the consequences of corporate health care

Has anyone noticed how impersonal medical care has become? Try calling a physician who belongs to a group affiliated with a large hospital or to schedule a laboratory study. A sinking feeling comes over you as the phone automation system drones you through the menu of numbers often leaving you to guess which one best meets your reason for calling. By the end of the call, you feel like you’ve been on some sort of conveyor belt in a high-tech grocery store.

More and more physician groups are selling their practices and being subsumed into large hospital conglomerates’ umbrella. Why do they do this? It’s more cost-efficient to be a part of a hospital system that will take care of all the details associated with running a practice. No more day-to-day management issues to worry about, such as rent, maintenance, taxes and employee issues. Other reasons involve the complicated system of reimbursement from insurance companies and Medicare. Now, theoretically, doctors can concentrate on what they do best: practice medicine.

Over the last several months I have conducted my own research and spoken to a number of doctors and their staffs. As a personal injury lawyer, I spend much of my time working with doctors and health care providers who are addressing the needs of my injured clients. Part of our job is to understand our client’s injury and to help them navigate the complex highways of medical care. We work with insurance companies along with billing departments of the various health care providers. Here are my observations.

Hospitals are among the largest employers in this country. Take any given community like ours here in the Lehigh Valley. St. Luke’s Hospital & Network and Lehigh Valley Health Network are our largest employers. Thousands of families depend on people being sick. It’s a bit like the queen bee and hive system. All of the worker bees have to produce to support the queen. While providing care is their underlying mission, let’s not forget for one moment that they are not much different than any other large corporation. The more money they can make, the more hives they can spread. Just look at our hospitals, and the dozens of locations and outpatient locations.

To service all of these locations, very sophisticated business models have been created. These models or cells (cannot get away from the queen bee analysis) create complicated management systems. Phone systems, accounting methods, employee manuals, office meetings and overlord bean counters now replace the small intimate setting of most of these small groups.

Rebellion and resistance can only be expected as nurses and staff, who come from small intimate practices, run up against the big business model. One doctor told me that the meetings are endless and unhappiness pervades. Most patients have relationships with the staff in their doctor’s offices. Let’s face it: There is nothing more personal or concerning than your and your family’s health. How upsetting is it to call and get a message that tells you to listen carefully because the menu has changed, and then ends with someone you don’t know and who does not know you?

So is this the future? I am afraid so. Everyone I have talked with feels helpless and demoralized. Health care can make us live longer and healthier but it is coming at a new cost. One staffer told me that the elderly are overwhelmed with the new systems. She said “they don’t have the patience” to go through the new learning curve. She said she spends a large part of her day comforting many of them because they get so upset.

Perhaps the bigger question is how will this affect the quality of care. My personal experience is that it is of great concern. The one consistent part of medical care has been the direct link between doctor and patient. Doctors are more isolated now than ever, and one doctor told me he has a difficult time navigating through the corporate way of doing things. Going or gone are the days when a doctor can have the hands-on style of treating that has been the hallmark of the doctor-patient relationship. Corporate management style is great for big impersonal companies, but not for the very personal nature of health care.

Dennis F. Feeley

(note: the above piece appeared in the Morning Call newspaper on Monday, September 26, 2011)

doctors fees responsible for driving up health care costs.

Today’s New York Times  disclosed the results of a  report to be released by the journal of Health Affairs later this week, which states that doctor’s fees for services are higher in the United States then in most other countries. The Times concludes that “this is a major factor in the nation’s higher overall cost of health care . . .”

The article sited that primary care docs and orthopedic surgeons earned far more than their counterparts in other places in the world. For example, orthopedic surgeons make on average $442,450 per year, which is more than double what similar surgeons make in other countries.

Over the last several years doctors, hospitals, the insurance industry as well as the medical society have sought to place blame on lawyers and the legal system as the cause for driving-up medical expenses. The Congressional Budget Office   has denied any such connection and has issued several reports which show the cold hard numbers. Those numbers show that only 2% of health cost is attributable to legal costs.

A recent report issued by the Administrator of Courts for Pennsylvania states that filings for medical malpractice lawsuits are down by over 45% across the state. The myth that fear of lawsuits results in defensive medicine, which also drives-up the cost of medicine, has also been debunked by the Budget Office who stated that they could find “no evidence” to support this claim.

