May 1, 2008 Recent News





Hospitals has a story on Sutter Health.  They state the entire system collected $471 million in income in 2007 compared to $452 million in 2006.  They also got an additional 2007 income of $152 million in investment income.  This meant the they had revenues of $7.7 Billion.  The system states that it had a community benefit of $492 million in 2007.  This is classified as charity care, unpaid costs of Medicaid, medical research, health education and community based public benefit programs such as school based clinics and prenatal care for patients.  There charity care was a whopping $78 million in 2007 compared to $73 million in 2006.  This massive $5 million increase was on a gain of $600 million in revenue.  They really are a generous organization.   

Franklin Regional Medical Center in North Carolina (have you noticed that all hospitals are medical centers) had a post op death and was investigated by CMS.  They not only found fault with the hospital for its care but also for many other items.  The CMS threatened to pull funding and that threat got the hospital off its duff.  They have fired the nurse administrator, the CEO and the president of the med staff.  The hospital has put up a stone wall and is not answering any questions which puts them at further risk with the community.  

The community hospitals are afraid, very afraid.  The Advisory Board is warning them that there will be more spine surgery done as outpatient at ASCs.  The Board believes in 2008 there will be many more total procedures done but the amount in ASCs will rise from 14% to 23%.  The Board also believes that the rise is due to the greedy surgeons wanting more money not that it is easier on the patient and the physician at the ASC.  

In the next section there is an article on Southern California physicians not taking specialist calls.  This article is from the USA Today and discusses the move by hospitals to move their EDs away from the hospital.  This is to capture patients from other hospitals and have them sent to their hospitals.  If physician owned hospitals did this the community hospitals and the biased AHA would be all over them.  When it is their own it is a different story.  Ambulances bypass these quasi EDs and take the patients to the real ones.  These visits are also more expensive for the insurer and therefore is good for the hospital.  Of course, the hospital wants specialists to staff these as well as the regular EDs.  Won't happen.     

The Wall Street Journal has an article about hospitals requiring cash prior to giving chemotherapy to patients.  This. the Journal states, is due to ballooning bad debts.  M. D. Anderson is one of the hospitals that have gone to the upfront payment system.  Their bad debt fell from $52 million to $32 million in one year.  Tenet and HCA have also gone to the upfront payment system.  The remainder of the story was a tear jerker with no meat. 

Thirty seven San Francisco Bay Area hospitals have banded together informally to reduce hospital acquired infections.  They believe that they have saved an estimated 194 lives.  They have reduced the number of ventilator associated pneumonia and central line sepsis.  The hospitals learn from each other and adopt the best of the best practices.       Top


Dr. Richard Reece has an article regarding the growing empowerment of physicians.  He first talks about how the physician is being left off all discussions on healthcare and the reasons.  They mostly are that physicians are too busy attempting to practice medicine and dealing with the new regs of the government and mangled care.  He also states that the AMA no longer represents the country's physicians as only 1 in 4 belong.  Physicians are not versed in the hardball tactics being used against them and also they are ( my phrase) sheep and will do as they are told.  There are changes afoot.  These include the lower supply of physicians and the higher demand for services, the beginning of a sense of outrage fueled by the Medicare cutting of physician payments with the possibility of private insurers following close behind.  Dr. Reece states that physicians are not beggars and are outraged by the upcoming cuts while executives in the industry are pulling down multimillion dollar salaries.  He believes that the money from the insurance company settlement in the Miami case can be used for a new large physician organization.  I am not as optimistic.  He also believes that internet rooms such as Sermo will serve as a core for physicians speaking out.  This may occur.  In all he is more optimistic that physicians will awake to what is happening to them and begin to push back.  I hope he is right.

Another article by Les Masterson talks about the idiocy of managed care attempting to get physicians to change their ways with newsletters and emails that are not read by the busy practitioner.  The insurers have not had any independent third party studies showing if anything they send out is actually read.  It is suggested that the insurers actually make sure the things they are trying to accomplish are even looked at.   

