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North Carolina reports the slow death of HMOs. In the past year the number of people that opted for HMO type insurance including POS dropped from 24% to 20%. Three years ago it had risen to 34%. Most of the HMOs posted profits despite the loss of membership by raising fees. This makes more companies drop the HMO methodology, which cause higher fees for those remaining. The spiral continues.
A new report on Florida HMOs show that even though membership dropped by 12%, net income increased by 19% due to double digit premium increases in four consecutive years. The hospitals are also improving their bottom lines with an average of 6.4% net increase.
A study by four researchers that are pro universal healthcare has shown that 63% of the physicians in the People's Republic of Massachusetts favor universal healthcare. These were primary care physicians. The specialists did not favor the universal care. Interestingly, in the state where HMOs rule, the physicians would give up 10% of their income for less paper work. In another study done in the state several months ago showed about 50% of physicians favored universal health care but not paid by the government.
Blue Cross and Shield of Florida has decided that they will stop covering any weight loss surgery or other treatments. They don't say the surgery doesn't work but that there are a significant amount of complications. They have no idea what the cost breakeven point for the treatment versus the lack of treatment is. All they know is they are spending more on the treatment. Other insurance companies have also stopped covering the treatments in Florida and other states. The spokesperson for United said it best "We are not in the business of medical necessity. Nobody's insurance covers everything. If you had everything, you couldn't afford it." Top
The Boston Business Journal has a story about the ills of Massachusetts. They are coming close to a perfect storm. The state is known for its high malpractice rates, low salary for those dumb enough to go into an employment situation and high overhead for those that don't. This will lead to an exodus of physicians from the People's Republic in the near future unless the people who run the Universities and major hospitals increase salaries. The problem is they can't due to the high HMO density. Until the Universities start to drop the plans the money flowing into the hospitals will continue to be dammed. Also the legislature must tackle the malpractice problem but the state is Democratic and therefore controlled by the trial lawyers. The studies show that about 7% of practicing physicians are planning on leaving the state as are over 40% of the resident physicians. In the laws of supply and demand, the demand for physicians will soon outstrip the supply and the hospitals will have become tougher on the HMO negotiations.
In an article, the Business Journal of Buffalo details the potential loss of cancer care to the people of the area due to the new Medicare laws reduction of payment for chemo drugs to physicians. It is potentially probable that the cancer therapy will shift back to whence it came. It started in the hospitals and then went to the physician offices. With the physicians now taking the hit, look for the therapy to go back to the hospital and the physicians deleting part of their staff.
Florida has issued an emergency injunction against Dr. Armando Angulo, one of the highest writers of Medicaid prescriptions, from any more addictive prescriptions. He apparently had hundreds of pre-signed prescriptions in his office for his staff to give out when he wasn't present.
Idaho's Eastern Idaho Regional Center, a for profit HCA institution, has tossed five physicians off its staff. The reason is economic credentialing. HCA, started by Bill Frist Sr., began as a physician specialty hospital. They are either investors in a specialty hospital owned by 33 investors or would not fill out a form stating if they were or were not investors. The rules were put in place 16 months ago and consisted that they would affect those who an investment or would not state AND changed their patient volume AND whether there had been a harmful change in payer mix of their patients. There was no provision for any reason outside of just going to the new hospital why the volume or mix had changed. There was no hearing on the decision and they can not be reported to the state or National Data Bank. The physicians were two plastic surgeons, two orthopedic surgeons and a OB/GYN. One of the physicians had been elected chief of staff but the hospital refused to seat him. Interestingly, the new hospital is a general hospital an not a specialty hospital according to CMS. This is beginning to sound like the Ventura Community Hospital fiasco again. There, the hospital eventually fired the CEO and Medical Director to try to woo the physicians back after they began to take their patients to a competing hospital. Is there a chance that the "big expensive hospital friendly eastern law firm" is at it again?
