April 15, 2012 Recent News





An article by an ED physician in KevinMD states that hospitals and physicians are being cheated by insurance companies during so called negotiations.  Most physicians do not negotiate.  They are given take it or leave it contracts which they almost always accept or lose the business the insurance company brings.  Insurance companies always know what the physician or hospital is being paid by their competitors.  They get this information legally by seeing the EOBs of cross insured people.  Hospitals are slightly better off since they may have more clout.

Kaiser Health News has again stated what has been stated in the past, that paying hospital based on quality did not cut death rates.  This goes against the central premise of Obamacare that paying for quality will give better results.  Not so for death.  In what might be the dumbest statement ever, Dr. Ashish Jha, a professor at Harvard Public Health, stated that "pay for performance is really important.  This study says to me that we haven't figured out the pay part or the performance part."  This is the lead author if the study.  Dr. Berwick said that no matter the outcomes, pay for performance is the way to go.  That is why he is no longer in government.  

Obama chastised the Supreme Court even before they have issued their vote on Obamacare.  He stated that if they overturn the potentially illegal law they are judicial activists.  Another political comment that deserves no credence.   The next day Obama tried to explain without any luck his attempt to pressure the High Court.  A federal justice has ordered the Justice Department to write an essay on what Obama meant by "judicial restraint".  Holder replied stating the the justices have the power to overturn all congressional or executive laws, including Obamacare.  He however, stated the justices should give deference to passed laws by Congress which he states are "presumptively constitutional".  This is constitutionally wrong and completely goes against the checks and balances set up in the Constitution.  

Speaking of that, Pelosi showed that her Botox has gone from her forehead to her brain.  She stated that Obamacare should be constitutional because it follows the preamble of the Declaration of Independence.  While the Declaration is a great document it holds no legal sway.

The IOM has recommended that medical transactions be taxed and the money used for public health spending.  They want more money for preventative issues.  They don't know that people do not get their medical care from public health systems.  They know this has no chance of passing.

The United States Preventative Services Task Force has done it again.  They continue to put money over patient lives.  This time they recommend an end to ovarian cancer screening unless a family history or a positive BRCA gene.  Again no one in the medical community will pay attention to the organization without an oncologist on board.  This is the same group that said not to do mammograms or PSA tests and no one listened to those recommendations either.

Aetna wrote a letter to about 8000 people in California wrongly telling them their physician was out of network.  They are now sending 8000 retraction letters to the patients plus letters to all the providers who they mistakenly took out of the network.  Ain't computers wonderful. 

The day after Aetna revealed the above they snubbed their nose at California and raised their premiums to the level they said they would.  This is after the state called the increases unreasonable.  The state, like the feds, have no power to stop the hikes.

California and other states are switching their dual eligibles to HMOs.  This means the duals will have a harder time seeing physicians.  It will save the poorly run states and the poorly run fed money.        Top


A hospital in Jodhpor, India, mistakenly gave a baby boy to the wrong family.  They had really had a baby girl.  Girls are not as popular as boys in this country so the girl remains in the hospital until the requested DNA returns proving who's baby is whose. 

Sands Hospital in Florida will begin liver transplants again after an almost one year hiatus.  They have gotten a transplant surgeon from another questionable program, UCLA.

A report says the Nevada specialty hospitals are doing well both in economics and quality.  That is bad news for the AHA.    

CMS has declared Pennsylvania's Saint Catherine's Hospital to be an immediate threat to patients and stopped all surgery and all admissions including emergency and outpatient procedures.  It has to April 19 to get its business in order or the ban becomes permanent.   

A study by Avalere showed that the average length of chemo was slightly longer in a physician's office than the hospital but still cost 24% more in the hospital than the physician office.   The reasons for the much higher cost in the hospital are patient acuity, billing practices and institutional norms.  The highest difference was in GU malignancies where the difference was 124% more in hospitals.  Only lung cancer was cheaper in the hospital setting by 1.6%.  With oncologists getting less money for chemo, some have switched to giving it at the hospitals with resultant increases in costs for all payors.        Top


Physician groups have decided that people with cancer that are in remission should not be followed by routine CT, MRI or PET scans.  They also state people with breast or prostate cancer who are low risk for metastatic disease not be worked up for metastasis with high cost tests.  I can not speak for the breast patient but I absolutely agree with the recommendation regarding prostate cancer.  They also believe people with neutropenia and febrile illness should not receive meds to increase white blood cell production.  Lastly they recommend no chemo for late stage patients who are not likely to benefit from the chemo.  Of course, one never knows until one tries.  

To nobody's surprise, except the government, almost no physicians are downloading Medicare use reports.  Physicians in four states have access to the database to determine the quality, whatever that is, and costs of their practices compared to other physicians.  The reports are only of value to primary care physicians.    

Urologists have always been ahead of others in getting legally the most money they can.  This intelligence riles other specialists.  The latest is the pathology groups.  Urologists legally hire pathologists to do their own in-house tests for prostate biopsies.  The pathology groups who originally made the rules now say that urologists put their biopsies in too many bottles to run up the charges.  The reason the biopsies are put in single bottles is to tell the urologist where the cancer is present and is a help in planning treatments.  The pathology societies originally made the rule that billing is by the bottle and not the number of specimens in a bottle.  Now the pathologists who are not getting the biopsies in the same numbers are complaining that urologists are using too many bottles.  A true conundrum for the pathologists as well as a old fashioned turf war.    

The Chicago Tribune has a piece about the young physicians who foresee a gloomy future.  The gloomy future is tied directly to Obamacare.  Of the 57% who believe Obamacare will be detrimental to their practice they cite regs as the biggest problem with declining income as a second.   The new physicians rightly find that Obamacare is all about money and not patients.  It also shows that 12% of physicians employed by hospitals would, if given a choice, stay in their current position.  The employee physician is only likely to stay two years in their position and over 40% would opt for their own practices.  

Medical malpractice reform works.  California, the first state to have med mal reform, continues to lead in reductions of premiums.  The reductions range from 7.25% for chiropractors to 19% for MEIC.  To date, only one has not rolled back rates.  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.