Managed care blamed for overworked NY residents
Albany, NY-New York health officials hope that a wide-ranging probe of major teaching hospitals in the state will be sufficient to get providers to comply with laws that restrict the number of hours medical residents can work. A report released two weeks ago found that in the aggregate, New York's largest medical centers were overworking residents in some 20 clinical specialties, including emergency medicine. Critics have blamed payment cuts in managed care for the trend.
In March, investigators raided more than 12 of the state's most prestigious teaching institutions, including 1200-bed St. Luke's-Roosevelt Hospital Center, based on complaints that medical residents were poorly supervised and were forced to work excessive hours. Using hospital records, investigators found evidence that many of the hospitals routinely violated the statute by requiring some physicians-in-training to put in 16-24-hour days, according to reports.
Officials were particularly concerned with violations of the decade-old Libby Zion law, which bars facilities from overworking residents. The law was enacted when Zion, the daughter of journalist Sidney Zion, died at New York Hospital in Manhattan due to what the elder Zion called untrained, overworked physicians. The incident fueled a widely held criticism that hospitals were squeezing more productivity out of clinicians to offset payment cuts from managed care organizations.
The Zion law provided funding for hospitals to lighten residents' workload. But, according to critics, including some physicians, many hospitals accepted the money and continued to overwork residents. State regulators hope the facilities will voluntarily comply with the law and avoid tougher enforcement action.
SC Blue tests a new outsourcing idea for providers
Columbia, SC -A major insurer in the state is testing a program designed to assist local physicians and hospitals in keeping track of patients and their health care costs under a variety of health plan contracts and storing that information for immediate retrieval. If successful, the program will be expanded to numerous providers throughout the state.
The service, which was launched earlier this year by Blue Cross and Blue Shield of South Carolina, is believed to be the first time a major health plan has established a subsidiary devoted specifically to selling sophisticated information technology support to medical providers.
Companion Information Management Resources, a for-profit subsidiary of the Columbia-based Blue Cross and Blue Shield saw an opportunity after noting that local providers could not afford the hefty capital investment in expensive information systems technology, according to John Tempesco, MHA, a company vice president.
The technology provides practitioners with immediate, "real-time" database information on patients and their benefit plans. It also performs claims processing, utilization review, referral authorization, billing, and payment functions. Providers can also do retrospective financial analysis and track costs by physician, hospital department, and individual contracts, Tempesco says.
"In most ways, the company performs much like a third-party administrator but offers long-range strategic support," Tempesco says. Providers are charged fees ranging from $4 to $16 per member per month on capitated contracts. With fee for service patients, providers are charged a fixed, published rate depending on volume of monthly transactions and breadth of services.
Kathy Schwarting, project director in the emergency department at Bamberg County Hospital and Nursing Center, says the system is presently used to link up 10 local agencies with relevant Medicaid eligibility, referral, and historical data on patients. For the hospital, the service has cut delays in obtaining the information by some 50%, Schwarting says.
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