New News - Class 3
Build a "hospital within a hospital" - Expand women’s, kids’ care - Calif.
system, school
ValleyCare Health System, Pleasanton, Calif., signed a letter of intent with the
University of California at San Francisco to enhance specialized children and
women’s services located in Tri-Valley region, east of San Francisco Bay.
Between 12 and 15 UCSF physicians in specialties such as neonatology,
perinatology and pediatric pulmonary medicine will work on-site at ValleyCare.
Over the next three to five years, the two providers plan to build a “hospital within a hospital” to be named UCSF Children’s Hospital at ValleyCare, with a Level 3 neonatal intensive-care unit and governed by a board of representatives from both facilities. Both parties said a new pediatric wing could evolve over the next 10 years, though they would not put a price tag on the deal; the first of its kind for the university. In January 2008, ValleyCare’s contract with Children’s Hospital & Research Center Oakland for pediatric services ends. Children’s Oakland officials have said they are considering expanding facilities in the Tri-Valley area as well. (Modern Healthcare Daily Dose 7-13-07)
FYI: See New News, Class 5 Re: Employer Aims to Improve Workers' Care by Training Primary Care Physicians to Follow Guidelines
Pay For Performance Alert:
Is it used as camouflage for cost containment or can it be measured like preventive care and improves patient care
This year Medicare imposed for the first time a pay for performance requirement on the nation's hospitals giving them a full inflationary increase in reimbursement it they submit certain data measuring quality of care. The AMA at its annual meeting warns doctors that this concept will be applied to doctors as well in the near future as employers and insurers attempt to reign in health care costs to slow spending. Physicians say they support the initiatives that can be measured such as preventive care where for example doctors earn bonuses if higher numbers of their patients were screened for colon or breast cancer and patient improvement could be measured but doctors fear pay for performance initiatives that merely reward doctors if they keep practice expenses down in ways that shortchange patient care in which pay for performance is really used as camouflage for cost containment. (Chicago Tribune, section 3,page 3, 12-8-04)
Office Issues include:
 | Fine-tune office operations |
| Make better use of new technology |
| Deal with human resource problems effectively |
| Boost morale among staff |
| Enhance patient satisfaction |
| Increase efficiency, cost-effectiveness and quality |
| Improve billing, collection and coding procedures |
| Increase bottom line |
Hospital Using Financial Incentive to
Discourage Inappropriate Use of ER Care
For the first time in southeast
Insured American Increase ER Visits
According to a national study by the Center for
Studying Health System Change (HSC) insured Americans accounted for most of the
16 percent rise in hospital emergency room visits between 1996-97 and 2000-01.
See report at: http://www.hschange.org/CONTENT/614/
Hip Replacements
Increasing number of orthopedic surgeons are offering less invasive hip
operations in an effort to reduce the pain and lengthy recovery that hip
replacement patients typically endure. Concerns
by some include: higher rate of
complications than conventional surgery, using the term minimally invasive to
describe a few variations on standard surgery is not supported by the medical
literature, surgery is too hard for the typical orthopedic surgeon who does
fewer than 20 hip replacements a year. (Modern
Healthcare
National
Health
Museum
Per
HHS 10-7-03: The National Health
Museum to be located in Washington, D.C. will use interactive, hands-on exhibits
and cutting-edge educational techniques to inspire people of all ages to achieve
better health, while exploring the achievements of health and medical discovery.
The goal of this museum is to
educate Americans about their health and empower them to make choices that will
lead to healthier, more productive lives.
Alternative
Care Research Grants
Per
HHS NIH (10-29-03): The National
Center for Complementary and Alternative Medicine (NCCAM) has made the first two
awards in a new program to establish
Centers of Excellence for Research on complementary and alternative medicine
(CAM). The purpose of these new centers is to bring the highest level of
scientific rigor to research on
NCCAM,
a component of the National Institutes of Health (NIH), established the Centers
of Excellence to support established researchers in applying cutting-edge
technologies to explore the underlying mechanisms and potential benefits of
The
first two 5-year grants in this program, funded using the NIH Program Project
(P01) mechanism, were awarded to: (1)
better
understand the mechanisms of action of several
Per http://www.aishealth.com/MDPractice(7--24-02): Prevea Health Services in Green Bay, Wis. with 145-physician is half owned by its physicians and half by two hospitals, and has 40 specialty subgroups. Prevea uses a production-oriented pay system that accommodates its physicians by allowing those who want to maximize earnings as well as accommodating those (particularly younger physicians) who are more concerned with their work/life balance.
