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HCA medical center plans trauma center against judge's ruling Print E-mail
Written by Michael Newhouse   
Thursday, 27 October 2011 09:58


As a fiscal conservative and health care executive, sometimes I am at odds with both hats. But when it comes to the question of adding trauma centers I have firsthand experience, and the State of Florida has some very strong data against the addition of most trauma centers. Plus, their process (last I looked) seemed pretty fair. These are highly specialized centers requiring specially trained personnel with exceptional skills that are not forged in the classroom. It takes years of sleepless nights working in a trauma center to develop the temperament and necessary skills to become an effective trauma center team.

My conservative side would say that let the market determine the outcome. I love that line-don't you? It sounds so fair and as American as apple pie. In most cases, I believe that it is true for most if not all commodities. The one big exception is health care because the public ultimately ends up picking up the cost of failure in terms of dollars and lives. Still, I may even argue this is part of natural selection.  Well, if natural selection would not be influenced by the highly paid lobbyist of HCA then sure.  But who does not believe these lobbyists have not already been involved and already have several votes in their hip pocket?

Well, then what do we do about this question? If you ask me first we should treat such things as trauma centers much like we treat public utilities, and put it up for bid. Also, it's all or nothing, i.e. either do a full trauma center or nothing. Then let's see if they have belly for the investment. Please don't cherry pick at the cost of the taxpayer. We can no longer do business as usual. So, sorry HCA.  Stop making a major portion of your profits in Florida, and then taking the money off shore at further expense to our tax payers. Have a little patriotism---haven't you been watching the protest on Wall Street? It's funny how the real issues are always relegated to the back page.

-Michael Newhouse, Healthcare Executive, Miami-Dade

Reader Response October 2011 Print E-mail
Written by Various Readers   
Friday, 21 October 2011 09:33

RE:  The Legality of Online Health Care Discounts

Attached you will find a link to an interesting article titled "Are Groupon discounts for medical treatments illegal?" highlighting an important issue: Those big discounts on health care treatments offered on websites like Groupon may be illegal, medical law experts say. Not for the patients but for the medical professionals giving them.

"The law is very strict. This seems like a problem," said Michael Segal, a South Florida health-care lawyer. "I would urge [practitioners] to be very careful. You don't want to find out there's a concern after you have done it."

A number of national and local medical associations, including the Palm Beach County Medical Society last month, have warned members because the issue is still in doubt. Florida regulators said they have not discussed it. Medicare has taken no position. Nor has the American Medical Association or other medical trade groups. 

 -Bernd Wollschlaeger, MD, Miami           

See related article:
Groupon and Other Daily Deal Sites: Old Regs, New Problems

RE:  Governments and Markets

Bill Clinton had an interesting comment recently.  "All the successful economies have public/private cooperation to generate economic opportunity, provide a good education, create an environment where government and the private sector work together and advance economies" he was quoted as saying on (How to Fix the Economy, Oct. 7).  Mr. Obama and his team don't appear to appreciate the concept of partnership between government and the firms that operate in the free marketplace.  It's not as if the government doesn't mean well.   Everyone abhors pre-existing condition clauses and it is virtually unanimous that health plans ought to cover basic preventative care and ought to eliminate policy limits.   But are these ideas feasible in the marketplace?  Supply and demand determine price.  These forces are innate.  And just as the government can't order a hurricane to veer right and avoid a direct hit on Florida, it also can't dictate to the market.  

-Healthcare Economist, College Park, MD
Last Updated on Friday, 21 October 2011 09:42
Readers weigh in on entitlements, whistleblowers Print E-mail
Written by Various Readers   
Thursday, 13 October 2011 09:41


RE:  Unsustainable Entitlements

A South American friend detailed the health system and health policy in her home country.  Fact is there isn't much of a policy, a system or a plan.   This is a developing nation that embraces democracy and capitalism and is similar to the U.S. pre WW II.  The small segment of the affluent professionals has a health plan through work.  And of course the very rich just pay cash. But middle class and lower don't have a plan.  They hope and pray they won't get sick.   They may eat well, exercise, quit smoking and drink in moderation.  Or they might not.  If they get sick, they go to a doctor and pay cash for the treatment and the prescription.  They rarely go to a physician for preventive care. Disabled people and the aged are taken care of by family.  If you don't have family or your family is poor, you rely on charity.  If you have a serious medical issue, you rely on charity.  A lot of people die because the charitable pesos can only go so far. 

