March 1, 2012 Recent News






St. Joseph Health System with hospitals in Napa, Santa Rosa, Petaluma, Fullerton and Mission Viejo California notified over 31,800 patients that their medical but not financial information has been available on line.    

UnitedHealth has started a new App for their insureds.  The people are to download it and enter personal information to get information on claims and benefits and find the nearest hospital or physician that is on their plan.  It also will work with health goals.  Other insurers have also done the same thing.  Some have cost data on physicians and hospitals that can be downloaded.  This is fine to keep on your cell phone as long as you don't lose it or have it stolen.    Top


White House Budget director Jeff Zients obviously did not get the memo.  He testified before Congress that the individual mandate was not a tax.  However, the White House said later that the mandate arises from the power to tax.  If it was a tax Obama would be accused of raising taxes on the middle class.  The White House says it's a penalty but before the Supreme Court they are arguing the mandate is a tax so that courts may not block it before it goes into effect.  Both sides of the mouth.

In a Gallup poll reported in the Los Angeles Times almost 75% of those polled thought the individual mandate of Obamacare was unconstitutional.  The poll went on to look at battleground states and found that 53% of those people want the law repealed as opposed to 40% nationally.  Half of all people in the country polled considered the law a bad idea and 40% felt it would make healthcare worse.  

Forbes has an article about how Obamacare is hurting children.  The law allows children with pre-existing conditions to be insured but the insurers have stopped offering individual coverage for children.  Also the premiums if the insurance is offered may be very very high.

The administration states that about 86 million people took advantage of the annual Wellness visits and preventative services that were offered at no co-pay or deductibles but an increase in premiums.  

Sebilius states that over $3.1 Billion has been paid for physicians and hospitals that utilize meaningful use of EMR.  That money has gone to 2000 hospitals and 411,000 physicians. The Deloitte Center for Health Solutions have reported that only 25% of the nation's physicians have met the meaningful use standards. This low number is due to the high costs in setting up the system and the small return by the government for doing so.

Two cancer drugs that have been in short supply will become more plentiful.  The FDA has allowed some drugs from overseas to enter the market without their rigorous look-see.   The Obama administration has taken a bow for their executive order of October that asked the drug manufacturers to notify the FDA about drug shortages.  This is supposed to have stopped 114 drug shortages.  It remains a mystery as to how this notification stopped the shortages but if the White House said so it must be true. They would never lie for their own gain.

In an article that speaks volumes as to what is wrong with healthcare, Bloomberg Businessweek has an article titled "How the experts would fix health care".  The discussion that follows is informative but it should be noted that not one of the panel is a practicing physician or nurse.  I believe strongly that the practicing physicians and nurses on the front lines should not be left out of the discussions.  Hillary Clinton made sure there was no physician on her healthcare plan discussions when she was first lady.  That went down in flames. 

California health insurers are raising premiums for individual members up to 14%.  California's health costs are climbing faster than the national average of 4%.  They state they are raising the premiums due to the individual usage and the dropping out of healthy individuals as the premiums are raised and the economy worsened.  The state does not have the authority to stop the raises but can look at the reasons and amount of the raises.  Obamacare will not help these premium increases as a matter of fact they may increase the rate of premium by the mandates.  

In a survey of 100 Colorado primary care physicians 2/3 said they have either stopped taking new Medicare patients or limiting who they take.  This shows the difference between government statistics and real life.  The government states that 96% of Colorado physicians take Medicare.  What they should have stated was they used to take Medicare.     Top 


The Medicus Firm has reported that 88% physicians that sign on with hospitals are getting signing bonuses of an average of $20,000 per physician.  Of those who signed 93% moved to a new community to practice. 

Physician hospital relations are always interesting.  Tri- State Cardiology in Johnson City, Tennessee, was going to go in with it's hospital Mountain State Health Alliance.  Instead it signed with the competitor hospital system Wellmont CVA Health Institute.  The physicians were then removed from the staff at Mountain State.  The patients had a choice of the hospital or the physicians.  The physicians chose the new organization over it's former one since it was already in a system and was actively adding physicians and services.  Sounds like Mountain was happy just being there.

No matter what TJC states or hospitals state there is still a disconnect between the hospital and what the physicians, nurses and other professionals believe.  All the organizations want reporting of adverse events but the professionals are afraid to report because the hospitals continue to use punitive measures of blame instead of looking at systems.  This comes from the Agency for Healthcare Research and Quality.  Culture change comes very slow to hospitals. 

In a good article by an attorney in Kansas City, MO, he recommends that hospitals have disruptive physician policies (now required by TJC) that give general wording followed by specific examples of disruptive conduct.  He goes on to state that initially physicians be given this policy and initial that they have read the policy.  He goes on to recommend that the bylaws state that initially the investigation of the incident is considered informal and the physician be notified of the result of the investigation.  The physician then signs the written conclusion and the warning that what the consequences will be for further problems, including suspension and reporting to the NPDB.      Top


Some hospitals are asking for payment prior to the patient being seen for non-emergency conditions.  HCA had 80,000 patients leave without being seen due to being asked for $150 upfront.  Over half of all hospitals are now doing this.  This is to keep hospitals fiscally viable and to reduce the bad debt.  Some ED physicians don't like the practice since they believe that some non-emergent patients will be admitted to the hospital and of course what they don't say is that they lose money.   

Lex Reddy, the CEO and President of Prime Healthcare, abruptly resigned as the FBI was questioning the company attorney about the company's reimbursement policies.  He is the brother of Prem Reddy, the owner and Director of the Board of Prime.  Prem will take over as CEO.       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.