Medical Marijuana

George Clooney learned a few basics about treating accident victims while playing a physician on "ER." Then he got a crash course in HIPAA when he became an accident victim in real life.

Employees of the Palisades Medical Center in North Bergen, N.J., were suspended for a month without pay when the hospital discovered they had violated Clooney's privacy during his stay there. The star was treated at Palisades after his motorcycle collided with another vehicle on Sept. 21.

The hospital did not respond to repeated requests from AMNews for information on the suspensions. But reports indicated that Palisades investigated nearly 40 employees who were suspected of violating Clooney's privacy in ways that include snooping at his electronic medical files, peeking inside his room, and leaking information, including Clooney's emergency contact information, to the media.

Jeanne Otersen, director of Health Professionals and Allied Employees, which represents 700 Palisades employees, confirmed that 27 were suspended, seven of whom were union-represented nurses and clinical technicians.

Clooney, who had a broken rib, scrapes and bruises, said he did not know about the privacy breaches until he was contacted for comment when news broke of the suspensions.

"And while I very much believe in a patient's right to privacy, I would hope that this could be settled without suspending medical workers," said Clooney in a statement released by his publicist.

Health care attorneys said regardless of how forgiving the star might be, the hospital took the right course of action.

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For years, there has been talk about reimporting drugs from Canada to cut pharmaceutical costs. But now, the conversation has turned to reimporting patients from Canada to cut procedure costs.

Richard Baker, a Vancouver native and a public critic of Canada's single-payer health care system, started his business, Timely Medical Alternatives, in 2003 to negotiate rates with American doctors and hospitals so fellow Canadians could avoid long queues. But earlier this year Baker expanded his business to match Americans with U.S. doctors and hospitals, a subsidiary he calls North American Surgery. Baker said uninsured Americans were calling him, looking for the same discounted deals he got for Canadians.

Technically, U.S. patients don't have to go to Canada and come back, like with reimported drugs -- but the effect is the same.

Baker negotiates rates with U.S. hospitals, similar to the discounted rates insurers negotiate. He adds a percentage onto that rate for his own fee, collects the money from the patients, then pays the hospital cash up front before the patient is treated. In most cases, the negotiated rate is a package deal that includes facility fees as well as payment to all the surgeons and ancillary staff, and the hospital distributes the lump sum appropriately.

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Getting a passport in preparation for surgery isn't on the minds of most patients. But the medical tourism industry is betting that it will be soon, as a small but growing group of companies work to create a medical travel system that is so well-oiled, they brag that scheduling surgery abroad will be easier than booking a vacation.

Firms are offering perks from full-service bookings that include recuperation time at four- and five-star hotels, money-back guarantees and even liability insurance -- like the kind someone would buy for a rental car -- to lessen the trepidation for patients considering overseas care.

The companies aren't just waiting for that comfort level to rise, either. They are courting large employers and health plans by promising to find the best foreign hospitals they claim rival U.S. facilities in quality measures, all while saving them up to 80% in health care costs so they will offer employees and members incentives for seeking care abroad.

And the medical travel companies themselves are being courted by countries and overseas hospitals eager to take American patients. For example, the director of medical services for the Singapore Tourism Board said 555,000 tourists had received medical treatment in that country last year. Singapore would like to bring that number to 1 million per year by 2012.

Wockhardt Hospitals in India has posted a series of videos on YouTube targeted to specific procedures and specific countries patients might be coming from. Hospitals also are organizing tours for medical travel companies, hoping to be included in their networks.

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Moonlighting isn't just for residents anymore. Many of the same factors -- a desire to supplement income, network for future positions and get a wider range of clinical experiences -- that drive residents to step into separate clinical positions increasingly are pushing practicing physicians into doing the same thing.

The career path of Philadelphia internist Alison Alexander, MD, has included numerous moonlighting gigs. During her residency, Dr. Alexander moonlighted within her residency program a few weekends a month. That, she said, allowed her to improve her training by seeing more patients and to supplement her residency income.

When she completed her residency, Dr. Alexander joined forces with another doctor to form a group. To supplement the practice's revenue, increase its patient base and provide continuity of care for patients, she took moonlighting jobs as medical director of two nursing homes.

"I had to work weekends and evenings, but it provided a number of benefits for our patients and those in the nursing home," Dr. Alexander says. For example, she says a surprisingly large number of patients entering the facilities did not have a doctor. Because they got to know her, Dr. Alexander ended up taking them on as patients. "It was a good way to help build my practice, and it gave the patients continuity of care from the nursing home to outpatient treatment," she says.

Dr. Alexander liked moonlighting so much that she decided to become a full-time moonlighter, leaving her practice to become a locum tenens physician. But most moonlighting physicians are sticking by their current positions as they fill the healthy demand for their skills.

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Anthem Blue Cross Blue Shield in New Hampshire says it will provide free e-prescribing software and a free handheld device to each physician in the state.

The move is expected to boost progress toward New Hampshire Gov. John Lynch's goal of launching a statewide electronic prescribing program by next year. New Hampshire was already halfway toward its goal when Gov. Lynch's plan was first announced, with 50% of the state's physicians then having e-prescribing capabilities. According to Palmer Jones, executive vice president of the New Hampshire Medical Society, this is because 75% of the state's physicians are hospital-employed.

But almost immediately after the governor announced his plan last year, the medical society believed the only way to make it happen was if the state's health plans took an active role, Jones said.

"Studies have found that payers accrue the most benefit of e-prescribing, and their support will be critical for its success. In that regard [funding from payers is] a good thing," said Anthony Schueth, who is managing partner at Point-of-Care Partners, a health care consulting group based in Coral Springs, Fla.

Charles Kennedy, MD, vice president of health information technology for Indianapolis-based WellPoint Inc., Anthem Blue Cross Blue Shield in New Hampshire's parent company, said because of WellPoint's size, it was able to negotiate deals that physicians or hospitals wouldn't have been able to reach on their own.

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