March 15, 2008 Recent News



Now the Egyptian physicians are wanting more money.  I can't understand that.  The starting pay for physicians is about $23.  If one works a 24 hour shift you get paid an additional $1.80.  Most physicians earn $63 a month and live with their parents.  The public hospitals wash and reuse their rubber gloves.  The physicians want $180 a month salary.  Many of the physicians have already left Egypt for other Arab countries where they are treated better and paid better.  The real problem with the possible strike is that the Doctors Union is in cahoots with the Muslim Brotherhood who wants Egypt run under the strict Islamic law. 

A story in a Florida paper sent to me by Richard Willner of the Center for Peer Review Justice tells of the inability of the people of Florida to obtain emergency care.  The story intimates that the problem is a combination of factors.  The first and easiest to fix is the med mal problem.  Legislation can be passed to help physicians seeing emergency patients from being sued. This is already in Florida in the public hospitals.  The second is the uninsured.  Although one can not wave a magic wand and insure people, the hospitals that want to take emergencies will have to compensate the physicians for taking call.  The third and the one that can not be solved is the change in the thinking of the physician where they want more work life balance.  When many of us came out of residency we started our practice via the ED.  That is no longer true.  Now one joins a physician organization and patients are funneled to you.  As long as the capitalistic nature is removed, there will be less people willing to take call for any amount of money.

I recently spoke to a physician in Florida who has become interested in the medical staff processes.  I asked him regarding the above.  His take was the problem of the hospital making the rules saying which specialists must come in and when, even though the specialist does not believe the patient needs to be seen as an emergency.  This disrupts both the office and the family life of the physician.  The physician is now making enough money that they don't need the hospital ED and in many cases the hospital at all.  The hospital is paying reasonable money to take call but not enough to compensate for the loss of family, sleep or office time.

Kaiser has finally had enough pressure and suspended Dr. Hamid Safari who has been on administrative leave.  Dr. Hamid has been accused of decreased competence and when his competence was questioned by two physicians the physicians were disciplined.  The hospital manager has also been relieved.  Kaiser is being sued by the two physicians. 

States are beginning to consider cross physician licensure.  This has been recommended to the conference of Governors for the use in telemedicine.  This would not be a national physician license.   

In the press usual way of grabbing a headline without substance, the Delawareonline has a story with the headline Doctors going wireless to write prescriptions and a subheader stating New electronic health record systems embraced by Delaware physicians.  The story states that Delaware ranks fourth in the country with a total of 4.2% of prescriptions filled electronically.  This is not even a small hug and definitely not an embrace.  The story is about a five physician practice that did go electronic.  It cost them about $200,000 plus the cost of maintenance and updates as well as loss of productivity while the steep learning curve is accomplished for at least six months.  Across the country 12% of physician offices have fully functional EMR.  The only way this is going to be accomplished in the country is with someone besides the physician footing the bill. 

A study by the MGMA shows that physicians are spending more time in non profitable areas. A surgeon is spending less time in the OR by 2.3% and more time in non patient care by 9.3%.  The number of clinical hours worked per week is also down.  They vary from Urology down 2.9% to CV Surgery down 6 %.  This goes along with the decrease in annual hospital admission growth from 2.6% in 2000 to 0.5% in 2005.    Top


St. Joseph Hospital in Orange County, California, is under investigation for operating on a wrong side knee, a never event.  This is the third wrong side event at the hospital in just over a year.  The other was the wrong side of a head and an ear tube in the wrong ear.  The hospital obviously did not follow protocol when the mistakes happened.  I hope the hospital is eating the costs of the surgery and of course is apologizing to the patient and compensating the patient as well. 

Kaiser growth is slowing to a snail pace.  After growing over 200,000 members in 2005 and 2006, they only grew 13,000 in 2007.  There was really a drop in paying members for the year.   

A survey of the nation's hospital CEOs have given poor marks to insurers.  The one with the worst rating was UnitedHealth.  91% gave it an unfavorable rating.  Next came Wellpoint and Cigna with 48% and 47% respectively. The best was Aetna with only a 37% unfavorable ranking.  United then did what all the hospitals that are ranked by the insurers do, they complained about the methodology and gave some double talk.  This is to help consumers shop for insurance companies.   

Broadlawn Medical Center, a public county hospital, in Iowa is lying to the public when they say the revolt among their staff psychiatrists will not harm patient care.  Without the physicians they are the proverbial snake pit.  The physicians left due to administration demands without getting approval from the physicians.  The administrator was on a money hatching job and got caught.  They now have general internists taking the place of a addiction trained physician.  

The Oregon Hospital Association has passed a resolution not to have its member hospitals charge for never events.  These events result in an increase length of stay, level of care or significant intervention, a additional procedure is required to correct an event in the prior procedure, an unintended procedure is performed or a re-admission is required as a result of an event that occurred in the same facility.  The guideline do not apply to the entire episode of care but only the care made necessary to the adverse event.  The Board then went on to list multiple events that should no be filled for.  This adds Oregon to Medicare, Pennsylvania and Massachusetts, Minnesota. 