Here’s one more fact. Even though law suits against doctors have dramatically decreased over the last 9 years, medical liability insurance companies have raised the premiums which doctors are charged by a considerable amount.

  I am not a statistician, but it seems this is a bit like the old proverb of the “pot calling the kettle black”. How can the same industry which tries to place blame on the legal system for bringing Armageddon to the health care industry be one of its primary culprits? I say, “physician heal thyself”.

Dennis F Feeley.

Recent Study Released on Medical Devices and the FDA Approval Process

Patient safety should be the primary concern when a new medical device is approved for sale.  Medical devices, especially artificial hips, have been in the news quite a bit recently. One of the main reasons for the recent coverage is the recall of the defective DePuy ASR hip replacement system (a product of DePuy Orthopedics, a subsidiary of Johnson & Johnson).  The DePuy ASR device is a metal hip replacement that, in August of 2010, because its unsafe design was causing metal ions to break down and enter the blood stream, leading to metal poisoning in many patients. This massive recall brought to the forefront the issue of FDA approval of devices for sale to patients. Many people were, and still are, unaware that a device such as a hip replacement, can be sold to a patient in the United States without undergoing any real testing by the FDA.  A medical device manufacturer can apply to have a new device approved under something called 510(k) by claiming that the new device is “substantially similar” to a device that the FDA has already approved under its strict pre-market approval process.

The Institute of Medicine, www.iom.edu, an independent, nonprofit organization that provides unbiased and authoritative advice, released a study criticizing the FDA approval process (510K). (http://www.iom.edu/Reports/2011/Medical-Devices-and-the-Publics-Health-The-FDA-510k-Clearance-Process-at-35-Years.aspx). Since 510(k) allows a manufacturer to apply to have a device put on the market relatively quickly and without rigorous testing, devices, such as the DePuy ASR hip, are sold to patients without even having been tested in an actual person. The result is that the manufacturers can sell and make profits on their products quicker and without spending money to make them safe – to the great risk and detriment to the public.

Patient safety should not take a back seat to quick profits of device manufacturers.  Device manufactures began attacking the report of the Institute of Medicine before it was even released because they knew that the report would be critical of the “fast-track” approval that some devices receive. Fear mongering device manufactures attempt to scare the public by raising baseless concerns about slower access to devices. There is no basis for these fears. As an attorney who has the honor to fight for the rights of victims of the DePuy ASR device, I can tell you that a slight delay that could have helped make this device safer would certainly be worth the trade of having an unsafe device put into a person’s body quicker at the expense of their health.

It is said that “haste makes waste” but in the medical device world, “haste makes unsafe”. Patient safety should be the most important concern when releasing a new device for sale to the public.

This is the first of a series of blogs related to Medical Device Study Reports and the FDA approval process.  

Jonathan B. Acklen

federal government to review insurance rate hikes in Pa.

Something I did not know is that many states do not have legislative overview of insurance rate hikes. Today’s New York Times reported that Pennsylvania is among those states currently earmarked for federal oversight. State insurance commissioners have complained that they lack regulatory oversight. This means that insurance companies in these states can raise rates without recourse or scrutiny.

Here in Pennsylvania rate increases for small groups is not overseen which has resulted in insurance companies raising their rates just to improve their bottom-line. The Times reported that Melissa L. Fox a spokeswoman for the Pennsylvania Insurance Commission said, “We do not have rate review authority in the small-group market, with few exceptions”

Apparently, in Oregon Blue Cross Blue Shield was prevented from imposing a 22% rate increase when, after investigation, it was determined that they were overcharging and therefore only allowed a 12.8% increase.

Say what you will about too much government, but without this type of oversight we are at the mercy of the health insurance industry. This type of oversight is necessary not just for the consumer like you and I but also for the health care industry.

Dennis F Feeley

the movie “hot coffee” premiers on HBO, June 27th.

