September 1, 2012 Recent News




Peer Review


The AMA states that small offices will be the least able to take in new patients under Medicaid when Obamacare takes effect.  The slight raise in payments will not offset the hassles of the program.  Also the raise is only for two years and then the practice will be stuck taking care of the patients for the new lower price.  When you lose money on each patient, you can not make it up on volume.

The AMGA has a survey on why physicians move.  The main reasons were financial considerations, dissatisfaction with the current position and significant personal life changes.

Approximately 40% of all primary care is given to patients by specialists including OB/GYN, medical subspecialists and other specialists.  The reason for this is simple.  There are only 30% of the physicians in the country who are truly primary care physicians.

Highlands Family Medicine in Louisville, Kentucky, has left KentuckyHealth One due to restrictions imposed by the Catholic organization.  They have decided they do not want their practice dictated to by religion.  They became employed by a rival organization.  Do not be surprised if more do not follow in the near future.

Two major surgeons in Tampa have left the University of South Florida and Tampa General Hospital and have gone to Florida Hospital Tampa.  they have taken with them 18 other techs and lab people who are integral to their research.  Tampa General downplayed the move by saying that they have good surgeons still at the hospital but in truth not of the caliber of the ones that left.   

There is a war between the California Medical Assn. and Aetna.  The insurer has refused to negotiate with some physicians and kicked out other ones.  The reason is for overbilling according to Aetna and for filing a lawsuit against Aetna according to the CMA.  This has put the patient, as usual, in the middle with some losing their physicians or forced to change insurers.     Top


In one of the worst surveys ever done, the National Treasury Employees Union interpreted its results with what the country wants.  They say the country wants more taxes rather than cutting federal services.  When you survey those who perform federal services you get what you expect.  They admit they did the survey to bolster their own image as budget cuts loom.

It's another week and of course Sebelius has another announcement of how good she is.  There will be a new health plan identification number that will save, according to Sebelius, about $6

A new study and the Academy of Pediatrics have finally come to the correct conclusion, circumcision prevents later diseases.  The Academy has done an about face and now states it is no longer against circumcision but it is a choice between the parents and the physician.  They do rightfully recommend anesthesia for the procedure.

New York City has paid out almost $500 million in med mal claims in the past four years, or should I say the taxpayers of New York have paid out the money for the med mal claims.  The claims are for a bad baby with a skull fracture and brain bleeding after not doing a C-Section when it was indicated, a missed brain bleed in a teenager and after doing a C-Section not having any physician or proper equipment in the room for the baby.         Top


The Wall Street Journal reported on the new move by hospitals to get their money back for purchasing physician practices.  After a practice is purchased it will become part of the cost center of the hospital and considered a hospital outpatient setting.  This allows the hospital to drastically increase the price of tests and x-rays up to triple what was charged when the procedure was done in the physician office.  This also increases the out of pocket expenses of the patients or in this case consumers. Insurers may not pay either some or all of the fee. The best was to combat this is to seek out places to have tests done that are not hospital owned.  About three years ago I reported to Medicare a hospital that charged a facility fee to a patient for seeing a physician.  This fee was $300 per visit.  Medicare couldn't care less.  They said it was OK and paid the fee at the usual lesser amount.  

Steward Healthcare is again on the move.  To date it has purchased ten hospitals in the People's Republic of Massachusetts and is now planning to purchase Mercy Health Systems of Maine, a financially struggling Catholic system.  They are also in negotiations with Rhode Island's Landmark Medical Center.  

A study has shown that large health centers have good access to physicians and services but are rigid and impersonal.  They rely more on electronic gadgets than bedside care.       Top

Peer Review

The hospital biased law firm of Horty Springer has the following Q and A in their 8/9 newsletter.  I believe this answer is telling the hospital to cheat and do whatever else is necessary to get the desired result no matter the truth of the matter.

Question: We sent a case out for external review and what we got back is not exactly what we were hoping for. The report provides valuable information about what went wrong and what could have been improved. Unfortunately, the ďall-in-oneĒ report critiques several physicians and nurses Ė identifying them by name Ė and addresses areas where the hospitalís own processes contributed to the poor outcome. Iím afraid that if we show this report to the doctor about whom we are primarily concerned, he will simply focus on the areas that critique others. What can we do?

Answer: The scenario that you report is not all that uncommon. Without explicit guidance, many providers of clinical reviews provide reports in the manner that does not best serve the needs of those on the receiving end, who must fit them into the peer review and performance improvement processes at their hospital. It is not necessarily that external reviewers are trying to be complicated. Itís just that to them, it seems logical when asked to review a case to simply identify all of the areas where concerns are noted and/or where there is room for improvement. For this reason, it is important that peer reviewers who seek external reviews always have written agreements with the reviewer. That agreement should clearly outline expectations for the review, the report, and any follow-up that may be necessary.

To me if a report is to be accurate it should do as much to exonerate an accused physician as to convict depending on the facts.  Apparently, Horty does not believe in the same fairness.  For those medical staffs that use this firm for consultations or legal work, you should think again about the completeness and the ethics of the information received.        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.