WhiteCoat

Healthcare Update – 08-25-2010

See the satellite edition with more news briefs from around the web over at ERP’s blog – ER Stories.


When states cut funding for mental health, where do all the patients go? You guessed it. Sacramento emergency departments are getting “swamped” by mental health patients. Visits for mental health illnesses are up 30% in the past year. Inpatient psych treatment centers close inpatient beds, then tell the community to call 911 or go to the nearest emergency room. About one patient every 30 minutes are taking that advice. Yet the county wants to cut more services – requiring a federal court to block them from doing so last month.

You take away our malpractice reform, we take away your database of doctors. Illinois removes online database listing physician crime convictions, physicians who were fired by a hospital and physicians who were forced to make medical malpractice payments. The database was required as part of Illinois’ medical malpractice reform bill, but since the Illinois Supreme Court overturned malpractice reform, it also got rid of the requirement for the database. Now only disciplinary actions are listed.
The president of the Illinois Trial Lawyers Association got into the act, too, being quoted as saying “That anyone would want to keep that information from the citizens of Illinois is appalling to me. Patients deserve to know whether their doctor poses any dangers to them.” Guess you should have thought about that before striking down tort reform. By the way, does the Illinois State Bar Association have the same database? Don’t clients deserve to know whether their lawyer poses any dangers to them? Yeah. Didn’t think so.

Does the admission of guilt and early offer of compensation reduce the costs of medical malpractice? The University of Michigan believes so. Ted Frank at Point of Law has his doubts, but does note that such a policy would decrease the amount of money going into the lawyer’s hands.

5’5″ 300 lb patient falls off of operating room table because velcro straps won’t hold him. Now the hospital is getting sued.
In other news, hospital names velcro strap manufacturer and McDonalds as codefendant in case.

“Florida has the highest rate of malpractice premiums in the U.S., and Miami is the highest in the state,” says Florida Attorney General Bill McCollum during a campaign speech. “As a result, the percentage of doctors practicing is among the lowest in the nation.” Nope. No connection there.

Savings you can believe in. Health care reform expected to increase Nebraska Medicaid costs by $526 million to $766 million over the next ten years.

Do seniors come to the hospital for warm meals and companionship? Researchers enrolled 118 seniors to get coaching visits plus deliveries of food for a month after they had been discharged from the hospital. Nurses visited homes two days, seven days, 14 days and 30 days after discharge to ask patients if they’d scheduled appointments with their doctors and to make sure they were taking medications as prescribed. The number of patients readmitted within 30 days dropped from 23.3 percent to 2.7 percent. Providing hot meals alone dropped the readmit rate by almost half.

Was the closure of St. Vincent’s Hospital due to financial mismanagement? Lawsuit will find out. While heading toward more than a billion dollar budget shortfall, hospital execs paid for a $278,000 golf outing, took home salaries of $1 million, spent $17 million on management consultants and had more than $100 million in “unspecified spending” for just one year.

Here we go again. Radiologists berating clinicians for ordering too many x-ray studies.
In other news, look soon for the American College of Radiology to publish whitepapers on how to judge the amount of coronary artery occlusion by palpation of pulsations in the patient’s chest, how to interpret a radiologic study without recommending further radiologic studies, and how to get out of lawsuits alleging that not enough radiologic testing is ordered.

Kudos to ACEP President Angela Gardner who was just elected as one of the 100 Most Powerful People in Healthcare (free registration required). Barack Obama was #1, Kethleen Sebelius was #2, and Nancy Pelosi was #3.
I admit being a partisan toward ACEP, but awards like this are the reason. I don’t agree with all ACEP policies or actions, but I also think that ACEP does a great job advocating for both emergency physicians and emergency patients. As I scrolled through the Top 100 list, the only other medical society members present were people from the AMA and the American Board of Internal Medicine. No other medical specialty societies were represented.

24 Responses to “Healthcare Update – 08-25-2010”

  1. Matt says:

    ““As a result, the percentage of doctors practicing is among the lowest in the nation.””

