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Some of the hospitals in the People's Republic of Massachusetts are now catching up with the rest of the country and starting to pay physicians for taking call. The young physicians rightly see the playing field tipped toward insurance companies and they are not paying for ED coverage. The physician expects to be paid for his work. This is not true in the medical centers where they have the resident slave labor. The hospitals in this great state get paid for "uncompensated" care but the physicians do not. The hospitals will now have to share that money with the physicians.
The Louisiana physicians are not taking more new Medicare patients. This is legal since involuntary servitude went out in the mid 1850s. Congress needs to stop the mindless formulas it uses to decrease physician payments on a yearly basis and give them cost of living increases instead. In Louisiana the problem is more severe than in other states since many physicians who left during Katrina have not returned.
The physician on call issue is progressing to the hospital paying out money. They either will pay it to physicians to take call or to purchase hospitalists, Nurse Practitioners, and/or pediatric hospitalists. The hospitals will also need to pay for tele-radiology to the radiologists and neurosurgeons homes and/or having electronic ICUs. In all the days of a free ride for the hospitals is over.
The average physician now generates about $1.5 million per year for a hospital. This is down about $100,000 per physician per year from 2004. The reason is the hospital is fast becoming more obsolete with more being done in outpatient surgical centers and outpatient radiology centers. Since the biggest physician contributor to the hospital is the invasive cardiologist, the hospitals may be okay for emergency procedures but not for elective ones which will go to the new physician owned outpatient facilities.
Gee, Palm Beach County, Florida is going to get shorter in the neurosurgical arena. No Surprise! The current neurosurgeons are sparse and aging. Others are not coming to the state due to the trial attorney laws passed. They now have five less than needed. In the training programs there are only half the numbers of new physicians as compared to the number that retire yearly.
How do we love you, Kaiser? In Ventura County, California, Kaiser has taken over a HMO. Almost 50% of the patients and almost all of the physicians opted to remain non-Kaiser. The infamous Community Hospital has had a significant increase in urgent care visits since the take-over.
About 2/3 of British physicians believe medicine is a bad career. Those go against a Department of Health study that shows 73% of medical staff in acute hospitals were generally satisfied. Of course, most medicine is not practiced in acute hospitals.
An article in the L A Times tells how physicians who have left New Orleans are not coming back. The hospitals have not reopened and those that have are short of workers. This reminds my of a hospital attorney who posted on a law listserv whether to peer review physicians who left during Katrina. I hope she is now practicing a different kind of law with more understanding.
The New Jersey physicians, especially Gynecologists have had it with their state's lack of progress in the malpractice arena. They have begun using the tactic to have the patient sign a form promising not to sue for med mal prior to being seen and agree to binding arbitration instead. They also agree to a cap on pain and suffering of $250,000. Those that will not sign will not be seen. Most people sign without a problem. The trial attorneys believe the contracts will not hold up in court but they don't know. They are legal in California. The med mal insurers are pushing the contracts and insist that they are legal. It is well known that many physicians use a form asking people to agree to binding arbitration instead of court either at the time of getting insurance, such as Kaiser, or just prior to service. No sign, no see. In New Jersey, those physicians that use the forms are seeing a significant decrease in their med mal premiums. The company that is pushing the physician arbitration contracts is not a licensed insurer in New jersey and is not well capitalized. The physicians may be putting their assets at risk or have them well sheltered. Top
Kaiser has begun to spend the $3 million it agreed to pay due to its botched transplant program. It has started an advertisement for transplant promotion.
A Medicare report states that when the physician increase in reimbursement goes into effect in January, the Medicare recipients will have to pay more in co-pays. The beneficiary currently pays $96.40 per month. If the physician increase is 2% per year then by 2016, the beneficiary will be paying $162.40. Of course if the Congress puts in the 10% decrease, there will be much fewer physicians to see the increased number of patients.
The VA task force is pushing the VA for better disability actions and more screening for head injuries. I will never know why there is a shadow VA system in place. This raises expenses and makes access more difficult. Top
Several Boston hospitals have reported that they are the problem. The study showed that hospital cutting costs are directly working against patient safety. Gee, I hope not much money was spent on this profound study.
A recent article by the hospital oriented Greeley Company quoted the hospital oriented "Big Eastern Law Firm" to state that hospitals must keep on top of the Medical Staff bylaws. It intimated, but did not overtly state, that although hospitals can not have direct authority over the bylaws, the hospital must make sure the bylaws work for the hospitals. The AMA believes the bylaws must work for the medical staff and that more law suits between the hospitals and the medical staffs are inevitable. The article notes two ongoing suits currently being won by the medical staff. One is in Lawnwood Hospital in Florida where the hospital attempted to state that if there was a conflict between the hospital bylaws and the medical staff bylaws the hospital would prevail. That has been deemed unconstitutional. The other was in the Baptist case where the hospital attempted to remove six cardiologists for economic credentialing. That also failed all the way to the state Supreme Court. It is the Medical Staff, not the hospital, that must remain vigilant so their powers are not usurped.
Thirty San Jose, California, physicians are banding together to open a short stay hospital and office building. The new endeavor is called the California Center for Healthcare and Biomedical Technology, San Jose. Top
As with almost every Update I publish, another laptop or tape is stolen or missing. This time it is a laptop fro a Baltimore county health center with 6000 names, dates of birth and social security numbers. The affected people have been offered free credit checks. Isn't electronics great. 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.