Another hospital in Idaho is planning to fight their medical staff on economic credentialing. Kootenai Medical Center is threatening to not allow those physicians applying for staff with competing interests to become staff members. The ruling will not affect those already on staff. The hospital has six rules regarding those on staff (1) physicians must have enough patient volume to be evaluated (vague) (2) must continue with ED back-up (3) may not redirect those who come to the ED to a different facility (4) patients must be given a choice of facilities (5) physician must work cooperatively with patients and staff (vague) and (6) physicians must maintain roughly equal payor mix at both facilities. This latter criteria is directly at odds with patient choice. This means that four of the six criteria are flawed and at least two are potentially illegal for vagueness. The policy also gives the Board the power to overrule the medical staff on matters of credentialing. Modern Physician insinuates that one of the Board members lied at a outside forum where, while running for reelection, stated he would not do economic credentialing. After being elected his spots changed and stated he never said that. Pants on fire!
See Recent Legal News this edition regarding a filed law suit on economical credentialing.
Sequoia Hospital in Redwood City, California, is planning to build a new hospital. The medical staff is planning to become a medical group (IPA). Some of the health plans are hopeful the physicians will form a group to make their contracting easier. Of course not is all roses. The new hospital will be sandwiched between two rival hospitals from the Sutter group.
Congratulations to the North Carolina Medical Board who, after receiving an increase in funds by having physicians pay more money, hired two more attorneys to police the physicians. For this money well spent they have disciplined eight more physicians in 2003 than they did in 2002, an increase of 10%. This should get them on the Ralph Nader good list. Top
The AMA has a story about the new ways trial attorneys are attacking physicians. It highlights a story about a $3.5 decision in Ohio to the family of a person who died following a heart attack. It had nothing to do with the treatment of the attack but was based on lack of enough preventative therapy. It is on appeal and hopefully will be overturned.
In Florida, a person who had a low grade pancreatic cancer is not suing for malpractice but for not referring to the hospital down the road who has a good track record of treatment with this type disease. The rationale is that if someone does a procedure more often, they should do it better. This is the following of the Leapfrog Group but debunked by Duke University.
In Ohio, with its new limit on pain and suffering, the amount of cases against physicians have dropped but those against hospitals for negligent credentialing have increased. This is so the trial attorney may get more records.
Ohio is now targeting lawyers that have filed "frivolous" malpractice lawsuits against physicians. The state medical association is collecting cases and will help the physician file suits against those attorneys that file shotgun lawsuits. The society is helping an intensivist file against a patient and the attorney for naming her in a case where she was not asked to see the patient until the patient was coding. She is asking for court costs. She also got dropped by her carrier and is asking for financial damages.
To those trial attorneys who believe the malpractice crisis is a bunch of bunk, I direct their attention to Virginia's Rappahannock General Hospital. The board has decided to shut the OB unit at the hospital because their OBs have lost their malpractice coverage. This will make for an hour drive for the women in labor. This is a terrible way to just make a point.
The Virginia physicians have made their pro forma march on the state capitol and the trial lawyers have trotted out their injured patients. A Republican state senator has introduced a $250,000 cap on non-economic damages and a reduction in attorney fees comparable to California.
In Maryland, the governor has continued to push for tort reform. One of the potential options is mandatory mediation of malpractice claims. Mediation involves a meeting of the minds and is binding only if the parties agree. With the National Practitioner Data Bank and the state wanting to punish physicians so they can raise their percentage of pelts, it is doubtful this would be successful.
In the Kansas City area a medical malpractice company, Reciprocal of America, has become insolvent. The physicians are now looking to the reinsurance companies to pay the claims. Top
In Los Angeles, Century City Hospital, one of the Tenet facilities to be sold, has reached a deal with a private specialty hospital company, Salus. This company according to their web site does not market to the patients but does bring in physicians to utilize the facilities. They will now operate the hospital as a full service hospital but who knows in the future when the moratorium is over. They have not decided whether or not to keep the ED open.
Tenet has said that none of their California hospitals that are up for sale will be closed. All who buy must agree to continue to use them as acute care centers. The question remains as to what happens if there are no buyers. Will Tenet close the hospitals? Nobody can say they can not close the hospitals including the state. They have no regulatory authority to force the hospitals to stay open.
