April 1, 2012 Recent News
A story in the Wall Street Journal on 3/15 showed the futility of conforming to the insurance companies and fed requirements early. It talks about a practice in Colorado that is just keeping it's nose above water due to the requirements imposed upon it to do "the right thing". It has cost the practice over $200,000 in lost revenue from decreased visits due to keeping in touch with patients by phone or internet. The practice was supposed to receive money from insurance companies for being a medical home and doing all the correct things. As usual, the physician got stiffed. The insurance companies say the payments are coming. The physician states that he will believe it when he sees the checks.
A Miami Orthodox Jewish Plastic Surgeon wanted to increase his nose job business so he hired a band who is also all Orthodox Jews to come with a song regarding nose jobs. They came up with a winner and his business has increased. The American Academy of Plastic surgeons are not noted for their sense of humor. They are conducting an investigation of the video and potentially could take away the physician's board certification. Usually Board certification is meaningless to patients except in plastic surgery where there are so many want-to-be's.
The AMA news reports that physicians want to work part time with flexible schedules. They do not want to work 24 on and 24 off. Therefore they are gravitating to those situations where they can have the life style they desire. This is especially true with older physicians who want to slow down and younger female physicians who want to spend more time with the children. It is also more common in large practices.
The Boston Globe reports that the Massachusetts Medical Board is becoming out of date. The state medical board does not list many physicians on their web site who have committed criminal acts or have med mal cases go against them in court. Although I truly doubt that many, if any, people query the board site prior to choosing a physician. The board also takes down any discipline if the physician does not renew his/her license. Therefore, according to the article but not reality, no person from another state could check on their physician while practicing in the state.
Some people have the sense of the obvious. The Baltimore newspaper wrote that anesthesiologists make GI procedures more expensive. Yes they do. However, if people undergo GI procedures with general anesthesia the doctors are indispensable. Do you want a GI physician to give you complete general anesthesia when he/she is not trained to do so? I agree that nurse anesthetists or anesthesiologists are not necessary for ordinary sedation and that GI physicians should be competent to give the sedation. If you take away the ability for general anesthesia less people will get colonoscopy and be screened for colon cancer, a preventable or curable disease.
Peninsula Hospital in New York has a full resident physician mutiny on it's hands. The hospital's lab has been closed which essentially closes the hospital. The hospital has a teaching component and if they fire the residents they can keep the money given to them by the feds for having a residency program. The physicians want the hospital to shutter the residency program so they can get other residencies without saying they were fired. Top
UCSF, the hospital that proclaims itself the teacher of how good medical marijuana is in the treatment of cancer and pain has had their bluff called. Angel Raich, the champion of medical marijuana, was in the hospital for an inoperable brain tumor. She, under physician order, was using medical marijuana every 2 hours. Some person in the hospital, possibly a pharmacist, got on their high horse, and told her to stop or he would call the police. She did not stop and Ms. Raich was removed from the hospital. She was speaking about the situation when she had a seizure and was taken to a different hospital. UCSF became the new poster boy for hypocrisy by talking how great the drug is and then saying that the hospital is a smoke free zone which includes medical marijuana.
The 1-800-Get-Thin billboards in southern California are being removed. This is after multiple law suits against the physicians doing the procedures, the company not able to get more lap-bands and the FTC investigating the company.
Brooklyn's Wykoff Heights Medical Center got the major write up in the New York Times for their terrible hospital. The hospital is nonprofit and in a poor neighborhood so the CEO comes to work in a Bentley costing $160,000. Also he and his wife are chauffeured in a Lincoln Town Car or a Cadillac Escalade. The local pols and their wives also are on the payroll for doing nothing they are capable of doing. The Board is also on the take selling pharmaceuticals to the hospital or loaning money to the hospital with the hospital buildings as collateral. The hospital has defaulted on its bonds until the state allowed the default and the hospital has no med mal insurance. There is so much fraud at the hospital that it needs to be closed ala King Hospital in Los Angeles. The Brooklyn hospitals need to be consolidated and if some people are inconvenienced for a year or so they will have a better hospital and medical care.
Dr. George Lundberg has written an op-ed which asked and answered the question "Why do we need insurance companies?". The short answer is we do not. The reasons is that they do nothing but put people to work and impeding the practice of medicine. His solution would be to have Medicare for all but with changes. There would be means testing for all outpatient episodes of care. Those who could afford it would pay for the care out of pocket. All Americans would have catastrophic insurance. Government should pay for preventative services.
As all know the government does stupid things no matter who is in power. We have had in the country a significant shortage of medications. One of the main reasons for the shortages is the fed's rule and TJC's adherence to the rules that pharmacies must strictly adhere to the manufacturer's use by date and discard all that go even one day beyond. If they don't throw out the meds they fear reprisals by the powers. This is true even if there is evidence to the contrary by the much used compendia such as the American Hospital Formulary Services database. This shows the shortage of drugs goes directly to the CMS and those that do their bidding.
An op-ed in the Pittsburgh Post Gazette by a physician tells it truthfully. EHR is here to stay and will save no money since systems do not talk to one another. They also make it easy to order expensive tests that one might not otherwise order. I saw this first hand several days ago when attending a tumor board, a physician admitted she ordered an abdominal CT scan because her finger just went to the button. As it turned out the scan found a problem but it needed no care except watchful waiting.
The medical home projects do not save money for the private or the Medicaid sectors. In a study in the Journal of Managed Care, over 100 medical homes were examined and only one saved some money. It was not a Medicaid home. However the feds are convinced the homes save money in spite of the evidence. If physicians did what the feds are doing they would be terminated from the hospitals for not following the evidence. North Carolina states that they have saved alot of money but the Journal article states that they had no adequate control studies to prove their savings.
In California ACOs better work. A company, HCP National Insurance Services, is offering reinsurance to those in the Medicare Shared Saving Program. It is designed to cover shortfalls if the ACO goes over budget. The premium is deductible to the ACO and is cheaper than borrowing cash when needed.
California Blue Cross will raise rates on an average 8.2%. Remember, this is an average. Families may see a 20% raise in the next several months. The reason for these raises are the estimates of future medical costs, many due to mandates either by the state or the feds.
California continues in the news with the state attempting without any law to back it up to stop the trend of small business self insurance. This would allow the small business of 25 or less with healthy people to get insurance cheaper and leave the older sicker for the stated and fed exchanges. This is nothing new since over 60% of workers nationally have been insured as self insured. The difference is this is small amd not large businesses. They tend to be healthier people and they are using stop loss insurance. Also by being self insured the companies do not have to participate in the idiotic state and federal health mandates that drive up insurance costs. The state insurance commissioner is proposing legislation and if all goes well it will not get through the legislature. Interesting is that ERISA prohibits states from interfering with self insurance plans.
CMS has stated that two insurance companies with insureds in nine states have "excessive" premium hikes. The problem is the CMS can do nothing about it.
The New York times and the national news agencies all put out the news that autism was on the rise. They state that 1:155 children. What they don't say is the massive rise in the diagnosis coincides with the change of the definition of autism so more are able to be diagnosed and treated. This is to show that more money is needed to help the children who several years ago would not have been diagnosed with the disease.
After all the talk regarding the idiots at the US Preventative Health not wanting PSA, mammograms and other tests so frequently comes a report from the CDC that states the rate of cancer deaths in the country has declined at an amazing rate. The CDC states this is from better life styles and earlier detection by better screening. Top
DISCLAIMER: Although this
article is updated periodically, it reflects the author's point of view at the
time of publication. Nothing in this article constitutes legal advice. Readers
should consult with their own legal counsel before acting on any of the