September 1, 2007 Recent News 



MetCath continues to open hospitals with the physicians.  The newest one is in Kingman, Arizona.  It will be called the Haulapai Mountain Medical Center and will be 78 beds now with the possibility of an additional 33 in the future.  For those of you who don't know, Kingman is on the Mother Road, Route 66.  They have a great Route 66 museum and they also have the annual Fun Run, a three day classic car rally.  It is also the gateway to the new Haulapai Skywalk over the Grand Canyon. 

Press Ganey, the largest gather of hospital information has released its report on physician hospital relations. The biggest thing in the survey was the lack of response by the administration to the concerns of physicians.  Other problems were to have patient care made easier, lack of confidence in hospital administration and of course the lack of communication with the hospital administration. To no one's surprise, surgeons are the least satisfied with the hospital setting.  This is the major reason for surgical specialty hospitals where procedures can be done with better equipment and less time between cases or at least a 50/50 split between the hospital and the physicians instead of the current 100/0%.  It was interesting that the physicians that had been at the hospital between 11 and 20 years are the least satisfied with the hospital as opposed to those who had been there less than 11 or more than 20 years.

The AHA did a bad job of investing its money so received about $7 million less than the prior year.  It still made a profit of $11 million.  The dues rose 5% but the expenses rose 7%.  The outgoing president made $1.5 million for 2005 and the new president made $761,944 in 2006.  

The AHA wants the CMS to reconsider how much it will charge hospitals when they are found wanting under the COPs.  They believe that one problem should not cost as much as seven.  They want the charges only for revisits and if the original charges are found true.  They forget they are always true when found.  They then may be fixed. (SEE ALSO RECENT LEGISLATION FOR MORE OF THE AHA NONSENSE)

In an interesting turn of events, Baptist Memorial Healthcare, the people who tossed cardiologists off their staff for starting a competing hospital, is now seeing the light.  They have decided to partner with or purchase from a group of physicians who have a great all private room hospital in Jonesboro, Arkansas the hospital.  Unless the money is too good to pass up, the physicians better watch the fine print or they will become hospital lackeys.  

Kaiser continues to show what government health would look like.  They believe in putting their patients in one place and inconvenience is not inconvenient.  They have their northern California heart patients operated in San Francisco, their neurosurgery in South San Francisco and now their radiation which takes weeks of daily treatments in South San Francisco.  Patients will be traveling for many miles to go for their therapy and will have to stay in the area for weeks at a time.   You get what you pay for!          Top


Blue Shield of California will pay out $31 Million in bonus payments to the medical groups of the state.  This is unchanged from the prior year.  About half are a part of the Integrated Healthcare Association which rewards physician groups for clinical care, patient experience and information technology.  

The New York Attorney General has stepped into the law suit by physicians against Aetna and Cigna.  The Attorney general wants the insurers to justify their rankings of physicians.  The insurers only rely on claims data for their flawed  rankings. This dataset may be too small and lack key information.  If that is true then the only motive for steering patients to certain doctors is that the physician is costing the insurers less.  This is not quality but economics.  This is the same that the Attorney General did to United Health earlier this year stopping their ranking rollout.

The new CMS payments to ASCs will be 66% of what they pay to hospital outpatient surgical procedures.  This is especially true for GI endoscopy centers.  They are currently being paid about 89% of hospitals.  The major drop may force them to stop seeing Medicare patients or to close altogether.  At least the drop in financials will be phased in over four years. The good news for the ASCs are the additional 700 procedures that may now be performed there instead of the hospital outpatient surgery only.  It is interesting that the new payment system will increase shoulder arthroscopy in the ASC from $500 per procedure to almost $2000.       Top


It's coming closer.  The new laws for prescriptions for Medicaid patients start in one month.  Spend your money to get the prescription pads so you can lose money seeing the patients.

A new survey published in Health Affairs shows that only 8% of Medicare enrollees had no prescription coverage that is a major change from the 33% that did not have coverage the year before.  The survey faulted the plan since some seniors didn't know they could apply for assistance in obtaining meds.  This sounds like someone who wants the Democratic giveaways.   

