September 15, 2012 Recent News
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Physicians are finally catching on to mandates interfering with the doctor patient relationship. This is especially true when the state mandates certain conversations with patients. The American College of Physicians has drafted a white paper on the subject and hopes that all will follow. An example of interfering is the Connecticut law requiring physicians to notify women that they have a high breast density. This means that some insurance companies may not cover certain procedures and the physician gets the blame by the patient. This is typical of legislators not thinking though all the ramifications of the laws they make.
Health insurers are seeing lower profits due to patients seeing their physicians more often. In 2012 second quarter, visits increased by 4.8%. This may be that patients have started to go more often for initial complaints that they did not go for in the past or that they are returning more often since physicians do not have the time to take care of them in one visit due to time constraints secondary to more patients or more time for EMR.
The PCI (percutaneous angioplasty) debate continues. Since the NY Times denounced HCA's for profit hospital Lawnwood Medical Center in Florida for doing inappropriate stenting procedures, there has been significant divergent opinions regarding when and who to stent. The main group representing invasive cardiologists wants physicians to belong to registries. However, the Mayo clinic study showed very good results with stenting with decrease mortality. Also the St. Jude company did a study that had to be cancelled early due to complications of the arm that had only aggressive medical therapy. Did HCA physicians do too many angioplasties? Time will tell.
The IOM has come out with a report on the amount of money wasted in Medicare and Medicaid. The total amount of $750 Billion annually is more than the Defense budget. There are several ways of attacking the problem. The IOM believes the best way is "Choosing Wisely", a program to give care but not so much as to be potentially harmful. The problem lies in the definitions. The IOM specifically recommended ten items. They are (1) improve EHR (2) revise research regs (3) increase the best clinical knowledge into care decisions (4) involve patients and their families more (5) promote community clinical partnerships (6) improve coordination (7) continuous improvement of operations (8) change payments to value and not fee for service (9) increase transparency and (10) expand commitment to a continuously learning healthcare system. Of course, like always, the devil is in the details.
Another Wednesday and another blurb from Sebelius about how good they are. This one tells how much money was saved by consumers. However, another report states that premiums have increased 4%. The HHS states that their watchdog effect on premium kept them this low. Top
The AMA states that nearly half the physicians in the country are at or near burnout. This is due to the long working hours and the lack of life work balance. The burnout is causing earlier retirements and shifting away from clinical medicine. This is especially true in front line medicine such as ED, Family Practice and Internal Medicine. They are seeing more patients with less resources and increasing pressure to cut costs. This is becoming worse with the new quality control reporting. As the physicians become burnt out they become employed and then have to face the loss of autonomy.
Another medical group in the People's Republic of Massachusetts has gone from a major Boston hospital to Steward Health Care. Hawthorn Medical, a 110 man group and the largest in New Bedford, has left Partners to go to the new rival. The decision was based not only on money due to bundled payments but also by more coordinated health care. Stewart owns the hospital where most of the medical group hospitalize their patients. Partners has no hospitals in the area. All want to keep care local and not refer to the high cost urban medical centers.
Physicians are getting antsy about the government taking a hard nose attitude against physicians who prescribe narcotics. A recent case in Los Angeles charged a physician for murder after a patient overdosed on medication she prescribed. The problem is when is it too much medication. Many of the charges made by the DAs of the country are only to increase their standing in the community and go to a higher office. There are physicians who overprescribe and prescribe for money without any legitimate reason. The question again is should this be criminal or civil. In Florida there are several physician now up on murder charges for patients overdosing. Regular physicians are becoming more afraid to prescribe opiates to patients for fear of prosecution. Patients suffer.
An article stated that OB/Gyns are still not taking high risk patients or doing some surgeries due to medical malpractice concerns. About half have made changes to their practices due to the high cost of insurance. This is better than 2009 when almost 60% had made changes. Only 43% of the patients that sue win any money but those that do may get very high awards. It also takes a toll on the physician over the course of the many years it takes for a case to come to trial. 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.