October 1, 2011 Recent News






The feds believe that Medicare HMO enrollment will increase about 10% next year.  They think this because premium rates will decline by 4%.  However, payments to the HMOs by the government will decline over the decade.

Steve Frew, the person who has specialized in EMTALA since its inception, has put out a scathing criticism of those who state that the law is from Reagan.  He gives details of a backroom deal with the law not read created by none other than medicine's friend Rep. Pete Stark.  The law was inserted as four pages in the miscellaneous section of a huge Omnibus bill.

Since Obama has done his debt reduction thing that can never be passed, it seems that all stakeholders including the left leaning AARP is grumbling.  It would cut payments to physicians and hospitals, make beneficiaries pay more for Medicare and shift Medicaid costs back to the states.  

I was asked by a reader regarding the upcoming 2% decrease for physicians not doing CPOE by the first of the year.  He wanted to know how to bill depending on whether the physician was participating or non participating.  I did not know the answer with any certainty so I asked the American Health Lawyers Reimbursement Section.  I got one reply who said that CMS has not decided how the physician should bill.  I believe that the physician should never bill the Medicare or insurance amount but always bill their usual and customary charges.  Let the insurer pay what the contract price calls for but a physician should never decrease their price.

The OIG has criticized CMS for overpaying about $30 million for incorrect place of service claims.

The Washington Post wrote that the reforms Obama is proposing for Medicare reforms will delay bankruptcy by three years up to 2027.  Not a major piece of legislation.  He ignored almost all of the reforms suggested by his own commission that reported last year.  He only suggested cuts to providers without any major changes necessary to the program such as recipients paying more or co-pays so they realize the costs.  There was also no mention of increasing the Medicare age.  

Jackson Healthcare reports that up to 34% of total annual healthcare costs are for defensive medicine.  This comes to about $700 billion a year.  If people are wondering why healthcare is costing so much in the US this is one of the first places they should look.  Since the US physician in private (not federal) practice are the only physicians in the world responsible for their medical decisions, one does not need to be a rocket scientist to see the problem and the solution.  Besides the economics many patients are being over treated in fear of litigation.  I see this routinely.  Jackson says that the physicians benefit only about 6% of their practice by the over treatment so money is not the driver for the treatments.  

The same day the above story appeared it became known that medical insurance premiums are going up 9% over the past year.  The major driver is the cost of care.  Could there be a relationship between the two stories.

The AHA is pushing for increasing the Medicare age to 67.  They do not want their money reduced and they think this may help.  Of course, they also get two more years of higher private insurance payments as well.  Being the friends all physicians know and love, the AHA also wants the feds to raise the premiums for doctor visits from 25% to 35%.  They truly know how to look after themselves and forget all others.  The people paying into Medicare will have their premiums increased by a minimum of 3% as older sicker individuals join and as there are less to pay the percentage will also increase rapidly.   

Pennsylvania is considering paying cash to Medicaid recipients who use cheaper hospitals.  They are considering first to target the patients in the fee for service Medicaid program and then the HMO Medicaid patients.  Advocates for Medicaid patients still do not get it.  An attorney for Medicaid patients stated stupidly that we want full access for Medicaid patients or see any physician of their choosing.  Of course, very few physicians participate in Medicaid.  

Britain is attempting to ban the Croc shoe from all hospitals.  They are afraid that a needle may fall and go between the straps to puncture a foot.  They state a similar ban is in place in the US, Sweden, Canada and Austria.  

Roche and other drug manufacturers are keeping meds, especially high price cancer and insulin meds, out of the Greek hospitals.  Apparently the hospitals have not been paying their bills but pharmacies have.  Therefore patients now have to go to the pharmacy to pick up prescriptions and bring the meds to the hospital.      Top


Rueters has an article regarding the increasing criminal prosecution of physicians for dispensing pills that harm patients.  This used to be a civil matter but the prosecutors are now attempting to go after the physician criminally.  This happened to the physician for Anna Nicole Smith who was just found not guilty.  He was charged under the Controlled Substance Act.  Michael Jackson's physician has been charged with manslaughter since the drug he gave Jackson was not under the Act.  Most of the physicians charged and convicted, now up to 226, have been under the Act and the most have been in Florida. 

Becker's Hospital Review states that medical practices have seen a 53% increase in operating costs since 2001 with ratcheting down of income.  The practices have responded by decreasing expenses as much as possible especially on purchasing of drugs and furniture.  This is an excellent example of how small business responds when they have less money from any source such as increased taxes.  

