December 1, 2012 Recent News





HealthLeaders has an editorial drawing from the Archive of Internal Medicine article by two "progressives" on why Canadian healthcare is so much cheaper than that in the USA.  The points are that over 30 years our spending per patient rose 198% versus 73% for Canada.  The lefties state that Canada has more benefits than the US.  They also state that in the US Medicare pays only 50% of the bill.  I challenge that figure.  Canada, they say, pays 80% of the "costs".  They also state that life expectancy has grown faster for the over 65s in Canada that in the US and clinical outcome are better than for insured Americans.  The savings seem to be twofold.  The first is that primary care, the usual type of care in Canada, is cheaper than specialist care.  I agree.  However, in the US the primary care physicians can not diagnose without fancy equipment which is expensive.  If they were better diagnosticians with less worry about med mal we would need much fewer specialists.  Of course, that would mean doing as they do in Canada with long waits for specialist care.  They also state the second reason is lower administrative costs but they equate Canada to all of the US insurance, not just Medicare.  Apples and Oranges.

The GAO has done a survey and to no one's surprise there are few specialists and dentists that take Medicaid patients.  The reason also is no surprise, not enough money.  So are they going to pay more?  No, they will just pay the pittance faster.

The government stopped allowing consultations for Medicare patients and only allowed office or hospital visit codes instead.  They did this to save money.  It ended up costing the government 5% more.  What it did do was to narrow the gap between specialist and primary care slightly, a secondary reason to cut out the consultations.

The government has also pushed electronic medical records but they have forgotten to but in safeguards making the records vulnerable to fraud according to federal investigators.  They also have no way of knowing the accuracy of the information sent to Medicare by the hospitals and doctors.  This leaves the program vulnerable to paying for inaccurate information.   Medicare has become very defensive against the charges by the OIG and believes erroneously that it is protecting taxpayer dollars.  Nobody believe the money spent on the program is well spent.  Medicare also has never audited any of the billions of dollars spent on the program.  Medicare does not believe that any prepay audit is necessary.  It plans at some time to audit the program retrospectively (pay and chase).

It's about time that someone did a study that showed mammograms are not all they are thought to be.  There has been a well known false positive rate of over 30% for decades.  The false negative rate has been around 5% but is getting better with better equipment.  Now two male researchers have found that the test makes no difference in the outcomes. They say that the drop in breast cancer mortality is due to better treatment not earlier detection and many of the cancers detected early would not go on to deadly cancers.  Does any of this sound familiar to men and PSA.   This should raise the hackles of the females and the radiographers who make a lot of money from this exam.

Ah, the savior of healthcare, Obamacare, will not be for all.  Bloomberg reports that Kaiser News estimates that a family of four with a $75,000 income will pay a premium of $7125 PLUS an additional $8333 in co-pays and deductibles.  A 40 year old with a $30,000 income will pay $2509 in premiums AND $3125 in cost sharing.  A 60 year old making $40,000 will pay a premium of $3800 PLUS $167 in out of pocket fees.  Subsidies will help but will not make the money costs disappear.  Now who will not get insurance.  All those whose costs are over 8% of their income may opt out.  Also those who decide not to join will pay a paltry fine of either $695 or 2.5% of their income whichever is greater. The White House continues to have it's head in the sand and states that Obamacare will cover those without insurance.  True, but not related.  They still will not be able to afford the coverage especially with the mandates.  

A study looked at states with CON laws and found that there is as much robotic prostatectomies done as in states without the ridiculous laws.  The same was true in another study looking at IMRT for prostate cancer.  It shows that first no one believes the study regarding the treatment of prostate cancer done by pediatricians and like ilk.  Secondly, it shows that the CON laws are just work arounds.

Illinois is really good at scare tactics.  The legislature is told that if they don't raise more money for the Medical Board that about half of the people that investigate physicians in the state (18) will be laid off.  The Board wants the legislature to raise fees physicians pay for their licenses to pay for the keeping of the watchdogs.  The current fee is about $100 per year and has not been raised since 1987.  One wonders how they could have paid all those people all this time and only now need more money.  Physicians are against the raise since the money gotten from them in the past has gone to the state for other uses.  The legislature took $8.9 million from the fund for other uses which is the reason for the current shortfall.

California insurers are again raising rates in the double digits.  Anthem will raise some rates as much as 25%.  These are on individual policies.  The state can attempt to bully the insurers but legally can do nothing to stop the raises.  This is directly tied to Obamacare and the insurers wanting to have as high rates as possible going into 2014 when they must take all comers.  The federal law already in place requires 80% medical loss ratio which does not say how high the premiums can be.        Top


Orlando Health has purchased Physician Associates, Central Florida's largest medical practice for $50 million.  That is about $500,000 per each of the 95 physicians. As of the first of the year they will become hospital employees along with the other 400 physicians already in the grasp of the hospital.  The next largest independent physician group has 10 physicians.  Look for a facility fee to be added shortly for the privilege of seeing the physicians.  This will also decrease the taxes to the community since the for profit physicians will now be part of the non profit hospital.  The hospital denies that there will be facility fees but time will tell which side of their mouth they speak.  If there are no fees and no changes in referrals then why pay the money.  It makes sense for the physicians but not for the hospital.  The senior physicians will leave shortly taking their money with them.  

Prime Healthcare is branching out.  To date, it has been mostly a California hospital owner.  It is now purchasing St. Mary's Hospital in Passaic, New Jersey. 

Someone got very smart.  An entrepreneur set up a website for appointments to about 140 hospital emergency rooms.  It is legal and does not violate EMTALA.  This allows the hospital to increase it's patient satisfaction and get more money.  The company is InQuicker LLC.

Mass General has a problem.  Their nurses and others at the hospital were informed that if they do not get flu shots they must wear masks when taking care of patients.  The hospital has a flu shot rate of only 61% and if they do not get 90% they may lose money.  That is the real reason for the hospitals to push.  It has nothing to do with the shot per se since all know that is a fallacy. 

In the last update I wrote about the law suit filed between two Idaho hospitals, St. Alphonsus and St. Luke's.  Now the New York Times has a major story about the problems in Boise.  The independent physicians are complaining that St. Luke's dictates which tests and procedures be performed, how much to charge and which patients they should admit.  They also say patients are paying too much at the hospital and their referrals from the St. Luke's employed physicians have dropped sharply.  The paper states this is true across the country where physicians are told by their hospital masters to perform unnecessary tests and procedures or to admit patients who do not need admission.  The FTC is now investigation St. Luke's for its purchase of another group of physicians possibly leading to almost complete control of the healthcare in the area with rising prices.  The story goes on to blast HMA, a for profit hospital chain, for forcing ED physicians to admit patients who do not need admitting and for firing people who bring up poor care in their facilities.          Top


Dartmouth has found that physicians do unnecessary testing.  I hope they did not spend much money on the obvious.  They used Medicare patients and Medicare guidelines which are usually either out of date or geared toward payments and not quality.  A commentary accuses physicians of over testing due to self payment.  There was no proof of this in the article.        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.