospitals that serve the chronic disease population may make out better than those that are not part of an ACO or Medical Home. There will be massive shortages of physicians (90,000 more needed) and the residency slots are full and are not increased in the aggregate. Also, the "non-profits" of the hospital world will need to comply with the new regs showing they deserve the name "non-profit".
The Supreme Court's ruling has not stopped the every Tuesday CMS report of wonderful they are. The latest one tells of how many people have taken advantage of "free" preventative health. Those are free to the people getting them but they are paying with higher premiums and the government is still paying the physicians for doing the tests.
The ones who started this entire healthcare mess and are showing the way, the People's republic of Massachusetts, still have not got it figured. Five years after the implementation of their health care program in a state that already had the highest rate of insureds in the country, they continue to have the great unwashed, those that have no insurance or pay a penalty (sorry, that is now a tax). Last year the Dept. of Revenue of the Republic took in $20.6 million in taxes on those without insurance. The penalty in the Republic is much less than insurance as will be true nationally. The amount of people paying has dropped considerably in the Republic but much of that is due to the recession and those that no longer can afford the tax.
The Republic of Massachusetts is spending 43% of its budget on healthcare. It sounds more like an European country. Socialism has a cost. When you run out of other people's money and need to spend your own you have a major problem.
It seems that Obamacare is saving the employers a lot of money. The amount of people covered under employer based insurance is dropping. It has dropped from 61% to 55% since 2008. Those that are now insured by the government have increased significantly since 2008.
The Wall Street Journal had an article about the high cost of dying and they used an extreme case to highlight the point. They told the story of a 41 year old man who needed and received a heart transplant at Johns Hopkins. His post op period was slightly rocky necessitating a gall bladder surgery, a leg amputation, and the removal of part of his lung. He remained in ICU for almost a year until he died. The family thought he was going to live and refused to pull the plug. This cost Medicare $2.1 million dollars just for his care and One of the main contributors to this fiasco was the transplant surgeon who could not stomach that a good heart transplant should go to waste. He continued to tell the family that the man should make a recovery. By that time he had renal failure and significant sepsis as well as being on a ventilator. He was only the fifth highest patient cost that year. Currently Medicare is 13.5% of all the federal spending and will be over 16% in ten years (See article above about the spending in Massachusetts).
The American Health Lawyers Association has an article about the Independent Payment Advisory Board (IPAB). This board is 15 members appointed for six year terms and must be confirmed by the Senate. The members may have no other job. Once approved the board member may not be removed unless there is neglect of duty or malfeasance of office. The job of the board is to recommend to Congress, providing Medicare exceeds certain spending limits, ways to control spending. This assumes that Congress does not act on their own. Once the board recommends the action, if Congress does not act, HHS must implement the changes. There are three year cycles for proposals. Interestingly, the board is forbidden from changing spending by rationing of services, raising revenues or premiums, increasing cost sharing or otherwise restrict benefits or modify eligibility requirements. This means all they can do is to reduce payments mainly to physicians since hospitals, home health and hospice are exempt. One of the main goals of a bi-partisan coalition in the Congress and Senate is to get rid of the IPAB. Top
Vanguard Health Systems based in Tennessee has has given its anesthesiology services in Illinois to a company in Long Island. The current anesthesiologists are either going to join North American Partners Anesthesia or go out of business. This continues a recent trend of outsourcing departments to the cheapest competitor and the hospital staff be damned.
The Washington Post has an article regarding how physicians should not give in to patients who insist on tests and prescriptions that the physician thinks are not necessary. Choosing Wisely, a campaign by some physician groups and consumers, believe that 30% of the expenditures are unnecessary ($700 Billion per year). They want physicians to follow Nancy Reagan and just say "no". They published a list of 45 tests and procedures that are usually not necessary. One of then was the routine physical EKG. I can't wait until the first case comes to court because of the rationing. What is the physician to do when there is not enough time now and there will be much less when Obamacare kicks in in 2014? Of course, there are some unscrupulous physicians who just order tests in their offices to make money. Hopefully, those are the exception and not the rule.
The Wall Street Journal has an article on the Opinion page titled "Obamacare's Lost Tribe: Doctors". It talks finally about how the law will affect the physician. It will push the physician out of practice into early retirement if they are able or into employment situations. He asks the same question as others have asked, Will your physician keep you or even want to keep you. The article discusses the demise of the patient-physician bond. The article quotes another article in an earlier edition of the same paper of a quote by a hospital administrator who says they will make up the loss of income by increasing volume. The author states this equates volume with patients. The article goes on to explain that the law will reduce drastically the ability of thinking time afforded the physician who instead will be doing the idiotic reports required under the law. This is a disservice to the patients.
In Texas the physicians like their independence and are not afraid to act. They are declining to accept new Medicare or Medicaid patients. Only 31% will take Medicaid only patients. This is down 11% from two years ago. Since Medicaid pays only 50% of the cost of care no one should blame the physicians. You do not make up losses by taking more patients. Those who take Medicare dropped from 66% in 2010 to 58% today. Here it is not money that stops the physician from taking patients, it's the red tape.
An article in CNN Money tells of the demise of the solo physician. It is not a new story but a rehash of what is known. Physicians want to be employed due to the new lower prices being paid to physicians. Salaries look much better even if it means giving up autonomy. A headhunter states that they are now getting orders or fill for solo physicians at the 1% level. It used to be 22% in 2004. Hospitals looking to hire physicians have gone from 11% to 63% in the same time span. It also states, although not specifically, that the new physicians are going to be discouraged in the next few years. They want a good quality of life but will get hit with the new influx of patients and be mandated by the hospitals to see more and more patients as well as fill out more and more reports.
Medscape reports that med mal payments are continuing a downward slope along with the amount of claims. According to the people that did the study this disproves the need for med mal reform on the federal level. This is the same group of people who believe every physician in every state should be punished by their medical board in order for the board to be passable. The counter argument to the med mal claim is that many med mal claims are not reported since they are against the employer and not the physician. I think all can agree that the NPDB is a poor source of information since as mentioned above many med mal is not reported. Also it needs to be noted that it takes about $150,000 to defend any med mal claim not counting the personal toll on the physician. This takes the air out of the claim that med mal reform is not needed and that defensive medicine is not widely practiced. 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.