September 1, 2015 Recent News





Medicare has added new some new contracts for its bundled payment initiative for various conditions.  However, 2/3 of those already in the ortho program dropped out of the program.

In another blow to Obamacare it was noticed that 35% of physicians did not take new Medicaid patients in 2013 as opposed to 8% that did not take any new patients.  This was just prior to Obamacare and their lower payments to a smaller number of physicians.

In yet another blast at the VA, the Arizona Central writes that half of the crucial position in the system are vacant.  This is especially acute with the psychologists where up to 64% of the positions are vacant.  Schedulers have a 21% vacancy rate and the physician assistant vacancy rate is 23%.  With clinical positions much of the problem is the time it takes for the process of hiring.  I t can be up to 8 months and by then most of the good people have other jobs.  At the West Texas VA 43% of the medical jobs are vacant.

ACOs are terrific.  75% did not earn bonuses last year since they did not slow health care spending.  The feds doled out $422 million out of the $833 million that 97 out of 323 ACOs saved.  This is similar to 2013.  This suggests that they "cannot bend the health care spending trajectory".  Medicare is now realizing how dumb they were.  There is no downsize for ACOs as they have no risk, the organizations are not dumb enough to change just for Medicare and the patients do not have to stay in the ACO for the lesser care.  It should be noted that 6 of the 92 organizations who met financial goals didn't get money because they did not hit quality goals.

A new report by the Kaiser Family foundation says that over 25% of employers that offer health insurance would get stuck paying the Cadillac Tax under Obamacare unless they change by 2018.  This is a 40% tax.  Watch employers get rid of the tax by raising deductibles or co-pays or using narrow networks.  Even H Clinton is against it.  It may be dropped by Congress, at least they are trying against the wishes of the current lame duck administration.

The CBO has predicted that healthcare spending will rise from 5.2% of the GDP to 6.2%.  This means the fed will spend $272 Billion on healthcare in the next decade.  They say this is due to Obamacare and the physician fee increase of 0.5% per year over the next four years.

Nothing to do with Obamacare but Medicare is raising its rates for Part B coverage.  Watch your Social Security as more is taken out to pay for the program.  If SS payments are raised one will see a bump from $104.90 per month to $120.70 to cover higher costs.  Without a raise in SS benefits there could not be an increase for most so dual eligibles and those who are new to Part B and those with incomes over $85,000 will see their premiums go up 30% to $159.30.

We should not leave out Obamacare for its claim to the highest cost healthcare insurance in the world. The WSJ has an article regarding the insurance premiums for next year.  Not all states have come up with their rates for next year but for those who have, most will see significant increases.  They took aim at Obama's claim in July that Tennessee premiums will come in significantly lower than requested.  He has been wrong on most things related to the healthcare plan and this was no exception.  Tennessee Blues requested and got a 36.3% increase.  The administration always looking for a spin says the law helps lower premium since people can more easily switch plans and does not talk abut actual rate increases.  The largest insurers in the states that have decided on have gotten increases ranging from 2% in Maine to Tennessee.  Most are above 10%. 

The Democratic controlled NLRB voted 3-2 to make workers employed by staffing agencies also employees of the organization for which they work  This makes millions of hospital workers now employees of hospitals.  Hospitals may now have to pay them union wages even if the staffing company is not unionized.  Hospitals may also have to negotiate with more unions.  Let us hope a new president will get rid of the current NLRB board and the decisions are revoked.

This year has been bad for Medicare Advantage plans.  Some have seen steep declines in enrollment.  Summa was prohibited from enrolling members during open season due to their screwing up appeals for the members. They lost 20% of their members.  Some blue plans also lost over 10%.  The MA plans hope to rebound this coming year with more narrow networks and higher enrollee payments.  Good luck with that.

California is awash in narrow networks.  A study showed that 75% of Obamacare plans utilize this gambit.  This is the fourth largest percentage of narrow networks in the country.  The other three higher are in Georgia, Florida and Oklahoma.  This is against 12 states that have no narrow network plans.        Top


An anonymous article in the Annals of Internal Medicine "Our Family Secrets" the author tells of two real life stories of OR humor that is not PC.  The first by a medical student who tells of a moment he was embarrassed by an attending who told an off color remark and another by an attempt at humor after a life threatening moment has passed.  This what some people do to relieve stress and gallows humor is as old as the hills and will continue for eons.  It may not be PC but it works to relieve stress.  Get over it!        Top


Hutchinson Medical Center in Oglethorpe, Georgia, filed for bankruptcy Chapter 11 in November last year.  Since that time they have continued to pile up debt to a tune of $5 million.  Due to the combination the hospital is unable to get supplies in a timely manner and the patients may be suffering because of it.  The US Trustee on the case wants the bankruptcy ended since it has not filed a reorganization plan.

Four leaders of New York City's Health and Hospitals Corporation have left after an investigation.  The organizations EHR has cost about twice the expected amount, now a whopping $1.4 Billion.  They had a lot of people but no leaders.  Sounds like a typical government office.

In what sounds like a disaster of PR about a hospital, West Palm Beach's St. Mary's Medical Center has lost its pediatric cardiac program and maybe much more.  They were the center of a CNN investigation into their program and a very large mortality rate.  The hospital tried to "correct" the report but failed as others agreed with it.  The physician in charge of the program has been accused of lying to the parents of the children who died.  The CEO has now left as well.  Bad Bad PR.

Erlanger Health System fired four top administrators.  Several board members now say that the CEO and the board did not have the legal right under federal law to fire them.  There is a PR fight in the media over this but nothing will come of it.

Two hospitals in two separate incidents reported patients being shot by police. The first was when a patient under guard attacked the police and was tasered.  The taser did not stop the perp and he was shot.  the police were severely injured. This was in Texas.  The other was in Ohio and the patient was again tased.  The patient got the taser and used it against the police and a nurse.  He was then shot.        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.