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Stanford has decided to pull its sponsorship of the Stanford Coastal Clinic in Half Moon Bay. The clinic which Stanford has run for the past seven years sees about 25,000 people per year and loses about $900,000 per year. Stanford, who is known to have monetary problems, is doing all they can to decrease expenses. Half Moon is now a Quarter Moon. Top
Sebastopol has voted *yes* to the local proposition of self imposing a tax to keep the Palm Drive ED open. The residents voted to require a $60 tax annually of each homeowner over a five year period. Palm Drive Hospital is licensed for 49 beds and has been in financial difficulty for some time. The nearest hospital is 12 miles away. Top
Olympia Washington MDs Leaving
In a story here several months ago I reported on the exodus of primary care physicians from the South Sound area. Recently an open forum was had between the residents of the area and their US Senators. The solons stated they will report the meeting to Washington, which means nothing will happen. The Democratic Senators stated that now that the Democrats control the Senate there may be some movement in prescription drugs. That's nice but it doesn't help the people keep their physicians. The Senators also want to keep the current $850,000 grant that is on the reduction block. This money would have to come at the expense of someone else. Who? Rural physicians in states that pay low Medicaid and Medicare fees will continue to be unable to attract or keep physicians, who will gravitate to those areas that pay more. Top
Two articles printed the same day were opposed. One article
stated that only tobacco companies were worse than managed care organizations in
serving their customers. The downtrend of consumer confidence is to
continue according to the Harris Poll.
Another article stated that even though people are moving to defined
contribution, managed care will continue to play a key role in the healthcare
system. This news came from the CEOs of Aetna, Wellpoint and Pilgrim
Health Plans. The statement that even though quality is important, it has
not made an impact on the market since "employers, at the end of the day,
only care about cost."
Medicare has lost a significant amount of their HMOs over the past few years. Now HCFA's Scully has made a commitment to attempt to attract the HMOs back to the fold. His goal is to have 30% of Medicare enrollees in managed care, up from the current 15%. He stated that HHS would help patients find the best nursing homes, doctors and other providers and release the information on the net. This was denied shortly after by HHS. Scully did not give any specifics as to how the Department would re-attract the managed care industry. Top
Several hundred people lined up outside a failed clinic in the Tampa Florida area demanding their medical records. Some had tried before but were turned away since they did not have a medical records number. Many that waited left disappointed without records since they did have the magic numbers or there were other foul-ups. The clinic said the people would be able to get their records now if they had a number or there was an emergency. Others would need to wait until the Bankruptcy Court judge appointed an custodian for the records. The people in line in the 90 degree Florida sun were mostly of Medicare age. Top
Insurance companies are not paying for the treatment of autism since they say the neurological disease is psychological and therefore not covered. If a state does not have specific legislation regarding the payment for therapeutic coverage or mental health parity laws, the children may be out of luck. Some costs are paid by the educational system but there may be a difference of opinion between the parents and the school as to the level of services. The insurers state that there needs to be evidence based medicine for them to pay for treatment. Top
The master of the universe, OIG, has concluded that about one third of the mental health services performed are unnecessary, performed by unqualified staff, or billed incorrectly. The unqualified people performing the care are nurses, social workers and graduate students. The bottom line is the OIG really doesn't care about the quality of care but they do care about the money. In Alzheimer's when should therapy be discontinued. The OIG states if the patient is too ill to benefit. The providers state that that decision is best left to them. The providers state that the OIG should focus on the other part of their report, that some patients aren't receiving enough treatment. Top
We currently have Compliance and Privacy officers. The American Society of Health-System Pharmacists has recommended yet another officer, Medication Safety Officer. This person would be a key member of the health care team (as if they are not already in this position) and coordinate all activities related to patient safety and quality improvement in the medication process. As a former head of quality improvement and risk management in a hospital I can say that that pharmacy is not a stand alone function. It is a part of the overall hospital quality improvement process. Top
The Top Patient Medical Centers
Modern Maturity, the AARP magazine has named their top patient focused medical centers. The centers needed to focus on traditional and innovative services such as Eastern techniques. The winners are Bronson Methodist in Michigan, Griffen in CT, Highline in WA, Longmont in CO, Mid-Columbia in OR, Shawano in WI, St. Charles in OR, Warren in VA and Windber in PA. Congratulations to Oregon. You are a double winner. Sorry about the rest of you. Top
Shame! The Federal Agency did not report the bad apples to the NPDB. Neither does managed care organizations who use binding arbitration. The whistle blower on the Feddies was Public Citizen, who stated that at least 2592 physicians who voluntarily surrendered their licenses were not reported. How the organization gets its information on a confidential organization is scary and not reported. It does not seem to matter that the DEA is not required to report to the NPDB. Top
The 1975 California malpractice crisis has returned; this time in West Virginia. One of the largest carriers in the state, who has been overcharging the physicians, wants to change ever so slightly the policy. They want cancel the policies, revamp them and then reissue. Sounds good to me, but I don't live in West Virginia. Some physicians are worried that they will need to report in the future that they had their insurance cancelled. They won't since it was not done to them but to a class of individuals. The company wants to get large deductibles and lower amounts they would need to pay. I do not understand the mentality of physicians that go along with this blackmail. California physicians did not and got tort reform (MICRA) and their own insurance companies. West Virginia physicians need to do likewise.
