September 15, 2003 Recent News
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The Community Hospital in Ventura, California, is beginning to see the error of their ways. They have made a start on their rift with the medical staff but have not gone far enough. The Board has voted to relax some of the crazy rules they attempted to place on the staff.
There is no longer any penalty for making critical statements about the hospital, the board or the administrator. Now there would only be punishment if the statements about these people were the same as defamation; false or showing a reckless disregard of the truth. What this is saying is that truth is an always win situation for the staff. It does not state who the burden is on to prove the truth or falsity of the statement.
The board also got rid of most of their no competition clause. Doctors now may continue to compete with the hospital but only in their private offices, not in surgical centers etc., but if they do they will not be allowed on three committees; the credentials committee, the medical executive committee or the committee that recommends physicians to the board. This also does not make sense since the physicians could serve but sign non-disclosure statements as is done in most other businesses. This will keep out of leadership those with initiative. This will also ensure that the hospital can control the committees. This can not be allowed.
In a real woopty-do the physicians that are accused of violating the board's directives may appeal their exclusions from the staff to the same board. There is nothing in the board's statement about the theft of the medical staffs money by the hospital.
The hospital's outside counsel is obviously attempting to rectify some of the problems without having to go to court after the medical staff won round one. The suit will and should continue. The medical staff should continue to do all in their power to rid the hospital of the board, administrator and the inside counsel.
All of this was done by the board and is now being presented as policies already in place. The medical executive committee will now review the handed down policies that affect them.
Seven retired former chiefs of staff of the hospital have written a letter to the editor. They side with the physicians in their fight against the onerous conditions of the hospital administration.
In yet another stupid move, the hospital CEO has put his foot in mouth again. He threatened to replace the anesthesia department for reducing their time in the OR of the hospital. The hospital has less surgery since the dispute began and surgeons are taking patients to other hospitals. The CEO stated the "This is about avaricious dissident physicians trying to destroy MY (emphasis added) hospital". This quote may be the basis for all the problems of the hospital. It is not the CEO's hospital. Later the CEO retracted his statement of tossing out the anesthesiologists and getting a new exclusive contract with another group that would do his bidding.
The medical staff held its first meeting in the hospital in nine months. The meeting was initially chaired by the hospital appointed chief of staff. The medical staff rejected his leadership and the elected chief of staff took control of the meeting. The CEO and his divorce lawyer (sorry, hospital lawyer) left soon afterwards. The medical staff reaffirmed all the business done at the outside meetings. They also voted to continue the lawsuit against the illegal hospital acts by a vote of 115 to 5. The same night, the Department of surgery voted unanimously to uphold the medical staff bylaws and allow the elected Chief to run the meeting in spite of the CEO's threat that he would not recognize the meeting.
IT SHOULD BE OBVIOUS TO ALL THAT NO MATTER THE RESULT OF THE LAWSUIT, THE CEO, HOSPITAL ATTORNEY AND BOARD MUST BE REPLACED OR THE HOSPITAL WILL CONTINUE TO BE RELEGATED TO A DYING INSTITUTION. THERE CAN BE NO TRUST BETWEEN THE PARTIES, NOT FOR MANY YEARS. Top
The GAO has stated that rising malpractice premiums do not appear to limit access to healthcare by driving physicians from states with high premiums. They did see specific instances in certain subspecialties where care was limited in certain instances, there was no national problem.
In the meantime another federal agency, DHHS' Agency for Healthcare and Quality, stated that those states which cap malpractice non-economic damages had about 12% more physicians per capita than those states that did not use a cap. This is different than in 1970, when there were no caps in any state, when the numbers were equivalent.
In Tampa, Florida the University Community Hospital is changing the way and amount physicians need to put away to practice. It was $250,000 in an escrow account or a letter of credit for that amount. The new agreement is to go bare and agree to pay up to $250,000 within thirty days of a jury award. The other Tampa hospitals are considering the same thing. If the physician doesn't pay the money within the time period they may lose their license. In Florida, most of the physician's other assets are protected and attempting to obtain them is usually futile.
In Philadelphia, Pennsylvania, the absolute amount of law suits has decreased by 2/3 in the first seven months of the year. The reason may be the new laws or it could be that the attorneys raced to file the suits from previous times prior to the new laws. Also about 300 suits have been transferred out of Philadelphia to the venue where the malpractice allegedly occurred.
