• E-mail
• Print
• RSS

Hemorrhaging Dollars - If the Courts Don't Get You Congress Will

Medical Staff Affairs Monthly, June 15, 2006

Summer is fast approaching and that means many of us are suffering "death by a thousand cuts" as we brave the growing seasonal hordes of mosquitoes and black flies.  The body politic is suffering similarly by the assaults recently made on health care funding. Most of us have paid little attention to the Budget Reduction Act of 2005 -possibly because it was signed into law by President Bush in February of 2006 under circumstance which have resulted in lawsuits challenging its validity. Assuming it passes muster in the courts, it will have significant impact on most of our health care institutions. While the bill has particulars addressing everything from expanded funding for fraud and abuse investigations to provisions on specialty hospitals, its most significant impact will come from the draconian slashes in funding for Medicare and Medicaid. Medicaid will see a net reduction in funding of about 4.8 billion dollars over the next five years and 26.1 billion over the next ten. Medicare will see funding reduced by about 6.4 billion over the next five years and 22 billion over the next ten. During this same time the number of uninsured will likely keep rising, costs for hospitals and physicians will continue to grow inexorably, and the baby boomers will creep ever closer to geriatric status.  Almost every challenge we face today in health care will be exacerbated by this huge diversion of dollars away from medical treatment. Beyond funding the law touches on many other issues germane to health care providers: identification requirements for those seeking health care, reimbursement for multiple imaging procedures, and much more. A nice summary of the salient features of this legislation can be found at www.foley.com.

On a different front, many of you will remember a previous column where I wrote about the lawsuit brought by Kadlec Medical Center against a Louisiana hospital for failure to disclose important peer review/credentialing information. In this case an anesthesiologist had been discovered by Lakeview Medical Center and by the doctor's clinical partners to be diverting narcotics and using them on the job. He was fired from his practice and the hospital did not renew his privileges. Neither shared this information with Kadlec Medical Center in response to their credentialing queries. Kadlec utilized the anesthesiologist in a locum tenems capacity and he subsequently caused a young woman to enter a permanent coma as a result of negligence related to drug abuse.  On May 26 a jury in a federal district court in New Orleans awarded more than $4 million for fraud and negligent misrepresentation against Lakeview Medical Center and the Louisiana anesthesia group. Perhaps this verdict will cause institutions to have a little more spine when it comes to sharing appropriate peer review information that is so necessary to robust credentialing. William Mayo said that the "aim of medicine is to prevent disease and prolong life; the ideal of medicine is to eliminate the need of a physician".  Until we achieve this ambitious goal, we will continue to need physicians and effective credentialing processes to assure they are competent. Only the honest sharing of appropriate information will allow us to perform this duty accurately on behalf of patients everywhere.

Enjoy the start of summer!

Best Regards,

Todd Sagin, MD, JD
Vice President and Medical Director
The Greeley Company

For more information on The Greeley Company's medical staff consulting services, contact Ali Drayer, Practice Manager, by e-mail at adrayer@greeley.com or by phone at 888/749-3054, ext. 3814, or visit The Greeley Company's Web site by clicking here.

• E-mail to a Colleague
• Print
• RSS
• Archive