The real story about “big business” versus the little guy is best told through the HBO movie HOT COFFEE premiering Monday June 27^th at 9:00 PM, here in the Lehigh Valley and across the country. Previously, In February, I posted that I would announce  when the movie would be released. Go to “Hot Coffee” for a preview of this great film which exposes the real propaganda machine behind the creation of the myth about the famous case involving the woman who was burned at McDonald’s when superheated coffee caused her serious burns.

This movie received critical acclaim at the Sundance Film festival for its true and accurate revelations regarding how corporate America used this episode to frighten everyone about a personal injury explosion which was sure to bankrupt everyone. Well,  after the last few years, the only question I have is –  who really did bankrupt America? I think we all know that answer, and it wasn’t personal injury lawsuits.

Dennis F Feeley

 

 

lack of public interest leads to loss of news sources

Today’s New York Times reported some very disturbing statistics about the state of investigative journalism across the Lehigh Valley and the nation. There are fewer and fewer reporters available to cover all of the important governmental decisions being made at local and state levels.

It’s no surprise to any of us who read our local Morning Call and Express-Times that the paper is getting thin enough to slide through a mail slot. It’s no different for those who get their daily news fix through on-line services. We have turned into a country that seems to have less need for being informed about those decisions which will affect the quality of public services which include issues involving everything from education to pollution.

The hallmark of good governance is accountability, and I don’t mean just the tabloid stuff about political scandals for which there is no coverage shortage. I am talking about good investigative journalism without the opinion stuff. We have no shortage of talking heads with personal opinions about everything. What I call entertainment news.

I am not sure if the problem is lack of interest about these issues or lack of serious journalists to cover the stories. Just about every night there is a township meeting somewhere where community input keeps all of our local officials in tune with the voters. Decisions about school calendars and curriculum and land development and taxing issues, etc. etc. are discussed and votes

After the revolutionary war our forefathers believed that it would be the mighty power of the pen that would keep all of the citizens informed should some dark force attempt to undermine our guiding principles. Bottom line – democracy works best when everyone participates – and without the sources from which we can get the knowledge needed to cast our vote we are in trouble.

Between the Revolution and the Civil War this country grew like none other in the history of modern society. Citizens demanded public work projects to build roads, schools and protective services. They freely gathered everywhere to discuss, argue and unite about what was needed in each community. Political speeches were public events attended by everyone. These forums gave the average citizen not only a way to discuss important political issues but also to stay in touch. Guys like Horace Greeley and other journalist became champions of the people who relied on their reporting of events.

In a country, which prides itself on freedom of expression, we should be concerned that there are fewer sources and fewer news journalists to deliver the facts affecting our future.

Dennis F Feeley

what congressman weiner should have known?

the past we have posted on some of the legal issues relating to social networking because of what we post on our sites. Recently, I was asked to plan and teach a course to lawyers about these very issues. Our seminar was taught by lawyers and those who host websites and social media sites. It was amazing how many of the attendees were relatively clueless about  how the technology works,  and most importantly, how  these sites can involve grave consequences for their clients – which is you.

 My worst fears were confirmed again this week as the Anthony Weiner matter unravels.  How is it possible that a U.S. Congressman could have made such a novice mistake? The moral and ethical  issues aside for the moment – The Congressman was pushing buttons without knowing what they do and now the ship is crashing.

Facebooking, tweeting and blogging, along with all of the other instant ways of sharing information have consequences, and I don’t mean short term consequences. I think we sometimes confuse electronic mail (e-mail) with social networking postings. If you send an e-mail to 10 of your best friends it is still relatively secure. Sure, it can be forwarded to others but not to the whole world with a single push of a button. Not only that, but e-mails have certain legal protections attached to them associated with the First Amendment.  Our courts are ruling that social networking exchanges like Facebook and Twitter do not have any such protections.

When you share a photo or good story about that great night out with your friends, remember it’s there forever and can be shared and passed along with relative ease. This is why the social networking sources use the word “publish” to describe what happened to your post. Think of posting like what gets published in the newspaper. It’s a public document once it’s out there and there is no taking it back. Congressman Weiner tried to take it back, but there are “no take backs” in the world of social networking.

That having been said – Social networking has many advantages, and is a great way to stay in touch with friends and family and get reacquainted with old friends. Have fun but remember – don’t say anything that you would not be comfortable with the whole world knowing.