Ron Menaker, the group's executive vice president at Prevea, says there are four factors that largely determine each physician's pay:
| The physician's billings measured by gross charges. Gross charges are used so that the physician does not consider the patient's source of funds. |
| A percentage applied to billings. Each specialty has a percentage applicable to all physicians in the subgroup. The percentages range from about 25% to nearly 60%, with primary care specialties having the highest figures because other specialties are able to bill so much more. Also, some, but not all, specialties have tiered percentages. Thus, internal medicine uses approximately 50% for billings up to approximately $240,000, 55% for billings from that level up to perhaps $360,000, and 60% for billings above the latter amount. The tiered percentages rise with billings because in medical practices marginal costs fall as revenues increase. The basic percentage structure lets the group pay "fair and equitable" amounts that are competitive to retain and recruit good physicians in each specialty, Menaker says. Keeping PCPs and specialists together is not the purpose of this part of the pay system. |
| A uniform collection rate applied across the entire practice reduces everyone's compensation. |
| A "success factor" based on whether the entire group meets or misses its budgeted profit for the year either increases or decreases pay for all physicians. |
The results for each physician are calibrated for market competitiveness against MGMA benchmarks in light of each physician's production. Prevea does not allocate costs to individual physicians because deciding on such allocations among physicians is often contentious and unproductive, and Menaker's job includes keeping "effective cost control.
Per NIH 7/23/02: The Institute's Strategic Plan to Address Health Disparities specifically addresses how health disparities among various groups can be narrowed as the population ages, as research attempts to explain and understand why differences occur. To see the Strategic Plan and other information on aging, visit the NIA website at www.nia.nih.gov.
Nurse Information
Per Modern Healthcare (7-24-02): Three hospitals under the HCA-Corpus Christi (Texas) Medical Center umbrella and six hospitals in the Christus Spohn Health Network recently instituted a home-laundering program for nurses - including those working in invasive environments. Allegedly, this is to save time for the nurses and save money for the hospitals.
Per Statement 7-24-02 by HHS SECRETARY TOMMY G. THOMPSON: The Nurse Reinvestment Act is a fundamental priority of this Administration. About half of all registered nurses in 1980 were under the age of 40 and by 2000, less than a third were under 40. Nearly 20 percent of all licensed registered nurses have left active nursing.
Per Modern Healthcare (6-20-02: Due to high medical malpractice liability insurance, low reimbursement and growing shortage of obstetricians, another hospital, Mercy Hospital of Philadelphia, has said it will cease providing inpatient obstetrical services as of August 23. Previously, Thomas Jefferson University Hospital, Philadelphia, stopped delivering babies at its Methodist Hospital division for much of the same reasons. Mercy in west Philadelphia has run the ob program for 10 years and will now transition care to Mercy Fitzgerald Hospital, Darby.
6/3/02: Per AMedNews.Com: An article by Tyler Chin, "Patients E-Mail But They Still Keep Calling" indicates that "Electronic mail has been touted as a way to improve physician-patient communication. A study finds it can. But that doesn't mean it'll save you time." and cites a May study in the American Journal of Managed Care, "Bridging the Electronic Divide: Patient and Provider Perspectives on E-mail Communication in Primary Care".
5/31/02: Per HHS: HHS Secretary Tommy G. Thompson today released
Women's Health USA 2002, a new statistical report on the health status of
America's women that shows the disproportionate impact that certain health
conditions such as osteoporosis, asthma, diabetes and lupus have on women.
"For the first time, we're giving people a single place to go to get a
comprehensive look at the health status of women across the nation,"
Secretary Thompson said. "It reflects our ongoing commitment not only
to identifying trends in women's health but also to taking the right steps to
improve their health in the future." Compiled by HHS' Health
Resources and Services Administration (HRSA), the new report highlights current
and historical data on some of the most pressing health challenges facing women
and their families. Data are provided on health and health-related
indicators in three categories:
population characteristics, health status and health services utilization.
