May 1, 2010 Recent News
Connecticut physicians have been polled regarding the new fed reform law and 28% of internists as well as 20% of family physicians are not taking new patients now. Those who are taking new patients have waiting lists of over two weeks. This bodes poorly for those new to the system. The survey also noted dissatisfaction in the medical community. About the same percentages of the two groups were considering moving to other states due to the practice environment of the state and the large amount of paper work.
Never fear. If the physicians leave Dr. Nurse will come in to take up the slack. The advance nurse practitioners want to write prescriptions and admit patients to hospitals. I wonder who will oversee them. They want their own credentials but will the hospitals give them this? It is doubtful without supervision by physicians. Are physicians going to supervise these non physicians? That also is doubtful. The Medical Board of California, never the sharpest of tacks, believe that telemedicine will allow this. I hope the Medical Board will also pay the med mal payments the physicians will pay for the oversight. Top
The top insurers in the country will discontinue their practices of rescission, that is unless there is fraud. Now, what is fraud. It is the intentional misrepresentation of an essential fact. Is it fraud that the husband did not put down he smoked? Yes, of course. How about if the wife develops breast cancer and the smoking of the husband had nothing to do with the claim? Is that fraud and can the insurance company cancel the wife's payments for her breast cancer? That is what was happening. After 2014, the wife can just get her own policy via the exchanges.
California Anthem, the company that wanted a 39% increase in premiums for individuals just before the Obamacare vote, has now understood it made a mistake. They made "inadvertent calculations" that were in error. They have now asked to pull their request off the table and will resubmit a new premium in several weeks. Anthem says they did not pull their increase due to the report but to help the new healthcare reform. There is a bridge I would like to sell you if you believe that.
Under Obamacare, insurers must spend at least 80% of premiums for medical expenses for individuals and small groups, 85% for large groups. The reason the insurers will reach the goals with such ease is the treatment of taxes. Taxes on premiums are deducted from income and any programs that improve health care quality count as spending for health care.
CMS is trying to do the right thing. They have reduced the number of payors from 51 contractors to 19. Of te 19, 15 are paying medical claims and the other four are for durable medical equipment. This was done to eliminate the fraud up front instead of years later finding the problems and trying to collect the money back. In the consolidation processes there have been snags which has cost the payors time to fix taking away the time necessary to pay claims in a timely manner. Top
In a study in BMC Health Services Research it was found that when for-profit, not for profit and government hospitals were compared for uncompensated care government hospitals provided the most and the other two were very close in the amount they provided. It makes one wonder if the non profits should lose their special tax status as did Provena in Illinois.
The Harry Truman VA in Missouri got skunked by the federal inspectors for their poor sterilization procedures. Now hundreds will undergo training to stop doing "flash sterilization" for routine surgery. They will also be taught how to gown and glove in decontamination areas. This is the same as was recommended in 2008 but never implemented.
A study in Health Services Research showed that nurses make a huge difference in patient recovery. The California nursing ratios cut the 30 day inpatient mortality rates and better nurse satisfaction. The study was done by a Pennsylvania nurse who wants the same ratios in her state. Top
Remember when Caterpillar Tractor Company and then others started writing off the loss of the tax exemption under Obamacare there was a hew and cry from the Democrats. The same Democrats now agree with the business decisions of the companies. The Republicans now state that these same companies would be better off financially to drop paying for healthcare and allowing their employees to get their own via the exchanges. Verizon has also told its employees that many of the plans in existence will qualify as "Cadillac plans" and will be eligible for the 40% excise tax.
The CBO states that approximately four million people will have to pay penalties in 2016 due to not having health insurance.
In a study of the Medicare population with cancer it was found that 57% of the total cost of the care of that patient was diagnostic imaging. The study did not state but this will increase as the use of PET-CT scans increase.
A study in the Journal of Health Affairs show that if all insurers went to the Medicare billing form physicians could save about $7 Billion per year. The problem is that the insurers don't care how much the physicians spend as long as they don't have to. 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