Dennis F Feeley

    

Yet, another tractor trailer death on our Lehigh Valley roads

Over the last year I have posted a number of times about the on-going rash of truck accidents on our Lehigh Valley roads and highways. Yesterday another horrific accident occurred on Route 309 in the Tamaqua area. A 71 year old woman was killed and her husband seriously injured in the crash. According to the Morning Call  a Hess Express tractor trailer truck failed to stop and smashed into the back of the car and pushed it into a utility van. The photos on the Call’s site are very graphic. These poor people did not stand a chance.

How fast was the truck travelling to cause this kind of damage on a strip of highway which is in a commercial area? How inattentive or distracted was this driver? The investigation continues and charges are pending.

 

Barely a week goes by without a truck crash in the Lehigh Valley these days. There can be no other explanation then this driver was distracted by something. Cell phones, satellite systems and loads of other equipment make the dashboard of these trucks look like something from star wars. Please be careful this summer as traffic in our once sleepy Lehigh Valley continues to cause congestion, and practice defensive driving techniques.

Dennis F Feeley

 

cell phones cause cancer scare

Today’s Allentown and Easton papers, as well as most newscasts are filled with the imposing doom about to befall us all. Yes – once again –  dangers associated with cell phone usage are a major topic of conversation. This time it’s the World Health Organization, which by all expert accounts is one of the most reliable scientific groups, has placed the radiation emitted by cell phones as  “possibly” carcinogenic to humans. What does the word “possibly” mean in this context? All of the reports I read (and I read several) seem confused by what this really means.

The WHO did not do any new studies but just examined existing data. Everyone agrees that a certain amount of radiation – like the stuff which comes out of your microwave –  also comes out of your cell phone when you are talking (apparently more of it while connecting then actually talking) and goes into your brain. Hum – Doesn’t sound good to me. Apparently this type of radiation can cause a tumor called a giloma.  Other scientific experts are predicting that cognitive function and memory could be effected.

The US Food and Drug Administration has previously said there is no reason for concern.  The European Environmental Agency is demanding more studies and according to CNN  has said that cell phone use could be as big a risk as smoking, asbestos and leaded gasoline. Some cell phones actually contain warnings. My Iphone came with a warning that I should not hold the phone against my head while talking. Well – where should I put it?

Don’t panic just yet. The totality of the information I read says there are not enough studies or statistics from which to draw solid conclusion. There is one thing of which I am certain and to which there is no disagreement. Texting or talking on a cell phone while driving causes accidents and injury and death. Let’s continue the investigation into whether cell phones cause cancer but let’s work on the more urgent problem which our Pennsylvania legislature is seemingly ignoring.

Dennis F Feeley   

medical malpractice crisis is over

According to today’s Allentown Morning Call, any medical malpractice crisis which existed is now over . For several years hospitals and doctors in the Leigh Valley and across the state have complained that because of the threat of medical malpractice lawsuits they were leaving the state. The most recent study released by the Administrative Office of Pennsylvania Courts reports that the number of medical malpractice filings is down 45% in the last decade and since new rules were implemented governing the mechanics of such lawsuits.

Not only are the law suites way down, but even in those cases which have been filed and go to trial the doctors and hospital are winning 80% of the time. It doesn’t take a math wiz to figure out that if you only have a 20% chance of winning that fewer cases will be filed.  As a lawyer who has been handling these cases for 30 years I can report that such cases are not only extremely expensive to litigate but also require tremendous amounts of man-power. Hence the filing of a frivolous law suits never made financial sense to a lawyer – even before the new rules. But, what the new rules did accomplish was the near elimination of shot-guns filings that name multiple doctors. These types of filings were routine because lawyers were concerned that they might not name all of the correct medical treater’s in the suit. It is often difficult to pin-point all of the medical providers who may share responsibility in a medical error until all of the records and testimony have been gathered.

 In addition, jurors have become more conservative in their verdicts. So, based on these statistics, I guess we won’t be hearing the doctors and hospitals crying about “frivolous” lawsuits anymore? Now the question we have to ask  is whether justice is being served because meritorious suites are not being perused or juries are just plain scarred they may lose their doctors if they find against one from their community.

Dennis F Feeley