September 1, 2006 News





The Federation of American Hospitals, a kissing cousin of the AHA, mimicked the AHA harassment of CMS for its enlightened stance on specialty hospitals.  They want the CMS to go against the law and illegally put in whole hospital ban on self referral. 

Since the moratorium has been lifted there is a huge pent up activity for the competitors to community hospitals.  It is predicted that in the next year 30 new specialty hospitals will be break ground.  

A specialty hospital in the Kansas City area shows the evolution of specialty hospitals.  The Heartland Spine and Specialty Hospital has evolved        from the specialty to more specialties and diagnostic procedures.  The problem is the inability to get managed care contracts due to hospital pressure.  The community hospitals will go to trial on antitrust in 2008.  The specialty hospital is profitable but is only working at 40% capacity.  This shows how much one can do if they are efficient and not run like a hospital.    

It should be noted that the AHA profits have doubled in the past year to $18 million.  The revenue was $102 million.  The retiring AHA President compensation went to $1.38 million.  The new President will receive a base salary of $700,000.  If anyone wants to know where healthcare dollars are going they need only to look at the salaries of the heads of medical insurance companies, hospitals and these type organizations.  

Did you know that the AHA was able to get a 38% decrease in payments from Medicare to the nasty ASCs.  This is opposite what California Blue Cross is doing.  They are paying physicians more to do endoscopies in ASCs than in hospitals.  Who controls where the procedure is done?

The New York Health Department closed the Long Island Stony Brook Hospital's pediatric heart surgery program.  They had only one part time heart surgeon but had a low mortality and morbidity rate.  The hospital had three pediatric deaths recently, but only one may have been from the cardiac program.  The other two were an overdose of meds and one post adenoid surgery.  

Another hospital laptop has been stolen.  This one has the names, social security numbers and medical information of about 28,000 home health patients from Detroit's Beaumont Hospital.  The laptop was stolen from a car and the password was with the computer.  The hospital will pay for one year's free credit checks for the patients.  There are about 3-5 laptops taken every week across the country.  To date, the OIG has had about 19,500 complaints for HIPAA violations but has levied no fines and prosecuted two cases.

Ah, yes.  The computer fiascos continue.  Washington's Compass Health has lost a laptop with many mental patients medical information.  The laptop was missing more than a month ago and the clinic just sent out an alert.  It is telling patients how to set up fraud alerts but it doesn't seem to be paying for anything.  This lack on their part may lead to a negligence suit.  

As we await the fate of the nation's worse hospital Drew/King, LA may lose yet another ED.  The Centinela Freeman in Inglewood may close.  The health system has another hospital 1 1/2 miles away and would switch patients there.  Last year the Inglewood ED saw about 38,000 patients, the same as its sister.  The Centinela campus has excess capacity.  Recently, nine EDs in LA county have closed.      Top


A study by the Commonwealth Fund Commission showed that in a telephone survey of 1023 people showed about half of the people had unnecessary treatments or procedures or had duplicative tests.  Of course, the survey only spoke to patients who occasionally get things mixed up.  Nobody followed up to see if what they said was true.

The Houston Business Journal had a recent article that is telling about why EMR will not come soon to physician offices.  The article talks about how hospitals can budget for EMR but the cost is prohibitive for physician offices.  One cardiologist found that it would cost $80,000 which he stated he could not afford.  A FP did buy an EMR system for $100,000.  This does not include the $1,100 per month to maintain the system.  It also took several months of training.  Another FP says it may be okay for new physicians who trained with EMR but not for those that have been in practice for some time due to the steep learning curve.    

Aetna has developed what it calls transparency in quality and pricing.  They will tell the patients how much providers will accept from the company.  They don't say anything about how much it will cost the consumers who see an out of network physician.  There is nothing about true quality, only money.  Nobody knows how to measure quality.  The quality that Aetna measures is the artificial generic ones of number of readmissions, hospital complications whatever that is, the use of screening and the use of protocols.  The Aetna physician must see at least 20 Aetna patients in two years.  As you can see, it is possible to get very skewed information with small sample size.  The last quality variable is the most important.  Total cost of treating a specific ailment as compared to peers with nothing to do with severity of illness.  Aetna is smart enough to disclaim any guarantee of their system or the quality that anyone of their patients may obtain. If a physician did not score in each category nothing would happen to them.