The report includes the most recent federal data available from HHS and the
departments of Justice and Agriculture.
| Women's life expectancy reached a new record in 2000 -- 79.5 years. |
| Nearly 87 percent of women had health insurance coverage in 2000. |
| Women's enrollment in medical school increased by 66 percent from 1980-81 to 1999-2000, while dental school enrollment rose 122 percent during the same period. |
See: http://mchb.hrsa.gov/data/women.htm
Minn. frees anesthetists of physician oversight
Minnesota with about 1,100 nurse anesthetists, is the fourth state to allow
nurse anesthetists to work without physician supervision. Gov. Jesse
Ventura notified the Centers for Medicare and Medicaid Services that Minnesota
would exercise its right to opt out of the supervision requirement.
Minnesota joins Idaho, Iowa and Nebraska in opting out. Anesthesiologists have
vehemently opposed allowing nurse anesthetists to provide anesthesia without
physician supervision, and the battle has been particularly fierce in Minnesota.
In January, a federal appeals court reinstated a $1.3 billion False Claims
Act lawsuit in which the Minnesota Association of Nurse Anesthetists
charged area anesthesiologists with defrauding Medicare of as much as $100
million by billing for procedures as “personally performed” when nurses did
the majority of the work. Source: Modern Healthcare
(4-23-02) This information also applies to Class 10, regarding Laws and
Public Policies.
5-30-02: Per advertsiement for 7th Annual Disease Management Congress: The healthcare industry is using information technology to boost efficiency and introduce new services for improved patient well-being. William Haus, Advest Inc. analyst, estimates health care organizations will spend approximately $20.5-22.5 billion on information technology in 2002 and that the market will grow at 7-10% over the next five years.
3-08-02: From HHS press release regarding , a component of the National Institutes of Health (NIH).
"A national survey revealed that in 1997 over 42 percent of
the American public used complementary and alternative
medicine, at a cost of $27 billion per year, which exceeded
out-of-pocket spending for all U.S. hospitalizations. In
1998, the Congress established the NCCAM to stimulate,
develop, and support research in CAM for the benefit of the
public. The NCCAM is an advocate for high quality science,
rigorous and relevant research, and open and objective
inquiry into which CAM practices work, which ones do not,
and why. Its overriding mission is to give the American
public reliable information about the safety and
effectiveness of CAM practices."
See: http://nccam.nih.gov
2/26/02: Careers
According to HHS press release, at the end of March, Dr. Jeffrey Koplan will step down as director of the Centers for Disease Control and Prevention. Dr. Koplan's career at the CDC began 26 years ago and he has headed the HHS agency since 1998. HHS Secretary Tommy G. Thompson called Koplan's departure, "a loss for the Department of Health and Human Services and our country...Throughout his career, Dr. Koplan has touched and improved the lives of millions of people worldwide...He sets the standard for what it means to truly be a public servant." The Secretary praised Dr. Koplan's "dedicated leadership" during last year's anthrax attacks and in preparing the nation against bioterrorism. During his tenure at the CDC, the agency also led anti-obesity initiatives,helped raise national immunization levels, and worked to prevent chronic diseases.
From online Crain's: "Acambis plc, the British vaccine maker that partnered with Deerfield-based Baxter International Inc. to replenish U.S. supplies of smallpox vaccine, is on schedule to deliver 209 million doses by the end of this year, according to Acambis CEO John Brown". Baxter will own a 20% stake in the company in June 2003. Government contracts are a lucrative business for both. The U.S. contracts, issued by Atlanta-based Centers for Disease Control and Prevention, alone are worth $771 million. The second of the two—a $428-million contract for which Baxter is a subcontractor—has profit margins of 30% to 40%, Mr. Brown says. He would not say if the Acambis would charge more, or less, for future orders of the vaccine.
1-21-02: What happens to Surgeon Generals when their term expires?
When U.S. Surgeon General David Satcher term expires in February DHHS has announced that he will join the Morehouse School of Medicine's National Center for Primary Care as its first director.
