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Nevada has passed its version of tort reform. The State nonprofit company formed to help physicians obtain insurance when other companies pulled out of the state has declared that they will not lower rates since they are not sure the new law will pass judicial scrutiny. The OBs continue to not increase their OB load over 125 babies per year since that would increase their premiums dramatically. The OBs are also dropping their HMO affiliations to increase what they can charge per delivery. As they get older, they get smarter.
Although not truly under malpractice, the Feds are instigating an investigation against the OBs for collusion in getting more money per delivery. It is probable that one of the HMOs have ratted on the physicians. Sierra Health Services, the parent of the largest Nevada HMO Health Plan of Nevada, is a likely culprit. Health Plan of Nevada pays under Medicaid rates for deliveries. The OBs state they have done nothing wrong since they are negotiating individually.
It is truly wonderful to be independent. That statement has different meanings depending on where you live. The Mississippi Supreme Court Chief Justice, who is running for re-election, came out against the physician malpractice carriers as the root of all evil. It may help that he is being heavily funded in his run by the Trial Lawyers. It also gives al look as to what will happen in Mississippi if the legislature does pass tort reform and the legislation goes to the court. The special session only came out for a $500,000 cap on non-economic damages which can be bypassed in "egregious" cases.
At the same time the Mississippi Trial Lawyers are beginning to gear up. A group of them did a whirl wind state tour to stop the misinformation that the trial lawyers are the reason physicians are leaving the state. They probably have the same believability index as used car salesmen known for their puffery.
Meantime, in southern Mississippi, five physicians are planning to close shop on November 1 due to lack of malpractice insurance. their sin was to have the audacity to prescribe a FDA approved medication, Rezulin. This medication was later taken off the market for potential liver problems. In a tort lawyers dream, those who prescribed the medication will be named in multiple suits regarding this drug.
The Mississippi Governor is calling for an insurance pool to cover those physicians having problems obtaining insurance. If a physician took money from the $10 million fund that would help pay the premium, they would need to participate in the government sponsored programs. He also is for a $500,000 cap on non-economic damages that can be topped in extraordinary circumstances.
In a recent article, the physicians in the Ft. Meyer, Florida area are going bare. One OB said he would need to pay $200,000 per year for a $250,000 policy, not a worthwhile investment. The hospitals are also beginning to loosen up their rules to require malpractice insurance as long as the physician can post a $250,000 bond per the state regulations. Those hospitals that are not following suit will soon lose physicians to those that no longer require insurance.
In a separate article the physicians of Manatee, Florida are also opting for bareness. The Manatee hospital physicians voted 235-5 to amend their bylaws to allow the physicians to either have insurance or go bare. The physicians have already warned the hospital and corporate boards that if they do not approve, patients will not be sent to the hospital.
West Virginia is back in the news. The physicians who have had serious difficulty getting liability insurance are now attempting to rally again. That won't cut it. Until they get a spine transplant and discontinue trauma work, OB deliveries, ED coverage and start to leave the state nothing will happen. Governor Wise isn't and won't call a session to deal with the problem.
The physicians of West Virginia have decided not to start their own malpractice company. The reason is the lack of tort reform. Until there is tort reform the State has the only viable insurance company and they will lose the money.
West Virginia has two trauma centers. the one in Charleston has major problems finding physicians to work. To date 29 physicians have left the hospital with 12 moving out of state, 6 retired and 4 of those were under 65. The hospital can not get anyone to come there to practice. Charleston is now a level 3 trauma center, basically equivalent to a hospital.
The physician who was the chief of the ER at Charleston and who is now a plaintiff attorney has questioned the veracity of the hospital's administration. The physician states that there are physicians who would come her but one must look in areas not traditionally looked at. This may include payment of some of the malpractice premiums.
Pennsylvania doesn't want to be left out. There is a week long meeting for all the physicians of the Politically Active Physicians Association to discuss the malpractice climate in this tort attorney run state. The Association is open to all and the organizers hope that most physicians in the state will attend the five day confab. Since this would close the offices for a week the pansy Pennsylvania Medical Association will not endorse the meeting. The same thing happened in California in 1975 when the Physician's Crisis Committee called for a stoppage and organized medicine fell on their face. The conference organizers are hoping for 300 participants daily except the one day when they are meeting with the legislators. That day they hope for 1500 people.
The patients of a Westlake , Ohio oncologist have come up with the $40,000 necessary to help pay for his $80,000 malpractice insurance for this year. Their mistake is to pay the bill and not put the pressure on the legislature and the Supreme Court, which stated the tort reform was illegal. Top
Thank you to the People's Republic of Massachusetts for continuing their stupidity and for giving me fodder for this newsletter. As you may or may not know the PR recently stated that they would decrease what they would pay pharmacists and also tax them on non-Medicaid prescriptions they fill. This is to save money. The pharmacists said ta ta and the Jane not so Swift Governor changed her mind. Now the Medicaid program is going to put in a formulary to help control drug charges. It tells something about the state when they want to go with the generic for Prilosec for stomach problems. This medication is only surpassed by two schizophrenic meds all probably caused by their legislature. There is nothing wrong with a formulary if it is done with thought and with the ability to go outside the formulary for special cases.
The legislature is now meeting to discuss the above stupid law and eat crow and change it. Their other choice is to play hardball with the private pharmacies. This would not be smart but with their history might be what they decide.
