August 1, 2010 Recent News




Electronic Records


US News has come out with their rankings of the best hospitals in the country.  To no one's surprise they are all teaching hospitals spread out over the country.  Number one again was Hopkins.

Illinois has finally started to pay closer attention to ambulatory surgical centers, no matter who the owners are.  They have found significant problems with cleanliness and training.  The article in the Trib did not name the facilities with the problems.

HealthLeaders had an article that hospitals must cut costs by 14% if they want to stay in business.  They state that there must be clinical integration and to get in on clinical performance based incentives.  They point to the decreasing Medicare revenue and the increasing Medicare population along with the commercial insurers using Medicare as their measure of payment.  CMS estimates that about 40% of total Medicare spending is waste due to provider error, unnecessary care, avoidable admissions and lack of care coordination. 

The hospitals in the Republic of Massachusetts have reported that they have slowed the rise of their costs over the past 18 months.  They have cut by cutting staff, holiday parties, cutting pay, and consolidating services.  There are some in the legislature that just don't believe the hospitals.  If they cut their costs why can't they live within temporary limitations on cost increases.  The payors state they have not benefited from the hospitals cost savings.  Can you imagine the size of the parties the hospitals had that by stopping them they save so much money.     

Patients spent 4 minutes more in the ED last year than they did the year before.  It has gone from 4 hour three minutes to 4 hours and seven minutes.  The range was from two hours fifty five minutes in Iowa to eight hours and 17 minutes in Utah.  The reporters are happy since 32 states either reduced time by five minutes or stayed steady.  It sounds like oncologists who will spend thousands of dollars to keep people alive an additional month maybe. 

St. Clair Hospital in the Pittsburgh, Pennsylvania, area is smart.  They are offering the physicians on their medical staff a EHR tied to the hospital.  This is a win win.  It allows the practice to be eligible for the $11,000 per physician fed bonus for using EHR and it ties the physician to the hospital.     Top


In a story not related to medicine directly but is related indirectly, the Daily Finance wrote that it is possible that unemployment is not the 9.5% the government states but is in fact possibly 28%.  The President of TechnoMetrica Market Intelligence calls 1000 homes per week and found that in 22% of the calls at least one person is looking for work.  He states his statistics are always good.  A member of the White House wrote in 2003 that the government cooked the books to make unemployment better than it was.  She is now unavailable for comment states the White House.  The problem is that when people get tired of looking they stop and then are no longer counted as unemployed.  The same is true for college grads who are flipping burgers.  They are employed but they continue to look for work in their field of study.  The next time a government official states the unemployment rate, question their motives and their information.

The Chicago Tribune has a story regarding how much adding coverage under Obamacare to college age dependents will cost.  It will add about 2% to the cost of the premiums to all.  This is above the 1% add due to the preventative care freebies.  There will also be a standard 8% to 10% raise for large employers.  

National health is based on the Republic of Massachusetts model.  That is bad news for the country.  The Boston Globe reports that small business is dropping their insurances due to cost and allowing the Republic to pick up the cost.  The Republic is not seeing a spike in the enrollment in the public insurance, so they say.  Insurance brokers have seen the rise.

The Boston Globe has run another article on the lack of access for patients to see primary care physicians.  This in the area with the highest ratio of physicians to patients in the country.  There has been a 20% decrease in both internists and GPs taking new patients.  There seems to be a correlation between this and more ED visits. 

Obama, Pelosi and Reid lied like all politicians.  They all said people will be able to keep their physicians.  That is not true.  Insurers are being pushed by Obamacare and are going back to the old non workable HMO model where one must see physicians in a plan to get care.  If the people want to keep their physicians they will pay significantly more.  

The trio also lied about the savings from Obamacare.  The CBO states that there will be a $143 Billion reduction in the deficit by 2019 and then a 0.5% reduction in the following decade.  This is miniscule.  The Dems did not like the report.  

Even worse, the feds now state that despite Obama's lie of not taxing anyone making under $250,000 the forcing of people to pay for health care is going to be considered a tax for their claim in the courts.  

The new health law has some good items.  One that is good for consumers is that the hospitals and physicians who go to out of network EDs can not be charged higher co-pays than if they went to in network hospitals.  Of course, unless one is one of ten states that prohibit balance billing, the consumer will be billed for that amount the non-contracted hospital and provider is not paid by the insurance company which may be far greater than any co-pay.