A new study has shown what all have known, businesses and patients prefer PPO over HMO products.  Employers are offering many more PPO plans than they used to but are only offering about the same number of HMO plans.  The annual premium for a single HMO member is $3492 versus $3791 for the less restrictive PPO.  

In an interesting turn of events, employees are turning down their employer's health insurance due to cost and being enrolled via a spouse in another plan. In large companies (over 1000 employees) the percentage of people taking the insurance dropped from 87.7% to 81%. Currently the average family in a large company is paying approximately $226 per month or about 20% of the true cost.

Med mal causes higher health care costs.  The fear of med mal causes at least 80% of physicians to order tests that are not needed to protect their butts.  Someone pays for those these tests and it is the consumer. 

Physicians are now charging patients for all the things they used to do for free.  This includes over the phone refills and all forms being filled out.  The only way email will ever work is if there is a charge for it.  It seems the "consumer advocates" don't like this, but too bad. As the government and the insurance companies ratchet down the payments for the care of the patient, the physician will start charging for all the things they used to do for free.  Some physicians will not even give refills unless the patient is seen, a billable event.  Some physicians are charging for helping patients in the morass of Part D Medicare and pediatricians are charging for after hour calls.  The patients will eventually look to the insurance companies to pay for these events.

In Minnesota, the hotbed of managed care, HMOs are continuing their sinking into the sunset.  Now only 20% of the Minnesotans belong to the restrictive HMO.  This is the lowest in 20 years.  Employers in the state are switching to self insurance or indemnity products.  The state HMOs are just breaking even on operations and making money on investments.  This will change in the near future as they lose more money.               Top


Congratulations to my comrade Stuart Bussey, a FP/JD in Walnut Creek, California, who has become the third president of the Union of American Physicians and Dentists.  He succeeds Dr. Robert Weinman who took over the reins from the founder, Dr. Sanford Marcus.  I know Stuart will do a great job as the new head of the union.   

According to a recent report, for the FPs and Internists are the physicians working over 20 hours a week.  Family Practice had slightly over 100,000 and Internal Medicine has slightly less than 100,000.  Peds is third with about 50,000.  About 75% of active physicians are male as compared with 58% in training.  About 33% of physicians are over 54 years of age.   

For some reasons physicians are taking less Medicaid patients.  I wonder why?  Could it be that the pay is only 70% of Medicare?  Could it be the hassles of pre-approval? 

The physicians seem to be winning the payment wars with hospitals for on-call services.  Approximately 78% of the hospitals are now paying for coverage.  The median daily rate for on call on the premises is $1700.  For those that take at home it is about $500.  The more likely a call and the harder to find the specialist results in higher pay.  Trauma Surgeons get a $1200 median daily stipend; Ortho $1000; Neurosurgery $1000 and OB/GYN $750.  It seems like the rate of pay and those who will require pay will increase in the future.  The hospital is required to provide their regular services in the ED under EMTALA.  If they can't get physicians to cover the ED, they will have to drop their in-house services. This is happening in about 13% of the hospitals. Some hospitals are paying locums to take call, have cross covering arrangements with other hospitals or hiring employed physicians to take call. 

The USA Today had an article about physicians getting only a slap on the wrist when they do bad things.  They believe that physicians who do insurance fraud and drugs get off light.  Most of the article was generated by the poorly thought of Public Citizen.  The AMA said it best.  Those that come before a medical board get individualized sentences and not the automatic death knell that Public citizen wants but will never have. 

In an interesting piece of news that is no surprise, medical students in Florida are not going into ON/GYN.  The reason is the poor med mal climate in the state for OBs.  This is true for all states but especially in Florida.  When the student is considering OB, they are also considering leaving Florida to practice.  Florida is the highest state for OB malpractice premiums for OB.   

In operative mortality the age of the surgeon is less of a bearing than experience.  It seems that more people do better with surgeons that have the highest volume of a procedure no matter the age of the surgeon. The older surgeon does not do as well as the younger counterpart of recert exams and knowledge of cutting edge treatments but the patients do better.        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.