10-3-01: Consider for Risk Management:
Studies have shown that physicians communicating with their patients is one of the best protections against lawsuits by dissatisfied patients. Also, humor helps. Though, good doctors get sued, consider the study by Richard L. Kravitz, M.D., M.S.P.H. of the University of California, Davis that reviews the conceptual relationships linking patients' expectations, requests, and satisfaction with care, and approaches to measuring these expectations and requests as indicated in the AHRQ Research Activities (August, 2001).
AHRQ is the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Public Health Service. According to this particular article:
"Dr. Kravitz points out that the clinical encounter is a negotiation between patient and physician. The negotiation will be easier if physicians remember that many patients are concerned that their symptoms represent a serious illness, and patients often have their own explanations for the symptoms. Various studies have found that some expectations are so prevalent (for example, expectations of physical examination and discussion of prognosis) that physicians should incorporate these elements into most symptom-focused office visits. Also, since patients' expectations are varied and can be specific, physicians should simply ask, "Is there anything in particular you were hoping I would do today?" Since many patients have residual unmet expectations, doctors should reserve time toward the end of the visit to ask, for example, "Is there anything we didn't get to or anything else you were hoping I would cover?"
10-3-01: According to Crain's Chicago Business (October 1, 2001): the Illinois Nursing Association leaders told a state House Registration and Regulation Committee that lawmakers should mandate minimum hospital staffing levels and prevent hospitals from imposing mandatory overtime. Hospital officials said they need state funding for nurse recruiting and education to solve staffing problems.
WHAT DO YOU THINK: To Educate Patients or Not to Educate Patients?
12-03-01: According to "Kids' World View Widens at Hospital," with sub text "Doc: Technology Can Aid Healing and Open Doors," by Yilu Zhao, the Children's Hospital at Montefiore Medical Center in the Bronx, NY, serves the local Bronx children who have one of the highest incidences of asthma, malnutrition, and anemia (all illnesses associated with poverty) in the US. This hospital has an emphasis on technology and education for the patients and is built on the theory that even brief encounters in a child's life can have a life changing experience. This hospital created an intranet for the hospital so that from their bed-side computers patients will have links to 2,000 pre-selected Web sites including the American Museum of Natural History, NASA, and Ask Dr. Universe. The hospital staff uses a "smart card" which turns the computers on and off and contains the children's age and other information and the children can receive different information when they conduct searches for the same words so that for example, a 12-year-old will get a lot more information than a 5-year old to the question "what is cancer?" Upon check out of the hospital, children can get a cd-rom that contains all of the Web sites that they visited during their stay. As far as patients learning more about their medical condition, some doctors think that "doctors in general want to take the patient's minds off their illnesses" and that "it doesn't help the patients to think too much about their illnesses" and other doctors disagree and claim that "to learn about your illness is very beneficial" and that "There are a number of ways. Asthma is an illness - if you know about it, the more control you have over it."
According to "Primary Care Physician Job Satisfaction and Turnover," by Sharon Buchbinder, R.N., Ph.D. Modena Wilson, M.D., et. al. in the American Journal of Managed Care (July, 2001), more than half (55%) of a group of primary care physicians (PCPs) younger than age 45 left at least one practice between 1987 and 1991 and 20% of the group studied left two practices. This was a study based on national survey responses in 1987 and 1991 of 507 non-federally employed PCPs younger than 45 years who completed their medical training between 1982 and 1985. Two personal characteristics were particularly significant: PCPs who believed that third-party-payer influence would decrease in 5 years were 1.3 times more likely to leave than those who did not and PCPs who were not board certified were 1.3 times more likely to leave than those who were board certified. One organization factor significantly affected PCP job turnover which was the perceived overuse of standardized protocols for patient care with PCP who perceived overuse being 1.18 times more likely to leave. PCP job satisfaction was the most powerful predictor of PCP turnover with dissatisfied PCPs 2.4 times as likely to change jobs. The researches claim a need for a standardized physician hob satisfaction instrument to improve measurement and management of PCP job satisfaction and turnover.
