July 1, 2011 Recent News




The AMA continues to lose physician membership.  Another 12,000 have departed.  This is a 5% decrease since 2009.  One third of the remaining physicians are those in training and know no better.  Remember 2009 was when the AMA supported Obamacare.  Draw your own conclusions.  

The Washington Post has an article on the major push of hospitals to buy physician practices.  They want primary care and specialists in their fold.  This is to be ready for the extra money that they hope materializes from ACOs.  One physician put it well "It is like the local coffee shop versus Starbucks." You will get more variety with the local but always the same with Starbucks.  With hospital acquired physicians in ACOs the patients will continue to see their own physicians in their offices but the hospital will control the staffs and all else in their treatment.

Eighteen Portland cardiologists from the independent Oregon Clinic left to join the employed ranks at Washington's Providence System.  It is a major blow but not a death knell to the Clinic.  The physicians wanted more money and security.  The problem for the cardiologists is that it is only a one year contract.  The physician head of the Clinic talked about how non-physicians are controlling medicine.  He used the example of CMS reducing cardiology imaging by 40% for the cardiology offices but increasing it 5% for the same tests at the hospital.  He then went on to talk about evidence based medicine and how there are so many different ideas as to what is best that there is for the most part no evidence based best practices for many diseases.  The comments to the article in the Lund Report were about evenly split in favor of the cardiology move and a move toward one payor system.

Medicare claims apparently show that CT scans are being overused with some patients getting two lung CTs a day.  The 2008 claims data (reliability?) show that 80% of the hospitals were doing this.  This is patently false.  Hospitals do no scans.  they are ordered by clinical physicians and allowed to occur by radiologists.  The scans were done for checking blood flow and one regular one.  One is all that is needed.  Again this goes back to the physician and not the hospital.  Now that hospitals are under scrutiny for this they are instituting protocols and requiring the radiologists to finally talk to the clinicians, a novel concept. 

It is hard to understand but Bloomberg reports that physicians are turning away private pay patients and would rather see Medicare patients.  The reason was low pay and administrative hassles.  The government is planning to look for themselves with a secret shopper program that will call physician offices and see if they will take Medicare or Medicaid patients.  There is no question that Medicaid patients will have a hard time since few physicians will accept the low pay and the administrative hassles of the program.  This will come to a head in 2014 when more patients will seek the services of the same number or fewer physicians.  This means the new patients will see lesser trained individuals for their care and more will enter the ED.  The insurance industry states erroneously that one of the reasons that there are less physicians seeing patients is that the insurance companies are wanting safer higher quality for their patients.  What they want is less money per physician.

The Wall Street Journal asks a good question, Why would anyone want to join an ACO.  All agree that ACOs will not work under fee for service as shown by the Duke study.  There has to be another payment model.  Why would people in fee for service Medicare enroll?  They can get better coverage with more choice of physicians in the fee for service model.

The Colorectal Surgeons of the People's Republic of Massachusetts want more money.  They are attempting to for the Republic to mandate insurers pay for screening for colorectal cancer.   

The AMA has put out a report that 20% of medical claims to commercial payors are being paid incorrectly.  This adds up to about $17 billion in annual waste.       Top   


The people don't believe the government.  CMS continues to offer free preventative care and the people are not getting it.  CMS is now taking out large advertisements in newspapers to try and coax the people to get the free care.  

Recently, 270 different groups including biotech signed to get rid of the idea of IPAB.  Let us hope Congress is listening.

A report by The National Journal states that 5% of the people account for half of the health care spending in the US. Adults aged 55 and over was the largest part of the spenders as one would imagine.  People with at least one chronic health condition were two to four times more likely to have spending in the top 5% group.  These mostly were hypertensives and high cholesterol with diabetes coming in third.  

The Hill states that 57% of people polled are against the Ryan plan.  This percentage held true with Independents.  

The government is also behind on the issue of pre-existing conditions.  They lowered the price of the insurance for those with the conditions but still are having few takers.  To date all of 22,000 people have signed up for the insurance.  The government dropped the price almost 40% and still people are not buying the product.  

Bipartisan House members signed a letter to MedPac stating they believe their contemplated rules regarding paying less for second radiological procedures as this will raise healthcare costs.

Several weeks ago McKinsey & Company released a report that 30% of employers will drop healthcare insurance when Obamacare comes into full force in several years.  This raised the hackles of the Dems who blasted McKinsey for the report that contradicted their own reports.  McKinsey has now posted the questions asked and methodology used in their report.  The difference is that McKinsey actually asked businesses what they were planning to do, not on economic modeling.

Two days after announcing they were going to send mystery shoppers to physician offices the administration said they are not going to do it.  They got alot of flack for the idea but said the new decision is not political.

The People's Republic of Massachusetts (the model for Obamacare) is again and still not achieving its goals.  The budgeting of payments to hospitals and physicians continue to cost the same or more.  The reason is the clout the hospitals have to get high payments.  Even the physicians on HMO type payments got good money and more money if they were aggressive.  The attorney general stated that the state should bring down the excessive rates.  There is no indication as to the definition of excessive rates except that it is more than the state wants to spend.

The Boston Globe had a series of two long articles on healthcare in their Republic.  They state it is working as well or better than originally expected.  However, they acknowledge the costs the Republic pays for the care is only 1/3 of the true cost.  The other 2/3 is paid by the feds.  That is the problem.  The feds will soon cut payments for state aid and the program will become a large albatross in the Republic.  The other problem this brings up is that Obamacare is based on Rommeycare.  If the same thing happens with the same cost increases there is nothing to bail out the feds except the taxpayers.  

Kaiser has announced a raise of approximately 10% on average for premiums for Californians in small business plans.

In 2004 The Joint Commission issued their decree regarding wrong sided surgery and time-outs.  It has not worked.  Kaiser Health News reports that there are up to 40 wrong sided surgeries per week still done.          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.