    Florida is 27th in the nation in non-federal physicians per capita. Maybe you’ve redefined the term “lowest” though:

    http://www.statemaster.com/graph/hea_tot_non_phy_percap-total-nonfederal-physicians-per-capita

    Texas, which is touted as a tort reform “miracle” is 40th. And Florida has all you ever asked for in tort “reform”, and has for several years.

    Your lobbyist logic falls apart when confronted with the facts, WC. Sorry. But if it was said in a campaign speech, well, it must be true. . . right? Kinda like when Obama told us how much would be saved by health care “reform”.

    Oh wait – we only believe claims that agree with what we already thing, huh? Clearly what we need is another big government Republican like Mr. McCollum – there’s no way that will go badly. You should send him some campaign money.

    • doc99 says:

      Save your money, Matt. McC lost.

    • throckmorton says:

      Matt;

      A point that is often left out is access. What I mean by this is simple. If you have no insurnace, or have Medicare or Medicaid your chance of getting in to see a cardiothorasic or neurosurgeon in Dade are little to none. They are there but they will not accept you as a patient. The hospitals are having to pay just to have someone to take call to comply with mandates. They will take care of your emergency but you will have to pay to follow up out of your pocket.

      Texas is a bit more interesting. There are fewer physicians but they are seeing more patients. This is primarily due to economics. If your overhead is lower, you can afford to see more patients who pay less. If your overhead is higher ($420K) for medmal you can only afford to see those that pay more.

      • Matt says:

        So are you promising that physicians will take those money losing patients if we give them something? If not, I’m not sure the point of your first paragraph.

        $420,000 for med mal? Where? Who? On average, CMS reports that malpractice insurance is less than 5% of a physicians’ overhead. You claim that Texas physicians are seeing more patients? How can I confirm that?

        If that’s the case, why don’t we just arbitrarily cap your insurance premiums so you’ll see more patients – can you give us a dollar-patient figure?

  2. Matt says:

    And do you really think it reflects well on your profession to not inform the public if one of your colleagues has been convicted of a crime, like, say, sexual assault? Or drug use? Because you’re pissy that a jury might still get to decide how much an insurer owes?

    Be careful, some might conclude that you’re not as noble as you claim to be, and wonder why you’re throwing a fit because insurers will have to pay the full measure of damages.

    Oh, you asked about attorney sanctions in Illinois? The Illinois Supreme Court has a handy link on its homepage. It’s on the right – says “Has My Attorney been Disciplined?”:

    http://www.state.il.us/court/

  3. Matt says:

    “Nope. No connection there.”

    Not according to this study:

    http://www.nber.org/aginghealth/fall04/w10709.html

    “Nonetheless, they conclude “the arguments that state tort reforms will avert local physician shortages or lead to greater efficiencies in care are not supported by our findings.””

    But maybe the National Institute on Aging has an ax to grind we don’t know about.

    • throckmorton says:

      Matt;

      You site a “working paper”. This is very different from a “study”. This working paper didnt include even a MANOVA analysis to statistically support its conclusions.

      In looking at physician shortages and the economics of medmal the other variables must be controlled or at least understood.

      Have you ever looked to see what the number of attorneys per capita is in rural areas with high overhead? I think you will find it is better in areas with lower overhead.

      • Matt says:

        Rural areas with high overhead? Where can you find calculations of the overhead for any profession? Other than average labor costs?

        Remember though, attorneys aren’t asking for extraordinary limitations on their liability – you are.

  4. WhiteCoat says:

    Matt,
    First, do you realize you’ve wasted almost an hour of your day getting up in arms about news articles posted elsewhere on the web? Decaf, dude.
    I didn’t “define” any term. I simply posted what the Florida Attorney General stated during a campaign speech. So if an attorney makes the correlation between high malpractice premiums and low physicians per capita, we should just ignore it, I suppose.
    Next, the State of Illinois took detailed information about the docs offline. Now only physician disciplinary actions are listed – just like the attorneys. Try reading the article. Oh, and do you really think it reflects well on YOUR profession to not inform the public if one of YOUR colleagues has been convicted of a crime, like, say, sexual assault? Or drug use? Because you’re pissy that … well who knows what you’re pissy about, but you’re pissy.
    You personalize your arguments to me when it is a state agency that removed the physician databases. Good smoke and mirrors routine, though.
    Your arguments about how physician access should go up if malpractice risk goes down distort the picture. If you ask any practicing physician, malpractice insurance rates and malpractice risk will affect the willingness of a physician to practice in a certain area and the willingness of a physician to perform higher risk procedures. However, that willingness can’t be viewed in a vacuum. You’ve been told about the other factors multiple times, but keep ignoring them.
    Your argument is like going to a car dealer to trade in your low mileage perfect condition Toyota Prius for a new Ford Focus. You get 50 bucks for your trade-in and you pay $60,000 for your new Ford Focus, but you go around bragging that you got a 0.9% finance rate. Woo hoo!

