November 1, 2015 Recent News





Two more of the ACO originals have dropped out.  There are now only 16 or the original 32 remaining.  They like others have left for financial reasons.

The House is going after the administration for throwing money at a dying program.  They are talking about the coop program of Obamacare.  To date over half of the programs have gone out of commission due to funding problems.  They are all operating at a substantial loss.  The administration continues to fund these bad programs because of the name, Obamacare.  They can not compete in the marketplace and deserve to just go away.

Insurers may be loath to continue to be part of the Obamacare program since the risk fund is nearly depleted.  Since more insurers than expected have ended in the red the fund has gone dry.  Congress will have to add more funds to the program but that is not likely.  The only way this will not be a substantial factor in the demise of the program is if the insurers raise their premiums to make sure they are solvent.

UnitedHealthcare is enlarging its bundled payments for cancer care.  Last year is showed a large savings (34%) even though there was a large spike in the cost of the drugs.  They are adding about 650 more oncologists to their bundled program this year.  Other payers had only modest savings in their attempts to rein in costs.  Medical homes did not seem to work to save significant money.  United will add paying physicians $160 per patient per month for round the clock support for the chemo patient.  They are trying to save hospitalizations.  They have frozen or limited profits from cancer drugs. The insurer pays the average sales price for any drug the physician wants to use plus a small amount for physician care in the hospital hospice and case management.

According to the Kaiser Health News, it is getting more difficult to find PPOs in the health marketplace that allow out of network care.  They say that 2/3 of those that offered the program last year will either drop them or severely cut them back this year.  It seems like patients want low premiums and do not care about the consequences until they get sick and then it is too late.

The administration is targeting 20 cities to boost Obamacare signups.  These are the locations that have been laggards in the program. The one that signs up the most gets a visit from the illustrious leader.

In the first week of Obamacare signups more have swallowed the Kool-Aid than last year but there are fewer new people on board.  Approximately 553,000 signed up but no one knows how many will pay a premium.  The newbies fell from a half of the signups to one third.

The VA continues to disappoint.  They gave bonuses in 2014 to their middle managers.  This included the drones in the hospitals that have the problems with the vets.

California is spending $29 million to launch their Obamacare project.  this includes a bus driving the state especially in the Hispanic areas to drum up business.  So far, about 2.4% of those enrolled in the program in the state are black and about half are on subsidies.  About 30% of the enrollees are latinos and 37% are eligible for subsidies.

Gee!  California has found the their Medicaid patients are having worse cancer outcomes.  I wonder if that is because they put impediments in the way of care or is it due to their very very low reimbursements.  They are diagnosed later since they do not have access to physicians in a timely manner.  Physicians will not see then due to the state's low fees.

The administration is warning Medicaid that they can not legally restrict access to high price drugs such as the hepatitis drugs.  

I thought EHR could not get any stupider.  I was wrong.  The Mayo  Clinic is building a $6.1 million new electronic substation so they can institute the Satan Epic.  Epic will contribute to this so you know they are charging an arm and leg for the program.        Top


Kaiser is breaking new ground.  The San Francisco Business Times reports it has purchased a 20% stake in Stockton, California's St. Joseph Hospital.  They e doing this to be able to ship their local patients there as they have no local hospital.  They also are in negotiations with Detroit's Henry Ford Hospital.  That hospital has had many problems in the recent past including a new CEO from Oakland who ran that hospital into the ground.

Kaiser Permanente has , according to the San Francisco Business Times, lost significant money in the latest quarter due to huge losses in their investments.  A year ago the posted a $997 million profit.  This time the posted a $115 million loss.  They also had a loss in operating income but operating revenue was up by 7%.        Top


Pediatricians are not following the 2012 American Academy of Pediatric guidelines and instead are kicking patients out of their practice who are not being vaccinated.  Now about 20% are dismissing patients who refuse to be vaccinated.  Most pediatricians make parents who refuse vaccinations in a form documenting their refusal.  Those polled said that about 1% to 4% of their patients would not be vaccinated.  

It appears that those physicians that order the most defensive medicine tests are doing it for a good reason.  They are being sued less.  A study of Florida physicians found this to be true.  It found that those that spent less are five times as likely to be sued.  OBs that do more C Sections have less chance of suit.  Therefore, why go along with the whole lets save money bit that the fed wants?      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.