Texas has a cap of $750,000 on non-economic damages as of September 1. This has panicked the Texas trial lawyers into rushing to the courthouse to file all the malpractice suits they could prior to the September 1 deadline. The county courts are now up to their butts in back logs of cases. About 800 were filed in the one week prior to the effective date in Harris County alone. Many believe they are filing without any prior investigation as to the merits of the case, but only to beat the deadline. Top
Several South Florida hospitals are no longer in the same corner. A group of seven of the hospitals in an effort to lure wealthy Hispanics from the Caribbean and Latin America to their hospitals started a mass marketing plan, Salud Miami. That group is breaking up. This is due to several hospitals suing the other hospitals to stop building projects. Recently contributions from the hospitals decreased and the marketing of the individual hospitals increased.
If you haven't heard of HeartMate, you will. This artificial device made by Thoratec Corp. for permanent implantation for people with chronic heart failure will cost hospitals about $150,000-$200,000 each. Medicare states it will pay about $55,000 per implant. The device is in lieu of heart transplantation. Hospitals will be left to fund the difference. This will mean only a fraction of the estimated 100,000 people a year who need one will actually be able to get one. This may be the impetus for the required national debate over rationing of care due to costs. The device actually costs about $65,000 to make but Thoratec must also recoup their research and development costs which was about $30 million. Thoratec will help hospitals apply to Medicare for additional payments and they hope that the hospital will get a total fee of $100,000 per unit. CMS is scrutinizing the device carefully since it will cost CMS billions of dollars.
In Dayton, Ohio, the hospitals have seen a drop in admissions. The reason may have been a mild flu season and not specialty hospitals since there are none in the area. In those few hospitals where the inpatient population has remained steady or increased the bottom line is still decreased due to the Medicare and HMO cutbacks.
Health Care premiums will climb another 14% this year according to a report by the Kaiser Family Foundation. This means the premium has increased to employers for family and employee coverage approximately 50% in the past three years. Top
Applications to medical schools are down nearly 22% since 1997. There are still more applicants than slots but what about the quality of the applicants. The AMA states there has been no drop in the quality of the applicant academically. The drop may be due to the increase tuition or the decreasing prestige of the physician. Top
In my last issue I had an article about medical record theft at Memorial Hermann Hospital that were sold to Industrial Safety Consultants who are pimps for shysters. The investigation has now spread to Ben Taub Hospital and a different employee. Top
The Tennessean reported that more central Tennessee physician are investing in surgical centers. The cause of this is both financial and practical. With a surgical center the surgeon and his/her preferences are known to all the staff. The same may not be true in the more rigid hospital.
In Texas several different physician groups are seeking to buy part of an existing hospital and to build specialty hospitals in the Arlington area. Most of the specialty hospitals in the area are owned jointly with physicians and hospital who have learned how to coexist and for profit hospital chains that eventually sell the entire enterprise to the physicians. Top
Medicare HMOs Continue Pullout
Medicare HMOs are planning to drop another 40,000 member this year. This is a drop in the bucket compared to the 2.4 million members they have dropped in the past six years. They continue to maintain the government is not paying them enough. However, they don't do anything. They are pure middle men that deliver nothing that could not be had by going to the end user at a significantly cheaper price. There are only 11% of the eligible Medicare beneficiaries in HMOs. This has dropped 4% in the past year and is not due to HMOs dropping the recipients, but vice versa.
Of the reported 40,000 to be dropped almost half are in Atlanta, Georgia. Blue Cross states their costs have increased 12% but reimbursements have increased only 2%. Welcome to the world of medicine as physicians have seen it from the insurance industry. Don't cry for me, Argentina. Top
It will be interesting to see what happens in Orlando now that the surrounding counties have decided not to participate in the payment to the Orlando trauma center, one of six in the state. The neurosurgeons had threatened to quit several months ago due to the cost of insurance and the amount of call. Top
Since Southeast Hospital lost it's JCAHO accreditation, Aetna has dropped them. This is a dumb move by Aetna as it creates the impression that if one is not accredited by the JCAHO, they are not a good hospital. In case Aetna and the other insurers don't know, there are two other ways to become approved for Medicare without going through all the hoops of the JCAHO. One is by the oldest accreditation agency, the American Osteopathic Association. They will inspect any hospital etc., not just osteopathic ones. The other is the state Department of Health which inspects the hospital only for the Conditions of Participation and does it for free. I have no problem with the dropping of the hospital since it appears it should be a dead goose. I only object to the reason cited. Top
Calif. Blue Cross Payments to IPAs
Blue Cross of California had paid out approximately $28 million in bonuses to various IPAs under its incentive program. The best of southern California was St. Joseph Medical Group and Hill Medical Group was the best of Northern California. About 80 of the eligible 180 groups received payment. 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.