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The Governor of South Dakota has proposed malpractice reform by using independent investigators to study complaints against physicians to the medical board and to post disciplinary actions online. He also want more lay members on the Board.
In California, the medical board is believed to go after physicians that legally recommend marijuana to their patients. They state that they investigate in the context of good medicine but that is not true. The investigators are on a witch hunt due to complaints filed by federal agencies.
Throughout the country the medical boards are getting more money and are hiring more investigators. This is leading to the good result of quicker claim resolution. This also helps resolve the backlog of cases. Iowa did more investigations without more money by simply focusing on those physicians who practice in the state. They don't get hung up on those physicians with inactive Iowa licenses that get disciplined in other states. Top
The day after I published the last issue and chastised the attorneys for both sides in the New Albany, Indiana specialty hospital fight, the specialty hospital voluntarily dropped its bid to build. The moratorium had nothing to do with the decision, it was pure money. The land acquisition costs became too high to make the venture economically viable. They will look for more economical land but now are forced to wait until June, 2005 to build.
An editorial in Modern Healthcare March 29,2004, spoke in favor of market forces determining specialty hospitals in the community and not legal pressure from the community hospitals. It talks about the lower error rate and the higher patient satisfaction rate at specialty hospitals. The article goes on to discuss that the community hospitals should not have to rely on their surgical profits to sustain their other programs. This means that they will need to get paid more from all insurers including the government.
In California, a hospital may have found the loophole in the Medicare specialty hospital moratorium. The orthopedic and cardiovascular hospital in Loma Linda would also have a one bed ED and take on ENT patients. This potentially would keep it from being a "specialty hospital". It also is not schedule to open until after the time of the moratorium is past. Top
Grady Hospital in Atlanta has cut back on non-emergency care for the fiscal good of the health system. There will be imposed a sliding scale fee schedule for those from outside Fulton and DeKalb counties. Only covered under this new policy are the uninsured.
Kaiser has sent letters to over 1000 patients of their South Sacramento hospital that they might have been exposed to hepatitis due to the use of contaminated gastrointestinal instruments. Those with bronchoscopy are being tested for TB. The problem was in the machinery used to disinfect the instruments. Of course some idiot attorney will find an idiot patient and file a class action suit to get their name in the paper and maybe, if they are lucky, get some hush money. In this case I doubt if any money will be forthcoming except to perform the necessary tests.
The LA supervisor in whose district the ill-fated Drew/King Hospital resides has apologized to the community for the instances of poor patient care. She should also have apologized for her lack of oversight of the hospital. The entire hospital board will also be asked to resign. In the meantime the neonatal unit is being downsized to save money. The sick babies will now be sent to Harbor or LA County.
Drew/ King also had the chutzpah to appeal its poor performance in its residency programs and of course lost. All the programs are either being terminated for cause, recommended for closing or under probation. It's a bad place due to lack of oversight from the county board of supervisors and political favors.
The New York Times has an article regarding how many hospitals are forgoing computerized patient care. The reason is hassle and especially money. This will fly in the face of the proposed JCAHO requirement of bar codes at the bedside and may lead more hospitals either to dump the JCAHO accreditation in favor of either the AOA or the State Department of Health. The other alternative would be for JCAHO to be forced to back down from its proposed requirement. Both standard bearers in this fall's election are for computerized records but no one is foolish enough to propose spending the $20 billion it will cost to institute the program.
The Catholic hospitals have resolved the quandary of the Pope's declaration that feeding tubes, etc. should not be removed. They have opted to go with secular and not religious law and will honor living wills and their ilk.
St. Mary's Hospital in Palm Beach Florida is back in the news. First it was cited by the state for not having neurosurgical back=up when it provided those services in the hospital and also is a trauma center. It rectified the problem by having it's trauma neurosurgeons see non-trauma patients. Now the state has found that although there are 11 neurologist on staff, they only cover the ED 2 days a month. The rest of the time internists cover and the neurologist comes in for a consultation if requested by the internist. The hospital will have to do something about this as well. The answer is paying physicians for taking ED call or face losing the majority of the doctors. Top
The physicians of Rhode Island are having a tough time getting anyone to come to their state to practice. The famous Brown University is not competitive with money and benefits due to the low reimbursement in Rhode Island from the insurance companies. Blue Cross is alleged to pay half of what it pays in Massachusetts for the same code. This is leading the physicians who train in the state to leave after their training.
The Pope has stated that it is a moral imperative to continue to give artificial food and water to those who are in a persistent vegetative state. This would only be binding in Catholic hospitals in states where state law does not overrule the Pope. The Pope's utterings are substantial to morality but not to the law of the states. Top
ANTHEM'S CEO LARRY GLASSCOCK WILL RECEIVE MERIT PAY OF $42.5 MILLION. THIS WILL BE PAID HALF IN CASH AND HALF IN STOCK. EVEN MICHAEL JORDAN OR AROD DIDN'T GET THAT MUCH AND THEY ARE WORLD CLASS. United Health CEO had a salary of almost $2 million plus a bonus $5.5 million. Wellpoint CEO $1.3 million in salary, $6 million bonus and $4.3 million in other compensation. Aetna CEO got $1 million and bonus of $2.2 million. Most CEOs are in this range.
Health Net has become the first insurer to offer drug discounts to low income members with Medicare. They will offer a 10-12% discount on prescriptions for qualified low income seniors. The company will also give up to a $600 credit to low income seniors to help purchase the drugs. Those that do not use all the money will be allowed to have it rolled over to the following year.
