If a new lawsuit is to be believed, a decline in the supply of primary care physicians is more than chance. It is being caused in large part from payment schedules designed to favor specialists at the expense of the doctors on the medical front lines. The issue was brought to the forefront by a group of primary care doctors based in Augusta, GA. This group, the Center for Primary Care, provides primary care to one-fourth of Augusta's population. In the suit filed with the U.S. District Court for the District of Maryland against the U.S. Department of Health and Human Services, the doctors allege that a valuation process managed by the American Medical Association is influential in setting Medicare reimbursement schedules that undervalue primary care. The AMA committee that comes up with the value is dominated by specialists, they claim. Medicare is the largest single payer in the American health care system. So when Medicare sets rates, the impact spreads throughout healthcare system.
A deputy St. Louis County medical examiner was so concerned about the patient care provided by neurosurgeon Stefan Konasiewicz that he requested an investigation to determine "if Dr. Konasiewicz is incompetent or reckless." Dr. Donald Kundel wrote to the Minnesota Board of Medical Practice in 2008, detailing cases of alleged patient harm caused by Konasiewicz, who was then a neurosurgeon at St. Luke's hospital. In the letter, the medical examiner told the board that more cases probably would be found if there was an investigation. "Based on hospital corridor conversation by physicians, it is likely these three cases are the tip of an iceberg," Kundel wrote. More than two years after Kundel's letter, in 2010, the medical board disciplined Konasiewicz for "unprofessional and unethical conduct." By then, Konasiewicz had left St. Luke's and Minnesota.
More than 20,000 registered nurses began a one-day strike Thursday at 34 Northern and Central California hospitals in what was one of the largest such labor actions in years. Hospitals across the Bay Area brought in replacement workers and remained open, though many elective surgeries were postponed. Nurses could be seen on hospital picket lines across the region, waving signs and urging passing motorists to honk and shout in support of their cause. The president of the largest labor federation in the nation joined striking nurses on a Berkeley picket line. He criticized corporate hospital leaders for what union members say are 200 proposed cutbacks by Sutter Health in employee benefits and patient services. AFL-CIO President Richard Trumka took the stage at the Alta Bates Summit Medical Center campus as the picket line swelled to about 200 nurses carrying signs and chanting "chop from the top."
Despite decades of warnings of a primary care crisis and the fact that some 60 million patients are without primary care doctors, the medical profession has continued to produce legions of specialists. When asked, most of my colleagues will point to the system that determines how medical charges are reimbursed by insurance, and how doctors in different areas of medicine are paid. Put simply, our payment system pays more for procedures performed by specialists. Specialists, therefore, have greater earning power, so more doctors choose to train to be specialists. Careers in specialties like radiology, dermatology and neurosurgery offer lifetime earnings several million dollars higher than those in primary care. It is no surprise that medical students emerging from the educational mole hole saddled with hundreds of thousands of dollars of debt choose more lucrative fields.
A severe shortage of drugs for chemotherapy, infections and other serious ailments is endangering patients and forcing hospitals to buy life-saving medications from secondary suppliers at huge markups because they can't get them any other way. An Associated Press review of industry reports and interviews with nearly two dozen experts found at least 15 deaths in the past 15 months blamed on the shortages, either because the right drug wasn't available or because of dosing errors or other problems in administering or preparing alternative medications. The shortages, mainly involving widely-used generic injected drugs that ordinarily are cheap, have been delaying surgeries and cancer treatments, leaving patients in unnecessary pain and forcing hospitals to give less effective treatments. That's resulted in complications and longer hospital stays
Gov. Pat Quinn has ordered state officials not to issue any new rulings that could deny tax-exempt status to nonprofit hospitals, saying he hopes to work with the hospital industry to find a legislative compromise. In a letter to the Illinois Hospital Association released to The Associated Press on Thursday, Quinn called for a solution that would be fair to both the hospitals and Illinois taxpayers. The letter follows the Illinois Department of Revenue's decision last month to deny tax exemptions to three hospitals, citing a 2010 Illinois Supreme Court ruling. The denials signaled that the state would get tough on hospitals it believes are operating more like businesses than charities.