April 15, 2013 Recent News






Obama is leaving small business out of Obamacare for at least one year due to the inability of Sebilius to get her act together.  Since the feds can not have more than one plan in place by 2014 for employers and employees of small business, there will be no plan for at least one year.  This will occur in all the states even the ones that are doing their own exchanges.  However some states have said they will do their own anyway.  The blame goes squarely on the feds who did not provide detailed guidance or final rules until last month.

The fickle finger of the feds is again at work.  They had decided on reducing payments to the private Medicare plans also known as Medicare Advantage.  The insurers lobbied hard and have not only derailed the decrease in payments but have gotten more money than the year prior.

CNN Money reports on a University of Chicago report that says insurance premiums will go way up for individual policy holder next year due to Obamacare.  They blame the increases on the benefits that must be included under Obamacare.  This looks like a set up for people paying a fine instead of buying insurance.

The WSJ had a story on small businesses that intend to opt out of paying for insurance and pay a fine instead.  They will save many thousands of dollars by either this route or changing the hours so more are part-time.  They acknowledge that those businesses that do not pay insurance may have problems hiring as compared to those that do pay for insurance.

There is an Obamacare loophole that some businesses are considering.  The loophole is to self insure and purchase stop loss coverage.  This would cause small group insurance to increase by as much as 25%.

Those that scoff at what will happen to access next year should take a look at Tricare today.  The people enrolled cannot get access now.  There has been a major decrease in physicians especially in the mental health field that will accept the insurance.  The reason is the reimbursement.

The Illinois Medicaid Director came out of her cocoon long enough to make the pronouncement that there are not enough physicians in Medicaid to take care of the new patients expected next year.  Very few physicians see significant or any Medicaid patients due to the rules and reimbursement.  She thinks the temporary increase in payments for primary care physicians will help.  She is mistaken.  The feds still haven't started the payments that were to begin the beginning of the year and are putting rules in to make it harder to get the money.  She can now go back to her cocoon.

HRSA has issued the final rules transferring the HIDP into the NPDB.  The former is a national healthcare fraud and abuse data collection agency for information against all providers.  The latter is the physician collection agency for any action against any physician.  When all data is transferred the HIDP will close.

The administration is looking to expand a safe harbor regarding hospitals paying for EMR for referring physicians.        Top


Two doctors in the Las Vegas area are saying patients are being shuffled between St. Rose hospitals so that the hospitals may financially benefit at the expense of patient safety.  The shuffling would be by an ambulance company that was owned by the same people who own the hospital thereby generating more fees.  The physicians were also pressured to falsify medical records to state the patients transferred were stable when they weren't.  The physicians were removed from the ER corporation hired by the hospital and are now suing for wrongful termination.  Other physicians in the hospital said the allegations were true. There are emails from the hospital director of the ER threatening physicians who did not transfer enough patients.  

Vanderbilt University has stopped any faculty or staff accruing and vacation time until July due to budget shortfall.  They are blaming the shortfall on the sequestration.  They will also freeze pay for the next year.  

Some outpatient oncology clinics are not seeing Medicare patients due to a cut in the price of drugs.  They will lose a significant amount of money on each drug and can not make it up.  The patients are being sent to the hospitals for care even though it costs many thousands of dollars more to deliver the same med at the hospital.  

Geneva Hospital in the Finger Lakes area of New York state will cease its OB deliveries in several weeks.  The OB physicians have decided to move their OB business to a competing hospital where there will be better on call and other back-up.  They will continue their other practice, GYN, at Geneva.

Brigham and Women's Hospital in Boston are publicizing their errors to help others not follow suit.  They publish a monthly newsletter on line for their staff telling of errors and how to not make them again.  They started doing this in 2011 and while they don't make them readily available to the public they did give all the issues to the Boston Globe who printed the story.        Top


The Orlando, Florida, independent physicians are taking out ads warning patients about higher bills when their physician gets purchased by a hospital.  They have formed a trade association to accomplish that means as well as explain the lack of access by patients to physicians due to directed referral patterns.   Several other states have also formed these same associations.  

Salt Lake City's Deseret News has a story about physicians going bankrupt and thinking about retiring due to the loss of reimbursements.  This is happening at the same time as the pipeline is bending toward lucrative specialties and away from primary care.

In a stand that can only harm patients the ACP recommends that patients and their internists discuss the "significant harms and minor benefits of doing a PSA test".  This applies to men between 50 and 69.  The organization already believes erroneously that the test should not be performed on anyone else.        Top


Teva Pharmaceuticals is reducing its manufacturing of drugs.  It is closing a plant in Irvine, California and will lay off people.  

Eli Lily will lay off hundreds of sales reps due to falling revenue in products out of patent.  They will also let go their contract workers.  Three years ago it let go 1000 workers or 25% of their workforce.  The industry has shed tens of thousands of jobs in the past five years with more coming.          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.