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In must have been a shock to the idiots that run TennCare, they are not getting a stampede of physicians to participate in the program. They are now looking to sign up three mental health care companies plus a safety net company when one fails. I truly believe the people who run the program should be the largest utilizer of the program. (Also see Legal)
In other physician monetary news a story in the Chicago Tribune discusses physicians who are asking patients to pay surcharges to cover the physician's costs. This in other parts of the country is called concierge medicine. The insurance companies in Illinois don't like it but if the physicians don't charge the fees, they won't be in medicine. A group of pediatricians is charging $25 for after hours calls. Others are charging to fill out forms for patients. Still others are charging for phone advice. Most of the physicians who charge the extra fees work in the affluent Chicago suburbs.
The reverse is true in Oregon. Physicians are boycotting the Oregon Health Plan's patients. This is due to the physician's increasing costs and the decreasing reimbursements by the State. About one half of the state's physicians are either not seeing the patients at all or limiting the number seen dramatically. Presently about 13% of Oregon's primary care physicians are not accepting new patients and about 25% are not accepting Worker Compensation patients. Top
In Texas where a new malpractice reform was just passed, one insurance company has dropped premiums by 12%. This was a physician owned non-profit trust. Of course that same physician owned trust has raised rates about 130% since 2000.
In an interesting two articles that came from different papers the same day, two slants on the same theme. The Washington Post wrote a major piece on the falsity of the malpractice crisis as reported in one aspect of the GAO study. They point to the GAO study that show that in Pennsylvania and West Virginia that there are actually more physicians than six years ago. They have no idea if those with licenses are practicing or reduced their practices. They also don't look at the increase in the general population in the same period. The paper also points to an increase in licenses given in the past several years in Florida, but doesn't state if the new licensees have come to the state.
In the Business First of Columbus there is an article showing that in Pennsylvania the state lost about 1000 physicians between 2001 and 2002. There was a 36% drop in surgeons, a 16% drop in orthopedic surgeons and a 16% drop in neurosurgeons between 1997-2002.
The Pennsylvania legislature is now attempting to craft a $250,000 cap for non-economic damages to be placed for two successive years on the state's ballots.
The Cleveland Plain Dealer has a story at the same time of a surgeon that dropped her practice and is now doing locum work. The other physicians in the article, a husband and wife, left for Wisconsin due to the large increase in malpractice premiums. They now pay about 1/5 of what they paid in Ohio.
In Connecticut, the Governor is pushing the legislature to start taking action on the malpractice bills. He wants caps on the non-economic damages of $250,000. The legislature is still holding hearings on the matter and it frustrating the Governor. He stated "Those states with caps have lower premiums." The legislature has no support for caps. The cost of insurance for one group of OBs in the state has risen from $12,000 to $105,000 each in four years.
In North Carolina, the state Senate voted along party lines to pass a bill on malpractice reform with no caps. They are looking at a system where there would be a pre-trial arbitration type proceeding where a three person panel would hear the evidence to determine if malpractice occurred. The report would be admissible and there could be a different result at the trial. If both the jury and the arbitrator agreed, the loser would pay all costs and the opposing side's attorney fees. The jury would have to award the amount put forth by the plaintiff or defense attorney. They are also looking at requiring investigations of physicians who get sued alot and attorneys who file alot of cases that go nowhere. The legislative thought processes do not include caps, structured payments, telling juries about medical insurance, or attorney fee limits. As in other states the Democrats favor the trial lawyer side and the Republicans favor the physician side. The main item will be a $25 million fund where $5 million would go to help the OBs with their premiums and the other $20 million would go into a liability fund, whatever that is. The State Assembly will take up the bill next year.
The Ohio Hospital Association has decided to create their own malpractice company for hospitals and physicians. They state they will be offering a company with a hospital perspective. The OHA will put up the initial $10 million to start the company and an insurer will begin selling the policies by the end of the year. This has also happened in Alabama, West Virginia and Kentucky. I would ask that the physicians be very wary of joining this type insurance company where the potential for conflict of interest is so high.
The Florida physicians have become terrible. The quality of their work has diminished drastically since the passage of the malpractice reform. With a deadline looming, the physicians are getting a flurry of malpractice warning letters from attorneys who believe they may have a case against them and want the case to be tried under the old rules. The same thing happened in Texas recently.
Farmers Insurance has announced they will stop selling medical malpractice insurance in all 18 states it currently sells. The decree happens January 1.
