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Providence Hospital in Columbia, South Carolina has made but not yet implemented a policy only allowing those physicians loyal to the hospital on staff. This means that those physicians with material financial interests in other hospitals may not be credentialed. There just happens to be another heart hospital opening up in town, but of course that has nothing to do with it. It will be up to the Board to determine whether or not to credential an individual with the conflict on a case by case basis. This means if the hospital needs the doctor as an admitter, he/she will be credentialed. The hospital is part of, ironically, the Sisters of Charity of St. Augustine Health Systems. They should take the word Charity out of their title and insert profit and no loyalty to their physicians into the title. The charitable sisters in Ohio have also placed this "McCarthy" loyalty into their hospitals.
In a related matter, a law firm noted for its hospital bias has stated on its web site that if any officer of a medical staff has any financial interest in a competing entity they should be removed but according to the medical staff bylaws. My advice is not to allow this verbiage into the bylaws. The law firm also suggests that all officers sign loyalty pledges and swear to refrain from any competing interests. I would think that as long as the individual discloses his/her involvement and recuses him/herself from any vote on a conflict, that should suffice. Top
Maryland Needs Diversity Training
In what could only be described as stupid the University of Maryland in October 2000, refused to allow the partner of a gay man dying of AIDS and who held the power of attorney to be with his partner during his death. They also refused to honor the wishes of no artificial means to keep him alive by intubating him. They are now being sued for their ridiculous policy of family only visitation. They will also be under investigation by the JCAHO for their policy. Top
In a recent study reported on Yahoo, providers that told patients of their incentives to restrict care continued to have the trust of their consumers. The study used a group that told and a control group. The told group had a 1.4% increase in trust as measured on a standardized test over the control group. Believe it or not this small percentage was statistically significant.
The Las Vegas Review reports that many physicians are dropping plans due to decreasing payments along with increasing overhead. This is especially true for an administrative organization called Managed Care Consultants (MCC). MCC has asked originally physicians to take a 35% pay cut and then switched it to 15%. About 200 Las Vegas physicians have refused to sign up with MCC. MCC is stuck and is sending out a new contract to the OB/GYNs who have mostly all not accepted the decrease payments.
In Houston, Texas, the MacGregor Medical Association (MMA) has gone out of business. This 50 year old Association owned by Methodist Health Care has 120 physicians and 100,000 patients. The physicians are forming new alliances and new groups. MMA lost contracts and money that was being subsidized by Methodist. Other Houston hospital owned medical groups have either gone or are going bye-bye.
In an interesting aside to the above and other like stories of the demise of hospital owned medical groups, a study has shown that the average physician generates $1.5 million in revenue for a hospital. This ranged from over $3 million for cardiovascular surgeons to a low of $1.2 million for primary care physicians.
Seven independent physician groups in Los Angeles and Ontario, California will be managed by NAMM. They are already managing nine physician groups in nearby counties. NAMM was a junior of PhyCor, who filed for bankruptcy this year. It will be interesting to see if NAMM has been guilty of overreaching and follow its parent.
The Seattle Times tells of local physicians no longer accepting new Medicare or Medicaid patients. In one county no physician will take pediatric Medicaid patients. In Spokane, the large clinics have stopped taking new Medicare and Medicaid patients. One clinic actually did a cost analysis and found they were losing $25 for every Medicaid and $15 on each Medicare patient. They obviously closed their doors to new patients from these groups. The patients will cost the government more since they will use the hospital emergency departments for their physician. In the bad old days physicians would see all comers, some for free. They would cost shift to the payors to make up for differences. This can no longer happen, so one can not lose money per patient and make it up on volume.
PacifiCare has now started to use a tiered system for payment to physicians. This has been a ploy to the hospitals in the past. Again there is no evidence of quality in their decision, only costs. Top
Parkview Hospital in Riverside, California tells the interesting story of what happens when a hospital is accused of jeopardizing patient welfare. A story on March 5, 2002 states that the hospital had been dropped from Medicare and MediCal. This necessitated a closing of the emergency room with patients waiting to be seen. At that time they had 82 patients in the hospital and the state inspectors were checking daily on their care. The hospital was found on state inspection to have problems with pharmacy, nursing, medical staff and quality assurance. The hospital gave a 10 hour notice to the county of the ED closure even though there is a 30 day requirement. This requirement is unenforceable.
