The Stark self-referral laws are supposed to reduce overutilization by prohibiting physicians from sending Medicare and Medicaid patients to organizations in which the doctors have a financial interest.
But in an example of good government intentions going awry, Stark enforcement rules proposed earlier this year block market attempts to achieve the same goal.
Comments in the proposed regulations appear to prohibit hospital-based risk pools, in which hospitals share capitated payments with doctors. Such pools are growing in popularity because they reward physicians for helping to reduce inpatient costs.
Providers have asked HCFA to remedy the problem when it issues final rules, but that could take a couple of years. "When they throw in roadblocks to where the market is headed in terms of more-efficient care, it's frustrating," says attorney Lou Glaser of Gardner, Carton & Douglas in Chicago.
One delivery system recently took a direct approach: requesting an advisory opinion from HCFA on its risk pool. That system's attorney, Gerald Peters of the San Francisco firm Latham & Watkins, says the alternative, is risk pools operated by HMOs, which would divert income and control from hospital systems. "Providers need to rally around this issue," he says.
Clowning around. Maybe "Patch" Adams will get a chance to build his hospital after all.
Adams, whose real first name is Hunter, is a physician profiled by MODERN HEALTHCARE back in 1995, who often dresses up as Patch the Clown for children's shows and who uses humor in his everyday practice at the fictional-sounding Gesundheit Institute in Arlington, Va.
He also has a dream: a hospital in another unlikely place, Pocahontas, W.Va., where there would be free care, and no malpractice insurance or healthcare insurance would be necessary.
Now a movie is being made of Adams' life, which includes his hospitalization for mental illness and slights by the medical establishment because of his methods. The film stars Robin Williams as Patch, marking at least the fifth time Williams has played a doctor of some sort ("Awakenings," "Good Will Hunting," "Dead Again," "What Dreams May Come").
"He's a doctor, but he's also a clown, which some people find redundant," the always irreverent Williams says of Adams. Geez, you'd think by now Williams would like the medical profession.
"Patch Adams" is set for a Christmas opening.
The pizza shift. Ever notice the girth of your nursing and security staff expands as the day wears on?
It turns out that late-shift workers are, on average, about seven pounds heavier than those who work the day shift.
Allan Geliebter, a researcher at St. Luke's-Roosevelt Hospital Center's obesity research center in New York, led the investigation into hospital workers' dietary habits. After eliminating data on 12 subjects who reported being in poor or fair health, his team examined 85 people, including nurses, nurses' aides and security staff.
Although the full study has yet to be published, an abstract appears in the International Journal of Obesity.
There was a significant weight gain for people who work either the evening or the night shift compared with day-shift staffers. Geliebter says late-shift workers tend to grab snacks at vending machines and order takeout because the hospital cafeteria is not open for business. Add poor sleep and exercise habits to the mix, and you have a recipe for thickening waistlines.
OK, there's more. The departure of a top exec at HBO & Co. on Nov. 13 in the wake of the company's unpopular proposed acquisition by McKesson Corp. was enough to ignite a new round of skittish stock selling. That prompted HBO & Co. last week to explain the matter in more detail than the standard cover about "pursuing other opportunities."
Jay Gilbertson was a 10-year veteran at the Atlanta-based information services company, ranking just behind Chief Executive Officer Charles McCall. When his resignation was announced, "the stock acted negatively on the assumption he quit-and if he quit, that means he knows something," says healthcare analyst Seth Frank.
Four days later, HBO & Co. got the word out that it was all a career thing for Gilbertson, a young comer at 38 who suddenly wasn't in line to run the company some day. In a meeting with McCall, Gilbertson said he was committed to staying on through the acquisition and a transition period but no longer than that, says spokeswoman Monika Brown.
Gilbertson wasn't asked to leave, she adds. "He voluntarily wanted to go. The timing, I don't think, was voluntary." The stock bounced back after the explanation.
Let us in, eh? You've heard of persecuted minorities and political prisoners from the Soviet Union and the Third World seeking asylum in the United States. Some U.S. physicians decided to make a point by seeking asylum last week in Canada.
Physicians for a National Health Program organized the event at the Canadian Embassy in Washington. Although their request for asylum under Canada's single-payer healthcare system was largely symbolic, their gripes against "marketplace medicine" were real.
The group objected to the number of Americans without health insurance, which total more than 40 million, and the pressure on physicians to limit care under their contracts with HMOs. It argued that a single-payer system like Canada's offers a cost-effective alternative that will cover all Americans.
