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PRIVATE HEALTHCARE CENTRAL
December 14, 2006
-- LAST MINUTE STORY: MEDICARE RELIEF
-- TOP STORY: HOSPITALIST PROGRAM CLARIFIED
-- RELATED STORY: HOSPITAL’S INPATIENT FINANCIAL CHALLENGES AND PROPOSED SOLUTION

 

LAST MINUTE STORY: MEDICARE RELIEF

     We held publication of this edition pending the resolution of the proposed Medicare physician payment reduction. By now you know that the lame duck Congress reversed the 5.1% overall reduction in a midnight vote. There was surprising bipartisan support. Specific reductions for imaging and other services are still coming and final numbers will be out soon. The “cliff” just gets higher each year and someday we will surely face broad reductions.


TOP STORY: HOSPITALIST PROGRAM CLARIFIED

      APPA met with the St.Johns CEO Lou Lazatan 2 weeks ago to make our position clear regarding the scope of inpatient hospitalist services we would favor and to listen the the hospital’s views. Drs. Cole, Kuhn, Peitrafesa, Taw, Terpenning and Weintraub were in attendance. We presented our strong opinion that APPA members do not want a hospitalist program imposed upon our hospital practices and do not want outside hospitalists given authority over our management of patients. Those of us who have a relationship with our own hospitalists want this to continue. We do not want our culture of private healthcare practice to be adversely impacted by any arbitrary imposition of other physicians managing our hospitalized patients.
      On these points there was no disagreement from the hospital. They recognize the importance of the private practice sector of their business portfolio and do not wish to change the image of the hospital in this regard. They have no plans to impose an outside contracted hospitalist program at this time. They intend to approach their inpatient financial losses by other means.


RELATED STORY: HOSPITAL’S INPATIENT FINANCIAL CHALLENGES AND PROPOSED SOLUTION

      APPA asked the hospital to better define their inpatient financial issues and how they thought a hospitalist program would impact these. As discussed above, they do not plan to use hospitalists specifically to this end but they did state that their problems have become very specific:
  • Length of stay for patients with medical diagnoses in oncology, pulmonary disease and infectious disease.
  • Intensity of inpatient services for problems unrelated to the admission diagnosis.
    •
      Their proposed solution is now the adoption of the recently publicized document “Clinical Duties and Responsibilities for Physicians with hospital admitting privileges.” This has been approved by all the appropriate medical staff committees and is now hospital policy. With this document in force, they hope the medical staff and medical director can identify and engage individual physicians and groups whose length of stay is much longer than colleagues for patients with the same diagnosis. The same is true for physicians who add hospital services working up outpatient problems to an inpatient admission.
      Our APPA committee agreed to help support this effort in that it is a voluntary, non-coercive policy. We will continue our dialogue on a quarterly basis.


      Private Healthcare Central is a publication of the American Private Physicians Association. Direct comments or questions to Pamela Deloney, administrator for APPA.


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