The following was published in Modern Healthcare's Daily enewsletter.

Article published Aug 27, 2007
Corp. execs don't enter data, why should docs?

In response to reader comments on Andis Robeznieks' "Vendors dispute EHR, ambulatory-care report":

This is in response to Al Puerini's letter where he wonders why electronic health records have not been widely adopted by the healthcare industry compared with other industries. In his letter, he says "Let's ask the airline industry if they could even exist without computerized record-keeping. Let's talk to UPS and FedEx and see if they think computerizing their industry has made a difference. How about the banking industry? Has it added to their efficiencies?"

Most people fail to recognize that the sophisticated computers and systems that power American industries and streamline operations rely upon data entry performed by a workforce of minimum or near-minimum wage earners. These responsibilities fall upon the shoulders of cashiers at McDonalds, Gap and Wal-Mart, or clerks in the banking industry that enter information into computer mainframes. Data entry is carried out by the bank teller, the bookkeeper and even the UPS and FedEx deliverymen and women who hold a wireless unit in their hands at all times.

One thing is certain: Highly compensated corporate executives earning as much as $250,000 or more are not taking on the tasks of data entry. So, it stands to reason that physicians, who earn comparable salaries, also would be unlikely candidates. Yet, it seems that everyone expects just the opposite.

It may surprise some people to learn the physicians are directly responsible for generating revenue of $200 to $500 per hour of work, and up to $1,000 per hour in some specialties. Any slowdown of this production rate, even a slight one, results in dramatic losses.

Evidence from exhaustive research concludes that manual data entry of patient exams slows the doctor down by up to 15%, equating to an approximate 30% decrease in take-home pay for the physician, according to a 2005 benchmark survey of 3,300 practices conducted by the Medical Group Management Association in collaboration with the University of Minnesota and funded by HHS.

Imagine telling UPS that if they equipped each delivery staffer with a hand-held device, it would increase customer satisfaction, but that all the company executives would take a 30% salary cut. It's unlikely that UPS would adopt that technology.

This is basically what the marketplace is telling physicians: Adopt an EHR to improve patient care, but the technology will significantly reduce your personal bottom line. It's no wonder that there is such resistance to EHR adoption among physician practices.

The lessons learned from this analogy are obvious. While there is significant return on investment to having ubiquitous access to data, including reduced medical errors or drug interactions, it may only come to fruition when it is cheap to input the data. If physicians are to take on these responsibilities, at rates approaching $500 an hour, the reality of ever achieving any return on investment is questionable.

It's no secret that EHR implementation is pricey. But few people realize just how expensive it really is, especially when physicians factor in the costs for training and lost staff productivity. According to the MGMA survey cited above, the average implementation costs of an EHR are $32,606 per physician; maintenance costs per physician per month are $1,177. Cost overruns above the vendor's initial estimate are 24.8%, a metric that would not be tolerated long in other verticals. For small- to mid-size practices, which represent the vast majority of medical practices in the U.S., this is simply unaffordable.

Furthermore, EHR implementation is highly complex and requires massive amounts of training time for physicians and their staff members to get up to speed. Protracted training periods slow down office operations, further taxing the enterprise with hours of lost productivity. It takes one year or longer before practices even begin to see the return on investment, if any.

Evan Steele
Chief executive officer
Montvale, N.J.

A new CMS report tells of Medicare paying 2/3 of what private insurers pay for anesthesia services.  Of course those administering anesthesia are usually exclusive providers and have no choice in the matter.  The difference was for all services and did not depend on location or supply of anesthesia personnel.  The compensation for anesthesiologists was good compared to colleagues.  The annual median compensation was $354,000 and for nurse anesthetists $131,000.  

The Mother Country is stirring up a hornet's nest.  The British NIH, which determines what is paid for, is considering taking drug eluding heart stents off the paid for list.  The country's cardiologists are not happy campers and are trying to scuttle the action.  The cardiologists call the possible decision fundamentally flawed.      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.