An article by the AP tells that only 1/3 of the nations physicians communicate with their patients via email.  I am surprised it is that high.  Patients want to email the physician for refills and appointments.  These should not go to the physician but to the office.  I do not know of too many physicians who make their own appointments.  A phone call to the office should suffice.  One of the main problems with email to the physician is that the physician needs the chart since almost no physicians have EMR in their office.  The email is part of the record and needs to be placed in the chart.  The physician is not compensated for his time and potential liability.  The patient may expect a return email which may not come for one business day.  The other problem is the potential for confidentiality breaks.  Email will become part of the normal process later when the physician is reimbursed and the government pays for the EMR( when pigs fly).   

The idiots at Public Citizen are at it again.  They just released their best to worst states in disciplining physicians.  They continue to base this on raw numbers of physicians disciplined over the total number of physicians in the state.  The more percentage of physicians the state disciplines the better the state.  This makes no sense. 

The President of the Federation of the Medical Boards answered in an oped in the LA Times.  He stated that the way and manner that Public Citizen rates Boards is misleading.  He talks about other penalties given to physicians who do not need their licenses removed.  Public Citizen ignores these.  They are only interested in self publicity.

The USA Today blames the high cost of imaging on physicians sending patients to imaging centers in which the physician has an interest.  It does not state the exams are not medically necessary, only that they are done either in the physician office on in one where the physician leases the equipment.   

The LA Times has an article on South California specialist physicians abandoning the ED.  This is more prevalent in the areas of SoCal with high Medicaid and No Pay patients.  It is also prevalent in areas where there are young physicians who do not want to work the 80 hour work week and want better life styles over work styles. The article does not give any solutions.  

An article in the Wall Street Journal discusses the new physician and work life balance.  The new physician is working much less than the "old guard: due to a need for more family time.  They are taking jobs in dermatology and hospitals which give set hours and then the beeper is off.  This leaves a major hole in the ongoing care of the outpatient with less going into primary care.  The hole is being closed by the use of physician extenders.  This means many hand-offs between people with more chance of mistakes.  One of the things that was interesting was the use of OB hospitalists who are at the hospital for a shift just to deliver babies.  The interesting notion was that the generation of women who were having a baby had no relationship with the physician and didn't care.           Top


The Wall Street Journal had a guest opinion by Dr. Jonathan Kellerman.  Dr. Kellerman is a pediatrician, psychologist and a fantastic writer of murder mysteries, one of my favorite authors.  His opinion was on the health insurance mafia (insurance companies).  He rightly states that the insurance industry serves no useful purpose except to skim money and raise prices.  He makes no differentiation between private and government insurers.  He believes both "suck the lifeblood out of the supply chain with obstructive strategies by the use of draconian rationing with denials and rising copays on patients and more paperwork and other unnecessary hurdles on the provider end".  He states that providers need to "liberate themselves from the Faustian bargain they've cut with the Mephistophelian suits who now run their professional lives and realize that insurance is not paying anything, the patient is after paying the insurance company".  He remembers fondly the days of the patient paying the physician directly and the physician having under a 1% bad debt with much lower prices.  In those days the county hospitals took care of those with no insurance and in the process trained excellent physicians as opposed to today.   

An internist in the Los Angeles area has an oped piece in the April 16 edition of the LA Times stating how he woke up and found that by dropping insurance companies he could control the amount of patients and his compensation.  He now can practice medicine the way he wants to by giving good service to his patients and not rushing them after making them wait for a long period of time to see him.  He now has enough time to volunteer two afternoons a month in a clinic.  I congratulate him for his strength and fortitude in taking the step to drop the shackles of the insurance companies.  He is not one of the physician sheep.

Cigna has joined other insurers in stopping payments to hospitals for medical errors.  

