NJ AHA takes aim at physicians now

[rncountry]

http://www.nj.com/news/ledger/index.ssf?/page1/ledger/12a1965.html

Edison hospital tells doctors: Clear beds sooner or clear out

03/14/01

BY CAROL ANN CAMPBELL STAR-LEDGER STAFF

In a tough new tactic for the financially squeezed hospital industry, administrators at JFK Medical Center in Edison have threatened to cut off admitting privileges of doctors who they say keep patients in the hospital too long.

The move highlights the tensions between hospital management and doctors, who want to protect their ability to make independent medical decisions. Many disputes center around what is called "length of stay."

"There isn't a hospital in the state that doesn't have a spotlight on this right now," said Ron J. Czajkowski, a spokesman for the New Jersey Hospital Association. But Czajkowski knew of no other hospital threatening to kick doctors out over the issue.

More than 35 angry doctors, claiming the policy endangers patients, gathered Monday night in a conference room across from the hospital to express their outrage. They decided to chip in between $500 and $1,000 each to hire a lawyer to fight the plan.

Several doctors said they believed the hospital was trying to save money as government programs and insurance companies limit what they will pay for specific treatments.

"We're being pushed to get patients out of the hospital before we think they are ready to go home," said Tiberiu Kovacs, a cardiologist who was among the physicians singled out. He said many of his patients are elderly, with multiple health problems. "If I don't think they are ready to go home, then they are not going home. But now the hospital is threatening my livelihood."

"You are going to be a test case," attorney Steven Kern told the doctors. "This is the first time in the state, and possibly the country, that a hospital has linked privileges to length of stay," said Kern, who practices in Bridgewater and has worked closely with the state Medical Society.

Hospital spokesman Tom Casey insisted yesterday that the issue was about quality care.

"This is a quality improvement effort we are trying to do on behalf of our patients," he said.

The average length of stay at JFK exceeds the state average, which the Hospital Association puts at 5.1 days. For a suburban hospital, the average is 4.8 days. The association says the average length of stay at JFK Medical Center is 6 days.

Casey declined to release any examples of the guidelines that now govern length of stay at the hospital. He said physicians at the hospital helped determine them, along with an outside consultant, GE Medical Systems.

"We worked with our medical staff on this," Casey said. "Our standpoint is that a too short or a too long length of stay is bad."

The controversy erupted last week, when Kovacs and about 40 other physicians who are up for two-year reappointment received letters signed by William Oser, the hospital's chief medical officer. The letters were sent to doctors whose average length of stay exceeded "expected" length of stay by 30 percent.

The doctors were told they would only be reappointed to the medical staff for 30 days. They also must submit a written "performance improvement plan." If the plan is accepted, the doctors will be reappointed for three more months. Those who don't submit an acceptable plan will not be reappointed. Doctors who are not reappointed can't admit patients to the hospital, a tremendous blow to a medical practice.

Robert A. Panebianco, a cardiologist, said he doesn't know what kind of improvement plan he can submit.

"Should I come up with a plan that says I won't admit patients who are really sick?" he asked. He said he admits many patients from the nearby New Jersey Home for Disabled Veterans. "Should I say I won't admit patients from the veterans home if they have dementia and can't swallow? If they have multiple problems?"

Doctors complained that they have never seen any length-of-stay guidelines. Nor has the hospital told them which of their patients were in the hospital too long.

Several of the doctors at Monday's meeting -- many with stethoscopes around their necks and beepers going off intermittently -- called the letter disturbing.

Joseph Mathew, a pulmonologist, said he worries about how he will treat his patients.

"Are you going to push patients out of the hospital, or are you going to close your practice?" he asked. Several doctors said that sometimes patients can't leave the hospital because tests results are not in, or because complications arise. They also said they fear being reported to the National Practitioner Data Bank, which tracks troubled doctors, if they lose their hospital privileges.

Walter Kahn, president of the Medical Society of New Jersey, said computers now can analyze lengths of stay, along with how many tests doctors order and how much money they bring into a hospital. Hospitals then can push out the doctors who cost money. Kahn derided the process as "economic credentialing."

"They can pit doctor against doctor," he said.

Carol Ann Campbell covers medicine. She can be reached at [email protected] or [phone].

Anybody else out there that thinks its time to let these people know it is time for those without a license to stop practicing medicine?

[Mijourney]

Hi rncountry. Is this greed vs. greed or greed vs. need? The AHA and AMA deserve each other. Instead of complaining about LOS, why don't they complain about the need to beef up nursing services and ancillaries to handle the dilemma of patient care and discharges. I'm a former hospital nurse now home health nurse. Believe me, with the right resources and support, I can work with the patients, families, facility nurses and other members of the team, even the physicians, on what's best for the patient in the hospital and home.

Do you think either group will do the right thing and protest the high charges for technology and biotechnology like pharmaceuticals and all of the fully-loaded luxury equipment that we get clinical data from? Do you think that they will protest the pitiful pay, poor staffing, and working conditions in the hospital? Do you think that they will protest the poor predicament of LTC services? Do they protest the lack of health and medical coverage for children?

I say let the AHA and AMA eat each other. Maybe, we'll see the elimination of unnecessary administrators and specialty physicians that have served to bleed the system. Over the years, they have engaged in tactics that have only served to manipulate and undermine the most vulnerable in health and medical services and that's patients, families, and those that provide direct bedside care. Thanks for bringing this topic to our attention.

PS: I do want to clarify that there are truly caring physicians and administrators out there. I don't want to portray all physicians and administrators as bad. But there are policies and positions of the AHA, AMA, and even the ANA that makes one hair stand on the head from time to time.