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Northern California Kaiser has finally come out with a statement that all have known, that they have focused upon being the low cost leader. They now hope to better their image in the Sacramento area by offering in-vitro fertilization at one facility for a cost to their patients of $8000, better neurosurgery in the area, and other specialized care. The problem will still be getting the proper referrals which Kaiser is known far and wide for not providing. Kaiser will continue to send complex neurosurgery to UC Davis, heart surgery to Mercy hospitals and transplants to the San Francisco area. Top
Providence Health in Oregon had the misfortune of having the medical records of over 365,000 patients stolen from a car. The car had the records on a back-up tape. Now four people have been fired from the organization for the faux pas. The company erroneously states that the problem has been fixed by removing the four who had lapses of judgment. They fail to realize it is a system problem and not individual problems. There is now a class action suit against the hospital that should cost the system many millions of dollars plus the money they will spend to fix the credit of those whose records were stolen.
Providence Hospital System has done it again. This time it happened in Washington. Two car break-ins occurred and 122 records were obtained. This time it was on hospice patients and in one instance a provider left the laptop in the car when going to see a patient. In the other a laptop was left in the car when an employee went into a store. If this doesn't sound like it is a problem with the system and not the individuals, I don't know what does. Top
Why do Southern California hospitals have such problems? First it was the notorious Drew/ King fiasco, followed by the UC Irvine transplant and nepotism problems and now two hospitals in Huntington Park and St. Vincent Hospital in Los Angeles are in the spotlight. The nurses at Community and Mission Hospitals in Huntington Park, two hospitals owned by the same physician groups, have gotten rubber checks. Some of the nurses have gotten replacement checks and those have bounced as well. The nurses are not bright. They are threatening to strike over the bounced checks which will lessen patients and revenue. The hospitals have apologized and agreed to cover all charges plus add an additional $100 to the next paycheck for the inconvenience. The hospital may do all that but the hospital employees should begin to look for back-up jobs as this is probably the beginning of the end for the hospitals.
St. Vincent Hospital in Los Angeles has the honor of being the first hospital in the country sanctioned by the United Network for Organ Sharing. The reason is the well publicized giving an organ to a paying Saudi national in place of another on the waiting list. The liver transplant section has since closed due to the problems. The sanction will have no practical effect except to publicly humiliate the hospital. The hospital must notify all those patients on its waiting lists that it has been sanctioned for its stupidity and allow those on its waiting lists to go elsewhere. The hospital has already been removed from many private insurance company lists and many physicians no longer send their patients there.
In Northern California the giant Sutter organization is getting unwanted publicity. Sutter is attempting to out Kaiser Kaiser with their foundation model. The private practice physicians are not happy campers. They are afraid that Sutter will take away their autonomy, which of course is true. It has happened at Kaiser, the other Sutter areas and at the Walnut Creek John Muir System. However, the reality is in the Bay Area it is difficult to recruit physicians due to the high cost of living. Most physicians who are now in private practice are paid a godly sum for their practices but have restrictive covenants and are now paid by salary instead of fee for service.
Physician's Hospital in Portland, Oregon, suspended all inpatient surgeries after being dinged by CMS. The CMS is after it since it is a political hot potato. Some people believe it is a specialty hospital but it is licensed as a general acute care hospital but without an emergency room. Top
In Florida the malpractice climate is changing. There have been new insurers entering the state and claims and premiums have been steady. The problem has been the exodus of the high risk specialists and the refusal to work in the EDs. Many of the high risk physicians also do not carry med mal insurance. The legislature is attempting to change that but this will force more physicians to leave the state entirely, not just drop the high risk procedures like OB.
Tennessee has been put on the AMA liability alert. The reason is lack of physicians. The following are from the ACS: 81 counties with no neurosurgeon, 49 counties with no Orthopod, 47 counties with no ED physician, 42 counties with no OB/GYN. Top
Anthem of Indiana is doing an experiment. They will no longer pay physicians for the amount of people they see but instead will pay for performance. It is a grand idea except it is a standalone product. The physician must still rush through the patients since Anthem is only one of many insurers the physician works with. If the physician works with Anthem to do the tests and preventative measures that the insurer believes is right they will get paid more money. The only study to date on pay for performance has yielded better results in only one of the areas, cervical pap smears. The physicians will still need to see the large volume of patients in order to get the small bonus but retain their base compensation.
The New York Times had a story that the treatment oncologists use to treat cancer patients is driven by monetary concerns. Oncologists get money over and above drug costs when they use chemotherapy. The physicians get a major discount on the drugs and charge and receive a much higher amount per drug. They need this extra money in order to continue to treat patients in their offices versus sending them to the hospital for therapy which would cost the insurers even more. Top
The insurers are trying a new tact, they will pay the consumer portion of the bill to the provider and then collect it back from the employee. The employee will have 20 days to repay the debt to the insurer and then the insurer will take the money from the paycheck along with a 7.5% interest rate. This will be attempted in Texas with several companies including Tenet and United HealthCare.
California has a law that an association that qualifies for health insurance must be at least 1000 members in size, not be organized just to get health insurance and have provided health insurance prior to 1992. This leaves out most chambers of commerce and other like organizations. The rationale for the law is that the uninsured would join and skew the population against the insurance company. Kaiser has just become the last of the insurers to pull out of the business. 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.