April 15, 2010 Recent News







Dr. Jack Cassell, a urologist in Mount Dora, Florida, has a sign stating "If you voted for Obama, seek urological care elsewhere".  What he is doing is legal and ethical.  He will see those who voted for Obama but not happily.  He also has pamphlets in his office on health care legislation with a sign that states "This is what the morons in Washington have done to your health care.  Take one, read it and vote out anyone who voted for it".  The local Democratic Congressman Grayson is not happy about it but he should get used to it while still in office.  He actually is filing a suit against the urologist for violation of the Hippocratic Oath.  That means he really is stupid about the Constitution as well as health.  He deserves to be voted out.  

California physicians must now have a sign in their offices telling people where to complain if they have a problem with the physician's care.  The notice must only state that physicians are regulated by the Medical Board and the Board's phone number and web site.  Of course the Board also calls the patients "consumers".  One wonders why physicians hate the Board.

The physician hating Public Citizen is still criticizing the country's medical boards for not disciplining enough physicians.  It makes no difference what the issues are they just want numbers.

HealthLeaders, a publication for hospitals, state that physician owners of surgery centers operate more often than they did prior to ownership.  The article says nothing about the necessity of the surgery and does intimate that hospitals are more expensive and inefficient places to practice when compared to physician owned surgical centers.  The Surgery Center Group states the article is based on incorrect assumptions and therefore is invalid.  The group pointed out the increase is part of a general move from the inefficient hospital outpatient setting to the surgical center setting. 

The New York Times had an article about the ridiculous amount of paperwork required by a physician.  The physician uses approximately 1/3 of his/her time on the forms.  This takes away time with the patients especially for those in training and only allowed to work limited hours.  The physicians then rely on the prior notes instead of talking to the patients.  This is a disaster waiting to happen. 

The Wall Street Journal had an article about San Diego's PACE.  This is a "school" to teach physicians about how to do medical records, anger management and other scofflaws.  The school uses data and observation (gut instinct) to determine the fate of the physicians. The school can run between $7000 to $17,000 and about 10% fail.  If they fail the state who is usually the one who sends the physician may revoke or continue suspension of the physician's license.  One may think this is expensive but when the amount of money a physician may make during his/her career is figured, it is cheap.   

The Manchester Independent in England has a story about a surgeon who claims that physicians and nurses are being prosecuted if they speak out for patient safety.  He was a London's Queen Elizabeth Hospital Urologist who lost his privileges for speaking out for patient safety.  The urology ward was closed to save money being spent due to a insider building spending fraud.  The patients were spread around the hospital leading to poor nursing and complications.  The hospital also delayed treating patients with cancer.  The patients were lied to by the hospital to explain the delay.  Due to his complaints he was suspended with pay for ten weeks while an investigation was held by an outside urologist.  A locum had to come in and was also paid.  The urologist was reinstated and wanted an apology.  That was denied.  He sued and won.  The taxpayer funded hospital could be out over 500,000 pounds.  He of course is now not hireable.  This has happened to others as well in England and they needed to go to Australia to practice.  This sounds like many hospitals in the US who also do not like physicians whistleblowing. Here it is called sham peer review.    Top


The new fed health plan may be very costly to some towns.  The Boston Globe has a story that cities and towns may get hit with significant levies if the high price health insurance they purchase for their personnel and retirees aren't scaled back.  The tax payers of those areas will have to pay the piper.  These municipalities will have to get rid of the high cost spread or face the wrath of the constituents, voted out.

The Boston Globe also reports that the wonderful universal care is allowing people to purchase insurance just as they need it and then drop it after the needs falls.  This drives up costs for the rest of the people.  The same thing will occur during Obamacare.

The Globe states that the insurers are stopping writing health insurance for individuals and small groups that the state refuses to allow premium increases.  The state has warned the insurers to post rates for renewals on the web site by 4/9.  The insurers say that is impossible until the court rules on their lawsuit.  The insurers must give a 30 day notice to stop writing insurance under state law.  Can anyone foresee the insurers just not writing any more insurance in the Republic?  Two insurers the day following the announcement have made made rates as prior available to individuals and small groups.  Others to date have not.

There continue to be interesting tidbits that come out regarding the Reform law.  There is a law that mandates physicians who order MRI, CT, PET or other designated procedures in office tell patients that the tests may be done at other places where the individual resides and where those places are.  The statute states this started last January but of course that is impossible.  It is more logical, but with this Congress I'm not sure, to have the law go into effect after the secretary defines the other procedures and the definition of where the patient resides.

The law also gives primary care physicians Medicare rates for treating Medicaid patients in 2013 and 2014 only.  This is probably the reason that the organizations that supported Reform were those representing primary care physicians and all the surgical and anesthesia groups were against the bill.  It is also interesting that the state medical societies that were from Blue states were for Obamacare and those from Red states were against the plan.