 My friend told me her father had died years ago.  How old was he?  Late 60's.  Why did he die?  He was old, he got sick and he died.He was seen by a PCP but no specialists cared for him.  There were no lab tests.  No diagnostic imaging was performed.  There was no diagnosis.  "Maybe it was a cancer" my friend said.  The mother died recently.  Similar story, except she was in her 70's.  She got sick, she stopped eating, and she spent a lot of time in bed.  Eventually she died. At home.  She was seen by a PCP but no specialists were called in and no tests were done.  There was no explanation for her death except the obvious:  She was old, she got sick and she died. 
In my friend's country, they spend 7.3% of GDP on healthcare.  In the U.S. it's 16%.   Please view this link which displays health care costs as a percentage of GDP in various countries.  My friend's country does a much better job of allocating scarce resources and these efficiencies deliver healthcare at less than half the cost of the U.S.  There are no overutilization issues.  There is no national debate on fraud or reform.  Free markets are efficient, government programs are not.  But free markets can be cruel.  In the U.S., the Progressives choose the high road by building a healthcare system mired in red tape, inefficiency and high costs.  Thus, a system was conceived and implemented that is bit more fair and bit less cruel.   A very, very expensive scheme that is humane and civilized. 

We face a crossroads here.  Can we elevate our health system so it can be both humane and affordable?     

-Healthcare Executive, Broward


RE:  Whistleblowers

I enjoyed Tara Pihn's recent article on the subject and wanted to share this link:
Blowing the Whistle Can Net You Big Bucks
9.21.11 - Daily Finance               

 -Healthcare Marketing Consultant, Gainesville
Last Updated on Friday, 21 October 2011 09:43
Hospital Status Quo Battles HCA Print E-mail
Written by Jeffrey Herschler   
Thursday, 13 October 2011 09:39

This headline ran in the late Sept issue of FHIweekly:

Judge Rules Against Trauma Centers
9.27.11 - News Service of Florida via

See also:

HCA medical center plans trauma center against judge's ruling
9.29.11 -Fierce Healthcare

This dispute pits HCA against some prominent hospitals in the Tampa and Jacksonville areas (Bayfront Medical Center, Tampa General, St. Joseph's and Shands).  In the article, one hospital spokesman complained the proposed new centers would result in a "...loss of approximately 1,000 patients annually, or 25 percent of... current trauma volume.''

Meanwhile, HCA argues that Jacksonville and Tampa Bay hospitals are attempting to "monopolize the delivery of trauma services through restraint of trade or commerce."

Please weigh in on this issue by submitting a READER RESONSE.

Last Updated on Thursday, 13 October 2011 09:56
Court Grants Preliminary Injunction Against Physician Gag Law Print E-mail
Written by Bernd Wollschlaeger, MD   
Tuesday, 27 September 2011 16:19

Since Taking Effect, Unconstitutional Gag Law Had Chilled Speech by Florida Doctors

 The Florida chapters of three national medical organizations, along with six physicians, applauded the decision of a federal district judge to immediately block enforcement of the new state law that bars healthcare professionals from asking patients if they own guns and have them stored properly.   These questions are a key element in the practice of preventive medicine.

The groups, along with individual doctors, had asked Judge Marcia Cooke of the U.S. District Court for the Southern District, Miami Division to issue a preliminary injunction because the new law has already curtailed the First Amendment rights of physicians across the state to speak with their patients about gun safety.  A preliminary injunction is an order that prevents a party from pursuing a particular course of conduct until a case has been decided.  To grant a preliminary injunction, the court must find that plaintiffs have a substantial likelihood of success on the merits of the case.

Lisa A. Cosgrove, M.D., FAAP, President of the Florida Chapter of the American Academy of Pediatrics (Florida Pediatric Society) said: "Pediatricians simply want to do what they do best: protect children.  We hope that now we will be able to get back to working with parents to maintain their guns, pools and poisons to keep kids safe."

Dennis Mayeaux, MD, Chair, Board of Directors, Florida Academy of Family Physicians said:  "The impact of this law has already caused serious rifts in physician-patient relationships.  Casual conversations with patients often bring other medical issues to light, and erosion of these opportunities also erodes the quality of care.  The preliminary injunction will now allow us to talk to our patients again about firearm safety."

Stuart Himmelstein, M.D., American College of Physicians Governor for Florida, stated: "Reversing this law is essential in order to preserve the sanctity of the doctor -patient relationship by keeping the government out of the exam room.  The preliminary injunction will preserve free speech between both doctors and patients as protected by the Constitution and which is necessary to obtain the highest of quality care that every citizen deserves."
Physicians and other healthcare professionals routinely provide their patients with information about a variety of health risks in the home and broader environment.  Such preventive counseling has become a cornerstone in the practice of medicine and is recommended by numerous professional medical societies.  In the course of practicing preventive medicine, healthcare professionals routinely ask and counsel patients about firearm safety.

The state chapters of the American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians collectively represent more than 11,000 healthcare professionals in Florida.  On June 24, 2011, these organizations, along with six individual physicians, filed papers asking the court to enjoin the law because it substantially curtailed their First Amendment rights to exchange information with patients about gun safety. 

