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Finally, O'Leary has committed to retirement. This sounds like the old SNL skit about the death of Franco. O'Leary has stated he would retire several times but always reneged. I won't believe it this time until he is actually gone and the organization can hopefully move on. Top
The Governance Institute, a highly thought of hospital leadership group, has been sold to NRC. NRC is publicly traded and specializes in performance measurement and improvement. The sale price was $20 million and assumption of $2 million in liabilities. The Governance Group had 436 members and had revenue of $6 million per year. Top
Kaiser is being investigated by California again. This time for potential false advertising. In the Coachella Valley ( Palm Springs and the surrounding communities) Kaiser is starting three clinics for its 11,000 members in the area. They continue to list the local physicians in their book of physicians. These physicians will be gone on June 30. The patients will have a choice of 11 physicians spread over the Valley. This was apparently not made clear to the patients before they had the enrollment for members. This is the second state investigation of Kaiser in a month. The first was for their mishandling of now defunct their transplant program.
After an investigation, the California Department of Managed Health Care has stated that there is no evidence that Kaiser misled the Coachella Valley members. The continued listing of non-Kaiser physician as available for the patients when they weren't was found not to be misleading. Kaiser did try to allow the patients to continue to see their physicians but were willing to pay them less than the physicians were willing to accept.
In a study pf physician payments, Reuters reports that the worst of all HMO insurance companies is WellPoint. They are also the largest HMO provider in the country with about 10% of the enrollees. They fared as the worst company in shifting payments to physicians to collect from patients, likelihood of denial of claims and length of time in paying claims. This is not something the company should strive for and not try to shrug off because the sample size was smaller than they would have liked. The best overall HMO insurer was Humana. Second best was Medicare.
A recent story in the Boston Globe told of Dr. Hoffmann, a FP in Framingham, Mass., who wrote prescriptions for 10 Lunesta for a patient and another prescription for 10 for her husband. The reason is that the Tufts Health Plan has made an arbitrary decision that 10 is the maximum amount of pills one should need a month. The physician decided his patient's health outweighed the rules. He may get dinged by the state for his needed advocacy but I doubt if it will be more than a tiny slap. All know the problems of health plans bottom line at the expense of patients. The state should be investigating the rationale of the rigid rule promulgated by Tufts and not the physician. There seems to be a shortage of FPs in the country and stories like this will not increase the likelihood of physicians going into this primary care. Top
They're back! The country's worst hospital has been given notice that they will be inspected within the next 90 days. If King/Drew doesn't pass they will be removed from the fed roster. Why they let them know in advance regarding the inspection is part of the political process to give them every opportunity to pass. The "hospital" was supposed to be inspected prior to this. If it doesn't pass muster the County Board of Stupes will have to downsize, close or give the hospital to someone who can actually run a hospital. The only reason the feds are doing the inspection is because they got a public rebuke. The feds know that a neighboring hospital, Willowbrook, has been out of compliance for two years and have done nothing. For some reason, politics, the Medicare agency itself has helped train nurses and others on what the inspectors will look for and how to be ready.
Another hospital down the road, UC Irvine still has the state legislators in a tizzy about their liver transplant mismanagement. The state senate is considering a bill to decrease the funding to the UCI hospital until the hospital can prove to the state that all corrective actions have been taken.
Southern California transplant centers are not doing well. The latest is Western Medical Center-Santa Ana. This small center did 13 transplants last year which is two short of the 15 needed to keep their proficiency ratings. They also had multiple other problems from record keeping to being unable to prove competency. All this was fixed and the center is back in the state's good graces. St. Vincent, UCI and Kaiser should be so lucky.
Still in California, Kaiser may get sanctioned by CMS for not only its now defunct transplant program but also for hemodialysis. They could lose it and/or pay a fine for their negligence.
The specialty moratorium finally ends on August 8 and the new specialty hospitals are raring to go. There are hospitals ready to open in as early as one month after the moratorium ends. Most of the new specialty hospitals will be partnered between physicians who own up to 90% and hospitals or for profit companies. In some states with CONs the growth will be slower as will hospitals with strict zoning controlled by competitor community hospitals.
Since the moratorium is over, a new physician hospital will be built in Newark, Ohio. It is currently an ASC which will expand into a hospital. The new hospital will be one mile from the only other community hospital in town. The ASC states that it has a good relationship with the the hospital and hopes to see that continue in the future. This is not likely since they have already fired a shot at the ASC. The new physician hospital will have 23 specialties as well as two operating rooms, an emergency room and full lab and x-ray facilities.
The AHA continues to fight the losing battle on specialty hospitals. They realize they have lost the war now they are trying to dictate the terms. They want CMS to limit any one physician to a 3% ownership. Most specialty hospitals already have this. They also want the specialty hospital to notify patients that they may need to be transferred to a community hospital and that a transfer agreement be in place. The AHA also wants the CMS to dictate what a specialty hospital must have in place to deal with all complications. Nobody can have this including many tertiary centers. I wonder where the straw is that they are grasping for.
Jacksonville's Naval Hospital has a rash of med mal suits against it. Recently two babies died due to alleged negligence by the hospital personnel and physicians. Since it is a military hospital it doesn't answer to the state.
The same is not true for another Florida hospital. Aventura Hospital in Aventura has been ordered to admit no more non emergency patients. The hospital has been called an immediate threat to public safety. The CMS is now getting involved but of course they will do nothing except saber rattle unless there is no political problems. The main problem is the misuse of restraints.
As all know, the People's Republic of Massachusetts has passed the Governor's run for presidency healthcare for all program. Now one of the byproducts of the law is that the Medicaid people may be limited to what hospitals they can use. This will be done by limiting the Medicaid people to certain provider groups. Top
The independent country of San Francisco has defied the state law and the CDC recommendation that all HIV positive results be transmitted to the state by name and no longer be considered confidential. The ACLU has filed a suit against the wayward " country" to force them to use the new registration forms and not the old anonymous ones. Top
I never thought I would see the day but recently on an online forum, a representative of HealthSouth admitted that in peer review hearings at their organizations the require the physician being charged to be charged money to defend him/herself. The hospital and physician have to split the costs of the hearing including the hearing officer, court reporter and transcript. When the hearing is requested the practitioner must put up $3000. There may be a waiver if financial hardship. As another on the listserv put it, this may jeopardize the immunity or the requirement to exhaust all administrative remedies prior to filing a suit. This is spelled out in the bylaws written by the corporation. Another good reason for the medical staff not to allow this and get independent counsel. Top
In yet another electronic error, the medical information of many Texans went to Seattle by mistake. The wrong fax number was continually dialed. The warehouse that received the errant information notified the state of Texas of their error. The State took over three weeks to investigate and correct the problem. This was obviously a human error of not programming the number into the machine or programming it in erroneously and not checking for accuracy, all HIPAA problems that were preventable if the proper protocol was followed.
A Humana employee called up a file of Medicare beneficiaries on a hotel computer and then did not delete the file. CMS has ordered Humana top contact all 17,000 people that their data has been compromised. The insurer will also be required to give free access to a credit monitoring service for one year and submit a plan to the CMS to prevent further violations.
In yet another electronic gaffe, a laptop with personal data of 65,000 YMCA members was stolen from a locked office. It had all the usual information for identity theft including SSN and credit card information. At least this one in Rhode Island did not involve an employee leaving a laptop in a car or other such stupid act. 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.