The Christian Science Monitor believes that sustaining the Reform law through the 2010 and 2012 elections may be as daunting as passing the law.  The Medicare Act of 1968 was repealed the following year after seniors found out how much out of pocket the bill would cost them.  When the Medicare Part D passed under Bush II there were Democrats who voted for it in both Houses as opposed to zero votes for the current bill.

It is unusual that after a bill is passed that the President has to go around the country to continue to push the bill.  That usually means the country doesn't like the bill and will punish those who passed it.  Congress is also going to their constituents during the Easter recess but only to those who agree with them.  They pick and choose who will attend their rallies for the news photo ops.  The President must defend those who voted for the bill since the US Chamber of Commerce is going to devote at least $50 million to defeat those incumbents that voted for the bill.  The Dems are organized with cue cards of what to tell the voters whereas the Republicans just tell about the bill.

The Washington Post states that the bill may hobble the economy not just due to the pull back of building on physician owned hospitals but also by businesses not hiring to to the increased taxes they will have to pay.  The article states that very few economists believe Obama when he states the measure will the rapid rise in health care costs or close the federal budget.  I have talked to several brokers and economists in the past week and none have been in favor of the bill. 

There are as all knows multiple tax changes related to the bill.  How many know that small business tax breaks begin to phase out if the annual average salary is over $25,000 and is gone if the average income is above $50,000?  The bill is only based on 25 full time employees, a good reason to have part timers.  Those people with kids under 27 will be able to deduct the kid's premiums off their income tax even if they can not deduct the child per se.  All know that those with incomes above $200,000 or families with income over $250,000 will be hit by higher Medicare and income taxes on dividends.  However, how many know this is not indexed for inflation?  Therefore many more will pay this tax as years go by.  Hospitals will need to do a needs assessment of its patients every three years and those patients who fall into the needy category must be billed as if insured.  Failure to do so will result in a $50,000 penalty per person.

The law also has free preventative screening but it does not say who will pay for that.  It just means the patient will not pay out of pocket.  This includes mammography and colonoscopy for Medicare patients.  It sounds like the facility and physician payments will be paid in full by Medicare but I am not sure which part as Part B only now pays 80% of the approved rate.  

The AHA is promoting ads in the districts of 16 House Dems who voted for the Obamacare bill and are at a potential for losing their seats over their vote.  The ads thank the Congress people for their votes.

The number of states who are suing to stop Obamacare is now up to 18 and may hit over 20.  Latest to be added to the suit are Indiana, North Dakota, Mississippi, Nevada and Arizona.  The latter two are interesting since they represent a split between the Governors and the Attorney Generals.

The Wall Street Journal has two articles on EMR.  The first states that EMR has not lived up to its billing as a tool for making medicine better or safer.  It told of a 2009 study that showed those hospitals that had EMR did no better than those without.  Most believe the EMR is for better coding and not better patient care.  The head of HIM doesn't agree.  He believes that they are primarily to improve outcomes and secondarily for administrative purposes.  The article emphasizes the need for nurses and physicians to be involved and customize the product.

The other article in the Journal the same day tells of a another problem with EMR, the inability of the systems of communicate with each other and the potential for privacy problems.  These will hopefully be decreased as fed money is added to the mix.

Those who believe the US does not have the best healthcare in the world need to relook at the UK.  The Wall Street Journal states that the US has the highest survival rate for breast and prostate cancer at 84% and 92% respectively versus the UK at 70% and 51% respectively.  This is directly related to politics dictating what drugs are available and how they may be used.


In a recent California poll on member satisfaction only two HMOs were above the national average.  These were Kaiser and Cigna.  Kaiser was way above Cigna.  It might be mentioned that the average score nationwide went down over the past year by over 10%.        Top


There seems to be some discord between UC San Diego hospitals and its rival Scripps.  The CEO of Scripps was not happy that the UC hospital in La Jolla, a very expensive suburb of San Diego, was going to be twice the size originally thought.  At the same time they are downsizing their hospital in downtown San Diego which cared for many of the uninsured.

The AHA has a notice by AHRQ saying that care in hospitals improved faster than that in other settings (ACS).  Of course it did.  It was so bad compared to the others and therefore had farther to go. The article also said that hospitals are still not safe as they have not reduced the infection rates.       Top


The Rhode Island court system has been in chaos in relation to med mal suits.  The lawyers were never ready and had to pay experts who blocked off time but were not called.  There is now a new way of doing things.  A new judge has set up a realistic routine of how to schedule depos and cases with mandatory mediation to be done prior to a trial.  So far the new process is working.          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.