Consulting firm Avalere Health reported that the real figures for Obamacare Medicaid enrollment are about 2.4 million not the administration reported eligible 9 million.
Two new surveys have shown that Obamacare has failed to attract the uninsured because they believe they can not afford it. Only about 27% of those who have signed up have been without insurance for the past year. Only half of them have actually paid their first months premium. For those that were switching from one plan to another about 90% have paid a months premium.
The administration is going all out to keep their Senate majority. They have completed gutted the rule that all Americans will carry insurance or be faced with a penalty (tax). The administration has decreed that if people state that it would be a hardship to comply with the law they do not have to. So much for the law. This means there is basically no individual mandate.
Bloomberg writes that 80% of companies have or will soon raise health insurance deductibles for their employees as the premium rises. If they do not raise deductibles, they will drop spousal coverage and/or sending employees to the exchanges.
California now states that almost 15,000 must reapply for insurance with Covered California due to computer glitches. This is a small amount of the total signups. They have been signing up about 7000 patients per day in February.
In California, about 15% of exchange enrollees have not paid their first month premium so are not really enrolled. Top
In a long article the New York Times writes about the dichotomy between private practice and employment under the Obamacare law. It focuses on two practices about 50 miles apart in Kentucky. The private practice must decide who they will service as reimbursements are too long in some of the exchanges and with Medicaid. The employed physician can not worry about all that as he is on a salary and has no costs. The article also speaks about the financial downgrades of hospitals due to the employment of physicians. The private physician saw 15 patient in a day in an unhurried manner with a basic EMR and the employed physician saw twice as many and had to enter all on a sophisticated EMR via voice recognition. How is that possible?
Forbes has an article about how physicians are being driven crazy by technology. It tells of the problems with EMR requiring physicians do do many keystrokes for not much increase in patient care and this ruins the face to face time with the patient. A study of the American Journal of Emergency Medicine found that these physicians spend about 43% of their time entering into computers. In a typical 10 hour shift they would click a mouse about 4000 times. The article goes on to state the folly of hospitals employing physicians while losing about $250,000 on each per year. They say rightly that the physician's aim is to "provide the best possible care and outcome for my patient." The regulators want the most patient information and personal data possible.
Becker Hospital Review has an article titled Are We Trading Happy Physicians for Efficient Ones. The article basically says yes. Physicians now are not congenial they are too busy entering information.
The GAO has found that hospitals and physicians are dropping out of the EMR incentive program. The providers dropped out especially in the Medicaid program. I wonder why. Could it be that the money received did not match the money lost from low reimbursement. The agency reported that 16% of physicians and 9.5% of hospitals dropped out in 2012 after receiving money in 2011. Top
A large physician group has left Summit Health in the People's Republic and joined rival Beth Israel. The 200 physician group had left Beth Israel two years ago for the Summit system. It is unknown why the jump back was being made but it might have to do with the presence of a separate hospital in the area and the need to send routine care there and more complex to Boston under the new arrangement.
An interesting article in the New York Times describes the transformation of some bankrupt New Jersey hospitals into medical malls. These are for profit and the developers are interested in selling space. The malls do not have emergency rooms but may have urgent care centers. The do not have ORs but may have ASCs. The interest is to move form the inpatient to the outpatient setting. The hospitals do not like it as they as usual can not compete with entrepreneurial efforts.
Baylor Hospital in Plano Texas won the prestigious Baldridge Award but then declined it. They declined the prestigious award because they had looked the other way to the problems of Dr. Duntsch, a neurosurgeon, who just had his license revoked by the Texas Medical Board for cocaine and alcohol problems and harming patients. The hospital allegedly knew about the problems and since the position was hard to fill ignored it. They are being sued by several patients for negligently credentialing Dr. Duntsch as well as negligently promoting him and even more damning allowing him to resign and to to Dallas Memorial Center with a good recommendation. Dallas Medical has also terminated his privileges.
Bloomberg writes a major piece on the possible shenanigans at Mt. Sinai Hospital in New York City and their cardiology cath lab. The head of the lab was being paid $4.8 million in 2012. He is opening a medical tourist hospital in his homeland and linking it to Mt. Sinai. There is also the matter of how much the referring physicians are making from leasing and other arrangements with the hospital. Even though to date there has been not allegations of impropriety I sense there will be a full fledged inquiry soon at the hospital and watch for a major settlement. Top
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article is updated periodically, it reflects the author's point of view at the
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