According to the study "Long-term Effectiveness of Disseminating Quality Improvement for Depression in Primary Care" by Cathy D. Sherbourne, Ph.D. and Kenneth B. Wells, M.D., et. al. in the Archives of General Psychiatry (July, 2001), models that support integrated psychotherapy and medication-based treatment strategies in primary care have the potential for relatively long-term patient benefits.
10/10/01: The doctors say basically it's a small price to pay for protecting freedom.
From AMedNews(10/15/01): About 4,600 doctors in the Army, Navy and Air Force Reserves and National Guard were among military personnel President Bush called upon during his first address to the nation after the Sept. 11 attacks in New York and Washington, D.C. For those in rural settings, or in solo practice, or in areas where they may be the only specialist, the task can be a little more daunting as they scramble to find physicians who can fill in while they're gone. Physicians faced similar challenges during the Gulf War, said a vice president of government affairs for National Rural Health Assn. The association is trying to help physicians work out details before they get the call to leave home.
According to Department of Defense, there are 4,603 physicians in the Reserves and National Guard serving in the branches as follows:
Army Reserve: 1,738
Naval Reserve: 1,044
Air Reserve: 754
Army National Guard: 628
Air National Guard: 439
9-28-01: Re: Nurse Shortage
HHS Secretary Tommy G. Thompson today announced a series of grants and contracts totaling more than $27.4 million to increase the number of qualified nurses and the quality of nursing services across the country.
According to the article "Less Pain is a Gain With New Hip Surgery" by Karen Rivedal in the Chicago Tribune (June 12, 2001), new surgical techniques in hip-replacement operations allow patients to go home the day after surgery and speed up recovery time by months. On average patients it is claimed will spend one day in the hospital with 3 to 4 weeks to recover as compared with a 4 or 5 days hospital stay and 3 or 4 months of recovery for patients after traditional hip surgery.
For 20 years, Richard Berger at Rush-Presbytarian-St. Lukes Medical Center, said that doctors favored a single big incision for hip replacements, making cuts 12 to 18 inches long to replace the damaged bone and cartilage with a metal ball and socket prosthetic. Instead Berger developed an approach using two small holes in the proper position can do the job as well causing patients less pain after surgery and bring much quicker healing.
Berger said that getting enough practice to have skills may be difficult for doctors at smaller hospitals, likely limiting the procedure to large ones.
Berger said "we all become doctors to alleviate pain, but part of surgery involves causing a certain amount of pain to begin to heal, and it's just nice to be able to alleviate the pain that we ourselves cause."
5/23/01 Department of Health and Human Services ("DHHS") Secretary Tommy G. Thompson delayed for 180 days the effective date of the January 18 regulation on anesthesia services under Medicare that would allow certified registered nurse anesthetists ("CRNAs") to administer anesthesia to patients without a physician's supervision. The rule was published at 66 Fed. Reg. 4674 (Jan. 18, 2001), was delayed by sixty days on March 19 under the Bush administration's regulatory review plan. The notice in the May 18 Federal Register (66 Fed. Reg. 27598) says that the rule's effective date will be delayed until November 14.
5/23/01 Interesting Information About From the Telegraph to the Internet
According to a press release from the National Institutes of Health an exhibit presented by the National Library of Medicine, "The Once and Future Web: Worlds Woven by the Telegraph and Internet", will explore the telegraph and the Internet as parallel histories of "two electronic communications technologies that transformed the world". One of the themes of the exhibit is "Saved By the Wire", which looks at the medical applications of the telegraph and Internet.
The first official Morse - code telegraphic message, "What hath God wrought" was transmitted from Washington to Baltimore on May 24, 1844. Donald A.B. Lindberg, MD, Director of the National Library of Medicine states that "We live in an amazing time in terms of the speed of technology development but it's important to understand how we got here. Few people realize the telegraph's dramatic impact on commerce, war, societal mores, and health care."
According to the press release: "In 1925, an urgent telegraphic message set in motion the
famous dog-sled relay that supplied icebound Nome, Alaska with lifesaving diphtheria antitoxin. With a clattering of
telegraph keys, reporters sent news of the race to a world
suddenly transfixed by the drama in the far north. Telegrams also helped arrange the relay's complex
logistics. The hero of that expedition was Balto, lead dog of the sled
team that delivered the medicine. The team's mercy race to Nome is now memorialized in the annual
Iditarod dog-sled race. After Balto died in 1933, his body was preserved and
is now on permanent display at the Cleveland Museum of
Natural History."