In Missouri there is an impasse in any meaningful tort reform. Earlier the Governor vetoed a bill that would have restricted venue to the area where the alleged malpractice took place. It would also have capped the non-economic damages. The problem for the Governor was the legislation also capped the liability of non medical malpractice torts as well. The Missouri Hospital Association wants a bill that will hold them harmless for actions of the non-employed physicians working in their hospitals. This goes against the general tort law of apparent agency. Top
The People's Republic of Massachusetts is again in financial trouble due to their free care for everybody mentality. The State gives free care to those who don't have insurance and make too much to qualify for Medicaid. This goes up to $121,680 for large families. The State mandates that all hospitals contribute into a pool for the care of this population. The amount of money contributed is dependent upon how much free care they give. Those that treat the highest amount give the most. Yes, that's right. Then the pool money and money from the State are added together and the money is given out to the hospitals who treat the patient population. The Governor has decided to take a significant amount of money from the two hospital systems that treat the most of these patients and give it to those who treat a lesser amount. This is creating ill winds in the People's Republic. As an interesting side note, none of the money goes to physicians.
The Feds and State officials are investigating Boston Children's Hospital for the adequacy of their care. There have been problems with medical staff issues, nursing services and governance. The hospital had a recent problem when a child died while having unrelenting seizures so the physicians could map the location of the seizures. This investigation will be a full investigation of the entire hospital.
In yet another People's Republic hospital problem, there was a baby mix-up at Melrose-Wakefield Hospital. The wrong baby was given to a mother for breast feeding. The mother recognized the baby was not hers and there was no milk passed. The hospital is now be investigated to see if this was an isolated incident or symptomatic of greater problems. The hospital states it was human error but all those in the field recognize this as a system error, usually in the realm of pharmacy.
There was a second baby mix-up when the wrong baby was delivered to the wrong mother at South Shore Hospital in Weymouth. This hospital attempted to cover the mistake by not reporting it as they are required to do. Does it seem that maybe the hype of the hospitals and medical care in the People's Republic is just that, hype. Top
As you know there will be only approximately 40,000 HMO members dropped this year by HMOs and about half are in the Atlanta area. This doesn't mean the remaining HMOs aren't cutting back. In California, Blue Cross and Kaiser will drop 7500 people totally in Ventura and Santa Clara County. The HMOs state they don't have enough consumers in those counties. Remember when there were no consumers but there were patients. Top
Physicians in residency have been able to legally become a union for years. They are true employees. The employers have in the past played hardball. In L.A. when the residents unionized in 1999 the Board of Supervisors voted to strip the residents of a benefits package that had been available only to non-union employees. This package paid physicians about 19% more than their base salary to purchase insurance. The unionization did lead to some minor increases on on-call time pay. The Union sued the County but lost on the first round. They are continuing the suit even though the physicians have now deunionized and the Board has reinstated the benefit package. Top
In a recent JAMA article a study of 168 Pennsylvania hospitals showed that those patients that were cared for post-op by nurses with bachelors degrees had almost a 50% lower mortality rate than those taken care of by non-degreed nurses. For some reason the National Association for Associate Degree Nursing challenged the findings. The find fault with the methodology and the conclusions. The study lumped those with master degrees with the degreed nurses. Currently about 60% of new nurses are from associate programs, 36% from degreed programs and 3% from hospital diploma programs. Top
Hospital Admits Rationing Care
In a fascinating article in the Wall street Journal, the University of Texas in Galveston has slashed the care given to its patients. The medical director has been tasked with being a strict gatekeeper and she is. The hospital has cut back on expensive drugs and procedures. The hospital also has stopped giving non-emergency care to non-legal aliens. I commend the hospital for having the intestinal fortitude to do the right thing. Top
Aetna is attempting again to ration care. It falsely uses the guise of quality but what it really means is cheap. Aetna has begun a new network of specialists called Aexcel. These are physicians in six specialties who practice cheap medicine. Aetna states that the physicians chosen were on the basis of cost, quality and access. All know that two of the three are meaningless. In the employers choose the Aexcel network physicians, their premiums will be slightly more, but they hope to make that back via the lesser costs. The specialties are OB/GYN, cardiology, CV surgery, gastro, general surgery and ortho. It is starting on the new year in Dallas, Seattle and north Florida. Top
MedCath Having Second Thoughts
MedCath, the for-profit power behind the boom in free standing cardiac hospitals, is relooking at its future. The problem is in a minor amendment in the Medicare Bill inserted by Sen. Breaux of Louisiana. The Amendment would grandfather in all the MedCath hospitals to date but would prohibit payment to future hospitals built with physician investments. The House version waters the amendment down by only calling for a study of the problem. The hospital industry has been pouring alot of money into this fight. Top
Duke is again in the headlines for patient injury. This time they had a premature infant burned by an incubator. A sterile cover accidentally blocked an air outlet in the incubator shooting hot air directly at the baby. The baby had first and second degree burns. Several months ago another baby was burned while being connected to a life support machine. That one had third degree burns. Investigators blamed nursing in this incident and again threatened to remove funding from the hospital, which of course will not happen. 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.