A recent study in Switzerland showed that MRSA screening probably will not reduce surgical infection rates,  They don't have never events not being paid for.  If the person has MRSA on admission the hospital can be paid if the patient develops an overt infection during his/her stay since it was not hospital acquired.           Top


The People's Republic of Massachusetts has seen a decrease in the use of their free care pool.  Of course, since all are required to have insurance.  Those that are for the program believe without any facts that the less people that get free care the better the care.  The state free care program pays the hospitals etc for the care of the patients in this program.        

The Massachusetts Blues has agreed with most physicians, EMR is not worth the money.  The insurer has decided that physicians do not have to purchase these systems to participate in the Blues bonus program.  The same is not true for hospitals where CPOE must be installed by 2012 in order for the hospitals to participate.  The insurer states that hospitals can afford the systems but physician offices have more of a problem and need financial help to put the systems in place.  It would take about 2 years for a hospital to recoup its outlay but over 5 to 6 years for a medical office to recoup.  

South Africa's health minister, who is known for being an AIDS denialist and called Dr. Beetroot for her use of the food and other foods in the treatment of the disease, is calling for a reform of the country's private healthcare.  It is too expensive for those without money to use.  The country has an extensive public system.  

In another third world country, the VA system continues to have significant problems.  They continue to be underfunded and request not enough money for the massive amount of soldiers returning injured either physically or mentally.  The VA wants to have the vets pay more in co-pays and fees. I again call for the VA to be disbanded and all vets treated at government expense at the community hospitals that can see them quicker and closer to home. 

Japan has seen its patients rejected by hospitals due to lack of beds or a shortage of physicians.  In a recent survey 3.5% of serious illness patients as defined as needing about three weeks of hospitalization were turned away from hospitals.

Thailand has decided to ignore patients on expensive anti-cancer therapy.  They will use generic therapy instead.  If the generics don't work then that is too bad.

Highmark, the largest Medicare insurer in the Pittsburgh area, has started to charge a co-pay for injectables given in a office under part B.  The oncologists of the area are not happy since that means patients will need to pay a large price per visit for chemotherapy.   They are planning to lobby their legislators about the charges.  At the same time the University of Pittsburgh Medical Center has stopped seeing Highmark cancer enrollees.  The reason is not the co-pay but low reimbursement rates for their HMO fee for service people for drugs. Highmark is also trying to merge with Independence Blue Cross of Philadelphia.  I would assume the Pennsylvania legislature would take into account the above problems but it depends on how much the insurers lobbyists pay the legislators.    

Pennsylvania is a weird state.  The legislature wants to help the uninsured.  They don't want to pay the freight so they want the hospitals in two counties to pay for all the state.  The hospitals in Philadelphia and Allegheny counties would be taxed on net patient revenues an undisclosed sum (the state is calling it an assessment, but it  is a tax).  The hospitals are having none of it.  

The University of North Carolina not only has a good basketball team but it also has some business savvy. The hospital has decided to be run as a business and have patients pay their co-pays upfront just like physicians do in their offices.  This saves billing patients and not collecting.  Those that can not pay can set up a no interest payment plan.  The statistics show that if one doesn't bill upfront the chance of collecting falls by 60%.  

A Washington Post article states that as the population increases in age the amount of Geriatricians decrease.  Someone found this hard to understand.  If they would look at the amount of time these physicians put in per patient to coordinate care and actually do the care versus how much they are valued in monetary terms and managed care hassles there would be no surprise.  The same is true for primary care physicians in general.  Several schools are attempting to help by adding geriatric programs to their curriculum.  Top


Physicians and attorneys in Montgomery County, Pennsylvania, have gotten together for a pilot project to medicate conflicts.  This is a first for the state but has been done for at least 30 years in Contra County, California.          Top


I received the following email from one of my subscribers.  

This outfit has a chronology and basic information about most data
breaches- electronic and otherwise- occurring in the US since January 2005.
Includes many useful links to studies and other relevant sites.  One
leads to, which has papers including
on EMR data security (or the lack thereof).  

In Salt Lake City a teacher paid $20 for scrap paper and found that she had purchased a box of confidential health records from a Florida hospital.  Central Florida Regional Hospital shipped several months ago three boxes of medical records to Las Vegas for an audit.  One box never arrived.  The hospital was contacted and they contacted UPS.  How the box got to Utah is a mystery.

Cedar Sinai Hospital in Los Angeles has fired and disciplined employees for the second time due to their snooping into the medical records of Britney Spears.  The employees accessed her non psychiatric medical records from a prior admission but could not get her psychiatric records from her recent admission.  Some of the people disciplined were physicians.  The hospital had disciplined employees for snooping into Ms. Spears records in 2005.      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.