Co-curator Hunter Crowther-Heyck,PhD. of the exhibit notes that the opportunities
the Internet brings are truly amazing. "But, if the history of the telegraph is any guide, making the
most of these opportunities will depend on the choices we make: will we ensure that there is wide
access, as with the telephone, or will access be limited, as with the
telegraph? Will our rights, such as freedom of speech and
the right to privacy, be protected online, or will we live
in a network of digital company towns?" The Internet, to a far greater extent than its predecessor,
has revolutionized the field of medicine, bringing such breakthroughs as telemedicine, computer-assisted surgery
and the development of massive databases of consumer-
friendly medical information.
5/18/01 Tribute to a Special Doctor:
According to the Chicago Tribune (May 18, 2001), Obituaries, "Town Doctor, Model for Rockwell Painting," Dr. Donald E. Campbell, "a small town doctor who made house calls for more than a half - century and was a model for one of Norman Rockwell's best known paintings" died at 95. Mr. Rockwell was a neighbor and patient of Dr. Campbell until the artist's death in 1978. Mr. Rockwell used Dr. Campbell as a model for the "Before the Shot" which he painted for a Saturday Evening Post magazine cover in 1958. This painting shows Dr. Campbell preparing a shot for a bare-bottomed boy as the boy suspiciously examines framed medical degrees. Dr. Campbell often took his fee in vegetables, venison or cord wood instead of his usual fee of $2 for an office visit ad $3 for a home visit starting in 1939 after graduating from what is now Brandeis University. He did his own laboratory work and developed his own x-rays between examinations in his cluttered office and kept on making house calls until he retired on his 83rd birthday. Before the town had an ambulance squad, he was the first person called by police to accidents. According to this article, for "generations, children also brought him their sick dogs, birds and turtles for treatment."
According to Crain's Chicago Business, (April 23, 2001), page 24, "Docs See Software as Fast-Payment RX": Four of Chicago's largest physician groups are turning to technology in a bid to improve cash flow. Northwestern Medical Faculty Foundation Inc., Loyola University Physician Foundation, West Suburban health Care and Advocate Health Care's High tech Medical Park are installing software that instantly confirms a patient's insurance eligibility and the percentage of each bill covered by the insurer. This allows the groups to collect the balance from patients while they are still in the doctor's office, rather than sending bills weeks later. The insurer's portion of the payment can be received as fast as two days as compared with about a week. Most importantly, the program will enable the group to determine whether a claim is properly submitted, instead of waiting 60 to 90 days for the insurance company to reject it for insufficient documentation.
West Suburban Health Care in Oak Park submits 22,000 claims per year to medical insurers.
For now, Blue Cross Blue Shield of Illinois, which has the largest share of the local insurance market, is the only local insurer that is signed on with the software developer, Indianapolis based Real Med Corp. Real Med estimates that its software saves insurers at least 50% of the cost of administering claims.
On average insurers pay $10 to $12 to process a claim, while physicians and other providers pay $6 to $8. Blue Cross puts the savings at 5% to 10% for the average claim.
Alternative care: National Center for Complementary and Alternative Medicine
(NCCAM), a component of the National Institutes of Health (NIH) appointed Marc R. Blackman, M.D.
the first clinical director of the new Division of Intramural Research.
Starting April 16, 2001, he will oversee the activities of clinical scientists he will recruit to conduct exacting studies of the safety
and efficacy of widely used complementary and alternative medical (CAM) practices, as well as studies of their
underlying mechanisms of action. Stephen E. Straus, M.D., is a NCCAM Director.