An article in Medscape details what physicians hate the most about EHR.  The first physician, an internist, doesn't mind working an extra 4-5 hours a day to do his EHR even if he is doing it at home when he should be with his family.  He does mind that he has problems with his EHR talking to other computers for CPOE and getting labs from the hospital.  Most physicians hate the extra time it takes even with voice recognition for meaningful use EHR, non connectivity, EHR not user friendly and the need to create custom templates as the standard ones even by the national organizations are not user friendly.  There is also a long initial break in period not only for the physician but also the staff.  There is no dispute that even those systems that are certified for meaningful use are pitiful in terms of user friendliness.  The physicians are also finding the meaningful use aspect of the EHR to have no clinical benefits and increases costs and decreases patient flow.  The final statement in the article states that after a while physicians come to like EHR and would not go back to paper that is until Phase 2 of the meaningful use hits.  

The Washington Post has found that the physicians that are listed for Washington DC do not practice full time there.  They actually have less than 3000 physicians for the area.  There are only 900 in primary care.  Those that do practice in the District seem to reasonably cluster around the hospitals. 

The ABMS has listed new specialties.  They are pediatric cardiology, sleep medicine, neurology and computers.  Yes, you read that right.  There will be a test developed by next year and ready for taking by the fall of 2012.  The first certificates will be given the following year.    

The People's Republic of Massachusetts may have a problem since 58% of the physicians in the Republic will not participate in their global payment system.  Also half of the physicians stated that they would not participate in ACOs.     Top        


HealthLeaders writes that just because physicians are employed does not mean they are non thinking drones.  The percentage of physicians now employed by hospitals as opposed to voluntary medical staffs come up to 76% of the hospitals.  Apparently 2% of nonemployed physicians are aligned with hospital thinking and only 11% of employed physicians are. The article states that 59% of hospitals tie performance bonus to quality 46% of hospitals tie it to regular payments.  The main impediment in the near future to physician alignment is ACO where the physician is expected to give up treatment autonomy.   

Knapp Hospital in Weslaco, Texas, has its physicians protesting openly against the CEO.  The CEO had tried in the past to merge the hospital with another and that was foiled by the physicians.  According to the paper the CEO also forced a member off the Board for asking too many questions regarding transparency.  That member is a state Representative who just received a letter from the CEO that he would no longer be on the Board.  there was no explanation.  There is also ongoing litigation between the hospital and a group of physicians regarding the release of financial information.  The last straw was the letting go of the local ED physicians due to communication problems between them and the CEO.  The Board issued a letter to the community not addressing any of the concerns raised by the physicians but only extolling their past moments of glory.   

Beaumont Hospital in Michigan has lost five of it's best radiation oncologists due to their disagreements over a business deal.  The hospital states that they have a large department and will find another chair soon.  The report states that the radiologists resigned but the attorney for them states that they were let go.  

Still in Michigan about 1000 private practice physicians affiliated with Detroit Medical Center signed up with a IPA competing with the Detroit Medical Center's own IPA.  Detroit's IPA has a provision that they can only treat Detroit's managed care patients.  The competing United Outstanding Physicians has no such restrictions.  Detroit IPA still welcomes all physicians even those that belong to other IPAs.  

Bloomberg writes that hospitals are risking lower payments for failing to reduce unnecessary and preventable readmissions.  This will start in 2013.  To date the Academic medical centers are the worst performers.

Central Peninsula Hospital in Kenai, Alaska, is about to become a troubled institution.  An unknown entity has filed a CON for opening a nearby ASC.  There is not any in the area as all outpatient surgeries are done in the hospital.  The hospital does not know which if any physicians are on board with the ASC venture and has not ever felt the need to partner with the physicians in a similar venture.  The hospital could lose about $12 million in revenue from the loss of surgeries plus loss of lab and other ancillary services.                  Top


Blue Cross of California does it again.  There is no other insurer that will do more stupid things than Anthem.  They have decided that they will no longer allow patients to pay automatically via credit card.  It will take automatic payments from a person's checking account.  If a member wants to still use plastic they have to call each time and be charged a $15 "convenience fee".  Of course California has a law forbidding the charging of a fee when someone uses a credit card in lieu of paying in cash or kind.  When told they were being reported to the state they put the $15 fee on hold but continue to make the customer call each month to use a credit card.          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.