New News for Class 6
7-15-07: Health Alliance of Greater Cincinnati eliminated the job of chief medical officer
Sources claim Health Alliance of Greater Cincinnati has eliminated the job of chief medical officer as part of an effort to cut spending by $40 million annually in the wake of an April court ruling that allowed three alliance hospitals to exit the system.
Reuven Pasternak became the alliance’s first CMO in September 2005 and is said to step down July 15. Most if not all quality and clinical efforts previously overseen by the CMO will shift to individual hospitals due to the reorganization. Also, the alliance’s emergency medicine service-line vice president, will step down Aug. 10 as the emergency department management will shift from the alliance to its remaining hospitals. Health Alliance reported income of $90.2 million off revenue of $1.4 billion for the fiscal year ended June 30, 2006. Health Alliance appealed the April 16 ruling that cleared the pullout of 470-bed Christ Hospital, Cincinnati, 217-bed St. Luke Hospital East, Fort Thomas, Ky., and 177-bed St. Luke Hospital West, Florence, Ky. (Modern Healthcare Daily Dose, 7-13-07)
9-24-03: Per AIS Physician Management: To pass the fraud and abuse smell test have adequate documentation to link pay to a physician's performance not his or her star quality and document the medical director's duties and time spent fulfilling them. According to a survey of 225 hospitals some hospitals do not adhere to the basic compliance tenets for medical director agreements.
The following is excerpted from the article indicating criteria used by one health system to ensure its medical-director agreements are in compliance:
 | The agreements must be in writing and have a term of at least one year; |
| Compensation must be set in advance and be at a stated amount (a flat fee, not a percentage, provided that bonuses may be based on objective verifiable standards subject to a stated cap); |
| Written documentation should support the reasonableness of the total compensation package (including benefits, if any) and must be included in the file; |
| Compensation must be based on the value of medical-directorship services provided as opposed to the fees the physician could have charged patients during the hours he or she was providing medical-director services. Written documentation should include ranges of pay in the market for medical directors in similar specialties; |
| Medical-director agreements must be awarded on the basis of experience, quality, reputation, availability, accessibility, and other appropriate factors (not the amount of referrals to the hospital or the number of ancillary services ordered by the physician); |
| The agreement may not in any way be based on or pay compensation for referrals; |
| The agreement must clearly set forth all of the duties and responsibilities of the physician in his or her capacity as a medical director; |
| The services performed by the physician must be necessary to promote a legitimate business or charitable need; |
| The terms of the agreement must, in the aggregate, be commercially reasonable (i.e., not more favorable to the physician than those commonly found in the market); |
| The services to be performed by the physician can't promote any activity that violates state or federal law; |
| The agreement must provide the minimum number of hours per month the physician is required to expend with respect to his or her medical director duties; and |
| The agreement must require that the physician provide time cards and/or other documentation of the hours spent during the pay period as well as a general description of the duties and activities performed during those hours. |
Longstanding agreements may pose risk of fraud and abuse and/or self referral liability. The survey found 83% of hospitals surveyed have written agreements governing their medical directorships however only 57% review them annually.
For more information - See: http://www.aishealth.com/MDPractice/092403.html#story3
10-21-02: Per Modern Healthcare: Richard Sabo, M.D., age 62, a private-practice general surgeon at 70-bed Bozeman (Mont.) Deaconess Hospital, has become the 83rd president of the American College of Surgeons, Chicago. Dr. Sabo is one of the first practicing surgeons from a rural area to lead the 65,000-member organization. He said he believes the college should set standards for training surgeons to use the latest technology.
7/22/02: Cigna Healthcare has named Jeffrey Kang, M.D. senior vice president and medical director. Kang was Centers for Medicare and Medicaid Services (CMS) chief clinical officer and director of the agency's office for clinical standards and quality.