A native of Boston, Dr. Blackman received his undergraduate degree, summa cum laude, in 1968 from
Northeastern University in Boston, MA. He received his medical degree in 1972 from the New York University School of Medicine,
where he was inducted into the Alpha Omega Alpha Medical Honor Society. He trained in internal medicine at the
Bronx Municipal Hospital Center of the Albert Einstein College of Medicine, and then undertook clinical and
research fellowship training in endocrinology and metabolism at the National Institute for Diabetes and
Digestive and Kidney Diseases. He is board certified in internal medicine, endocrinology and
metabolism, Dr. Blackman is currently Professor of Medicine at the Johns Hopkins University School of Medicine and
Chief of the Division of Endocrinology and Metabolism at the Johns Hopkins Bayview Medical Center, where he is also
program director of the NIH-funded General Clinical Research Center.
See: http://nccam.nih.gov.
Senator Tom Harkin (D-IA), spearheaded legislation to
create NCCAM (formerly the Office of Alternative Medicine).
According to the Chicago Tribune (November 27, 2000), section 1, page 8, "Many Surfing Internet for Health Advice Report Finds," about 52 million Americans have used the Internet according to the Pew Internet and American Life Project for health related reasons such as to gain knowledge about diseases and treatments, investigate how to participate in clinical trials and find low-fat recipes. With doctor patient time decreasing to below 15 minutes, many patients are turning to the Internet, many doing so at least once a month. The report was based on surveys of more than 12,000 people. Health information seeking on the Internet (55%) outranks shopping on the Internet (47%). About 41% of Internet users polled said they used the Internet for guidance about whether they should go to a doctor, how to treat an illness or how to question a physician. About 50% said the advice found on the Internet improved how they care for themselves. Only 9% said they exchanged e-mails with their doctors and 10% said they had filled prescriptions or bought dietary supplements online. Many were concerned about privacy on the Internet and 63% opposed keeping medical records online for fear that others might see the information even with password protection.
A federal Appeals Court in Chicago decided a case, Moran and State of Illinois v. Rush Prudential HMO, Incorporated, on October 19, 2000 held that when the patient's primary care physician and HMO disagree about medical necessity of a treatment proposed by the primary care physician and an independent review by a physician reviewing the claim agrees with the primary care physician then the HMO must provide the proposed treatment. This case looks at the various issues falling under Employee Retirement Income Security Act (ERISA) and reverses the state court's opinion that state law was preempted by ERISA.
In this case Ms. Moran opted to have some complicated surgery provided by an out-of-network provider that her primary care physician agreed in a letter to the HMO would best serve the patient. However, the HMO disagreed and denied coverage based on the ground that the procedure was not "medically necessary" as defined by the plan, and stated that it would cover the standard procedure by an in-network surgeon. Ms. Moran's surgery took 14 hours and cost $94,841.27 and Ms. Moran paid for the surgery herself. The month before she had surgery, Ms. Moran made a written demand to Rush for it to comply with the HMO Act and to provide a mechanism for a review by an independent physician when the patient's primary care physician and HMO disagree about medical necessity of a treatment proposed by the primary care physician. A review by an independent physician was made and this physician determined that the surgery performed was medically necessary, however this physician proposed that a different procedure would have been less intrusive and less time consuming than the one performed. Rush's medical director concluded that the surgery performed was not "medically necessary".
Also, see: Crain's Chicago Business, "Court Rules Against Insurers" (October 23, 2000), page 2:
According to Crain's Chicago Business, August 7, 2000:
See Mayo Clinic Health Oasis at www.mayohealth.org to access current, relevant and fast information on health issues, diseases and developments. Health areas, symptoms or diseases, "ask a Mayo physician", and pertinent research links are available.
See: Petrovich v. Share Health Plan of Illinois, Inc. 188 Ill.2d 17; 719 N.E.2d 756; 241 Ill. Dec. 627 (Sept. 30, 1999).
This is a case that went to the Supreme Court of Illinois in which the court held that an HMO may be held vicariously liable for its independent-contractor physicians under both the doctrines of apparent authority and implied authority.