Also, Maryland believes that it will save $829 million under Obamacare while providing coverage to an additional 350,000.  This will be accomplished by substituting Maryland funds with fed funds.  

Arizona has told their state and university employees to expect a rise of up to 37% in their health insurance next year.  They blame the increase on the federal health bill and the increases due to no lifetime caps and insuring the dependent children up to age 26.  This also is for the "free" preventative services. There is no money left in the budget to pay so the costs will be shifted to the employees. 

It comes as no surprise that the head of Anthem Blue Cross in California is quitting.  After all the company almost single handedly got us "health care reform" by their 39% premium raise request just when Congress was discussing Obamacare.  Then they found the error of their ways. 

In a related story it is reported that health plans may have huge stockpiles of money and are continuing to raise premiums for the insured.  This is focused on Blue Cross where 7 of the 10 insurers have amassed huge surpluses, over three times the necessary amounts.  The worse one was the Arizona Blue Cross where they have a surplus of $717 Billion (over seven times the required amount) and raised premiums for individual insured between 8.8% and 18.4%.  They deserve all the words that Obama used against the insurers.  Remember these are non profit organizations.  The Blues came back stating they were attempting to make up for past losses.  

The New York Times has a story regarding Texas and how they are preparing for Obamacare while at the same time they are fighting the law in court.  The state has 6.1 million uninsured.  That is equal to the total amount of people in 33 states.  The Medicaid program is antiquated and they are planning to reduce the payments to physicians under the program by 1%.  They have no idea how many physicians will stop seeing Medicaid patients after that goes into effect. The state also will not participate in the federal high risk insurance scheme.  They will defer to the feds to do it.  They are afraid of the costs.  They feel Obamacare will add $27 Billion to the state debt over a decade. 

The White House has stated that in the first year Obamacare will save Medicare $8 Billion and $575 Billion over the decade.  How, you might ask?  Simple.  Pay the hospitals and providers of care less money.  I wonder why my colleagues are getting out of the profession?  CMS is going ahead with the 2.9% decrease in hospital payments.  

The Democrats passed as part of Obamacare a strict reporting requirement that makes all providers of care give 1099s to all that they buy over $500 from.  This is sure to be overlooked by many providers and they will get in trouble.  There is now a push to drop the requirement.        Top


The Pennsylvania Patient Safety Authority reported that they found 177 disruptive incidents in 31 months in the entire state.  They usually but not always involved physicians.  Most were physicians that ignored nurses warnings or was uncooperative.    

New Mexico is short of physicians.  They need an additional 1000 or so. 

Medicare took away consult fees on this year's billing rules.  The predictable result came to pass.  About 20% of specialists has cut back or eliminated Medicare patients from their practice. 

The AMA is again yelling that the physician profiles by health plans are inaccurate.  Everybody knows that and the plans know it.  They don't care as long as they can show some physicians are cheaper than others and they can direct their patients to the cheaper not necessarily better physicians.  The plans use cost profiles which are notoriously inaccurate.

The Florida Medical Association will vote next month on whether or not to split from the AMA.  The reason for the vote is the AMA's stance on health care reform.  The resolution accuses the AMA of making a mockery of the physician payment "fiasco" and for "failing to lead and represent physicians and the American people on the signature medical legislative issue of this century."  

The AMA is reporting job growth in physician offices.  This is due to increased regulations and is a drain on the practice finances.   

A story in the LA Times discusses the reaction of some physicians to the new healthcare laws.  They are giving up their private practices to become salaried employees of hospitals or their foundations.  The physicians are doing this to preserve income by forming Accountable Care Organizations with hospitals.  This way the physicians will be paid more to keep patients with chronic diseases out of the hospital.  The hospital will lose money but will skim money off the monies paid to the physicians. The question is who controls the government's payment.  Physicians question how much a hospital should get if their patient census goes down due to good work by the physician.   

Electronic Records

Leapfrog did a study on CPOE in 214 hospitals and found half of wrong drug orders that were not lethal didn't give warnings.  One third of fatal errors were not detected.  The hospitals tweaked their systems and all made improvements but not to the zero status.  In 2009 the Journal of the American College of Surgeons did a study at Mayo Scottsdale where efficiency was raised by CPOE but not safety.

The Brits have been using EHR and in Birmingham have found that 10% of the records are erroneous including meds and allergies.  The Government is loading the records without patient consent and they state not for physician use.  One wonders why they are doing it.        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.