June 1, 2013 Recent News





The Wall Street Journal reported that physician owned hospitals are doing very well.  Some have removed beds to put in MRI or other machines, others have stopped taking Medicare patients and are thriving.  All this to the chagrin of the AHA who spent millions of dollars to get rid of the physician hospitals.  The physician hospitals also make up a significant percentage (half) of the top hospitals to receive Medicare reimbursements for cost efficiency and patient satisfaction.  Not bad for a small percentage of the nation's hospitals.

Spectrum Health in Grand Rapids, Michigan, is really into multidisciplinary teamwork.  If a physician can not be part of a team approach he/she is asked to leave the team.  This includes the cardiac team. 

The AP reports that the latest VA hospital problem in Atlanta is just that, the latest in a string of VA screw-ups.  It is a shame that our vets get such poor care in general.  This furthers my thesis that the VA should be dissolved except for those who do specialized rehab.  The vets could then be taken in my all local hospitals and mental health facilities for quicker and probably better treatment.

It looks like Epic and Meditech are the leaders in EHR.  Both are terrible.  I spoke to a nurse this am whose hospital just started Epic two months ago and she told me the staff is up in arms.  Contra Costa Hospital in California almost had a full uprising on their hand because of Epic.  Meditech was being used in my old hospitals and they just switched to Epic because Meditech was so bad.  The bottom line is that there is no such thing as a good EHR.  None of them are interoperable and most are only good for billing. The CPOE on most EHR have so many alarms they are ignored on a routine basis.  All who use EHR are slowed down in their ability to see patients and if they run their own practice see less patients or stay much later to do the entry by memory, a poor practice.  The worst part is that no one cares.

In an interesting story out of the Las Vegas area, a man lost his distal thumb and since he was savvy he called ahead to St. Rose Hospital to make sure they could do a reimplantation.  When he arrived he was told they could not help him and wanted to transfer him to the University Hospital.  When he got to the University Hospital the hand surgeon that saw him was the same one on call at St. Rose but was never called by St. Rose.  He eventually lost his distal thumb.  He states he has been overcharged by St. Rose and refuses to pay the amount they say he owes.  He also states St. Rose will not discuss the case with him.  He now plans to sue St. Rose to make them explain their charges.  

The San Francisco Business Times reports that Kaiser has sold its Ohio operations to Catholic Health Partners.  This includes 11 medical offices and 200 physicians.  There are 80,000 enrollees in northern Ohio.      Top


The CBO has stated that only 25 million are expected to gain coverage via exchanges or expansion of Medicaid.  This is 2 million less than the estimate several months ago.  About 1 million people will not get any insurance and will escape any penalties.  In 2011, it was estimated that over 31 million would get insurance via Obamacare.

The unions are finally seeing the light.  They are now against Obamacare since they see their members paying much more money for the coverage.  They are now calling for the repeal of their hero's plan.  They state this may affect the 2014 elections negatively for Democrats.

The New York Times reports about the demise of the "Cadillac Health Insurance".  This is the insurance that gives first dollar coverage or low deductibles with low or no co-pays.  Under Obamacare, starting in 2018, there will be a significant tax for those who offer this type of insurance.  The companies have started to decrease their insurance now in anticipation of the tax.  The tax is 40% of the amount over a potential premium of $10,200 for an individual and $27,500 for a family.  The operative word here is potential.  Most employers are going to plans that raise the deductible to at least $1000 per year and preferably to $2000.  As an example, Cummins an engine manufacturer, has raised the family deductible to $6000.  These companies have also pushed preventative care.  The Democratic unions are fighting this trend but they backed Obamacare originally and now have to face the consequences.

Obamacare mouthpieces state that the insurers are flocking to insure people in the exchanges and the there will be significant competition to drive down costs.  Health care experts disagree with the fed assessment.  They state that there will be some competition there will not be enough so that prices will drop a lot.  

Angelina Jolie has done a great service to medicine.  Her mother passed away with Ovarian cancer and Ms. Jolie was  tested for the BRACA genes.  She was positive for BRACA1 mutations and had a double mastectomy with immediate start to reconstruction.  She is now finished with the reconstruction and is going to have a bilateral oophorectomy.  This will bring to the forefront genetic testing for those women who need it.  In the past women were afraid of the test since if positive they may be denied insurance.  That is no longer true.  Most physicians in the field recommend that women be screened by their primary care physician to see if they should be sent for genetic counseling to determine the need for the test.

Medscape reports on a story in the London, England, Sunday Times about a patient with a family history of prostate cancer and breast cancer.  He was tested with a PSA which was normal, a DRE which was normal and BRACA2 mutation which was positive.  He underwent a prostate biopsy and was found to have a small amount of cancer cells present.  The patient had a prostetectomy.  There is some evidence to suggest that men with the mutation have shorter life spans by 1/2 and more aggressive prostate cancers than those men with out the mutation.  This needs more study before prophylactic treatment can be offered to BRACA2 positive men.  The above case is not considered prophylactic.

The LA Times has a story about a biotech firm that got $334 million for research on Antrax treatment.  It happens that the firm has as a director the former Navy Secretary Richard Danzig.  He has made over $1 million in his capacity in the company.  The company has just been purchased by Glaxo.  The medication Raxi has a 3 year life and that is coming up in 2015.  The original purchase of the drug was by the Bush regime and more was purchased by the Obama regime.  Danzig was Secretary under Clinton and told nobody of his involvement with the company making Raxi.  He has had multiple consulting positions with the Obama administration.  The only people buying the product is the government.  Danzig believes, since he is a lawyer, that he had no conflict of interest.  The people in the government see it differently. 

The AP has a story about potential surprises for people this fall.  Many will get letters from their Uncle Sam telling them that the insurance company they have had is not up to the Obamacare standards and needs to be replaced.  Remember when Obama stood up and lied with the famous "If you like your health plan then you can keep your health plan."  You can't.  He is hoping that when people see the increased benefits of the exchanges they will forget his lies.  Then they will see the premiums and remember the lies.  These changes will affect the 14 million individual plan members and small business.  Those who receive their insurance from a large business should not be affected.  The good thing is this will happen just before the fall elections.      Top


The concierge medicine three year report was surprising in that cardiology, dental and pediatric providers are getting into the game.  Most concierge physicians are in their late 40s and early 50s.  They are spending between 30-60 minutes with each patient and are doing follow-up calls to make sure the patients are following the advice.  The average physician is making between $100,000 and $300,000 per year with most stating their income is better than three years ago.  They are getting more inquires about their practice with Obamacare coming soon.

According to Deloitte approximately 15% of the nation's physicians will not purchase any EHR.  These physicians are older and wiser and also in solo practice.  They realize the expense involved for the lack of payback.  To date only abut half of physicians have EHR.  Of course these systems do not talk to one another so are useless is some situations.  They realize that if one gets an EHR the physician loses about one half year of income due to the slowness of the learning curve and that income may not be regained.

An article in the NY Times showed dramatically the difference between physicians in the past and those of today.  We elder physicians were at the hospital all the time not only seeing patients but also drawing blood and starting IVs.  Those today can spend no more than 80 hours a week at the hospital.  When they are there the study showed that over half the time they spent at a computer.  They spent 8 minutes a day per patient with the patient.  This is may be a forerunner of the future.    

The MGMA reports that on call payments rose for primary care physicians but went down for surgeons.  This seems strange since most primary care physicians do not go to the hospital as most hospitals have hospitalists.  The percentage of all physicians paid for call went from 60% to 70%.  The surgical subspecialists paid for call went over 87%.  The highest paid on call specialists are anesthesiologists at $2400 per day.    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.