The Obama administration blinked first. There has been a major impasse between Florida and the administration over the funding of hospitals. The administration has attempted to extort and bribe the state into expanding Medicaid by threatening to not refund their program of reimbursing hospitals for the care of uninsured patients. The state has refused to be browbeaten by Obama and was in danger of using money from other programs to fund the hospitals. The administration has now seen the error of their ways and agreed to fund $1 billion for 2015 and $600 million for 2016. The $1 Billion is under one half of the money requested so the state will still have to make some funding decisions. This gives the state some time to provide alternative funding.
Per usual when a budget is done someone gets screwed and this year like usual it is the physicians. They left out any increased funding for physicians who see Medicaid patients.
The feds have finally articulated their Medicaid managed care rules. Medicaid plans that contract with private insurers need to have uniform standards with those in the private marketplace. They also need to adhere to the 85% medical loss ratio rule. The Medicaid managed plans are gearing up for a fight over the law.
The relatively new Connecticut Access Health has raised the rate it charges insurers by 22%. This will bring in an additional $7 million. The cost will be passed on the the insured for about $25 in a $700 monthly premium. Yes, you read that right $700 monthly premium.
The American Urological Assn. is going to go against the ridiculous US Preventative Services Task Force in a wonderful manner. They are arguing that not only is the D recommendation regarding PSA screening a terrible decision and the recommendation need to be divorced from Medicare payment decisions but more importantly the task force itself needs to be changed. There needs to be both specialists as well as primary care physician on the force.
The FBI is beginning n investigation into J&J and the power morcellator. It is not clear why the FBI is doing the investigation but they have begun interviewing some people who are involved. They have not notified the company of any investigation.
Covered California, the Obamacare insurer in the golden state, has decided that people should not pay very much for the expensive cancer and hepatitis drugs. They have set a cap of $250 per month. This is in lieu of the patient paying the first several months of the drug before insurance. This will cost the premium paying hordes more money per month in premiums. Top
At the height of conflict of interest the always neutral AHA has sent a letter to Congress asking them to preserve the ban on physician self referral. This means patients will get services at higher costs delivered at the hospitals and not at physician offices. They know that hospitals can not compete on price nor quality with private physicians.
California has fined twelve hospitals for non compliance either causing or may cause patient injury. The hospitals are 1. California Pacific Medical Center $75,000 for not following surgical procedures; 2. Community Hospital in Monterey $50,000 for medication error; 3. Desert Valley $50,000 for lack of following procedures in the care of a patient; 4. Glenn Medical Center $50,000 for not following procedures in the care of a patient; 5. Kaiser San Diego $75,000 for not following the policies for the safety of a patient; 6. Marin General $100,000 not following procedures in surgery; 7. Mercy in Merced $100,000 for medication error; 8. Orange Coast Memorial $75,000 for medication error; 9. Redlands $50,000 for surgical error; 10. San Diego County Psychiatric Hospital $50,000 for not following policies for the safety of a patient; 11. Scripps Mercy Hospital $50,000 for not following policies in the care of a patient and 12. Seton Medical Center $50,000 for not following policies in the care of a patient.
CMS is threatening to pull funding from South Jackson Hospital in Jackson, Mississippi. They have been accused of patient dumping when patients can not pay. The hospital has failed to provide on call physicians to treat and stabilize patients. Top
Oregon is pushing a bill that only applies to one county physicians. They want the Lane County physicians who are now not taking the Obamacare Medicaid patients only to be able to care for public employees and teachers on state-sponsored health plans if an only if at least 15% of the physician's total caseload were the poor paying patients. It seems as this coercion will die in the state House. I wonder who will monitor the percentage and how much that will cost.
Minnesota is coming up to the rest of the country. They have passed a law to allow physicians in the state to opt out of the EHR craze. This was the only state that did not allow the opt out. Solo providers in private practice and cash providers will be freed of the yoke of tyranny. The remainder of the providers will still be chained to the computer.
Swedish physicians have found misconduct by Dr. Paolo Macchiarini, a surgeon who published data erroneously in journals. He reported on the five month progress of the patients operated on for damaged tracheas but actually never did the follow-up. Top
Missouri has fined Aetna and Aetna has agreed to pay $4.5 million for violating state law regarding paying for abortions. They paid for abortions for women who were not eligible under their policies. A 1983 law requires women who want to have abortions covered purchase that coverage separately. They also messed up on their autism coverage by not paying for mandated treatments. 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