October 15, 2015 Recent News







Be afraid!  Be very afraid!  The devil is starting.  CMS is considering allowing providers to be paid by Medicare only if they take Medicaid and Obamacare patients.  If you think this is never going to happen look at Massachusetts where licensure is dependant on Medicaid participation.  This comes from the enacted law that took away the SGR.  As part of the tradeoff the new payment system will require EHR, PQRS, and value based modifier program.  Depending on how each physician will do on the measurements their RVS will go up or down.  Regulators can and will draft the actual regs that one can be sure are not physician friendly.

Under Obamacare, insurers are supposed to receive money from the feds to cushion the expense of covering many patients with expensive medical treatment.  This year they are getting about 13% of what is owed.  The reason is that CMS does not have the money and Congress surely is not going to give it to them.  CMS acknowledged that this may result in some solvency and liquidity problems especially in new insurers attempting to get theirs.  

Medicare part B premiums will rise about 52% for 7 million people.  The premium is tied to COLA.  The huge increase will start at those making $85,000 single or $170,000 married.  After I wrote this the Budget Bill passed and changed the dynamics. (See Recent Legislation)

Planned Parenthood has denied doing anything illegal but has decided it will stop taking money for tissue from abortions.  They said it was a small number of clinics and a small amount of money.  This will not stop the Congress defunding PP.

More seniors are joining Medicare advantage.  Over 7% more joined in 2015 than in the previous year.  The major advantage is cost with lower premiums but more out of pocket costs.  The major disadvantage is lack of ability to see any physician.

California dual eligibles are rejecting the HMO model for their care.  They fear losing their physicians and are opting out of the program.  So far almost half have opted out.  However once in the program seniors zare opting to stay in with less than a 10% drop out rate.  I personally think that is a large percentage but the state does not agree.

The NYT has an article on the closure of community co-ops and how that is shrinking patient choices.  Of the original only 13 remain and many of those are in financial trouble.  When they close only the big insurers are left in the market and with their consolidation even less choices are available.  This leads to higher prices.  Many are closing because the feds are only giving those who are owed money via the fed $.13 of each dollar owed.  

The administration is pulling in its horns and now predicting the expensive insurance known as Obamacare will only get a few more people in the new year than are already signed up.  The predictions are that the original predictions were millions short of reality. This new low goal will help Democrats say look we are meeting our goal when they attempt to fool the voters again.

The Washington Post states that Obamacare premiums are rising by an average of 7.5%.  This is nearly four times bigger than a year ago.  The rural communities will get the lion's share of the increases.  The numbers are based on the silver plan, the most common plan chosen.

A story in the New York Times says the people on Obamacare in 2015 are being denied the use of specialists due to narrow networks.  They quote a study by Harvard on 135 Silver plans.  It found that 15% had no specialists in at least one specialty.

Many thousands of people who did not file income tax returns will be lucky enough to be denied Obamacare insurance.  This includes people who do not have enough income to need to file a return.  There are also the 760,000 people who received subsidies but did not file the 8962 form.

Medicare ACOs have been shown not to work now the private sectors plans are following suit.  A new stud showed the consumer engagement is very very low and the cost savings and quality are not there. 

Have you ever heard of "Choosing Wisely" a starting point for clinical decision making?  Well apparently neither have other providers since the seven things that they feel are not to be done are being done. In two of the seven there has been a slight drop off but he others have either remained static or increased.

I don't believe it!  The administration actually pressured a health agency to back the first lady's obesity program.  The study released in February, 2014, showed that obesity increased in elderly females and was stable in children between 2 and 19 but obesity in children from 2 to 5 fell from 13.9 to 8.4%.  The White House want to push this to show Michelle's program was working.  These children do not go to school.  The program was really not shown to work according to the CDC, the people who did the study.

The American Cancer Society has revised its recommendations on when mammograms are to start.  They have increased the age from 40 to 45, still below the non-representative USPSTF task force. They also went to every other year, a stance that the breast community will not stand for. The Cancer Society also did not say anything about the high end of screening since Americans are living longer.  The age 74 cutoff is not appropriate any longer.  The breast community is also up in arms about the recommendation to not go to a physician for an annual breast exam at any time.

Over the last 30 years with Mammography breast cancer diagnosis after spread has remained fairly stable.  the same is not true for prostate cancer.  Since the advent of PSA prostate cancer metastasis has dropped by 50%.  If the idiotic guidelines by the Preventative Task force are followed this may be reversed.

The Phoenix VA is again in the news and still not for good reasons.  Since they were outed in 2013 the VA has systematically allowed Urological patients to die due to not allowing them to go outside the system or not being clear in the instructions to private urologists.  The VA lost many physicians and have not replaced them.  They then cancelled appointments and did not reschedule them.  The VA continues to stonewall and lie.  The original perps remain in their jobs.

The FDA is warning about AbbVie's hepatitis C meds.  They can cause liver disease and may require liver transplants from the meds.  No warning for Gilead's product.

Obamacare is still a bad actor when it comes to verifying eligibility.  The GAO states that enrollees can still get insurance even though they are not eligible.  The GAO found the same thing a year ago and of course the feds have not fixed anything.

The GAO has found that over $1.6 Billion given to the states to help set up their exchanges years ago has not been either accounted for or returned to the feds.  A huge total of $ 1 million has been returned.  The article went on to state that 85% of the money went to Democratic states and that only 3 of 16 states given money have returned any.

