Remember the Pentagon's $600 toilet seat? Now it seems HCFA is trying to match its fellow federal agency-with the 22-cent Kleenex.
That's the value HCFA officials, apparently by mistake, put on facial tissues as they tried to estimate physician's practice expenses for treating Medicare beneficiaries.
Complying with a 1994 law, HCFA is developing a new schedule for reimbursing physicians for such costs as rent, utilities, staff, supplies and equipment that are attributable to serving Medicare beneficiaries. But in its calculations, some errors have shown up.
Terrence Kay, director of HCFA's practitioner and ambulatory-care division, says the agency will discount facial tissues in its final rule on physician practice expenses. But he added the inflated tissue prices would not have led to higher reimbursement for any particular services because it would have been a minuscule part of the fee calculation.
At least one other mistake-high prices for disinfectants-has been identified, Kay says. Others could be found because of the amount of data that was collected to calculate the practice expenses.
All the previous calculations, however, may be moot. Congress is likely to call on HCFA to delay the scheduled implementation of the new formula until at least 1999, and it could require HCFA to conduct further research to develop a new practice-expense compensation schedule.
You say probation, I say suspension...The Florida Board of Medicine was in no mood to split hairs over terminology when it voted last month to suspend embattled ophthalmologist James Desnick from practicing medicine in the state (July 14, p. 5).
In Illinois, Desnick is in the final three years of a five-year probation, which settled charges of malpractice and allegations of advertising and marketing abuses. In the first two years, he agreed to refrain from practicing medicine.
At the hearing, Stephen Ballinger, his attorney, argued against suspending Desnick's Florida license, alleging the Illinois action wasn't technically a suspension. But Board Chairman Edward Dauer, M.D., wasn't buying it.
"Mr. Ballinger, I'll remind you, you don't call it a suspension, but when the state says . . . you can't practice for two years, I don't care what you call it, that's a suspension," Dauer said. Florida's action is based on the Illinois probation.
When Ballinger persisted, Allen R. Grossman, counsel to the board, rebuked him, too:
"As this board has said on repeated occasions, they don't like to take care of other people's dirty laundry and dirty work," Grossman explained. "And if Illinois is willing to watch this doctor on probation, that's their problem. But this board shouldn't have to deal with it," he said.
The matter may not be over, though. Desnick says his attorneys have obtained an order to stay the Florida suspension.
Healthcare, not junk, bonds.Former junk-bond king Michael Milken hasn't stopped dreaming up new money-making schemes.
At Montgomery Securities' healthcare conference in New York last week, the 51-year-old ex-convict, who served time for securities fraud, proposed new ways of funding his pet cause, prostate cancer research, as well as financing possible cures to other life-threatening diseases. Milken suffers from prostate cancer.
"In cancer, I am hoping to propose the concept of war bonds," Milken says. The former titan of Wall Street suggests the government issue bonds dedicated to healthcare causes like the bonds Americans purchased during World War II.
He also proposes increasing the life of patents for companies' medical discoveries in exchange for an agreement that they invest more in certain diseases.
To draw pension money into small-capitalization biotechnology and medical instrumentation companies, Milken says financial firms should create index funds and index futures, enabling investors to bet on an industry instead of individual companies.
Milken says his prostate cancer venture, Cap Cure, raised more than $50 million over the last four years. His campaign at baseball parks across the country netted $6 million over Father's Day weekend.
Organized compliance.Starley Carr has proved that a guy who knows how to handle mobsters can make it in the healthcare business.
For 28 years, Carr, 55, was a special agent at the FBI, working on foreign counterintelligence, organized crime and general crime; he also taught police survival techniques at the FBI's Quantico, Va., training facility and at rural police departments in the Southeast. He's now vice president of corporate compliance at Principal Hospital Co., Brentwood, Tenn.
Carr is making sure Principal's hospitals-usually set in rural areas-are free of fraud and abuse. It's a new program for the company, so Carr is setting all the rules and regulations.
Carr says teaching hospital employees how to abide by the rules is kind of like teaching officers at rural police departments and smaller FBI offices.
"It was always the smaller police departments that needed the attention," Carr says. "The smaller ones fall through the cracks and need management and attention."
Show them the money.Washington University in St. Louis operates one of the premier medical schools in the Midwest. It's certainly got to be one of the most lucrative, if you're on the teaching faculty, that is.
The St. Louis Business Journal recently ran a short portrait of the university, including a list of its five highest-paid employees as reported on its IRS tax filing for 1996. Surprise! The five top earners are not only professors at the medical school, they are all professors of surgery. They are Nicholas Kouchoukos, who earned $759,956; James Cox, $756,291; Hendrick Barner, $643,849; Joel Cooper, $633,196; and Richard Gelberman, $590,305.
Such salaries are notable given that BJC Health System, Washington University's neighbor in St. Louis, has been having a hard time integrating the medical school's faculty practice into its system. With a payroll like that, we start to understand why.