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The April 2007 Louisiana Medical News
has an article by Dr. Lawrence Huntoon of the AAPS talking about sham peer review. The article correctly states that this problem has been accentuated by the passage of HCQIA which gives permission for hospitals and physicians to get rid of physicians who are competitors without any fear of repercussions. It also mentions the new Joint Commission standard that allows hospitals and medical staffs to punish physicians for their non verbal actions. Dr. Huntoon is the editor of the Journal of the American Physicians and Surgeons, the only national physician organization attempting to correct the injustice.
In the mode of the past, Lovelace Clinic, one of the first to purchase physicians, is letting them go. Lovelace had been purchased by Ardent Health. The Clinic hopes to get a long term contract with the physician group, hopefully for the group, one that is not exclusive.
The physicians are not getting on the electronic bandwagon. There is a basic disconnect between the nerds and the physicians. The nerd policy makers are correct in that electronics would be safer or prescribing and records but they don't see patients. The physicians using electronic prescribing were able to see the prescriptions written by others in their practice but not by those outside their own practice. A major problem. There is also a major limited use of help with decision making. This was not a problem until the physician became reliant on their computer instead of their brain. The electronic prescribing did not have in many instances a formulary component. There were limited connections to pharmacies. The use of e-prescribing used alot of resources to deal with vendors, regulators and pharmacies. This cost major bucks and can only be done by groups.
Then there is the VA system. They have gone almost totally paperless but still have terrible conditions. There is no disputing the fact the EHR is a huge advance over paper but only those with large amounts of money can put it in. Look at Kaiser. This is a large group with alot of money. They have spent many millions of dollars on a system that is not operable and when and if it is will not be able to talk to any other system. Top
The hospitals of Philadelphia are reacting to the high cost of med mal by dropping OB. The latest of the 15 hospitals to drop the service in the last ten years is Chestnut Hill. The payment is low and the liability is high, a lethal combination.
In the San Diego area, Paradise Valley Hospital was purchased by Dr. Prem Reddy, an entrepreneur who has purchased other in trouble hospitals in the past. He tends to trample on physicians at the hospitals and this one is no exception. The CEO has sent out memos detailing new marching orders without any input from the medical staff. These include automatic withdrawal from monitoring after 48 hours unless the physician specifically renews an order, get approval from the medical director prior to admitting to ICU, or getting approval from a committee prior to doing certain money losing procedures. This is done to better the quality of care and I have a bridge I want to sell you. It's not that the ideas are bad, it's just the lack of discussion and the showing that patient care would not be compromised. I can see another Ventura Community Hospital in the making.
The wonderful VA system continues to have major warts. In a review the hospitals of the North East are almost as bad as Walter Reed. The physical plants are terrible and the waits for care long. I continue to believe strongly that the system is beyond repair and should be dropped. All veterans should be able to get care under Medicare at any hospital or with any physician.
As if to prove my point, the Los Angeles Times wrote an article about a probe of five deaths at the West Los Angeles VA. These happened in the past few months and in residential programs. Some may have been from illegal drugs. The VA allowed the vets to administer their own drugs even if they were known drug abusers. (See Recent Legal for another case)
The good people of Connecticut are paying alot of money for health care which includes mucho dinero for hospital administrators. In the past year eight in the state got over $1 million in salary plus perks. The highest was $1.9 million. One CEO got over $400,000 in a car allowance.
A CEO in a hospital in Tennessee believes that hospitals must hire physicians. His reasons are the high debt and the lack of entrepreneurship in the new medical graduates. They only want to work 1/3 less than their predecessors. The hospitals are also finding the general surgeons are specializing and becoming breast surgeons or colorectal surgeons to work less hours and avoid the ED roster. Top
One must give the devil his due. The People's Republic of Massachusetts has got the state's insurers to drop their premium costs by an average f 8%. The big insurers were dropped since they would not trim any premiums. The average is skewed due to the dropping of the higher priced insurers and the major drop by one plan by 18%. They did this by drastically increasing the copays and switching from a PPO to a rationing HMO plan. For most plans the drop was in the 1-2% range.
Five California counties are asking CMS to pay $2.4 Billion for underpaying physicians in their counties from 2001 to the present. If the CMS does not pay, which they won't, the case will be filed as a class action in federal court. The issue is the pay disparity between rural and urban physician for the same care. This is a 40 year old procedure and has not been updated. The physicians in the underpaid counties are not taking Medicare patients.
Duh! A study has shown that HSAs with a high deductible insurance plan is costing women more than men. Women utilize medical services more than men so they should pay more. The female lead of the study stated that "high deductible plans punish women for having breasts and uteruses and having babies". I doubt if the term "punish" would be accurate or more needed to generate publicity for the article and the researchers and researchers biases regarding health care funding.
The April 9, 2007 Wall Street Journal had a listing of CEO Compensation for all industries. The median salary for healthcare, including companies and HMOs, was $1,088,000. The median total compensation was $12,548,000.
For those of you who love Canadian style medicine, look to the north. You will find the physicians are leaving the country. The latest figures are that one of nine Canadian trained physicians are leaving their country to practice in the US. This does not include American born physicians who are trained in Canada. This is part of the large physician shortage in the country. If you look at specialists, the numbers are at about 20% are in the US. Top
In one of the largest losses of personal information, a shipment of a computer disk with the names and SSNs of 2.9 Georgians on Medicaid has been lost. Ain't electronics grand. To date there has been no information to the people affected and of course the people on Medicaid do not have the resources to monitor their credit reports.
The University of Pittsburgh Medical Center had posted on its web site scans, names, SSNs and other medical information for all to see. This has been up for about two years. When contacted by the newspaper, the Center apologized and disabled the site stating it was a mistake. The University will notify all the patients involved and pay for a years credit monitoring. The information was part of a presentation by a radiologist several years ago. The University knew about it and ordered it removed but it didn't happen.
Privacy includes the right to deny medical care. In some Kansas counties, but not Kansas City, they have a different interpretation. They believe that a patient has no right to refuse an blood alcohol exam. They feel so strongly that they are threatening the ED physicians and nurses if they don't do a BA even without a verbal warrant. Someone has to be the test case and then sue for false arrest. Another way is to sue for declaratory relief prior to any arrest. This almost sounds like the local prosecutor in the Duke case.
In Fresno, California, the Community hospital physicians declared a person brain dead when he wasn't. The hospital policy is that two physicians must declare a patient brain dead. The first one goofed and the second concurred. Fortunately, a nurse intervened and found the patient had a gag reflex. A neurosurgeon was called and agreed that the patient was not brain dead. He died much later but his organs could not be transplanted. The patient's daughter had been pushed for calling a stop to the resuscitation and allowing the harvesting of the organs. This is being denied by the harvesting group. Someone is covering their ---. This is bad for the transplant program in general. If the public loses confidence in the program, less organs will be available. 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.