This case involves a patient who is required by her HMO to select a primary care physician, Dr. Kowalski, to act as her gatekeeper. The patient experiences pain and other symptoms in her mouth and other areas. Dr. Kowalski refers the plaintiff to a neurologist and an ear, nose and throat specialist, Dr. Friedman. Dr. Friedman recommended that plaintiff have a MRI or a CT scan performed on the base of her skull. Dr. Friedman reports this recommendation back to DR. Kowalski, rather than ordering the tests himself because of Dr. Kowalski's role as primary care physician. Dr. Kowalski informs plaintiff that her health plan, Share, would not allow new tests as recommended by Dr. Friedman. However, Dr. Kowalski did later order a MRI of plaintiff's brain, but it failed to image the portion recommended by Dr. Friedman. Plaintiff's pain persisted and Dr. Kowalski again referred her to Dr. Friedman who performed multiple biopsies and discovered cancer. He did surgery and plaintiff underwent radiation treatments and rehabilitation. Plaintiff sue for medical malpractice against Share, Dr. Kowalski and others. Dr. Friedman was not named as a party defendant. The plaintiff died during the pendency of the appeal.
This case also looks into some issues with the quality assurance techniques used by Share so as to negate the independent contractor issue claimed by Share in reference to Dr. Kowalski. The defendant, Share, claims that because the quality assurance program is retroactive in nature, after the fact, that there is no control over the Doctor's actions. The Plaintiff claims that by having a referral system in which a patient must be referred by a primary care physician to a specialist is evidence of Share's control.
This court held that all the facts and circumstances in this case raise the reasonable inference that "Share exerted such sufficient control over Drs. Kowalski and Friedman so as to negate their status as independent contractors." Accordingly, the case was remanded to circuit court for further proceedings.
It is interesting to note that the Illinois State Medical Society, a physicians group filed an amicus curiae (friend of the court) brief in support of the plaintiff, as did the Illinois Trial Lawyers Association. Also, it is interesting to note that though the primary care physician did get sued, the specialist, Dr. Friedman, was not named as a defendant in the case.
This case looks at the issue of primary care physicians (PCPs) as gatekeepers and the role of HMOs who claim that such PCPs are independent contractors of the HMO as compared to employees. Essentially, this is a case where the HMO is saying: we only pay for healthcare, we do not render the care; we do not employ doctors, we only contract with them. The court essentially is saying that because the HMO had so many controls over the doctors involved in this case, and for other reasons including the information given to people covered by the HMO and these peoples understanding and perceptions (such as the doctor seemed like an employee of Share) that for the earlier court (circuit court) to have granted summary judgment on these issues without hearing the case, claiming there is no question of fact, was error.
Consider patients accessing medical information on the internet:
See: HHS Press Release issued on November 9, 2000 regarding "NIH
Project to Link Local Native Americans to Medical Information on the Web".
This press release states that the National Library of Medicine and the National
Institutes of Health Office of the Director are " installing a fully equipped computer laboratory with eight computers
and high-speed Internet access in the American Indian Cultural Center in Waldorf, Maryland. The Federal
commitment includes all hardware, software, Internet connectivity, and training."
According to this press release there are about 8,000 members of the Piscataway Indian Tribe that live in southern Maryland and most do not have home computers. Health problems in this population include high blood pressure and diabetes. The acting NIH deputy director states that "This facility is an important step in reducing health disparities and in improving the health status of an at-risk population by providing information".
This press release begins by stating that there are some such as the elderly, the poor, rural populations, and other minorities such as Native Americans that are "left out of the digital revolution" and how this is going to change for this particular Indian community in suburban Washington, D.C.
Per
Modern Healthcare (6-18-02): The
Healthcare Financial Management Association (HFMA) will form a task force with
technology vendors and other healthcare industry and regulatory representatives
to develop new guidelines for its patient-friendly billing project.
The HFMA and the Medical Group Management Association also will make
efforts to improve physician billing.
McKesson Corp.,
Per Modern Healthcare (6-18-02): The June 4 issue of Annals of Internal Medicine published the first of eight detailed reports on real-life medical errors inspired in part by the Institute of Medicine’s 1999 study, “To Err is Human” which indicated that between 44,000 and 98,000 patients die each year as a result of medical errors. The journal asked doctors to disclose their own medical errors with the promise of anonymity. The cases were analyzed and evaluated by outside sources in an attempt to educate health professionals with the goal to prevent future medical errors by showing how easily they can occur. In this particular article, "The Wrong Patient", by M.R. Chassin and E.C. Becher, indicates that institutions are underreporting invasive procedures on the wrong patient.