May 1, 2011 Recent News
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Within weeks after the Wall Street Journal wrote about Dr. Vishal Makker being the orthopedic surgeon in the US who performs the most back fusions especially on the same patients, his surgical privileges at Oregon's Providence Hospital were suspended. He was doing about ten times the national average. How he talked people into allowing him to do so many surgeries on them after multiple failures is a mystery. The Oregon Medical Board is also looking into his licensure. It is possible that Dr. Makker is also being paid per procedure by Omega, the company that makes the equipment Dr. Makker used in the OR for his spine surgery.
Dr. Chen, a columnist at the New York Times, writes about the flow of physicians to becoming hospital employees. In the last decade there has been a 75% increase in hospital employed physicians, according to Dr. Chen. She quotes the recent article in the New England Journal of Medicine that states unlike the buyouts of the 1990s, the physicians of today who sell out may not be able to go back to private practice. The reason the Journal author believes the physician will not be able to return is the change in economics and the methodology of payments. The author also states that as hospitals become larger and purchase more physicians they will demand larger prices driving up the overall cost of medicine. Dr. Kocher, the author, also states that hospitals will lose $15,000 to $200,000 per physician per year for the first three years of employment and that will reduce after that time but will never be a positive. The reason for hiring the physicians is very straightforward, the hospital gets more referrals, and without violating Stark or Anti-kickback statutes. He states that in the future physicians in hospital settings should expect a change in the methodology of payment away from guaranteed salary to incentive driven linked to production and clinical behavior. This will include lower base salary and incentives which if reached can get a higher salary than previously.
CMS state that more physicians are opting for the new meaningful rules of comparative effectiveness. They are reporting the quality of care asked for which has little to do with quality of care in reality.
For some unexplained reason (money) the American College of Radiology is backing a California Democrat's bill to not allow physicians to refer to their own facility and have a radiologist read the films. The radiologists want all the money, not just part. The Congressperson did the same bill two years ago and it failed then. Hopefully it will fail again now.
A Texas attorney has warned all physician attorneys that if they or a physician changes locations, changes ownership or loses any legal action against them professionally they must tell their Medicare contractor within thirty (30) days or potentially lose their ability to bill Medicare. She backed up her statements with several cases including one recent case decided on April 1, 2011.
Is your practice compliant with HIPAA Version 5010? If you have no idea what I am saying or the answer is no then you will not be paid electronically by Medicare or other insurers starting in 2012. Medical practices must have tested their systems to make sure of compliance or face loss of payments electronically. This means delays in payments and cash flow problems. Have practices started to collect nine digit ZIP codes as they will need to report them and not the standard five digit codes.
The New York times hit the nail on the head. Medical practices are now not worth anything. They tell the story of a family practitioner in Maryland who can not even give his practice away. There are no takers. This is common in the country for solo practitioners or for those who want to retire and expect good will for their time starting or in the practice.
The FDA has sent a warning letter to Joseph Mercola, D.O. of suburban Chicago to stop touting thermography as a screening device for breast cancer. Dr. Mercola has warned patients on his website not to get mammograms and to get thermograms instead. This is the third warning letter sent to him since 2005. Dr. Mercola believes that the FDA does not have the power to regulate how the machine is used by a health care professional.
The University of Wisconsin has punished their physicians who illegally gave sick notices to the striking government employees so they could get paid during rallies. The penalties range from a letter of reprimand to loss of pay and loss of leadership positions. The state Medical Board has a separate investigation into the illegal physician activities.
After the many years of pushing EMR the amount of physicians using are up to 29%. The physicians are usually smart enough to see the cost of the EMR in money and time do not equal what they would get as an incentive payment.
HCPRO, not the individual physician's friend, suggests that medical staffs may want to decide how much a surgeon may drink the night prior to a surgical procedure. This comes from reading one article in the Annuls of Surgery that states if a surgeon is blotto the night prior to surgery, they have a hangover and lose some of their surgical skills. The surgeon in the study were pushed to drunkenness and not just several drinks. They did not test how many drinks were enough to throw the surgeons skill off. They also only tested laproscopic procedures and not open procedures. They did not test internists to see if they should not cogitate after getting wasted the night prior. Top
Kaiser Family Foundation reports that under Obamacare the population should be prepared to pay larger co-pays for their insurance. How high will be determined by the government insurance mandates which will be substantial.