  5. Matt says:

    Not up in arms at all. This is the internet – it doesn’t matter much, it’s just for fun. You gotta have cash to have an impact on this issue – I do my donating when I’m serious.

    You can find out if an attorney is convicted of a crime. Or anyone – pretty easily actually – it’s all public record.

    I don’t personalize arguments to you at all. I note your personal comments and point out the ridiculousness of them.

    My “argument” about access? Not sure what you’re talking about. There is no argument. Tort reform doesn’t affect access. That’s clear based on statistics, not anecdotes. Statistics developed by nonpartisan sources. If what you were saying was true, then there would be a correlation between physicians per capita and reform. There’s not. The only correlation between physician access is with community wealth. Lots of rich people, plenty of docs. Lots of poor people, not many.

    There is no “distortion” – those are just easily verifiable facts. If you rely on anecdotes in making your diagnosis on this issue, that’s fine. I prefer to let the data drive the opinions – not vice versa.

    • Aaron says:

      Oh, but most of the good information is behind paywalls in databases like Lexis Nexis and Westlaw.

      • Matt says:

        No, you can call your county clerk, and some states and counties keep the info online as well. Especially on sexual offenders.

      • Aaron says:

        The last time I inquired I would have had to pay 10 cents per page for proceedings in any criminal case not involving sex crimes (where the registry would be more than detailed enough).

        Tracking down a former landlord’s conviction record in another Illinois county was quite the exercise in patience. I will concede that different sorts of convictions would yield me differing levels of aversions depending of the professionals role in my life.

        A campus license to Lexis Nexis solved my particular curiosity, but for someone is a different position the chance that their public library’s reference librarian might fail to inform them of such resources is disturbing to me. Luckily I was able to consort with the same ace librarian that helped with much of my academic research.

        As much as I want to lionize the humble often underpaid librarian though the final disposition of the case is still unsettled, but the other parties previous convictions of fraud charges and my knowledge of them allowed me to enter the case with substantially more confidence.

        I might take a more extreme position in that I would like access to full case records be opened to electronic access without barrier of payment to any party. Our country’s legal system is a tremendous tool for addressing grievances, which I feel is more often just than not. The asymmetric opportunity to access information though presents an impediment to equal and fair access to the beneficial aspects to the justice system.

        While there may be greater pressure to provide access to the sins of certain classes of licensed professionals, I would like to see unimpeded access to the proceedings which lubricate our free nation’s applications of justice.

      • Matt says:

        I’m with you – what these county clerks get away with charging for information that is literally online is ridiculous. I think that government’s attempt to literally squeeze every nickel it can is ridiculous when it comes to public information.

  6. Matt says:

    But I do support you guys making ineffectual “we’ll show them!” gestures and saying “but the lawyers don’t do it”. That’s going to work really, really well.

    So far this year you guys are doing pretty piss poor politically. At what point do you change tactics? Or are you going to ride the whiny train into the ground and continue to work for your liability insurers while they ignore you?

  7. Carol says:

    It makes me very sad that people with mental illness cannot get appropriate care.

    • Fyrdoc says:

      Yeah Matt,

      I’d give you that one, except when you actually apply logic, even this falls apart. Now let’s see, I’m trying to create an on-line persona that will attract women. I know, I’ll say I’m a DOCTOR! OTOH, no one but a lawyer would ever admit to being one. So, I’m pretty sure in reality you have us beat there too.

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