March 1, 2010 Recent News
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Kaiser Permanente has increased operating revenue of $42.1 Billion, an increase of approximately $2 Billion from the year prior. This led to a profit for the year of $2.1 Billion instead of a loss of $794 million. That was the good news. The bad news was a decrease in member ship by 64,000. The above was from the San Francisco Business Times.
As all know by now, Anthem Blue Cross of California has stirred up a firestorm both in the state and nationally for proposing a large premium increase. Nationally they are responsible for the administration putting into the Obama plan a national panel to look at insurance increases and force potential rollbacks. In the state, the California Insurance Commissioner, who happens to be in the running for Governor, has stated that Anthem has broke state law over 700 times and can be fined $10,000 per incident. He stated that they failed to pay claims on time and misrepresented policy provisions to customers. This is on top of the ongoing investigation as to whether or not they are paying the requisite 70% of premiums to medical costs. The LA Times also reports that Anthem recently sent $525 million in profit to parent Wellpoint in 2009 and at the same time began the raising of rates for consumers. They are a one company public relations disaster.
Anthem did testify before the California Assembly and told them they believed the increases will pass regulatory muster and will go into effect as scheduled on May 1. They also told the Assembly that the profits should not be looked at in terms of the amount of money but by the percentage of profit. They contend that the profit is between 2.5 and 5%, which is a reasonable profit.
In a time of Anthem's folly, the trial against them is starting by a liver transplant recipient who Anthem refused to allow to go to Indiana for his surgery even though his UCLA physician recommended it. The insurer did not want to pay the larger out of network costs and would only cover the transplant at UCLA. Top
The San Francisco business Times reported that California hospitals paid out a total of $1.6 Billion in 2008 for physician on call services. Trauma hospitals paid about 30% more for the services than non trauma hospitals. This was about 3.6 of hospital expenses. This shows what happens when mandates occur and reimbursement for medical care decreases against inflation. What used to be part of hospital privileges now requires payments unless the physician is employed and then it is factored into the employment contract.
Boston's largest independent physician group, Harvard Vanguard, has abandoned Brigham and Women's Hospital in favor of Beth Israel Deaconess. The hospital agreed to send patients to Harvard Vanguard physicians post discharge. Atrius, another physician orthopedic group, is also switching from Faulkner Hospital to New England Baptist Hospital. Much of the switches are the result of changing to paying HMO rates instead of fee for service. The physicians can control the patients and get cheaper rates for their patients leaving more money for them.
CoxHealth in Springfield, Missouri, has reported 76 patients who have received more radiation than intended due to errors in new radiation systems. A medical physicist miscalibrated the system and it was not caught for five years on routine checks. Top
The report last year regarding mammograms have caused a rift between physicians and their patients. there are some physicians, especially those who work for HMOs, who want to follow the new recommendations of doing mammograms every two years starting at 50 years of age instead of the old recommendations of starting at 40 and doing it every year. The patients are not willing to change to the new guidelines. Insurers continue to pay for the annual exams.
A new poll by Zogby International has shown that 57% of Americans do not like either the Senate nor the House Health Bill and want a redo. This means nothing to Obama who is using the bills as the start for his new televised program. This program will be meaningless and will show the two sides unable to enter any agreement. Most Americans (68%) want some healthcare reform, just not what was passed by the two Democratic houses.
For the past year Obama has praised certain hospitals for high quality care. This was based on a study from Dartmouth. That study is now in disrepute according to an article in a Massachusetts study. It has shown that the original study was not meant to rate hospitals in their quality of care. The original authors stated that they should not be responsible for the misinterpretation of their article.
Obama called a fake healthcare summit and got what he wanted, a show. There was a collection of sound bites and nothing else. This opens the door for the death of the Democrats, the use of reconciliation to pass a bill that will throw the country into deeper debt.
England has found that men with what is to believed to be low risk prostate cancer are opting for active surveillance instead of therapy. It will be interesting to find out what happens to these people in five years.
The Amherst Daily News reports that Danny Williams, the Newfoundland, Canada Premier, left Canada to pay out of pocket for heart surgery in the United States. It is ironic that the Canadian Health System will not let people pay for care in Canada but has no restriction outside of the country. This is not unusual as Mr. Williams is only one of about 41,000 people that get elective healthcare outside of the country. The country does not ban private healthcare but the provinces state that if the physician takes private money they can not take any public money. Top
In the first valid study of medical marijuana conducted in at least 25 years researchers at the University of California have concluded that smoked weed is a good therapy for specific conditions. The conditions include injuries to the nervous system including the painful spasms of multiple sclerosis. The study did not go further since it was short on money. This may lead to more states going against the feds refusal to allow medical marijuana due to politics and not science. Top
Physicians are finding out what they have to contend with in order to get the additional 2% out of Medicare. Under PQRI they have to download a about nine hours to get their reports and then the reports do not say much. By the way the average money received for this work is $630. 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.