April 1, 2013 Recent News






The Wall Street Journal had a great article stating the Doctor Will Not See You Now, He is Clocked Out.  It describes what will happen as more physicians get employed and will not work overtime.  They will want their breaks and other times off just as other employees do.  This means they will see less patients than they did in their private offices. The physicians will also perform fewer procedures as Obamacare officials will be looking over their shoulders.  Recently, RVU per physicians purchased fell 25%.  Do the hospitals care?  Probably not since they will have their marker share and monopolies.  They will also benefit from the unethical practice of using facility fees for patients seen in an employed physician office.  

A new study by Cejka and AMGA has shown that as the economic recovery has slowly come about the amount of physicians that have left their employment and moved on has reached a new high.  Physicians have moved at a 6.8% clip and mid levels at a 11.5% rate.  It is expected that if the stock market continues to improve that the numbers of retirees will increase.  The major movers are those that have been in practice the longest and the newbies.  The employers expect to hire more physicians and mid levels in the next year.

To date only 11% of payments to hospitals and physicians are tied to performance.  The rest are still fee for service.  Of the 11% under half give hospitals and physicians financial incentives by offering a bonus to promote higher quality care, whatever that is.  The other 60% put hospitals and physicians at financial risk if they don't meet certain goals.  

In a recent controversy in Northern California, Washington Hospital built a special wing for joint replacement surgery.  The criteria to use the new wing were partially made up by the two major joint replacers in the hospital.  They are the only ones who can now use the new wing.  The other orthopods are getting testy and want to use the wing as well since the hospital is public but the wing was built with hospital and private money.  The problem is that the two that are using the wing do enough surgery to keep the wing and the ORs full.  By letting others come in the efficiency of the new wing would be compromised and the hospital would make less money.  The two surgeons that can use the wing perform about 1000 joint replacements a year and the volume is rising.  The want to be only perform about half of the required number of replacements per year.  Is it a two tiered system?  Yes.  Is it efficient? Yes.  What would happen to the hospital if the two surgeons left is devastation.  The other knock on the surgeons is that they are smart enough not to accept Medicaid insurance which nets more money for them and the hospital.          Top


The employers have just woke up and found that a little known aspect of Obamacare is a fee of $63 per employee they insure.  This money is to help fund a pool to help the insurance companies.  Most expect the employers to either pare benefits to absorb the fee or pass it on to the employees.  Employers and unions have asked the fee be removed but CMS refuses citing the law that was unread when passed.  The only ones not included are the employees who are on Medicare.

The Obama administration must be worried about Obamacare.  They continue to have their shill Sebelius give weekly or weakly press conferences about how much good the program is doing.  This time it is about the "free service" for 71 million people.  There is no free service.  This only means that patients do not pay for it directly but they pay for it pay taxes and premiums.

Forbes has an article about how costly Obamacare exchanges will be.  Aetna has done the math and states they believe with all the mandates and taxes that will be passed on to the patient the premium will increase 100%.  They have shared this with the Washington people who really don't care.

The Society of Actuaries have put out a report that claims will jump 32% under Obamacare.  This is biggest driver of premiums.  This means the majority of people will see double digit increases in their individual premiums.  A similar study was not done for employer plans.  The administration states that the costs will actually decrease due to competition with the exchanges.  Sebelius agreed with the assessment but the White House said everybody is wrong and Obamacare will decrease costs.

There seems to be a mandate that when people sign up for Obamacare exchanges they will also be asked if they wish to register to vote.  This is not unusual as it is also done when people sign up for other government programs such as Medicaid.

The New York Times believes that Kaiser is the model for the country's healthcare.  They have an integrated model with salaried  physicians in their own system and a good EMR but one that does not talk to any other.  They have since I first started practice in Northern California about 40% of the insured business in my area.  That number has not changed much in the 45 years I have been here.  They used to be much cheaper than the private competition but that is no longer true.  Their physicians used to be the leftovers from private practice and that also is no longer true.  They now pay competitive salaries and the partners make slightly less than if they were in private practice.  They were ahead of the curve in attempting to get people to take responsibility for their own general health.   The problems with the system are legendary from the inability to choose your own physician or go out of the system for care paid for by the system.  The latter was shown several years ago when Kaiser lied to the patients and the public regarding their renal transplant program that eventually went belly up.  Another major fault is when they have no facility in an area and their members are forced to travel some distance for care.  They also have only certain hospitals for certain procedures like open heart or neurosurgery making patients and families travel very long distances for care.

The New York Times reports that the administration is considering Medicare changes in order to get a budget deal.  One of the things considered is the combining of Parts A and B which would save money for the feds but increase out of pocket costs for the 80% of patients that only use physician services in any year.  It would however get rid of Medigap plans.  Obama wants increased revenue in exchange with more taxes on the "wealthy" and corporations.  

The American Action Forum has come out with a study showing Obamacare has to date imposed costs of $30 Billion and 111 million hours of paperwork.  They expect the Billions of dollars to effect premiums.

The new healthcare system is underway and it is not Obamacare and is definitely private.  These are the new walk-in clinics in malls and neighborhoods.  They are being funded mainly by private investors.  There are now almost 10,000 in the country and are growing at about 20% per year.  These keep it simple because insurance companies usually only pay a flat fee per visit.  Therefore, no long visits and no major re-visits.

California is having all their Medicare-Medicaid patients go into a managed care plan. The plan will be in selected counties and the duration is now scheduled for five years.  People in the plan will get not only medical care if they can find physicians to care for them but also dental, vision care and non emergency transport.  The people will have an opt out clause so that they can continue continuity of care.        Top


Nurses in SoCal that were working for the LA County as temporary relief workers in 2005 and 2006 were paid more money due to a shortage of nurses.  The county screwed up and continued paying them the increased money until 2008.  They then found their error and wanted repayment from the overpaid nurses.  The nurses sued and lost.  The county will now start the repayment process out of the checks that the nurses are currently getting.  The nurses believe it is a hardship to pay back money they did not earn or deserve.  However, the taxpayers should not have to pay either.        Top


Workers at the VA Hospital in Jackson, Mississippi, have sent a letter to Congress detailing problems at the facility.  This includes failure to sterilize instruments properly and problems with radiology not properly reading films.  The VA started the investigation in 2009 and it continues as of today because the hospital does not change and the VA does not follow through.  This is another reason why the VA system should be abandoned and the disabled vets given care at local hospitals of their choice instead of a duplicative system that is inferior.

Kentucky hospitals are losing just over $100,000 per physician per year.  Who could ever have predicted this?        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 information presented.