September 15, 2011 Recent News
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The American Journal of Infection Control reported that medical clothes were contaminated by infectious pathogens including MRSA. The study found that white coats or nurse uniforms were equally contaminated with germs. It also found that those uniforms that were changed every day had significantly fewer germs especially severe pathogens than those changed every other day. They also recommended short sleeve coats versus long sleeve ones for safety against bacteria reasons.
Just as with prostate cancer and PSA, there is a controversy with breast cancer and mammography. A Swedish study showed a 30% reduction of mortality from breast cancer with yearly mammograms. A rebuttal from Cook County Hospital said that decreased mortality is from treatment improvements and not from mammography. A rebuttal to that article by Mass General stated that since no one knows when a silent breast cancer may turn invasive mammography should be useful in taking out cancers prior to invasion. They all agree that there will be over diagnosis and unneeded biopsies but they are warranted. This is exactly the same as prostate cancer and PSA.
Illegal immigrants are between a rock and a hard place in Atlanta. They are not eligible for Medicare which covers dialysis. Grady Hospital, the hospital of last resort, discontinued their outpatient dialysis two years ago due to finances. They offered at that time to send the people back to their homelands and pay for dialysis for three months. Some took them up on the offer. Others didn't. Grady then contracted with Fresenius to do dialysis for those remaining patients for one year. The contract was then extended for one year. The contract is now up and Grady is further in the hole than prior so can not continue to contract for the services. Fresenius will not accept the Grady patients without payments so they have to get sick enough to go to the Grady ED where they can get inpatient dialysis. Grady is still stuck with the bill but it is costing them more than the contract would have.
A week later the two parties agreed that Grady would pay for dialysis after all the patients went to Grady for their dialysis. Final arrangements have not been worked out at the time of this writing.
Colorado has just woken up to Obamanomics. They have found that that under Obamacare there will be three times more people covered at a cost of nine times higher than predicted. This means that starting March 1, 2012, patients without children will get less benefits and the program will be capped at 10,000 individuals.
Ohio is now understanding the challenges of Obamacare. In their program to insure patients with pre-existing conditions they are finding it expensive and so are limiting enrollment and raising premiums. Just what Obama wanted to hear. This is one of the largest groups in the country with about 1400 enrolled. Think about what will happen in 2014 when it goes nationwide.
How to decrease health care costs? NPR says the way is to decrease high tech procedures. Anyone want to go back to x-ray over MRI for brain studies or being in the hospital for several weeks for a cataract operation? Commentators can really say stupid things. Another way to decrease costs is through ACOs. However, ACO's will have market power so will get higher reimbursements.
A study in Cleveland showed a total overall 4% improvement rate in outcomes for EMR over paper records. This improvement only cost many billions of dollars and multiple huge breaches of patient privacy.
A study I hope no one spent much money on showed that the bigger you are the better deal you get. HealthDay had an article that said the larger health plans can command lower hospital fees. That is why hospitals are joining forces to keep their fees adequate.
Kaiser Health News states that the elderly get too many medical tests. I personally do not believe it is just the elderly. Kaiser's article focused on the elderly and preventative health checks like PSA, mammography and colonoscopy. They focis on the US Preventative Health Force evaluation of tests. This Health force is made up mostly of HMO types who lose money with each test. They make judgments based on age and not quality of life. Age is no longer as important as people are living longer and with better quality of lives. If they want to talk about too many tests in general that I agree with. The new physicians are not good doctors they are good technicians and can order tests better than any physicians in the past. I have a friend who began having abdominal pains with nausea, vomiting and diarrhea soon after eating at a new place. He waited a day and did not see his provider (not a physician) but went to the hospital emergency room. They did many tests including an abdominal CT scan but forgot to examine the patient. He was happy but wondered why they didn't give him a precautionary antibiotic shot. He left the ED with no meds but was told to come back to the ED, not go to his regular provider, if the symptoms continue or recur. He has Medicare and a secondary insurer so pays nothing out of pocket but does for those purchasing Medicare secondary insurance. The hospital made good money and the ED physician gets to raise his level of visit and make more money since he had to evaluate all the blood and CT tests. If one wants to decrease the cost of healthcare this type of behavior by the patient, hospital for encouraging the testing and the physician for ordering the tests in place of an examination must be curtailed. This needs to start in medical school with going back to physical diagnosis without relying on testing unless absolutely necessary.
Cleveland.com had an interesting article questioning why there should still be a federal ban on HIV donors for transplants. There are approximately 400 HIV positive people on the list waiting for transplants. The list could be drastically shortened for all patients by allowing HIV positive people to donate organs to HIV positive recipients. There did not appear to be any downside except for the potential that the recipient may get a more virulent strain of HIV that is harder to control.
