In the opening days of the lawmaking session, two low-profile South Florida doctors helped funnel $70,000 to politicians and political groups, bringing their total contributions to an eye-opening $3 million in just one year. In the next two days, as lawmakers hammer out the state budget, it'll become clear if doctors Paul Zimmerman and Gerald Glass will get a return on their political investments. The two doctors are the founders of a Miramar-based company called Automated Healthcare Solutions, which sells software that workers-compensation doctors use to dispense medications in their office. But that profitable practice could be undermined by a little-debated provision slipped into an under-the-radar Senate budget bill at the behest of the insurance lobby, which says that doctors who dispense in-house are driving up the workers-compensation costs.
Nurses at St. Vincent Hospital are planning to walk off the job Friday because of stalled negotiations for a new contract at the downtown medical center, but their dispute goes beyond Worcester and reflects a disagreement between nurses' unions and hospital managers nationally about staffing. Unions in Maine, Illinois, California and Minnesota have raised complaints about staffing levels in contract negotiations recently in what hospital officials describe as a national union agenda and what nurses call concern for their patients. The issue generally boils down to ratios. Nurses' unions have argued that the way to guarantee safe staffing is to limit the number of patients handled by nurses on a unit. Hospital officials say ratios are too rigid and fail to account for complexities such as the skills of nurses assigned to particular units and the severity of patients' illnesses. The Massachusetts Hospital Association collects voluntary filings on staffing levels from hospitals and posts them on its website, but it opposes fixed ratios at hospitals.
When Karen Butler came out of sedation after oral surgery a year and a half ago, her mouth throbbed and her face was puffy. But that's not all that had changed. When she spoke, the words tumbled out in a thick and foreign accent. "I sounded like I was from Transylvania," she said.
Over the next few days, the swelling subsided and the pain vanished, but Butler's newly acquired accent did not. Though it has softened over time, she's never again spoken like a native Oregonian from Madras. To most people, she sounds British. It took months to find an explanation: foreign accent syndrome, a disorder so rare that only about 60 cases have been documented worldwide since the early 1900s. She's the first known case in Oregon, said Ted Lowenkopf, MD, medical director of the statewide Providence Stroke Center.
A crucial experiment in the future of Medicaid is playing out in Florida, where both houses of the Legislature are vying to find ways to drastically cut costs, manage care and reduce waste and fraud. The cuts and changes being sought by the Republican-led Legislature and encouraged by the new Republican governor, Rick Scott, a wealthy former hospital company executive, are deeper than those in many other states. Relying loosely on a five-year-old pilot program to shift care to H.M.O.'s, Florida lawmakers are poised to scrap the traditional model in which the state pays doctors for each service they perform. Instead, almost all of Florida's Medicaid recipients would be funneled into state-authorized, for-profit H.M.O.'s or networks run by hospitals or doctors. H.M.O.'s or networks would also manage the long-term care of the elderly, shifting them away from nursing homes and leading to an expansion of in-home care.
Not content to wait for the state budget to pass in late June, the Department of Human Services is alerting about 200,000 Medicaid recipients—many with developmental or mental disabilities—that they will be required to enroll in an HMO. Gov. Christie's administration anticipates the move will save $41 million in the budget year that begins July 1. But at least one advocacy group is worried people with complicated medical histories will be forced to find new doctors or new drugs, disrupting their care. "We understand about shared sacrifice. But the time frame is too rapid for people to really understand what's happening and to make a choice," said Beverly Roberts a director at The Arc of New Jersey. "There are concerns about people with the most complex conditions. They have to pick one HMO for all their needs."
Donald Berwick writes in Friday's Wall Street Journal, "In recent weeks, our country has continued an important conversation about our fiscal future. Washington doesn't agree on much, but we all agree that we need to reduce our deficit and debt. Reforming Medicare and reducing health-care spending is crucial to meeting that goal. But there's a right way to reform Medicare and a wrong way."