Doctors Sue Hospitals to Protect Patients; A University Buys Insurance that Doesn’t Protect Students; What Gay Marriage Laws Mean for Gay Coverage . . . . and More

The newest Health Wonk Review has been posted. This time around, Colorado Health Insurance Insider’s Louise Norris is the host, and it’s an excellent read.

A few highlights:

                                 Doctors Sue Hospitals, Protect Patients

Over at Healthcare Renewal, Roy Poses digs into how doctors are pushing back against hopsitals who put profits above everything else. His article describes two recent lawsuits filed by physician groups alleging that the hospital systems they worked for were sacrificing patient welfare in the name of profit. 

As Louise observes, “the details are sickening to read:  One hospital group encouraged its docs to exaggerate the severity of patient conditions and needlessly admit patients from the ER to hospital beds in order to bill more for their treatment.  Another hospital group that owns three hospitals and also partially owns an ambulance company was making patient transfers (using their own ambulance company despite slower response times) a top priority – to the extent that a doctor’s transfer rate was a factor in bonuses and performance reviews.  An admin email stated that “the performance we are looking for are transfers.”  Wow.  Transfers just for the sake of racking up revenue – patient welfare had nothing to do with it, and was likely compromised when the slower ambulance company was used in cases where the transfer was actually warranted.”

I’m just skimming the surface of the corruption Roy exposes. You really should read his entire post.

Often doctors are afraid to stand up to greedy hospital administrators.  But by banding together, physician groups can stand up for patients.

I would add that, in the past  two doctors— working at separate non-profit hospitals—have told me about hospital administrators pressuring physicians to admit ER patients, even when they did not need to be hospitalized. This is how some hospitals “put heads on beds.” 

                 When Universities Buy Inadequate Insurance for Their Students

On his blog, Duncan Cross tells the story of the Arizona State graduate student who died because his Aetna plan (a student plan purchased through the university) capped how much the insurer would pay out over the course of a lifetime at $300,000. It also didn’t cover prescription drugs.  One might be tempted to blame the insurance company,
but as Cross points out, university was the organization responsible for choosing a health insurance plan for its students – Aetna just provided the coverage that the school requested.
Under the Affordable Care Act, this won’t happen. Insurers will not be able to cap life-time or annual pay-outs, and policies will have to cover prescription drugs.

                                        Nurse Practitioners and Satisfied Customers

Norris also comments on HealthBeat’s post on Nurse Practitioners and confides: “For years, my primary care provider was a PA at a women’s clinic in Denver – I don’t think I ever saw any of the doctors at the practice at all. The PA handled all of my well-woman care needs perfectly. And now that we’re in Northern Colorado, I go to a practice run by nurse-midwives who provide excellent well-woman care. I would say it’s been at least a decade since I’ve seen an MD, and I’m 100% satisfied with the healthcare that I receive.”

                                                            Expensive Snake Oil
At Managed Care Matters Joe Paduda zeroes in on $700 pain relief gels that at Gensco Labs has been compounding and marketing to docs who take care of workers’ comp patients. Guess what’s in the gels?

Read Louise’s entire HWR  and learn more about
– what Medicare has been doing as it gathers data from patients being treated to    determine whether the treatment is effective and evidence-based;
–  what new Gay marriage laws mean for same-sex partners who are not married/
–  online reviews of doctors;
   — price transparency in healthcare
and More !

7 thoughts on “Doctors Sue Hospitals to Protect Patients; A University Buys Insurance that Doesn’t Protect Students; What Gay Marriage Laws Mean for Gay Coverage . . . . and More

  1. I have no affection for Aetna student insurance — in fact I helped a niece in an ugly claim fight against them

    But I have asserted before, and will assert again, that if it takes more than $300,000 to care for a single patient then what we have is price gouging by drug companies and hospitals.

    If we capped drug prices for medicines which have no substitutes, that would be a start.

    If a person needs repeat hospitalizations, we should make VA hospitals available to them. And/or slash the DRG codes or whatever leads to huge hospital reimbursements.

    I turn positively British when it comes to these lifetiime limits. I am in favor of low lifetime limits on insurance policies, and then the exposure of those providers who cause those limits to be exceeded.

  2. Bob–
    If a young person has a brain tumor, it will cost more than $300,000 to care for him. This isn’t because of the cost of the medication and chemo (though I agree cancer meds are over-priced), but because he must be hospitalized for an extended period of time and will undergo one, maybe more, surgeries. Throughout this treatment, he will need palliative care. if it appears that he is not going to make it, he will need hospice care. This is all labor intensive.

    As you know,I totally agree that we need to rein in how much we spend on hosptials, doctors, devices and drugs. But you can’t do it with an axe. You need to use a scalpel.

    A $300,000 limit is one of those simple solutions to complicated problems that are alwayw, inevitably, wrong

  3. I know I am somewhat ranting here, which is not so good, but not all those days in the hospital require intensive care.
    At $1500 per day, a person could spend 100 days in the hospital and still use up only half the policy. They could have 6 surgeries at $15000 each still have money left on the policy.

    I think that hospitals are dependent on these ‘big ticket’ reimbursements for heart and cancer care to meet their own swollen budgets.

  4. Bob —

    A couple of years ago, a hospital executive told a group of investors that a kidney transplant generates about $300K of revenue at contract reimbursement rates in the NYC metro area and only requires a three day stay in the hospital. That’s revenue generation on steroids! I am glad to see annual and lifetime caps disappearing even if it raises premiums somewhat vs. what they would have been with even low seven figure lifetime caps.

  5. I found a table on the Net with the highest paid Medicare claims for Indiana for 2011.

    There were 12,000 claims with an average of $200,000 each, ranging from transplants to open heart surgery (and not a lot else).

    Projected across the nation that is a huge amount.

    It is almost like we have two worlds of health care — the office visits and lab tests that generate a great amount of debate about fees and deductibles……and then the big ticket items that actually eat up most of the budget.

    • Bob–

      But millions of people rack up the smaller charges for tests and doctors’ visits. Those charges add up to Big Money

      As a result, if you look at a pie chart of the nation’s total health care spending, you will find that
      payments to doctors or not that far behind payments to hospitals (as a percentage of the nation’s total healthhcare bill.)

      Also, most people don’t realize that payments for drugs and devices now account for about 19% of health care spending. (This includes the drugs that are administered in doctors’ office (usually chemo) or in a hospital as well as the drugs you buy retail in a pharmacy.) Meanwhile our use of devices (artitfical hips, knees, stents, etc.) and their prices have spiraled in recent years.