September 15, 2007 Recent News
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In a story in the Baltimore Sun, now the nurses are turning against electronics. They are now saying that the time for documentations are taking them away from their nursing at the bedside. With nurses already at a premium, I wonder how many people will come into the profession to become data entry clerks. One of the complaints is that it takes about 30 minutes a day per patient to log all the information. Also the nurse may have to log twice if the systems are not talking to each other, once in the med record and once in the pharmacy. Much of the blame needs to go to the regulators who require so much documentation to prove something was done. An interesting comment was that nurses don't want technology, they want technology to do something for them.
Greeley Company is a well known hospital friendly and hospital paid organization. They are not medical staff or individual physician friendly, although they claim to be. They also own several publications including HealthLeaders. In a recent opinion piece they discuss a hospital disruptive action policy. All hospitals are required to have such a policy. The opinion piece is a good outline as to what the policy should contain. This includes a definition of disruptive conduct including harassment. I might add here that the new rule that states all hospitals have a policy includes as part of disruption those acts which disrupts the smooth running of the hospital and states that this is akin to patient quality issues.
In the Greeley subsidiary HealthLeaders, there is a Op-Ed piece that discusses the new Joint Commission MS 1.20 standard. The standard increases the power of the medical staff vis a vie the MEC and the Board. This is not liked by all hospital attorneys and hospital consultants since it forces all important aspects of the medical staff into the bylaws where it is voted on by the medical staff. The medical staff is in charge of making the decision who is eligible to vote and who can bypass the MEC to take an issue directly to the Board. The article uses scare tactics like saying the bylaws will have to be changed frequently to comply with new laws. This is not true. Yes, on a rare occasion, a small part of the bylaws may need to be revised but not the entire bylaws. This happens now and allows all the medical staff to know what are the changes and why. If the changes are being done for the hospital, the medical staff may not approve. Some hospital paid attorneys are using the scare tactic that all credentialing decisions such as removal of privileges may be taken to the whole medical staff by the affected physician. This is doubtful since it would defy the privacy aspect and the JC does not intend this to be the case. The medical staff will still decide what is a quorum for voting and if there needs to be a majority or supermajority vote to pass an issue. The other thing that is happening as the hospital becomes less relevant for the majority of physicians who send their patients to hospitalists is there will be fewer active voting members of the staff to hold office and to vote on issues. This may require allowing those non active members to vote and maybe by mail. The JC is not going to change their new standard but will explain it more in their late October conference. The JC also emphasizes that the new MS standard must not be read as a standalone but must be read with the new Leadership Standards.
In California, the Governor and the Democrats have been at odds in healthcare reform. The Democrats want universal healthcare and the Governor wants the healthcare to be universal but paid for by a combination of taxes. One is a tax on all hospitals of 4% and another is a 2% tax on physicians. The California Medical Association is against both programs and the California Hospital Association just agreed on the tax but with certain provisos. The concession to Kaiser would be that hospitals would not bill patients beyond what their insurers pay, no balance billing. The other proviso is that the state will increase what they pay the hospitals each year under Medicaid, no matter what they get from the Feds. The Republicans are having none of the above which means it will become a ballot provision.
The American Hospital Association has written a letter to Senator Grassley being against the change from the current community benefit standard needed for tax exemption and the replacement by the more reasonable percentage test of how much free service is given. As of now the hospitals use hospital costs to determine how much charity care they give. They state they give much more via other community services that end up benefiting the hospitals. The hospitals think a law is not necessary for things that hospitals already do. Well, if they already do them there should be no problems with the law. If in fact they only give lip service to doing it then they would have a problem with the proposed law. They bolster their argument with several court cases which have no basis on legislative intent. The AHA doesn't like that the proposed law would address the amount of independent community members that would need to be on a Board. They are a good lobby as long as one doesn't believe all they say. Top
In California, Blue Cross that it has given about $69 million in bonuses to medical groups in its P4P network. There were a total of 167 physician groups paid. This is just under half of all the medical money paid out by the insurer.
In Texas, the largest med mal carrier has reduced its med mal rates and will pay out a dividend of 22% to boot. This is due to the med mal legislation passed several years ago. The drop in premiums since 2003 when the law went into effect is a cumulative 31%.
