June 1, 2012 Recent News
A study funded by GE and ACS showed that laxative free CT colonoscopy can find polyps over 1 cm in diameter. Small polyps may be missed. It is done by a low fiber diet and giving small doses of radioactive iodine by mouth for two days prior. The isotope binds with the stool and can be removed from the image electronically. The study does not give the costs but does state that if something is found conventional colonoscopy with laxatives will be needed to remove the lesion.
If Obamacare is declared invalid in the individual mandate and Medicaid portions, the healthcare insurers will lose $1 TRILLION. That is a huge number and most of that money would go to others since at least 80% must go for healthcare. But, don't cry for them. If the law is kept intact the insurance industry will still keep $174 Billion. That is not chump change.
About 13.5 million people now have high deductible HSA insurance. This is an 18% increase over last year. It only shows that people are getting smarter.
The government believes it is safer for physicians to use CPOE for prescriptions than hand writing. It may be but there is a large percentage of electronic prescriptions that are erroneous due to either the physician or more likely the assistant being over wrought due to time constraints. Why is this never discussed? Could it be it doesn't comport with the wishes of the government?
Politico writes that even if the Supreme court deems health exchanges legal that they may not come into fruition due to IT concerns. The states need to have systems that talk to the feds and the other systems in the states. They can not talk to the other systems and the feds have, as usual, delayed any mention of their system. Many state Medicaid systems are not even computerized at all. The costs for all this are also prohibitive in the cash stripped states.
The law of unintended circumstances continue to plague the "thinking" of the government. In a recent study it was shown that the rises in health care costs are not unnecessary care caused by fee for service but are caused by an actual rise in prices. Therefore ACOs and their ilk will not save any money if they charge the same or more for the services rendered.
It seems that medical paperwork is well and alive. Documents being stored all almost exclusively paper and are not being digitalized. Digitalizing a box of 200 medical records cost about $100 and storing the same box of cords is $15 per year. It is cheaper in the short run to store and not digitalize.
The insurers are putting high cost medications in a separate classification that costs the patient much more money. Why do this? The answer is obvious, money saved for the insurer who are then able to hold down premium. What they have done is add a tier 4 which people pay much more in co-pays for the meds in this class. New York State has forbidden these tier 4 classes and the premiums for insurance go up accordingly as someone must pay the cost.
Veterans in the San Francisco Bay Area are continuing to get the run around from the inept VA system. It takes at least six months to get even a form to fill out for benefits. They then wait about one year to find out if they qualify for assistance.
Again the US Preventive Services Task Force has stated that PSA tests should not be performed. Remember this organization has no urologists nor oncologists as members. The chair of the organization does not have to worry about prostate cancer as it is a woman. The other person commenting is a male MD in IT at a University and with little if any clinical experience. No Urologist nor plaintiff attorney will pay any attention to this stupid advice.
The same organization has come out that Hormone replacement therapy in women who are past menopause should not take the meds to prevent bone fractures, heart problems or dementia. They may take it to fight symptoms of menopause. Another recommendation that will not be followed. Many physicians believe that the dangers of hormone replacement are overblown.
According to an article in Health Affairs, most insurance companies are not yet in compliance with Obamacare's insurance mandates. The benefit section must be beefed up and the out of pocket expenses for individual members must not be over a certain threshold. Of course this means that premiums will be raised to cover government mandates. This is especially true for those plans that get a lot of people with pre-existing conditions.
HealthLeaders has a piece on MediCal, California Medicaid. As of now specialists and many primary care physicians are not taking MediCal patients. This is leading to significant problems in the Golden State of access. This will intensify when more people may be added to the rolls if Obamacare comes to pass. As of now physicians get 57% of Medicare to treat MediCal patients and so do not take them or if they do only take a small percentage, except for the mills. The state is planning on another 10% cut of fees which will mean more physicians will drop the program. Hospitals also are dropping their contracts with MediCal for elective items. This leaves small choices for the folks on the dole and worse is yet to come. Top
The hospitals are at it again. They continue to harp at outpatient centers since they take money from them. The hospitals continually state untruthfully that patients are at greater risk. The procedures are done more stress free and less costly in outpatient facilities than at hospitals. Also the physician has better time management. It is the hospital's own fault the the outpatient facility started. They refused to allow the surgeons to control the ORs so they could be efficient.