The AMednews writes that it is unknown how many physicians will join ACOs. CMS estimates that it will cost for startup and first year expenditures approximately $1.76 million per ACO. The ACOs may make money or may have to pay CMS money depending on its savings or lack of same. CMS is making it very difficult to get shared savings due to their huge number of mandates such as at least 50% of the providers must be users of the CMS defined meaningful use standards.
Becker Hospital Review asks whether specialists should join ACOs. One advisor thinks the independent specialist will join since it is better to be in the room than to be left out. That is the thinking that allowed the ill fated 1990 HMOs to flourish and then die. Before any physician will be paid any extra money the start up costs must be paid off. Most ACOs are expected to lose money until the third year. The other reason to join is the ill thought out notion that the primaries will send their patients to other specialists if I am not a member. That was true in the HMO area but with ACOs the patient is not a member and can see any physician the wish, whether referred or not. ACOs may also put EMR requirements as well as requirements as to hw soon they need to see the ACO patient or how many ACO meetings the specialist must attend. The specialist in ACOs formed by private payers would require a contract with the usual onerous terms. All in all the independent specialist needs to consider all the facets of an ACO and not be a lemming.
The Rand Corporation states that high deductible insurance plans do not interfere with necessary medical services.
Pelosi is chastising the Ryan bill for cutting back spending by focusing on only the Medicare portion. She ignores the huge debt and the ways to decrease that unsustainable debt. There must be a decrease in spending and this includes all entitlements. There should also be some increase in revenue either by decreasing tax deductions or increasing the income tax. Pelosi made her pitch to the seniors the same day the government was put on notice that it's debt is too high.
Medicare is now smack in the middle of the budget debate. Ryan's House bill would change Medicare to a voucher system for enrollees ten years from now and get the feds out of the medical payment business with its huge red tape. This will not pass and Medicare will remain as is gobbling up huge chunks of the money and increasing our deficit. Ryan has started a debate that he may not win but at least will be good for discussion to find a middle ground between putting the onus to save money on the people or the providers.
The National Journal reports that Bloomberg believes that Obamacare will be 50% more than the CBO estimate of the cost of Medicaid. The CBO states it will cost the states about $60 Billion over 9 years and Bloomberg believes it will cost $90 billion over 14 years.
It is hard to believe the length a no nothing organization will go to get publicity. Public XXXXXX, led by S Wolfe, now wants the FDA to ban latex and cornstarch use in medical gloves. There is no doubt that some people have latex allergies but that amount is small and the cost of the change is large.
In Pennsylvania the seniors were mad at the Republicans for attempting to change Medicare. Of course, the Ryan bill only applies to those who are now 55 or younger but the seniors didn't get that. Top
Two hundred hospitals are trying to improve care by joining the Best Practices for Better Care Initiative affiliated with the Association of American Medical Colleges. They are attempting to improve medical education on quality and patient safety by getting future physician to think daily about what is the best for the patient. Now if they could only get hospital administrators to do the same thing.
Loma Linda University Hospital in California is planning to open its doors of a new hospital soon. The hospital was originally a joint venture between the University and physicians. However, the Obamacare law prohibited new physician owned hospital from opening and obtaining Medicare funds. The University had to buy out the physicians before it could open or even apply for inspection to open.
California has issued statements of deficiencies to UC San Diego emergency rooms. UCSD had planned to open a new facility in early April but the state will not allow that to occur until the other problems are fixed.
HMA has entered and is a controlling partner in a physician owned hospital in Batesville, Mississippi.
The Atlanta Courier has a story of how people with no insurance or use out of network hospitals get screwed by the hospitals charging full cost plus outrageous markups which all knows is never true. They used a story about a person charged over $23,000 for an appendectomy at Northside Hospital in Atlanta. The hospital offered to reduce the price by 40% if the patient could pay it within 90 days. The public hospital in Atlanta has a mid range markup at 285% and does the most charity care. The two for profit Tenet hospitals in the area have the highest markups of over 650%. Top
Illinois has dropped two HMOs from seeing its enrollees. this has caused consternation within the ranks of the employees. This means they may have to get new physicians or pay more to see their regular physician. The state did this to save money but the HMOs reject the idea saying it is the usual smoke and mirrors. 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.