Connecticut will also see a med mal premium reduction up to 20%. Actually the rates will be the same but those physicians with no claims for five years will get a credit. Another company will give a 24% rate decrease but they have only a few physicians due to very large raises in premiums in prior years. The state has no caps on non economic damages.
HealthLeaders has published an article on physician mindsets. The author, a physician, wanted to write about individual physician mindsets. The author got his mindsets from serma.com. He states that most physicians have very low morale due to the economics and the constant carping by people who do not know medicine. The first mindset he describes is that physician want incremental healthcare change, not single payor. Physicians have dealt with government and have not liked what they have seen. The second of the five mindsets is that physicians are not fighting the pressures on their income and the rules. They are wanting to become employees and just be salaried. The third is that physicians tend to be reactive and not proactive. This is especially true worth regard to the consumer driven health care. The fourth is that technology is good but only if done correctly and cheaply. Now only large groups can afford the technology. The last mindset described is that physicians are realizing economics of scale. More individuals are forming groups and more groups are forming larger groups. Top
A new census shows the number of uninsured in the country up to 47 million. It did break down the amount into those working without insurance. It also showed that of the uninsured 75% were citizens. About 60% lived in households with under $50,000. This means that 40% have incomes over that amount. About 9% are in households with income above $75,000. Approximately 20% of the children in families under the poverty level are uninsured although they qualify for insurance. Undocumented aliens had a 45% uninsured rate. What this shows is the gross numbers are ridiculous. There are many if not the majority of people who are uninsured that could be insured if they so desired. It also did not discuss how much it costs to treat the uninsured versus how much it would cost to purchase health insurance for them.
The US hospitals are finally doing what they should have done many years ago, turning patients every two hours to prevent bedsores. I remember when my mother, who had bedsores was admitted to a hospital in Southern California, the hospital social service department chastised my mother's caregivers but the hospital did not turn my mother at all the few days she was there. Now CMS has decreed that if bedsores are the cause of more hospitalization that the hospital will not be paid. The hospitals are now buying more air beds to help prevent pressure ulcers in some patients. All non moving patients are at risk for these ulcers and they can cause sepsis and death as they did in my mother's case. I might add that Christopher Reeve had pressure ulcers when he died of a cardiac arrest. Other items on the do not pay list are patient falls, UTI, vascular-catheter infections, mediastinitis following heart surgery, foreign bodies, air embolisms and blood incompatibility.
Almost half of the People's Republic of Massachusetts' hospitals have instituted a waiver of charges for their screw-ups. They will not charge for the "never" events for non-Medicare patients. The "never" events will not coincide with the Medicare events. The other question is the non charge only for that hospitalization or for all follow-up care as well.
Healthcare is based on statistics and the VA is not helping with these. The VA system is not reporting to the states their cancer statistics so state statistics are not accurate. The rationale is that the numbers are used in research not approved by the VA.
To make matter worse, the VA has been caught lying about their wait times for an appointment. The VA policy is that all vets will get an appointment within 30 day of a request. The VA told Congress that 95% of vets got the requested appointment within the time period. In fact they lied. Only 75% of vets got the appointment within the 30 day period. This is a difference of about 53,000 people. This study that showed the VA not telling the truth was from fellow fed the VA OIG.
It appears to no one's surprise that healthcare premiums will increase again next year, about 6.7%. This year premiums had increased 6.1% and inflation went up 2.6%. Wages went up this year an average of 3.7%. Since 2001 healthcare premiums have risen 78% whereas wages have increased 19% and inflation is up 17%. With these increases both employers and employees are dropping health insurance. The increases are due to hospital payments and the new technology. Physicians are being paid less. Employers will continue to shift payments to the employees via increased co-pays, premiums or deductibles.
It's hard to believe but the People's Republic of Massachusetts with their health care for everyone plan will have their policies go up more than the nation's average. The insurers are looking at a 10% increase in premiums. The citizens of the state want access to all the teaching hospitals which is more expensive than EDs.
In an interesting form of insurance, American Community Mutual of Michigan has introduced a policy with a limited cap up to $5000. If they come up with a catastrophic disease they can purchase a $5 million policy for a lump sum of about $10,000. This would need to be renewed with a new premium yearly. 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.