The top executives at the nation's five largest for-profit health insurance companies pulled in nearly $200 million in compensation last year — while their businesses prepared to hit ratepayers with double-digit premium increases, according to a new analysis conducted by healthcare activists. The leaders of Cigna Corp. Humana Inc. UnitedHealth Group and WellPoint Inc. each in effect received raises in 2009, the report concluded, based on an analysis of company reports filed with the Security and Exchange Commission. H. Edward Hanway, former chief executive of Philadelphia-based Cigna, topped the list of high-paid executives, thanks to a retirement package worth $110.9 million. Cigna paid Hanway and his successor, David Cordani, a total of $136.3 million last year.
A group of Catholics opposed to the sale of Caritas Christi Health Care to the private equity firm Cerberus Capital Management sent a letter to Pope Benedict XVI yesterday asking him to “call for the cessation of all negotiations with Cerberus.’’ Cerberus and Caritas representatives have said they intend to maintain the religious identity of Boston’s Catholic healthcare chain. But a stewardship agreement they negotiated with the Archdiocese of Boston would allow the hospital chain’s new owners to terminate its religious affiliation, if it became materially burdensome, in exchange for a $25 million donation to a charity chosen by the archdiocese. The Catholic church requires affiliated healthcare organizations to follow Catholic teachings, which prohibit abortion, sterilization, and euthanasia, among other procedures.
They call Missouri the “Show Me State,” but perhaps that name is better suited for Florida. Amendment 7—otherwise known as the Patient Right to Know about Adverse Medical Incidents Act—makes what would normally be considered protected peer review information discoverable to the public.
Many states have taken strides to protect peer review documentation from discoverability in an effort to promote thorough and candid peer review and encourage physicians to report near misses. Thus, if Dr. Smith makes a mistake that results in a near miss and subsequently works with the medical staff’s peer review committee to improve his performance, he doesn’t have to worry about a lawyer digging up and using the documentation of those efforts against him in the future.
However, Florida voters passed Amendment 7 in 2004 under the belief that they have the right to know if a physician is or has been involved in any type of adverse medical event. In the Sunshine State, a patient or plaintiff’s lawyer can subpoena peer review documentation regarding any physician for any reason—no holds barred.
In theory, it makes sense for patients to have the right to know if their physician has been involved in an adverse event, but Amendment 7 has caused physicians and medical staffs in hospitals to stifle peer review—the primary function of the medical staff.
As case law continues to build, it is becoming clear just how broad this amendment is. In 2008, the Florida Supreme Court ruled in Notami Hospital of Florida, Inc. v. Bowen and Florida Hospital Waterman, Inc. v. Buster that Amendment 7 trumps all other Florida laws that protect peer review privilege. In July 2010, The District Court of Appeal of Florida ruled that the defendant hospital must produce a risk management incident report, a peer review form, and other peer review documents to the plaintiff in Baldwin v. Shands. This most recent decision emphasizes just how much information patients—and their lawyers—have at their fingertips.
“There has been a move to reduce or eliminate documentation on medical review activities. A lot of peer review committees now do not take minutes of their meetings, and if they do, they are sanitized. The minutes are broad, and no patients or physicians are identified,” says George Indest, Esq., an attorney with The Health Law Firm in Altamonte Springs, FL.
However, choosing to keep only sketchy documentation of peer review activities can have a negative effect on peer review as a whole. According to Indest, inadequate documentation can result the medical staff’s inability to obtain meaningful feedback from the healthcare providers involved in specific incidents when they are unable to identify the specific incident or patient about whom feedback is sought.
They may also be unable to comply with certifying or accrediting organizations’ guidelines and requirements or unable to demonstrate compliance with state requirements for peer review activities.
Jonathan H. Burroughs, MD, MBA, FACPE, FACEP, CMSL, senior consultant with The Greeley Company, suggests that medical staffs in Florida should hire an independent attorney to act as a member of the medical staff peer review committee and keep minutes. The minutes should be sparing. “Don’t write down who said what about whom. Only document that you’ve reviewed the case and what the findings and improvement process are. In other words, you should just document the outcomes, not the discussion.”
The minutes then live with the attorney’s office, rather than with the medical staff, and are therefore protected under attorney/client privilege. It is important that the attorney who is on the peer review committee is not the attorney who regularly represents the medical staff or the attorney who regularly represents the hospital to avoid conflicts of interest.
“Be sure that attorney work product information and documentation is prepared only by your attorneys and the paralegals working directly for them and do not use routine attorney work product documents and information in your peer review activities. Otherwise they may be discoverable,” adds Indest.
Burroughs also suggests that hospitals join or create a patient safety organization under the Patient Safety and Quality Improvement Act (PSQIA). Under this act, peer review documentation that is reported to a patient safety organization is considered patient safety work product and is not discoverable or permissible at a fair hearing or in a court of law.
Although this is a reasonable strategy for protecting peer review documents, Burroughs warns that if the hospital thinks that it may take action against a physician, it can’t use patient safety work product that has already been reported to a patient safety organization against the physician during the fair hearing. “I always tell clients that they have to consider whether they are going to take professional review action at some point. If they do, they should keep the body of evidence.”
Indest adds that taking advantage of the provisions under PSQIA is a smart idea. “A federal privilege will, in most cases, take precedence over any conflicting state law—including this one.”
One big suburban cardiology practice has been snapped up by a hospital system and another is on the block, deals likely to deliver a defibrillator-like jolt to Chicago's lucrative heart-care market. Midwest Heart Specialists, the state's biggest cardiology practice, with 50 physicians blanketing the west and northwest suburbs, is in sale talks with Advocate Health Care and possibly others, sources say. And last week another cardiology group, Illinois Heart & Vascular, was acquired by Adventist Midwest Health, which will add 15 heart doctors to two of Adventist's four west suburban hospitals. Experts expect deals between cardiology groups and hospitals to multiply amid national health reforms and a crackdown on payments for heart-care services by the federal Medicare program. The feds cut payments for some heart-care tests and services earlier this year. The national reform law passed last spring dangles financial incentives for hospitals and doctors to better integrate care, making it more enticing for private-practice cardiologists to become salaried hospital employees.
Across Texas, hospital systems are scooping up physician groups and solo practitioners, scrambling to create the kinds of coordinated medical teams that federal healthcare reform puts a premium on. “Nobody really knows the right thing to do, but they’re doing something — because doing nothing is like you’re standing in the middle of the highway about to get run over,” says Norman Chenven, MD, founder and CEO of the Austin Regional Clinic. “Hospitals are approaching physicians, physicians are approaching hospitals. Nobody wants to be left standing at the station when the train leaves.” But some health care providers say the gold rush-style push is too much, too soon. They say physician groups are cashing in their chips for fear of being left behind and that hospitals are going on doctor spending sprees without knowing how — or even whether — these new medical teams will work.
Researchers report that a spinal fluid test can be 100% accurate in identifying patients with significant memory loss who are on their way to developing Alzheimer’s disease. Although there has been increasing evidence of the value of this and other tests in finding signs of Alzheimer’s, the study, which will appear Tuesday in the Archives of Neurology, shows how accurate they can be. The new result is one of a number of remarkable recent findings about Alzheimer’s. After decades when nothing much seemed to be happening, when this progressive brain disease seemed untreatable and when its diagnosis could be confirmed only at autopsy, the field has suddenly woken up.