In Rhode Island, Blue Cross is bowing to political pressure. The leaders were to meet with the Governor and announced that their pay and perks would be slashed as well as stopping their meetings at posh resorts. They offered three seats on their board to the political people to fill and they agreed to accelerate their review of physician payment rates. This all happened after 7000 health care providers called for the ouster of the CEO. Top
The latest warning from CMS regarding boutique medicine is not a concern to the vast majority of physicians who have chosen this mode of practice. Almost all who are paying attention to the initial rules do not charge extra for government paid services. There has been one internist in Minneapolis that has paid a fine because of his contract and also has agreed to stop offering the contract. What this may lead to is either the dropping of Medicare patients from the boutique practices or not take any insurance and make all care fee for service. This is a natural evolution as Medicare begins to cover more care such as initial physical exams.
A study by the California HealthCare Foundation shows that medical groups are becoming more dominant in the negotiations with insurers. This is causing less money to go to the hospitals who negotiate along side the medical groups. The medical groups are providing more management for the patients and as such are getting more of the pie.
In Orlando, Florida, the busiest orthopedic surgeon in central Florida has left Orlando Regional Healthcare and gone to Florida Hospital. The exodus includes 11 team members including scrub techs, x-ray tech and OR personnel. Florida Hospital will give the physician his own orthopedic floor and cadaver lab to train his staff.
In Florida, physicians who testify for the plaintiff as hired guns are going to be reported to the Medical Board and their professional societies. Those that testify are responsible for their statements.
Wisconsin physicians will not be required to testify as experts unless they agree to the designation. This came out of a case by a lawyer who screwed up by missing a deadline and then attempted to get out of his malpractice by stating a treating physician must testify against another treating physician as an expert. The state Supreme Court stated the physician did not have to testify as an expert thereby creating a legal malpractice headache for the attorney. A treating physician can be forced to testify about what they observed regarding the care but not about the standard of care.
The Houston Business Journal has reported new economic credentialing factors at work in insurer networks. This will look at cost and not quality and will lead to a lower class of physicians in the insurance organization, those who look at the bottom line and not the patient's welfare.
The ED physicians at Millard Fillmore hospitals in the Buffalo, New York, area are leaving to set up their own urgent care center. They hope to have four centers around the area in a year. The group is getting good play from the area's insurers who see the project as lower cost than the EDs. They will no longer be in partnership with the hospital but will be independent contractors to continue to provide ED care as well as their new urgent care.
In Massachusetts there is a new 700 physician gorilla. The Harvard Vanguard Medical Associates has merged with three smaller groups in the Boston area to form the 700 physician, 600,000 patient group. They hope to be able to look at electronic records and to increase reimbursement. If they negotiate with a hospital or insurer, they will have a huge advantage.
The People's Republic of Massachusetts is also short of neurosurgeons. It now takes 30 months to recruit a neurosurgeon in the state. The state is having many of its problems because of their low reimbursement rates and high malpractice rates. Top
A study has showed that Medicare is spending more money and getting less is those states with a higher proportion of specialist physicians. It appears the physicians are more attuned to their specialty than to the whole patient as are general practitioners. The study concluded that no more money need be spent but that there should be national guidelines for basic and effective care.
At the same time Medicare is paying more for HMO care than they are paying for traditional Medicare. The differential is up to 20% higher. This goes against the original thought of HMO care being cheaper by restricting care and paying only 95% of the traditional fee. It will be interesting to see if Medicare reduces the payments when traditional care begins to cover prescriptions. Top
The physicians of Will county, Illinois have paid for billboards. One shows a pregnant woman asking how far the drive is to find an obstetrician. Another states to drive carefully since there are no neurosurgeons in the county. The doctors have also contributed money to a downstate judge who is a Republican and running for the Illinois Supreme Court.
The Chicago Tribune has run an editorial saying goodbye to the physicians of the state who are leaving for the surrounding states because the Democratic controlled legislature and Governor will not pass any meaningful legislation that would hurt their trial lawyer bribers. They gave a good reporting of the facts that are behind the exodus of the Illinois physicians. In the past two years 11% of the state's OBs have stopped delivering babies. It is predicted that about 50% of those remaining will give up the OB portion in the next two years.
Maryland has passed a bill in its House to set up a task force to look into the malpractice problem. It would also stop the patient from recovering medical expenses already paid by insurance and would require mediation prior to litigation. Top
An official of CMS has given advice to hospitals for EMTALA compliance. If a receiving hospital believes it has received an improper transfer, they should notify the sending hospital that they are being reported to CMS. This gives the sending hospital a chance to explain to the receiving hospital the circumstances and also allows the sending hospital the opportunity to self report along with the receiving hospital. The main reason for EMTALA violations is the refusal of on-call physicians to respond. This sets up the hospital for a fine but not the physician. The OIG, not CMS, can then come in and fine both the hospital and physician. Another new ploy by hospitals is to refuse to accept ambulance patients that are on their property. This is also an EMTALA violation. If hospital billing office put up illegal signs such as payment is required for all hospital services or the comparison between hospital and medical office charges, a violation has occurred. Another biggie is hospitals refusing to accept transfers for inappropriate reasons. This includes stating that we'll check availability and call you back. They never do until the patient has been transferred elsewhere. He suggests that each hospital designate a point person for EMTALA contacts. 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.