The embattled and poorly run Drew/King hospital in LA is now having its trauma patients reduced by about 500 per year. This is being done by redrawing the line that the hospital serves. The rationale is the hospital's poor performance in the areas of residency and hospital management. This will allow more time for the hospital to focus on its core problems, the lack of oversight by the Board of Supervisors of the county.
New York hospitals have agreed to stop billing the non-insureds the full retail price for services and to curtail their abusive collection policies. This program is voluntary but may become legislated if the hospitals do not comply. The hospitals are to charge the usual fees they get from HMOs or Medicare.
The California Nurses Union has surveyed its members and found that staffing conditions have improved in 68% of the hospitals surveyed. However, only 59% were complying with the new regs. I'm truly surprised that it that high.
The worst ER problem in the country is the lack of specialist back-up. Three-fourths of the hospitals surveyed said to divert patient because of lack of specialists. About 1/2 said they had lost specialists from their panel in the past year. Fifteen percent of hospital administrators stated they would not want to go to their own ED if they were seriously injured. The survey was done at the end of 2003 by an ER management firm.
In the People's Republic of Massachusetts, a patient was given the wrong meds for his pneumonia and allowed him to become dehydrated to the point of death. There was nothing wrong with this according to the physician at the state hospital in charge of quality. However, a whistleblower sent a letter to the state and they investigated. The investigators found more wrong including one patient that fell 55 times from a drug reaction. The hospital is a Public Health hospital for society's "throwaways". The hospital now has three state and federal investigations going. Top
Under Legislation in this update I discussed the stupidity of the New York nursing board in their quest for all nurses to be four year degreed. I guess I'm not alone since Gateway Community College in the Cincinnati and Kentucky area is attempting to begin a two year associate program. They have received hundreds of calls. The first class will be 40 students of nurse wannabes. In this time of great need this makes sense. It also helps that there is a willing hospital across the street from the school. The graduates, like those from their four year school counterparts, must pass a national exam to become licensed. Top
The New York state pharmacists are not happy with the state legislature and the governor. The state has cut back on Medicaid payments to the pharmacists. The pharmacies that will close and those that remain open will both put posters in their windows telling who is responsible for the cutbacks and who should be voted out of office. The state built in an increased co-pay for the patients but the Medicaid social workers are coaching the patients how not to pay the fee.
In Denton, Texas, three Eckerd pharmacists have been fired for refusing to dispense a Plan B pill to a woman who had been raped. They did so on the basis of their religion. The company had a policy that prohibited pharmacists fro refusing to dispense based on their religious, moral or ethical beliefs. Top
California research advocates are attempting to collect enough signatures to place a proposition on the November ballot to force the California government to raise $295 million per year in tax-exempt bonds for stem cell research. If enough signatures, this will be on the ballot along side the repeal of SB2, the legislative requirement that will force business in California to either give their employees health insurance or pay into a pool. This latter bill as it currently stands is widely believed to be anti-business and will lead to a drop in employment in the state. The state is broke. While I am not in favor of the federal administration's ban on stem cell research, I am also against special interest mandated, but not funded, propositions. This idea, while noble, will eventually cost the California taxpayers $3 Billion. As Ev Dirkson, the silver tongued orator of Pekin, Illinois, once said "A billion here and a billion there and pretty soon you are talking about big money". Top
Steve Twedt of the Pittsburgh Post Gazette has another article about peer review. He discusses in the February 1 article the Association of American Physicians and Surgeons (AAPS) forming a committee to look into the peer review of physicians who "blow the whistle" on the quality of care issues in hospitals. The group will focus on the broad focus of immunity accorded under the Health Care Quality Improvement Act (HCQIA). The problem with the law is the absolute immunity afforded to those in the hospital who lie during the investigation. The Oregon Medical Association late last year voted to also look into the problem. (See Recent Legislation this Update) 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.