I happened to run across a study that shows the difference between government or HMO medicine and medical recommendations from an independent source.  In a study from the European literature it is recommended that women get mammograms every three years from age 40 to 75. There was some discussion that if at high risk the frequency should be yearly.  The American Cancer Society which has no payment bias states that women from 20-40 should get screening mammograms every three years unless they have a higher risk and then it should be yearly.  After age 40 the ACS recommends yearly mammograms for all women with no upper age limit except for medical ability to tolerate therapy if a cancer is found.  Obviously the ACS recommendation will cost more money than the less frequent exams.  I know of no study equivalent to the recent prostate study that showed a better survival outcome in the United States where screening with a rectal exam and PSA is performed annually over 40 and in England where the same guidelines are not used.  

The Advisory has stated that digital mammography is now an "imperative".  It released figures from a study that showed digital was better than analog in each of the three settings dense breasts, pre or peri- menopausal and over 50 age group.  The Group also noted the higher reimbursement for digital mammography over analog. 

An article in the Healthcare Financial News outlines the potential problems ahead for physicians and hospitals due to RACs.  These are the companies that are hired by CMS to make sure there is documentation for what is billed.  These companies get paid on a contingency basis and they get to keep their pay even if their decisions are overturned later on appeal.  The article talks about making sure of all documentation prior to submitting a bill.  

A Washington Post article states that about 1/4 of the supposedly 47 million people without health insurance are eligible but have not applied for either Medicaid or SCHIP.  This removes 12 million from the number making the number down to 35 million.  No one knows how many of those are the young people who are affluent enough to afford health insurance but believe they don't need it.  This would reduce the number of "uninsured" by another multimillion, still leaving too many without insurance on an involuntary basis.  

Michael Leavitt, the head of HHS, states that Medicare is heading for disaster and no one wants to take it on.  He believes that it is wasteful to pay Medicare funds for piece meal care.  He did not state what he would recommend in its place.         Top


The more one gets into electronic keeping of data the more is inadvertently released.  In the latest act of stupidity the Oklahoma Department of Corrections put on line 10,000 social security numbers by their crack internet team.  If that weren't bad enough the names could be put on the list of of state sexual offenders by anyone with some internet experience.  I hope they have good insurance. 

LPN Andrea Smith in Truman, Arkansas, has admitted to illegally accessing patient information to give to her husband for illegal gain.  She could be ordered to pay a fine of $250,000 which would be stupid plus be put in jail for ten years, again too much.  There is no information on the penalty potential for illegal activity of the husband. 

An Indiana debt collection agency had a computer stolen last month.  It had on it information on over 700,000 people including information from St. Vincent Health and Methodist Medical Group.  The information was double password protected but not encrypted.  The collection agency, Central Collection Bureau, has notified the companies whose data was stolen but not the people.  Who has that pleasant task.  I would think it would be the Credit Bureau since they are the ones that did not secure their server.  

Ah yes.  More electronic records, more records stolen.  The University of Miami has had the records of over 2 million people stolen from a storage company.  The information was formatted but according to at least one person may be penetrated.  The University will notify 47,000 of the patients that had financial information with the medical information.  

Even though they are entitled to have a copy of the medical records patients and their families have problems with hospitals and physicians obtaining them if something goes wrong.  This leads to further suspicion and the calling of attorneys to sue for med mal so says the USA Today.  

The Wall Street Journal also had an article the same day as the USA Today on patient's medical records and the major security lapses by those in charge of the records.  This is mainly hospitals, insurers and the governments.  This is not happening with the physician offices since they are not buying into the EMR due to cost constraints, privacy concerns and the need for different templates for different specialties.  The problems are not external to the organizations but with the organizations themselves.  The organizations have a second problem with medical records.  If they are too restrictive they would hinder medical care.  This is what Clinton wanted to do when he signed the original law.  There needs to be a balance but with oversight and logic, something most institutions lack.

See Article in Recent Legal News under Employment regarding the person at UCLA who allegedly leaked information on Farrah Fawcett.           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.