Maybe the hospitals should look internally. Two studies from the University of Maryland found that hospitals were discharging patients too early to collect extra money. The busier the hospital the more likely the patient would need re-admission within three days.
In an article in the AMA News, seven large hospitals in the People's Republic of Massachusetts have agreed on a "I'm sorry" program for the hospital and their physicians. The article did not state whether the physicians must go along with the program but since all or almost all are employed they probably have no choice. The article also left out whether or not the apology could be used against the hospital and physician in court.
Hospitals are being told to forget about readmitting patients within the 30 day window who have terminal diseases and just send them to hospice. It was recommended by a hospice marketing specialist that the hospital administration and not a physician talk to the patient about the decision since the physician may not want to lose a patient. Of course he does not mention that his group may want a patient that's care is paid for by Medicare.
Fairview Hospital is Minnesota has lost it's CEO. The CEO's contract will not be renewed and the decision come one month after the hospital stopped it's contract with Accretive Health, the company that used strong arm tactics to collect debt. This included placing people in the ED to collect past debt prior to being seen for non emergent conditions.
Mayo Clinic continues to grow; now with their fifth site. This one is Heartland Health is Missouri which was already linked to Mayo by use of Mayo's IT in their EDs. Now the Missouri physicians have access to Mayo physicians for all second opinions. Heartland is not being purchased by Mayo, only used to increase their volume.
Four Northern California VA sites have been cited by federal OSHA inspectors for safety violations. They can not fine the clinics as they are not given that power. Top
Congratulations to one of California's physician groups in the country, Partner Healthcare. They have been purchased by the largest Dialysis company, DiVita. Watch the amount of patients on dialysis go up. They also have inherited a huge amount of debt. I guess that is the American and Greek way.
A new study by The Bureau of Labor Statistics have shown the average GP in the country makes $177,000 or $85 per hour but they don't say how the hours are calculated. Those who make the most are in Northern Florida and the least in Columbia, Missouri, a college town. The study does not state if employed or fee for service make more and the hours each work. In other words, it is a study that gives generalities and not real data.
In a session for Becker Healthcare which panders to hospitals, Dr. Greeno, CMO for Cogent Healthcare, stated that hospitals will change their medical staffs radically in the future. The staff will consist mainly of hospital based physicians who can be controlled by the hospital and specialists who will be specialists. There will be administrators to "help" the specialists practice cost efficient medicine. This may force more physicians to build more outpatient surgical centers to get away from the hospital administrator's "help".
HealthLeaders says that there will not be any permanent cure for the dreaded SGR this year. It is not a high priority as yet on the Republican or Democratic agendas for the remainder of the year. Since the start of the SGR the potential cost of the program which has never seen the light of day has reached over $300 Billion and is not planned in any budget.
HCA owned Aventura Hospitals in the Miami area are shedding physicians. They purchased a bunch for an ACO but found they were poorly organized to handle the infrastructure causing losses. Some of the physicians were "transitioned" into private practice. One refused the offer and he was terminated. It is a shame that physicians are too stupid to see what they are becoming, a fungible quantity.
On the flip side of the physicians mentioned above are the 332 physicians who are shareholders in the California IPA Hill Physicians, based in San Ramon. The San Francisco Business Times states that the IPA has a total of about 3700 physicians including primary care and specialists, all are on contract except the 322 mentioned above. This year the organization made a profit of $11 million on revenue of $481 million. What do they do with all that money? They give it back to their physicians. In 2011 they gave the primary physicians $11 million and the specialists $4 million. They also spent $7 million on a multi year new electronic system. The IPA covers over 3000 managed care patients. That is a mark of a good physician IPA that contracts with insurers and hospitals. 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