kaiser

Adding yet another wrinkle to the agency's complex relationship with doctors, CMS may begin profiling physicians and targeting those it deems inefficient sometime next year. Herbert Kuhn, acting deputy administrator of CMS, told a House subcommittee that the agency will have the data and computer capacity available to do the tracking as soon as mid-2008. To monitor efficiency, CMS would compare levels of tests physicians order for certain types of patients to tests ordered by other …

The California Department of Managed Health Care (DMHC) is bringing the hammer down on Blue Cross of California (BCC). The DMHC has fined BCC $1 million after finding that it systematically and illegally canceled policies held by chronically ill and pregnant policyholders. Under state law, California health plans may only cancel individual policies if a policyholder intentionally lied on an application to cover up a pre-existing medical condition. But BCC violated this standard …

A Kaiser transplant surgeon is under investigation due to allegations that he purposely hastened a patient's death in order to harvest his organs for transplants. San Luis Obispo police and the Medical Board of California are examining whether Dr. Hootan Roozrokh gave high doses of a strong painkiller to Ruben Navarro, the patient. Another surgeon--Dr. Arturo Martinez--is also under investigation.

Navarro was in a long-term care facility when he was found unresponsive and taken to …

In a suit bringing more attention to an already-hot legal battle, Blue Shield of California has been sued by a college student whose coverage was dropped after he was hospitalized. The student has asked a Los Angeles judge to issue an injunction making the health plan stop canceling policies after people get sick and submit claims, as well as reinstate his coverage. In filing his complaint, the student only adds another stone to the pile falling on health insurers in California, many of …

Taking on a very tough problem, two federal legislators have re-introduced a bill which would reward doctors who provide ED- or other emergency-related care with 10 percent Medicare pay increases. The bill also establishes a commission which would look at related issues such as overcrowding in the ED, med mal issues in providing ED-based care, and the shrinking availability of specialists willing to take call. Right now, ED physicians end up with $140,000 in uncompensated care annually, …

The California Medical Association is mad as hell, and they're not going to take it anymore. Last week, the group began a campaign to bring patients into its class action lawsuit against Blue Cross of California. The suit, originally filed by a group of individual policyholders, alleges that Blue Cross of California has engaged in a pattern of dumping policyholders after approving expensive treatments, then refusing to pay the bills for those treatments. The state hospital association has …

An article from Hospitalist Management Advisor argues that by improving the discharge process, hospitals can increase patient satisfaction. Though it's commonly believed that patients don't like short hospital stays because they feel as though they're being hurried out before they're ready, a Press Ganey survey has found that patients with shorter stays are more satisfied with their experience than those with longer hospital visits. The study identifies four areas that contribute …

The never-ending story continues: Along with yesterday's announcement that Kaiser faces a $2 million fine for its kidney transplant debacle, California HMO regulators also revealed that they are investigating whether Kaiser's north California operation regularly mishandles patient complaints. They're concerned that since the HMO overlooked such massive problems with the transplant program, their oversight may be lacking in other areas as …

> More than 100,000 uninsured workers will be unable to sign up for new subsidized health plans in Massachusetts by the nominal October 1 deadline, because there hasn't been enough time to get systems in place since the universal coverage law was passed in April. The delay bodes ill for full implementation of the law by July 1, 2007. Story

> California taxpayers …

The University of Pittsburgh Center for Biosecurity estimates that the cost of planning for an influenza pandemic could be as high as $5 billion. The American Hospital Association is citing the number in its efforts to win more flu funding from Congress for its members. The AHA told the Senate Special Committee on Aging that a typically-sized 164 bed hospital should expect to spend at least $1 million on preparations. The $5 billion estimate does not include the cost of buying mechanical …