The lawsuit challenging the Physician Gag law was originally filed on June 6, 2011, shortly after Governor Scott signed it into law.  Prior to filing suit, the physician groups urged the Governor to veto the legislation since it infringes the First Amendment rights of healthcare professionals throughout Florida.  

The organizations and individual physicians in the lawsuit are represented by Ropes & Gray (lead counsel), Astigarraga Davis (local counsel), and lawyers from the Brady Center to Prevent Gun Violence's Legal Action Project.    
     Submit a READER RESPONSE for possible publication.  
Last Updated on Tuesday, 27 September 2011 16:25
Why can't we be friends? Examining Political Polarization Print E-mail
Written by Jeffrey Herschler   
Thursday, 22 September 2011 09:56
FOR CRYING OUT LOUD                                     

OK. Quick show of hands.  Who among us is in favor of mandatory safety belts in American automobiles?    How about federal guidelines dictating proper infection control standards in hospitals and ASC's?  And may I assume that the vast majority of us would not vote to eliminate federal oversight of pharmaceuticals?   And let's address TSA making us take off our shoes to pass through airport security:  Silly for sure, but I'm thinking we don't mind too much.  (see story:  Improved Technology promises to eliminate TSA's shoe removal requirement).  A few wackos on the periphery disagree but most reasonable men and women believe in a powerful government role for our society.  

Now. Yea or Nay.  Physicians should be allowed to own their practices and profit in that enterprise.  Citizens should be permitted to own private property including real estate and financial investments.    People ought to be monetarily rewarded for hard work and dedication;  those who are lazy and foolish will and should earn less.  Again, aside from a couple of kooks, I am receiving a lot of affirmative feedback.   Thus, it's safe to conclude that we overwhelming espouse free-market capitalism. 

So why not promote the best ideas for this country that embrace a strong, but limited, government that collaborates with a free market, subject to the rule of law?  In this Utopian world, each decision we make recognizes the need for balance between government and business.   Brand me an idealist.  Mock my naiveté.  Heck you can even call me wishy-washy for occasionally voting for a Democrat.  For crying out loud,  it's better than being a demagogue or an extremist.

Mr. Herschler is the Editor and Publisher of FHIweekly.

 Submit a READER RESPONSE for possible publication. 
Last Updated on Thursday, 22 September 2011 10:00
Heightened Risks in Healthcare M&A? Print E-mail
Written by Tara Pihn   
Thursday, 22 September 2011 09:31
With all this talk about Practice Mergers, Hospital/Physician Alignment and the ascent of ACO's, I have to bring up the possibility of inadvertently acquiring Whistle Blowers as a risk associated with Practice Acquisition.  None of the recent articles on the topic that I have read mention this very real risk.   Exhibit 1:   Whistle-Blower Suit at Mount Sinai  (11th Circuit Court via DBR).  The case involves an administrator employed in an Oncology practice that was acquired by Mt. Sinai in Miami Beach.  The complainant administrator had been employed by the practice for a dozen years and become an employee of the hospital in 2009.   I don't pretend to know the merits of the employee's case.  That said, some of the allegations seem improbable.  I do know that Mt. Sinai has enjoyed an above average reputation in the S. Florida healthcare community and recently was mentioned at the top of U.S. News & World Report's Hospital Rankings.  I am guessing they have a pretty good Compliance Department as well.  Without attempting to try this case in cyberspace, it's worth noting that opportunistic employees and former employees abound in this economy and have little loyalty to an acquirer. 

More recently I spotted this Whistle Blower headline in a local paper:  Doctors Receive $700k to resolve kickback allegations.  This involves Midtown Imaging and their employed doctors in WPB.  Again I don't pretend to know the merits of the case.  And for all I know, Midtown was culpable.   The point is that there are huge risks from within our organizations.  Payoffs from "blowing the whistle" can set one up for life so incentives are enormous. 

Meanwhile some law firms are trying to drum up business by soliciting Whistle Blower suits.  One example is  They are running this provocative advertisement headline in a S. Florida business paper:  Thinking About Blowing the Whistle on Corporate or Government Fraud?

There is no doubt that legitimate Whistle Blowers serve a beneficial purpose in exposing fraud and corruption and saving precious government resources.  However, just as in med mal, slip & fall, personal injury and product liability cases, frivolous litigation by opportunists (employees and their attorneys) does occur in the Whistle Blower world.   These unnecessary legal actions clog the courts and restrict an already sluggish economy.  They also harm lawful healthcare providers.    Compliance Departments must be extra vigilant in these trying economic times especially if engaged in a merger or acquisition.  An otherwise fine organization can be destroyed by one rogue employee.
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Last Updated on Sunday, 02 October 2011 13:16
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