Fifteen percent of Georgia physicians are also threatened by the potential loss of St. Paul insurance company. St. Paul wants to change the policies sold to physicians to a different product that is exempt from regulation. The State Insurance Commissioner has order St. Paul to continue to renew the present policies. St. Paul is going to sue the State. Top
In view of the recent US Supreme Court ruling that nurses who supervise others such as aides or LPNs are considered supervisors and not eligible to unionize, the AMA has dropped its bid to unionize. This makes it much more difficult for physicians employed in the private sector to unionize. Top
North Carolina is awaiting the Governor's signature on a bill
that require prompt payment. The bill is to give a 30 day window in which
insurers must ask pay, deny or ask for more information. After the
insurers get any requested information they will have an additional 30 days to
respond or an 18% charge begins to accrue. The bill also provides for a
uniform credentialing form for all insurers and limits the length of time that
is afforded for credentialing.
New Jersey HMOs just don't care. They have failed to promptly pay over $1
Billion in claims this year in spite of the law. The Department of Banking
and Insurance, which oversees this in the state, is asking for compliance
information from the plans and data on the number of appeals and outcomes.
This, of course, will cost the insurers a significant amount of money to
comply that they would have had for profit if they would only comply with the
law. Nobody ever accused them of being
smart.
Top
The three month old 29 physician group that formed and dropped all managed care contracts has entered into one new managed care contract, Lifeguard. All their other patients must pay their usual and customary fees and then be reimbursed by their insurance company. Cigna has walked away from the table and others have not even sat down. The CEO of the Santa Clara IPA believes the group is trying to change the way business is done in the state and the IPA is not interested. I wonder why? Another group The Woman Physicians OB/GYN Medical Group of Mountain View has also cancelled all contracts and so far their patient volume is only down a little. Maybe more physicians will get a spine transplant and become independent, but I doubt it. Top
A new fingerprinting requirement in Florida has found that about 2000 physicians have a criminal record. The offenses are for such extremes as illegal fireworks to aggravated battery. These doctors did not inform the State Board about the offenses and each are being fined $250 for failure to report the offense. Top
In another Florida story, the chair of the Board stated he
believes so many physicians are making errors like operating on the wrong body
part is due to hospital rushing physicians to make quotas. Maybe that is why
states like California have a law prohibiting physicians from working for any
non-medical entity. See Recent Legislation.
In a second story the Jacksonville hospitals are considering consolidation
in order to get better rates from the insurers. Whoops, I didn't say
that. That would be antitrust. I'm sure it is for greater efficiency
of care. The insurers think that there continues to be a very competitive
market in the area. The insurers also can no longer require an
"all-products" clause in their contracts. The new law prohibiting this
was signed by Gov. Bush on May 31, 2001. This only applies to physicians
renewing contracts and not to group
practices.
Top
It's about that time of the year when insurers begin to tell
which areas they will no longer cover. Aetna has decided to drop 11
Central California counties affecting about 44,000 people. This would become
effective on 1/1/02. Aetna also announced it leaving of Louisiana and
10,000 state employees. The reason for the pullback is to "pare membership
and focus on profits".
Maryland is losing FreeState and Delmarva affecting 45,000 people. When
will consumers smarten up and become patients?
Top
The CNA has authorized another strike, this time against CHW. There are 10 hospitals targeted for a one day strike scheduled for June 27. the Union wants salary increases, more benefits and more staffing from the drowning system. Top
The California Attorney General has begun investigations into the alleged illegal contributions to Gray Davis' campaign. The accusation is that Kaiser used their exclusive Permanente Medical Group to launder contributions to Davis. Kaiser is a non-profit and can not give to the politicos. Permanente is a for-profit and can give. The PACs gave a total of $220,000 with $62,000 going to Davis. Kaiser believes the two organizations are totally separate. If that is true why does their contract require Kaiser paying money to Permanente if Permanente has a bad year and if Permanente has a great year they pay excess to Kaiser. That sounds like a close relationship. Top
CalPERS has sent invitations to bid for their PPO business to 91 direct care organizations in an attempt to cut their costs. They believe the HMOs are skimming too much off the top and that they can get better value by the direct contracting route. Some groups are afraid to negotiate with the gorilla either because of its size or the possible retaliation from HMOs if the take the contract. 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.