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In North Palm Beach, Florida, a FP can no longer afford his malpractice payments. He is asking his patients to voluntarily contribute $125 a year to help defray the cost. If that doesn't happen he will get rid of his low paying payors to make room in his practice for the higher paying ones. These bottom feeders are the HMOs and Medicare. Since the patients are paying this voluntarily, there is not a illegal act. The other side of the coin is that HMOs and Medicare prohibit balance billings, if this is one.
In Jackson Memorial Hospital in Miami, Florida, has agreed to go along with the Miami Medical School to make a $200,000 cap for malpractice claims against it as a public entity. The medical schools premiums have risen from $32 million to $50 million in two years. This would affect all patients not just those on public assistance. This needs to be passed by the legislature.
The Georgia physicians are marching like General Sherman to fight for tort reform. They would do better by targeting those lawmakers who oppose tort reform when they stand for reelection. Show 'em where the money is.
In South Carolina, the physicians also went to the Capitol to get stronger tort reform. They also need to target the legislators who do not favor their position for defeat at the next and future elections. It will take money, resolve and time to do it but it will be worth it. In one county there are no neurosurgeons and in another the number of physicians that deliver babies has gone from 11 to 2.
Nevada passed a quasi tort reform in 2002 but the amount of claims has increased dramatically since then. There is a ballot measure in November that would mirror California's law by decreasing attorney fees, allowing future payments, allowing the telling of the jurors that insurance has paid the medical bill and strengthening the non-economic portion of the current law. The head of the trial lawyers either is a liar or doesn't understand the meaning of future payments. He states that the new rule will potentially make the physician pay more than currently depending on the degree of fault. He omitted the idea of the insurance company paying for an annuity that would pay the amount over time.
The Connecticut legislature has begun its second year of deliberations on malpractice reform. The caps are not being considered nor are the trial lawyers tossing out of the bad apples. What is being considered is creating an emergency fund to help physicians pay the premiums, periodic competency tests for licensure renewal, screening panels and insurance rate increases to be approved by the Department of Insurance.
New Jersey physicians continue to ask for help from the regulators. Now they want the lowered liability limits from the Medical Board. A Democratic state senator stated he would introduce a bill to prohibit the physicians from reducing their malpractice coverage from the current $1 million.
The Ohio Medical Association has decided to help finance motions for sanctions where physicians have been named in malpractice law suits in a frivolous manner. The three person panel that is reviewing suits is initially targeting the most egregious cases such as a physician being named in the suit where the physician had little or no contact with the patient. They hope to increase the actions to experts where the testimony is opposed with state-of-the art knowledge or the expert's own research or writings. The Association is doing this since just being sued may increase a physician's malpractice premium, even if dismissed at a later time. The current case is against an intensivist who was one of 23 named defendants. She was dropped after six motions and one deposition. Her malpractice carrier dropped her and she needed to get coverage elsewhere for a higher premium. Top
As predicted here months ago, the oncologists have started to discontinue treating patients with chemotherapy in their offices. This will force the patients to the hospital for treatment. The rationale is the significant decrease in payments to the oncologists for their chemotherapeutic drugs that they give their patients. The physicians are also letting go personnel or closing satellite offices even if they continue to give the chemotherapy due to continued large overhead. This is forcing the patient to travel farther for therapy and get less care at the office. The feds believe that their increase of the office visit part of the total payment will make up for the loss of revenue on the drug side. If that is true why not leave it the way it was? The reason is it is true for the first of the three year phase in of the new rules but not after that. The feds will also end up paying more because the hospital chemotherapy is more expensive than the office setting.
Medicare has initiated a new and crippling computer system to get physicians and other providers their Medicare numbers. The system dubbed Pecos, works on the premise that any time there is a change of information all information must be re-entered into the system, a most unreasonable policy. The makes for long waits to get a Medicare number that is needed for billing. Top
In Cincinnati capitation is dead. The HMO market is going, going, almost gone. A large staff model HMO has gone straight PPO. This trend is national and will sound the death knell for capitation. This change in payment has meant a change in the way physician in the group will be paid. With capitation, salary would work but with PPO productivity works better. Also since the patient now has o pay more of the bill, they are using less services and less money flows into the practice.