The Massachusetts Medical Society held its meeting to air problems with EHRs.  The discussion centered on pass fail using 100% as pass and all other as fail as regard to "meaningful use".  If one does not meet all the standards the physician gets penalized.  They complained that EHR has not made physicians more efficient but less productive.  One physician said the the requirement of the use of online patient portals has resulted in their senior citizens emailing "hi".  The physicians mocked the one size fits all metrics and the punishing of physicians for the sins of the vendors.  Some of the improvements suggested were separating billing from EHRs, specialty oriented meaningful use, patient controlled data, interoperability onus on vendors not physicians and enabling patients to have surrogates to access their data including physicians.  

In a scathing article Mother Jones rips the use of EHR and especially EPIC.  It talks a bout the expense and the inoperability of all EHR but especially EPIC.  It talks how the feds grew tired of EPIC and gave the large DoD contract to Cerner.

Utah is considering a law to make physicians pay for the state's lack of money for Medicaid.  I am sure physicians would love to pay about $800 apiece to help out the state so they can get more low paying patients. 

Hawaii, a good Democratic state, is raising premiums for their large insurers about 30%.  

CalPERS reports that they have dropped 18,000 ineligible dependents from it insurance plan.  This included former spouses and domestic partners.  This has saved the state over $2 million monthly in premiums and and additional $3.7 million per month on other costs.

Colorado's largest Obamacare insurer decided to close.  This leave about 83,000 people looking to find a new insurer for next year.  The Feds can not fund the Colorado HealthOP so the nonprofit will have to close.

The dead of New York are in the same boat as the dead of Chicago in 1960.  The Chicago dead elected JFK as president and the New York dead are getting money from the Obamacare benefits, another Democratic boondoggle.  

Romania is losing physicians to other countries. Over 1/3 have left the country in 2011 and 2012. They are thinking of attempting to keep them by allowing them to accept gifts after treatment if they declare it.  This is what is happening now but under the table.  The typical physician earns about $369 a month or $30 below the average in the country.  They survive by taking the bribes for all services.  The Prime Minister also raised the physician salaries by 25%.        Top 


A study by the IG showed that the OIG is lax in its oversight of the massive HIPAA breaches.  They have not fully implemented the audit program and have not made sure the breaching entities have actually fixed the problems.  Is this a surprise to anyone?        Top


John Assanti, the 800 pound man tossed from his Rhode Island hospital after it was found that while undergoing treatment for his morbid obesity he ordered a pizza, has found another sucker hospital willing to take him.  This one is in Ohio.

Stanford Hospital has said that 1500 children vaccinated need to be re-vaccinated due to a faulty refrigerator.  Approximately 10 vaccines were compromised.

A whistle blower physician in the Broward Health fiasco is warning people about having their physicians owned by a hospital.  Broward is the entity that just paid out $70 million after refusing to listen to good legal advice and hiring physicians and then paying them over fair market value.  He says that giving physicians incentives to generate medical revenue is unethical and over prescribe medical treatments.  He wants hospitals out of the business of hiring doctors.  However, with lower reimbursement by insurers the physicians need the stability of salary and not the lower fee for service reimbursement.  He legitimately states that hired docs need to hoe the company line and only refer to those who the hospital deems fit not who is the best for the patient.

As a follow-up to the above, hospital outpatient departments are increasing fees for the common surgical procedures much more than ASCs.  This is how they get the money to pay the salaries to the physicians.  This is the same boondoggle as the hospitals now charging patients seen in what used to be a private office before it was purchased by the hospital now charging facility fees to the patient and insurance company.

Another story reiterated the same thing but was focused on the Boston area.


Napa, California' Queen of the Valley hospital has now stated the its colonoscopes have not been sanitized to manufacturer's directions in the past seven years.  All the patients screened with the devices will get free lab tests.

New York Presbyterian Hospital made two announcements in two days.  The first stated it would close its family medicine program.  The second was a mea culpa and said it will not close its family medicine program.  It seems as if the hospital forgot to talk about this to the people on the ground prior to opening up its mouth.        Top


Who do you believe, the insurance industry of the the physicians and hospitals in regard to the potential for increased costs with the merging of the medical insurers?  In some areas there would be no significant competition.  Economists believe the mergers will increase costs.

Blue Shield of California has agreed to return money to people they overcharged for their insurance and to limit premiums in the coming year.  This comes after, according to a story in the San Francisco Business Times, the state "slammed" Blue Shield for their over estimating the projected drug costs.  Blue Shield has also removed Stanford from their PPO network as too expensive.

California believes the average rate hike of 27.4% by Aetna on small business plans unreasonable.  Aetna does not agree and California can not do anything about it.        Top


In a weird story an appeals court in New Mexico has apparently ruled that if a New Mexico resident has a procedure in Texas the New Mexico med mal rules will hold.  This is being appealed to the state supreme court.  The article says that Texas physician are still treating the New Mexico patients but are putting up signs that any dispute will be under Texas law.  this would be doubtful protection for them.  The major hospital in Albuquerque are not able to handle any more cases and are actually referring cases to Texas.

Modern Healthcare states that physicians are not billing the codes for the major $42 per month charge they can bill for if they deal with patients with chronic conditions.  Maybe they think it is just not worth it.  The documentation required is idiotic and may cost their patients a co-pay.

Consumers Union has filed a petition on the Medical Board of California requesting it require physicians on probation to notify patients of their status.  The Board rejected a similar request in 2012.        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.