The next day many people went to the Riverside City Council meeting wanting them to save Parkview. The Council voted to contact the appropriate powers for help. The hospital was given 30 days to transfer or finish treatment on Medicare or MediCal patients. This problem stemmed from a JCAHO survey followed by a validation state survey. The JCAHO has not commented on its findings but the problem was with the validation survey.
The following day the JCAHO issued a preliminary denial of accreditation due to significant non-compliance with the standards. They received a score in the upper 70s and had been give accreditation with requirements for improvement in the past. The survey team left the hospital with the impression they had passed the re-survey. The hospital believes the JCAHO changed their results due to pressure. That is a believable situation since the state surveyors did talk to JCAHO and if nothing else the JCAHO is a political organization.
The inspectors returned for another look on March 11. These were from the CMS office in San Francisco. The hospital was then re-admitted to the federal programs and give the usual two months to correct the deficiencies. The deficiencies are in the informed consent prior to surgery, tracking patient care processes and outcomes, staffing with well trained and competent staff members and leadership in how the hospital fulfills its mission. The readmission was retroactive to March 4, the date of termination. The hospital will continue to show a preliminary denial of accreditation on its JCAHO file. It should be added that significant political pressure was placed, including that from Sen. Feinstein and Governor Davis. Top
Chicago's Grant Hospital, who is broke since their partner was fined out of existence by the Feds, may have found a buyer. The proposed buyer is attempting to partner with New York Cardiovascular Surgeon Mehmet Oz. If this occurs Grant will become a cardiac surgical hospital. Top
In Pennsylvania there is a rush to file malpractice cases ahead of potential tort reform. In February five times the normal amount of cases were filed in Philadelphia, the city of brotherly love. This surge in malpractice suits will bolster the physicians case in the legislature for meaningful tort reform. These cases were filed in some cases without investigating the merits of the cases. The question for the legislature will be not only tort reform but whether or not the reforms will apply to cases already filed but not yet heard.
The Philadelphia Inquirer reported on the spreading of malpractice woes beyond their state. They cite an OB who moved his practice from Philadelphia to New Jersey and saved $42,000. Now his new carrier is doubling his rates and wiping out the savings. New Jersey, like Pennsylvania, is a non-tort reform state. However, even Indiana which is a tort reform state is seeing its premiums go up 40%. The president of the AMA calls this nationwide malpractice crisis "a perfect storm".
In Corpus Christi, Texas, there will be a closing of practices for one day. On April 8, physicians will close their offices in protest to the high malpractice rates and frivolous suits. The local medical society will back the physicians in their walkout.
The LA Times states that 10% of the Las Vegas physicians will either quit or relocate this year due to the increased cost of doing business associated with the low rates of reimbursement. To illustrate the point a Las Vegas OB closed shop and moved her office to West LA. Her malpractice premium in Nevada was $150,000 per year. In California, with it's tort reform enacted in 1975, her premium is $17,000. The story goes on to state the problems of the state in recruiting new physicians. Oregon rejected tort reform and their physicians will see major premium increases this year. In Wheeling, West Virginia both trauma centers have closed due to neurosurgical malpractice premiums. Las Vegas' only trauma center closed for 12 hours March 12 due to loss of coverage by two of eight trauma surgeons who can not get insurance. Top
It has long been an argument whether or not healthcare is a privilege or a right and if a right, is it an equal right. Now, Dr. C. Everest Koop has declared that healthcare is not a right. He stated that healthcare will never be a right. He noted the Bill of Rights is to protect people from the government not to entitle government programs. He also noted the Constitutional Preamble that provides for common defense but only promotes the general welfare. He used the usual notation that if I did not have to pay for a new car, which care would you get. Basically, he says that not everyone is entitled to the same care. He says that the medical community should use self-sacrifice and that when he started practice only 30% of his work was compensated. What he didn't say was how he could cost shift some of the uncompensated care which can no longer be done. 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.