Per Modern Healthcare (7-15-02): In 2001 top physician executives at hospital systems slightly out-earned CEOs according to Witt/Kieffer, Oakbrook, Illinois, an executive search firm. The compensation averages, reflects 408 senior placements at healthcare organizations last year. Physician executives at systems earned an average base salary of $278,172 and an average bonus of 21% in 2001. CEOs at the system level earned an average base salary of $275,000 with a 22% bonus, while their counterparts at the hospital level received an average base salary of $232,552 with a 19% bonus. Women executives placed by Witt/Kieffer recorded a 9% increase in average compensation to $190,455 in 2001; male CEOs saw their average compensation fall 0.2% to $222,564. Women made up 38% of all Witt/Kieffer placements in 2001, compared with 34% in 2000.
12/3/01: Per Crain's Chicago Business "AMA's New Executive Planning to Diagnose, Treat Ailing Group," Michael D. Maves is the American Medical Assn.'s new executive vice-president and CEO to deal with declining membership (the AMA, a 154 year old organization, in the year 2000, membership was down 3,338 from the year 1999 to 290,357 members) at a time "when doctors say the association has lost sight of their concerns. Dr. Maves, 53 year old otolaryngologist, starts Jan. 15 planning to: (1) increase AMA's role in fighting bio-terrorism, providing doctors with educational materials on smallpox, anthrax and other diseases; (2) promote AMA's role in advocacy efforts; (3) promote the AMA's publishing business and education and ethics operations. Dr. Maves has an MBA and is currently president of the Washington, D.C. based Consumer Healthcare Products Assn. He claims that he he will handle the AMA membership decline by "listen to what is troubling (physicians)" and concey that the organizztion "represents true values to them".
12/6/01 FYI: According to the National Institute of Allergy and Infectious Diseases (NIAID) press release - high-priority, "Category A" biological diseases as defined by the Centers for Disease Control and Prevention (CDC) are anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fevers.
A case to follow that is helpful to physicians and patients is the Musette Batas and Nancy T. Vogel v. The Prudential Co. of America case in which the court, New York Appellate Division, 1st Dept., held in a 5-0 decision in March, 2001 that a physician is to decide what is "medically necessary" and not a consulting book. In this case, Musette Batas and Nancy T. Vogel filed the lawsuit alleging that Prudential compromised their care with the way it decided what constituted medically necessary treatment. In 1996, Bata was 6 months pregnant and had Crohn's disease. Prudential authorized a 1-day hospital stay. Her PCP asked for a longer stay but a Prudential "concurrent review nurse" looked at Batas' chart and said it was not medically necessary. According to court documents, the nurse never consulted with the physician or saw the patient. Bates went to the emergency department 10 days later with fever and pain. A physician sought approval for exploratory surgery and 3 days later the doctor still hadn't heard back and Batas' intestine burst. Four days after emergency surgery, in which part of Batas' colon was removed a Prudential nurse told Batas' physician she had to be discharged, the physician refused. The nurse based her decision on reviewing Batas' chart and consulting Milliman & Robertson Care Guidelines. Based on that, the nurse said Prudential would not pay for any more hospital stay because it was not medically necessary. Batas left the hospital because she could not afford to pay for the care herself.
Vogel's experience was similar in that Vogel's physician wanted at least a 96 hour stay in the hospital to recover after a total abdominal hysterectomy to remove two tumors that weighed more than 31/2 pounds. A Prudential nurse using Milliman & Robertson determined that only 48 hours was medically necessary. Milliman & Robertson itself admits that its guidelines are not based on prevailing medical opinion, but are goals that predict what should happen in the best cases with patients free of any complications and that Prudential and others are mechanically using the guidelines to determine the necessity and appropriateness of medical treatment which is a practice that endangers public health.
A Different Kind of Physician Executive
9/27/01: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) announced that William E. Jacott, M.D., will head up a new Board of Commissioners initiative to strengthen Joint Commission relationships with the physician community. The initiative is the product of recent Board strategic planning activities that have defined effective physician engagement as a critical success factor in the achievement of future Joint Commission goals.