The insurance industry is all for universal coverage as long as they are the ones collecting the premiums. They are willing to do no pre-existing conditions if they can also insure the young and healthy who now are not insured.
California has rated its HMOs and Kaiser for the first time has received the highest rating possible. All the other HMOs were below Kaiser. Aetna, Blue Cross and Cigna all received the lowest marks. In patient satisfaction Cigna received a poor rating but Kaiser received three out of four stars. Both Kaiser and Sutter medical groups received four star ratings for quality and three stars in patient satisfaction.
Being high in quality does not translate to money. Kaiser lost $399 million in the third quarter mainly due to investment losses like the rest of us. For the first nine months it only made off operations about 1/10th as much as last year.
Moody Investment Services has stated that Obama's desired healthcare reform will cost not the projected $75 billion but closer to between $100 billion to $200 billion per year above the current $800 billion. Hospitals would get more money in direct payments and some indirect relief by having more patients going to primary care physicians, if they can find one, instead of emergency rooms. The dark side, besides the money we can not afford, is that insurers will be squeezed and in turn will squeeze the providers paying them less.
The People's Republic of Massachusetts, touted by Obama as a model for his health plan, continues to be in deep trouble. In order to fund its universal health it is stealing money from its Medicaid system. This means that two safety net hospitals will have to cut services and the republic will lose matching funds. The republic will also have to cut back on its immunizations.
The majority of physicians in the Republic of Massachusetts are practicing defensive medicine to the tune of about $1.4 billion per year. How can this be changed? Why not ask the legislature who are Democrats and are being paid off by the trial lawyers.
In an interesting story in the Boston Globe, hospitals in Boston are paid more for the same procedures than other hospitals even though their quality is less. An angioplasty at Framingham will be paid at about $217,000 where the same procedure by the same physician at Brigham will be paid at $24,000. The same is true for MRIs and other x-rays. Does this impact the extraordinary high health care costs in this corrupted state? Of course it does. This is mainly due to Partners Healthcare and the inability of the legislature to challenge them. The Globe is to be congratulated for showing the corruption of the Boston healthcare system. The problem is nothing will happen to correct the system.
Still in the Republic, Blue Cross is going to require that to be eligible for any bonus payments physicians will have to do e prescribing by 2011. The standalone software will cost between $1000 and $3500 per physician. Blue Cross stated they would pay an undisclosed sum to some physicians to help defray the costs.
The people at Health Affairs must have nothing to do with their time. They published a study showing that if Medicaid did not pay promptly, physicians were nor taking Medicaid patients. I hope not too much money was wasted on this common sense.
Another article in the same journal stated that Medicare Advantage does not increase quality to its members and costs much more than regular Medicare. Obama wants to lower payments to them.
Obama has picked Tom Daschle, the defeated US Senator and fervent Obama supporter to head the HHS. Obama needs someone experienced in the ways of the Senate to attempt to get his healthcare mandates through the legislative process.
In a peer reviewed study entitled "The Hidden Costs of Single Payer Health Insurance: A Comparison of the United States and Canada" an article by the Fraser Institute states that Canada's uninsured is almost comparable to the number in the US and that the Canadians have long wait lists for a limited supply of technology. The Canadians had problems accessing primary care physicians just like they do in the only place in the United States with Universal Care (see story above).
An article at Canadian Health shows that in about 12 years several provinces will be spending 50% of their revenue on healthcare. Some provinces like Ontario have increased taxes to keep up with healthcare spending.
Another article shows Canadian medicine is now spending $5170 per person on healthcare and this is expected to rise dramatically mostly due to drug costs. As a comparison the most expensive medicine is the United States at $6714 per person and next is Norway at $4520.
The Australia physicians state the public hospitals are unsafe and responsible for about 1500 deaths per year. This is directly due to reductions in spending by the government in the healthcare sector. About half of the Australian people go to public hospitals. Fortunately over 60% of surgery is done in private hospitals.
Zimbabwe has an inflation rate of 231 million percent under Mugabe. This is leading to the hospitals being unable to have meds or anything to help patients. In one month over 60 people have died from Cholera alone. The physicians have tried to protest but the dictator's riot police have stopped them.
I just returned from a trip to Viet Nam and Cambodia. Viet Nam still is communist in the government but the people are all capitalists. The medical care is socialized but people pay the physicians and nurses under the table for slightly better care. Cambodia has elections but the same person has been prime minister for 30 years. The ballot is not secret and the government mantra is "later". The roads are poor but we will fix them later. The Khmer Rouge is still powerful in the government. The medical care is private or none. If one doesn't have insurance one dies. Sounds like an HMO to me. Cheaper to let the person die than to treat. Top
The Advisory Group, a hospital think tank, show that over 50% of hospital acquired infections are in the Medicare population. This is important since Medicare will stop paying for these "never" events.
AMN Healthcare has an article regarding how the economic downturn is hitting hospitals. With more people out of work and without insurance, the hospitals are starting to see an increase in the uninsured in their EDs. This is leading to a slowdown in hospital expansion. Also many hospitals depend on investment income to supplement the stingy federal payments. However, this year they have investment losses and may have to cut services.
The Advisory Group states that not all is well with EMRs. They show that about 20% of hospitals are uninstalling their EMR system and that about 45% of hospitals have already uninstalled their systems.
West Pennsylvania Allegheny had four physicians give notice that they were leaving to join the competition, Pittsburgh Medical Center. The administrators of the Allegheny tossed the four with no notice. This is the second group locked out of their offices this year by this group for leaving for a competitor, all to the detriment of the patients. Administrators don't care.
The problems at UC Irvine continue to mount. Now the CEO will leave in March, 2009. She has been in the job under eight months. The hospital is also out of compliance with Medicare regs and may need to stop getting Medicare patients. Top
Shands (Jacksonville, Florida) Medical Center has fired twenty employees for illegally looking at a NFL players medical chart. The employee's union is not happy.
UCLA has to date found that over 1000 patient medical records have been improperly accessed. To date, 185 workers have been disciplined with more possible.
The Portland VA has posted patient information on its web site. Over 1500 patients were offered fraud protection by the VA.
The University of Iowa has fired one person and disciplined others in the unauthorized snooping of medical records. Top
The Las Vegas Review newspaper had an article on the good and the bad of tort reform passed in Nevada several years ago. There are less cases filed and less reaching the court. The attorneys are not happy since part of their livihood has been removed and since the trial lawyers pay the Democratic legislators big bucks, one is now considering relooking at the caps on non economic damage. Top
Wisconsin is finding itself with fewer than required primary care physicians and fewer on the way. The obvious reason is that fewer people are going into primary care since they get paid much less than specialists and have to work very hard to continue their income. Only about 40% of the state medical school graduates remain in the state.
Wisconsin is not alone. The Physicians Foundation has found that 60% of primary care physicians would not recommend medicine as a career. Many are spending less time with patients due to paperwork and are planning to quit early or at least cut back on their practices, not a good sign as the population ages.
The physicians in California, Nevada and Hawaii are not being paid timely by Medicare. The cause is Medicare's inefficiency with the new NPI numbers and then the switch in intermediaries on the left coast. Some physicians are now turning away Medicare patients and others like oncologists are referring patients to hospitals for their chemotherapy, an expensive change for Medicare. I spoke to the physicians in this article. They stated that they had turned to both the local and state medical societies for help with no result. The state medical society did recommend going to the press and this is working as a top Congressperson and US Senator have both contacted the state organization to help. Money is now started to flow again.
The AMA is taking exception to the abusive Joint Commission disruptive behavior standard as vague and giving too much power to the hospital. 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