Arkansas has reinstituted the any willing provider law that was passed several years ago and was on hold. This will allow all providers who agree with the conditions of an HMO to become members. There is no more exclusivity and therefore no reason to pay less to get more patients. Another nail in the coffin of the HMOs.
CalPERS, California's largest purchaser of health care is considering a plan to eliminate 45 hospitals from its program. These hospitals are the Sutter and CHW hospitals, where the costs to the program are the highest. They are not considering quality as any form of driver. Sutter has stated that if one contracts with one hospital, this is a contract for all system hospitals. This would mean that 100,000 patients state-wide would need to find other physicians since Sutter is integrating them more and more into the organization.
Sutter Health is using its medical foundations for organizing and recruiting more physicians. They are in a showdown with CHW to see which is second to Kaiser in numbers in the Northern California area. This model allows the organization to get around the corporate ban on medical care, which was in place to prohibit this type of corporate control over the practice of medicine.
Harvard Pilgrim Health is returning to yesteryear. They are reinstituting old style managed care authorizations for the expensive imaging studies. The HMO states that the studies for headache and low back pain may not be needed. The physicians will now have to say "Mother may I?" by calling a New Jersey firm and talk to a poorly qualified person to see if test meets the guidelines that she/he has before them. This is one of the best ways to gave the physicians leave the plan and take the patients with them. The increase in the hassle factor for physicians and their staffs is huge. Top
In Minnesota the hospitals are afraid they can not compete on price, quality and value. They are looking to the legislature to allow them to continue their anti-competitive ways. They don't want physicians to open their own radiology or surgical centers. It is doubtful that the 18 month moratorium on specialty hospitals applies to these institutions. They are looking for a CON for any new facilities built. I believe, if passed, it should include hospitals. This would cut out any new services at hospitals unless they got it approved by the state. The proposal would make the new centers also do the same reporting and pay the same surcharge as community hospitals. That is fair.
In Texas, the hospitals are building their own specialty hospitals without comment in order to stave off the physician model specialty hospital. This is in lieu of attempting to work out their own problems with the physicians or to work with the physicians on a true collaboration basis.
(See Recent Legal-Peer Review) Top
The CDC had LA do a pilot program of informing people of STD via the internet. The result was that they believe it is a good alternative when you have anonymous sexual partners.
On April 14, the privacy portion of HIPAA comes into play for those businesses defined as small. This is those companies that paid under $5 million in health premiums. The business must keep HR and medical records separate. Those companies must also now enter into business associate arrangements with any outside law firms or other business which may make use of the medical information. Top
The AMA reports that the Connecticut appellate decision where Dr. Chadha in Chadha v Hungerford Hospital won the right to sue for defamation where the other physicians in the peer review body opined about his mental health to the state Department of Health. The doctor argued, and I believe rightly, that the process only should be partial and not absolute immunity. absolute immunity fosters the potential for false reporting. Immunity is fine as long as all tell the truth. This doesn't always happen as there are many peer reviews that are for anti-competitive or economic reasons. These non-quality concerns should be allowed to be challenged. The court opined in the above case that the legislature did not state absolute immunity therefore only qualified immunity is proper. Top
That wonderful bastion of fine care and oversight King/Drew Hospital in LA has made the headlines again. This time for giving a chemotherapy drug to the wrong patient for four days. The nursing supervisor then came to the patient and told him to sign a paper stating that the error happened but it had no effect on him. He signed it but later stated he didn't realize what he was doing. Neither did the supervisor or the hospital or the Board of supervisors. The patient was actually in the hospital for meningitis and the chemotherapy may have reduced his ability to fight the disease. It is about time for a drastic housecleaning of the hospital of all supervisory personnel in all departments and for major training of the rank and file.
The care and oversight by the LA Board of Supervisors at the Drew/King hospital is so bad that the Association of Los Angeles Deputy Sheriffs want the state to take over the running of the hospital.
Ventura's Community Hospital, the hospital that fired its CEO and Medical Director after they lost a court battle with their medical staff, has hired a new CEO. The new CEO apparently has the blessing of the Board and the medical staff. He is currently COO of the Cottage Hospital System in Santa Barbara, California. It remains to be seen if he can settle the ongoing law suit between the medical staff and the board after the board unilaterally changed the bylaws and confiscated the medical staff funds. 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.