October 1, 2012 Recent News





A private center has stated that hospitals and physicians are billing higher codes in the last decade but the retort is that since seniors are living longer they are sicker and therefore higher coding is justified.  The center states this is due to upcoding which is illegal.  A possible cause is the government's push to electronic records which allows more data to be captured and therefore higher charges to be generated by the electronics, which is legal. (See Recent Legislation)

In the same vein, it has been found to no one's surprise, that prices charged when hospitals purchase physicians have risen.  This is a win monetarily for the physicians and hospitals but a loss for consumers (used to be patients).  This limits choice for patients as the physicians must refer to other employed physicians.  Hospitals love the captivity and "integrated care" and the physicians love the money without the hassle of the office.

The administration is caught in its own web.  It agreed to automatic budget cuts if Congress could not agree to a budget reduction.  The Congress can not even agree if it is day or night and so the automatic cuts will take place starting next year.  This will impact Defense and domestic spending.  Medicare will lose 2 per cent as a cutback to providers.  This will affect consumers as there will be less providers taking Medicare.  It is interesting that the salaries of the Congress will not be affected.

The physician, hospital and nursing association are concerned about the 2% drop in Medicare funding as stated above.  They feel this will cost 760,000 healthcare jobs by 2021.  The AMA chimed in that this on top of the SGR cut will kill access for Medicare patients.  This is not true but makes good press.  There are some that will cut back or stop taking new Medicare patients unless their are fixes.  

Kaiser Family Foundation has a report that costs for health insurance for small business continues to increase and the amount of business offering insurance is not going up. It seems to me these are related.

Another week and another Sebelius missive of how good she is.  She may be impeached soon but for now she continues to pimp for the President.  This time it is to the very important Hispanic voters.  She touts how good Obamacare is going to be for Latinos since it will increase Medicaid.  Doesn't sound like a good thing for the Latino population.  Sounds racist to me.  She then came out with the old saw of how much has been saved under Obamacare due to closure of the doughnut hole.  I agree it is good to slowly close the hole but it would be even less money for all if government could negotiate for pharmaceutical prices.

Then the article appears that Medicare contractors are routinely refilling strong pain meds without new prescriptions as required.  Medicare Part D is paying for this without asking any questions.  Most of the refills were from long term care pharmacies.

In an article that is rife for comment, Dr. Baugh at the People's Republic Brigham Hospital says truthfully that hospitals and the medical system could save billions of dollars a year by the greater use of observation units.  The problem he does not address is what happens to the people involved.  Since they were not admitted to the hospital they are technically outpatients and must pay co-pays accordingly.  That can be many thousand of dollars per patient.  Again the nasty law of unintended circumstances raises it's ugly head.

The People's Republic of Massachusetts is again looking at costs and not quality.  They are loading up on NPs and PAs to take the place of MDs who are lacking in the state.  Patients may choose PAs for their primary care physician, a misnomer.        Top  


Blue Cross has cut the physicians that work in Cedars-Sinai and UCLA hospitals from their California plan.  They are too expensive.  They cut them from a Los Angeles City health plan that could no longer afford the premiums with them in the plan.  The hospitals tried to justify their high costs by saying they do so much research.  The plan wasn't buying it and the physicians who make referrals to the hospital are gone but the hospitals remain in the system.  Earlier this year another  employer in the area DEC also went with a cheaper plan that cut out the same physicians.

Sutter Health in California has applied to the state for HMO status.  If granted this could make them the same as a Kaiser with hospitals, insurance and physicians.  It would make for interesting times for Kaiser to have some direct competition and for the physicians who now are independent but send their patients to Sutter institutions.        Top


A survey of New Jersey physicians showed that 45% plan on changing the mode of practice in the next year.  Most want practice expense reductions and are willing to consolidate to attempt to attain that goal.  About 1/3 have already joined an ACO.

The American college of Family Practitioners has come out against the use of Nurse Practitioners in place of physicians.  They feel the future in is the "Medical Home" concept led by the primary care physician.  The ANA basically agrees that the old model of treating sick people should be replaced by the new "Medical Home" model.  However they feel they can lead the model as well as the physician.  

HealthLeaders has a report that shows about 60% of physicians would quit the practice of medicine today if they could.  This is a terrible statistic and one that the wonks do not want to hear.  They continue to want more garbage from physicians and less patient care.  Those that will stay will work about 6% less than they are working now.  This does not bode well for access.  The survey showed that about 52% have limited access to Medicare patients and 26% have stopped taking any Medicaid patients.  About 75% of physicians do not like the trend to employment and that includes those that are already employed.  The report also states that there are two currents working in cross directions for and against the physician.  One is you need to see more patients and the other is better quality.  They can not both be done.  The report says in the end the physician will take his salary and work 9-5 and go home.  It will be a regular job and not a calling.

The CDC states that last year about 1 in 4 hospital providers did not get flu shots, 1 in three in physician offices and half of those in long term facilities.  This year hospitals will have to report to Medicare their percentage of employees and non-employees working at the hospital who get shots.  It is expected by Medicare that at least 90% of hospital providers will get the shots.  The AMA states that if an institution can not reach that goal they should consider making flu vaccination a condition of employment.          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.