One thing that is almost never discussed in tumor boards is the cost of drugs. The cost can be astronomical for each round of therapy. Britain has NICE which states that any drug that does not give an extra year of live for under $49,000 will not be approved. No one knows what will happen under Obamacare and the new Board that may be set up. An article in Oncology Times wants to know why the drugs are so expensive. It goes through most of the known reasons and states that the final reason is because the companies can get the amount they charge. The article ends up stating costs are murky and Congress is schizophrenic on why the feds can not negotiate for drugs. Top
UnitedHealth has purchased the 2500 person Monarch Healthcare of Irvine, California. The cost is not disclosed. In California they can not purchase the physicians individually so they usually purchase the non clinical assets and enter into a long term management arrangement. United has stated that the groups it purchases will be non exclusive but Monarch already has entered into an ACO arrangement with rival WellPoint. This is the third IPA United has purchased in the Orange County area.
The New York Times has an article stating that more physicians are learning business by getting MBA degrees. There are now 65 programs in the country that allows people to get the dual degrees with more on the way. Many of the combined degreed people want to modify the way medicine is practiced and they want to do this by running a company taking more physicians out of the seeing patients venue. This is fine as long as this is what the physician/MBAs want.
Becker Hospital Review has an article about the stealth purchasing of hospitals and physicians by insurers. UnitedHealth is the most aggressive but Cigna, Humana and WellPoint are also doing it. Watch out as the insurers are already accusing physicians of writing too many brand name prescriptions and ordering too many tests.
AMGA has a study that shows physician groups of over 100 no matter who owns them are losing money per physician. The loss varies depending on the section of the country. The range is from the low of $26 in the West to $10,669 in the North.
The New York Times has an article regarding physician medical practices. The state that since revenue is or will be stagnant the way to make money is to look at the expenses. The number one expense of any office is personnel. The way to contain the most costs is to cross train employees and then cull the herd. This goes against what Obama wants but it is reality in all businesses as overhead increases and revenues can't or won't keep pace. Physicians will need to start doing things themselves instead of depending on assistants. The next thing recommended is to spread out fixed expenses either via having more physicians involved with the fixed expenses or increasing hours. By consolidating practices one can get better deals on supplies. Electronic Records are a two edged sword. The set up and maintenance are very very expensive. Is it worth it? This is something that each office must consider.
In a direct contradiction to the above article two Columbia University professors who are wonks and one of which works now for Comrade Obama state that health care costs are the direct result of higher physician fees than their brethren in socialistic countries. They forget that physicians fees are set by insurance companies and the feds for the most part.
Of course as long as hospitals want physicians to be employees they, just like sport teams, will have to pay bonuses. In the last six years physician signing bonuses have increased 30%. That is called capitalism.
The USA today has an article about how physicians find ways to treat uninsured patients. That has always been the case. It is just harder now due to the economy, the lack of true charity hospitals and the set fees on the other patients. Now what the physicians are doing are volunteering in free clinics, seeing patients for sliding scales down to nil, getting more free samples of drugs for patients who can not afford to buy them and attempting to get their colleague consultants to see the patients for a reduced fee. They are also risking med mal claims for treating patients over the phone without an office visit in order to save the patient the cost of the visit. In some ways the pre Medicaid days were better. Many county hospitals took in all patients and they were treated by interns and residents. The attending outside physicians volunteered their time to teach either at the bedside or in surgery. There were full time excellent teachers at the hospital who loved to teach the staff. They are all gone now.
Medscape has a fascinating
article on how ACOs can increase the physician med mal risk. They list
eight way ACOs increase the risk. I commend the article posted on
9/9/11for you to read if you are planning to join an ACO. You can find it
at
http://www.medscape.com/viewarticle/749258.
Top
More hospitals are acting like the airlines, nickel and dimeing the public. Instead of charging for bags and picking your seat in advance they are charging "facility fees". As hospitals purchase physician practices they believe they are entitled to charge as if the physicians are practicing in the hospital and charge a fee for the patient to use the office. It is the same office as before and the physician's rent is still considered in what he gets paid for the visit by the insurer. This price gouging is not supposed to be paid for by insurers or Medicare but in fact in some cases it is paid for by both. The money goes directly to the hospital and not to the physician practice. The best thing a person can do when they find they are charged this fee is to find another physician who does not charge the fee. Those who pay this fee more than once get what they deserve. The fees can be as high as several hundred dollars a visit at an office owned by Eisenhower Hospital in Rancho Mirage, California.
Partners Healthcare in Boston is gobbling up a Medicaid HMO to go along with its hospitals and physicians. It is purchasing for no money Neighborhood Health Plan. It makes little sense for outsiders like me as there appears to be no way to make this a profitable venture. These patients have not in the past been seen at Partners hospitals and will continue to see their regular physicians with no push to have the patients sent to Partners.
Partners has also signed an agreement with the Blues to accept $80 million less per year for three years. Those paying premiums would pay more just not as much more. If they can to withstand that kind of cut just think about what they were making.
Why do hospitals hire physicians? According to the AMA it is to make sure they have a steady stream of referrals, control of ancillaries and to increase market share. The physicians are paid more money than their private counterparts and have a better work life balance all for the hospital getting what they want. This may be looked at as a form of inurement to create a hospital from a hotel.
The Royal Liverpool Hospital in Britain ran an ad for a trainee anesthetist. In the ad the wrote "Usual rubbish about equal opportunities employer etc". Some of the people were not happy with the truth. All employers in the US and GB must not discriminate. The wording on all the ads is a mandate by the government and is in fact meaningless. 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.