As the legislature meets to attempt to undo what Jane not so Swift has done, the Governor's lackeys and spinners are continue to question the private store's disagreement with the policy. They continue to want documents that the stores are not required to give. The head of the state's Medicaid program needs to come up with $30 million in reductions. She thought he could do it in one fell swoop but is getting stymied. Looks like she will actually have to work to find the cuts.
The Massachusetts State Senator on the Health Committee stated that he would recommend a law to force hospitals to tell patients when a physician was suspended. A noble idea, but stupid. The patient can find the information on line at the state medical board. The Senator, who obviously knows little or nothing about the rules, also wants a law to force hospitals to tell patients when something goes awry. He is a year late and a dollar short. JCAHO put that controversial measure into play a year ago. I hope the foot in his mouth does not get in the way of his tongue.
In a small segment of what the nation can expect in universal care, Massachusetts is going broke in their program that covers the people with free care who make to much for Medicaid and are not covered by insurance. Last year the state budgeted over $400 million for the program and had a $40 million shortfall. Top
Physician Employment Satisfaction
In a recent study of employed physicians by Press Ganey the physicians were only somewhat satisfied. This leads to decrease morale and lesser productivity. The study was of 2,636 physicians working in 32 hospitals. When asked how satisfied they were in their current employment there was a score of only 71. This is not good and shows significant improvement needs to be made. The physicians were most satisfied with volunteers and nurses. They were least satisfied with how the hospital represents them in negotiations, the closing of staffs by exclusive contracts and the lack of the hospital being open with physicians in hospital policy and decision making. Top
Blue Cross and Blue Shield of Illinois are targeting pharmacists in their effort to keep down costs. The Blues are paying pharmacists $1 for each prescription they can talk the patient into switching from trade to generic. This means they have to call the physicians to get approval for the switch and take the time to talk to the patient about the switch as well as their duty to discuss the medication side effects and potential interactions with the patient. Seems like $1 is enough for the Blues to pay the pharmacists for all their time so the Blues can save millions of dollars. Top
Dr. David Arndt, the infamous surgeon who left the patient on the OR table while he went to the bank, had past problems as well. He has had complaints by patients to the Harvard Vanguard physician's group to which he belonged for inexcusable behavior. He did not show for a surgery and then did not show for a scheduled apology session with the patient. Dr. Arndt had resigned for unknown reason from the Harvard Vanguard group in 2001. He has also resigned from area hospitals and been guilty of assault and helping his domestic partner illegally get a US passport. Top
Three more Floridians lost their lives in Florida during office cosmetic surgery. This happened in 2000 and caused a state imposed moratorium on all office based surgery. During that time strict rules regarding the anesthesiology and surgery were passed. Looks like new rules will be imposed.
At the same time, the nurse anesthetists are suing to get their independent privileges back for office surgery. Timing is everything. Top
Two Vermont hospitals have had enough of the too many rules and money for what they get have dropped JCAHO for State Certification. The hospitals believed, and rightly so, that the accreditation was too expensive and did not improve the quality of care. This is free and gives the hospital the same standing that they would have received under the accreditation agency. I believe that more hospitals should be doing this or looking to the AOA for accreditation.
JCAHO has caught its competitor AOA and has recently been named as accreditors of the Critical Hospitals (CAH). I am not sure why anyone would use the Joint but there are some that are impressed by spending money for no value. Top
In Wake County, North Carolina, there is only one anesthesia group and they won't play ball with Blue Cross. Blue Cross also forgot to tell their patients about the change. A law forbids Blue Cross from sending its members out of county for care, so the patients are paying the difference. Other anesthesia groups have also cancelled their Blue Cross contracts and are starting to do the same thing. The alternative is for the patients to join a Managed Care Organization that pays more money and therefore would not be cancelled by the anesthesiologists.
In the wake of Enron and WorldCom, Tenet has joined in with huge pensions. Jeffrey Barbakow, the CEO, gets a two for one credit for years worked for his retirement plan. This means he will get $1.89 million per year if he stays until 2004. Last year he "earned" $4.5 million in salary plus bonuses. Top
The rift between the medical staffs of Columbus, Ohio's OhioHealth and Mt Carmel Medical Systems continues. The Orthopods and neurologists originally went to the hospitals and asked them to help build a dedicated hospital for their surgery. The hospitals refused since they wanted all the money and did not want to share. The physicians then built their own. The Medical Systems then retaliated by forcing those physicians off the staff. The local medical society has recommended mediation but the hospitals want legislation to prohibit the hospitals.
In Austin, Texas a defunct hospital building is being considered for renovation to into a boutique hospital for orthopedics.
In Silicon Valley the medical groups are attempting to hire 150 physicians over the next 5-8 years. the problem is the cost of living in the area is sky high and the salaries aren't.
The North Shore Medical Center in Salem Massachusetts has figured out they are losing a large sum of money each year on their physician group. They have brought in an outside consulting group to fix the problem. The fix is to restructure the contracts with the physicians and if the physicians don't go along with the idea, to not renew the contracts. For this they needed a high power consultant?? Top
The North Suburban Clinics in northwest Chicago have stopped paying rent in their offices, abandoned the patient records and stole out of town. These were eleven "physicians" in several medical specialties. There were about 90,000 records and x-rays abandoned. This is comparable to the California fiasco of a year ago when a large IPA closed and no records were available. It sounds like the state will have to step in here as they did in California to force the retrieval of records. 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.