April 1, 2016 Recent News






More Americans are insured due to Obamacare.  Most of the gains are in the Medicaid arena due to loosening the perimeters to enter the program.  Employment insurance did not change much.  This is directly causing the Obamacare costs to rise much more than the originally estimated.  $136 Billion more.  The CBO also said this increase will not raise the cost of government since there will be more taxes and less paid towards Medicare.  

The WSJ had a front page article on the illegal immigrants getting Obamacare in spite of it being illegal under the law.  This is being paid by local funds and are to keep the illegals out of the ED where EMTALA would cost more.  The Journal found 20 of 25 counties with the highest illegals providing the care at a price of about $1 Billion.  A week later there was an article about California expanding Medicaid to illegal immigrant children and how to sign them up.

In a duh moment someone actually did a study on how patients who are "difficult" would get worse care than those who were "nice".  They showed that dealing with the problem patients led to more misdiagnosis.

Participation in the Medicare EHR incentive program is dropping as both physicians and hospitals are dropping out of the program.  They are frustrated with CMS changing the rules mid stream.  

To no one's surprise studies have shown that since the idiots decided PSA should not be done as much, prostate cancer has become more advanced when first detected. The impact on the original declaration that PSA should not be done on men over 75 has shown an increased likelihood or high risk and meta static prostate cancer in elderly men.  This is now predicted to occur in the younger population.  (See New Legislation)

Blue Cross came out with a study that the Obamacare patients tended to be sicker and incurred more medical costs than the employer insureds.  Those on Obamacare cost 22% more than the employer insured.  This is a great excuse to continue to raise rates for the Obamacare folk.

Insurers are cutting commissions to brokers who sell Obamacare products that are not making them money.  This will steer patients away from those products.

To no one's surprise the government has come out with a proposed rule that does nothing.  This one is for the opiate epidemic.  The rule allows physicians to prescribe buprenophine to up to 200 patents in their practice instead of 100.  Yea!!  The people who actually treat addiction say this is ridiculous.  The new rules say physicians need a special training to prescribe the drug and practice in an qualified practice setting, or have specialty board certification in addiction medicine or addiction psychiatry.  If they then want to treat the 200 people they would need to offer behavioral treatment services and spend time doing data reports..  Currently there are 32,000 physicians certified and only 10,000 eligible to treat more than 30 patients in their practices.  I am sure that the physicians will now race to fulfill these new proposed criteria.

California's Obamacare program may narrow the provider hospitals by imposing restrictions on which hospitals may join the program.   This is different than the insurer's narrow networks.  Covered California wants to get rid of hospitals that do not conform to their notion of quality and costs.  

Covered California is also dropping patients or shifting them to Medicaid but not telling them.  No one knows why this is happening but it is.  There may be a problem with the communication between Covered California and the health plans.

Maine's wonderful co-op Community Health Options is in deep doo doo with losses and very high pay to the CEO and COO.  The flagging business had been placed on the Maine Bureau of Insurance enhanced oversight list. 

The do nothing state of Illinois is still without a budget after 10 months.  This means the insurers that care of the state employees are not getting paid.  The state is over $2 Billion behind in the payments.   Wonderful state to leave.  Sure happy I did.      Top


It has been a long time coming, many years, but the recent CEO was demoted to his old COO position and the General Counsel will be reviewed at Broward Health.  This is a great start.  The physicians have taken no confidence votes in the law department of the hospital.  How many times have one seen that?  The hospital has lost physicians and the law department has not been able to work out contracts.  The hospital is also under severe investigation on conflict of interests.  The hospital has had problems for many years mostly due to the board not paying attention to the troops.

Several days after the above the Florida AG demanded a $5.3 million penalty for the hospital making the illegal payments to their physicians and Medicaid fraud.  The Governor then removed the Hospital Board Chair from his position.  The new CEO said she would fix the problems with the hospital's physicians who are working without a contract.  

There was a opinion piece in a paper that says the head of NYC Health is attempting to save his job by foisting Epic on two hospitals that are not ready and may harm patients.  There have been no dry runs as to whether the old records have been successfully transferred or will be lost nor any plans for the inevitable system crash.  

Blountstown, Florida,  Calhoun Liberty Hospital has a new CEO.  The 72 year old interim CEO left to take the reins as the Chair or the board and the new interim CEO is an executive in a turn around company.  This is the hospital that had a patient arrested when she failed to leave the ER.  The patient died.  The CEO fired two nurses and a paramedic who were involved.  The hospital has low morale and low revenue.  They also have thousands of state fines to pay.    The prior CEO is under investigation for embezzlement.  

Hackers have infiltrated several hospitals in both California and Kentucky.  Prime Health has had two hospitals in California hacked with some computer programs disrupted but no medical records were involved.  The FBI is investigating.  In Henderson, Kentucky, Methodist Hospital had a ransomware attack.  The patient files were locked and a payment is being asked for to release the files.  The FBI is on this as well.

Methodist Hospital in Kentucky is recovering from a five day problem when it was held for ransom with it s EHR.  It states it is now back running and did not pay any ransom.  

West Virginia University Hospital had a problem at its Ruby Memorial Hospital.  The computer system went haywire and the security cameras went off line.  They say no personal information was compromised.

MedStar stopped seeing patients after it was hacked and its EHR was down.  After a day they could read but not update records.  The employees reported messages wanting payments for release of the EHR.  This affected 10 hospitals and 250 outpatient centers.  MedStar says all is well however their nurses and physicians do not agree.  They were having problems with lab results arriving in a timely manner.  The ED at Washington Hospital went on diversion.  

An investigation by HHS found that the hospitals owned by Universal Health services in Texas have many serious patient safety problems.  The inspectors found a rate of 8.4% of serious problems compared to a nationwide rate of 3%.  In the past year there have been problems with the system's hospitals in Illinois and Massachusetts. 

The CEO of the troubled Denver Health will retire in June.  This may allow the hospital that has lost many physicians to either be obtained by another institution or to right its own ship.  The hospital has severe financial problems funding education, research and the underserved.  He ditched the in house computer system and went with Epic for the sum of $175 million plus the hiring of several hundred employees to run the system.           Top


Highmark has changed the Obamacare game. They have unilaterally decided that physicians treating patients covered under its individual insurance plans will receive less money.  The decrease for exams and medical procedures will be 0.6% less.  This is due to the insurer not receiving their risk corridor payments.  They would rather do this hoping physicians will not quit than raise rates again.        Top  


Any time a physician is murdered it is news.  This time it was Dr. Elbert Godier, a urologist in Metairie, Louisiana.  He was shot while seeing a patient and the killer then committed suicide.  Urologists are especially at risk for this misadventure.        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.