April 15, 2018 Recent News





In Audubon, Iowa, the hospital fired a physician and some people are upset about it.  It is the physician's own fault.  He lied when he stated he completed a residency when he had not.  The state found out and suspended his license for ten days for unethical behavior.  Blue Cross then dumped him since he did not have a residency.  The hospital then fired him since he was not credentialed by a carrier, absences from work and lack of productivity.  The board reaffirmed its previous axing of the physician.

Crain's Detroit Business has a long article on how insurers are redefining hospitals.  They want to save money where they can and one place is to make sure patients needing infusions get them in places other than hospitals.  The same is true for joint replacement surgery.  This is good medicine.

What is not good medicine is the new physicians who can not do physical exams.  They rely on tests instead of their own abilities to do H&Ps.  This was outlined in a Medscape article.

Ocare did well this year with it losing only about 400,000 members.  Almost all came from the fed marketplace.  Part of the reason may be that only 30% in one survey knew that the individual mandate had gone away.  The price of insurance dramatically increased but the subsides paid for most of the payments.

The VA is again rudderless and the vets are still waiting long times for appointments.  One of the major reasons for the long delays is lack of personnel to treat them.  The vacancy rate for all jobs is high, including physicians, mental health provider and even janitors.  The VA also has a lack of human resource personnel to vet candidates  for the positions.  Also the VA pay is below that of the private sector and the vetting process required is long.  President Trump seems to be favoring more outsourcing of care and nobody knows what the belief of the nominee for the position of the head of the VA is.  

One church in Texas, the Covenant Church in Carrollton, donated $100,000 to the charity RIP Medical Debt.  This eliminated debt for about 5000 local families for a total of over $10 million.

Medicare Advantage plans may be given the OK by CMS to pay for many more services in return for the additional monies they will receive.  They may be able to purchase air conditioners for those with asthma, rides to appointments, and get home delivered meals.  This plan still need the formal OK probably in the fall.

UnitedHealth soon with the finalization of the purchase of DaVita physicians will have many physicians (about 37,000) throughout the country.  They want to control their costs by keeping patients away form costly hospitals.  If the physicians are purchased by them they are not eligible to be purchased by the hospital which raises costs of care.  The physicians also care for those in other plans than United.

The DOJ and HHS have siad that in 2017 they clawed back about $2.6 Billion from judgments, settlements in fraud cases.  They get back about $4 for every dollar spent.  The fraud racket is about $15-20 Billion per year so the recovery is good but not great.

The SEIU is at it again.  Now they want a ballot initiative in California stating that dialysis centers can only receive 115% of care costs which would slash their currant reimbursement.  They want increased staffing and they can not get it via the legislative route.  It is possible that the ballot initiative would be dropped if more SEIU people are hired.

California continues to show why it is famous for being the land of fruits and nuts.  Legislation introduced would cap prices for hospital stays, doctor visits and all other services.  Noticeably the same is not true for legal services.  The SEIU is again behind this to free up more money for their employee's wages.  

Sometimes physicians can be petty.  The physicians in east London are mad at the NHS offering video appointments around the clock via an app GP at Hand.  Patients can also see a live practitioner at various clinics in the area.  The local physicians say the patients are being cherry picked with no complex mental health problems, dementia etc taken.          Top


As I wrote last newsletter Sonoma West Medical Center in Sebastopol, California, was accused by Anthem of being a front for doing toxicology tests for a national company and taking over $13 million illegally.  Now the Board of directors are mad since the hospital on its own and without their input discontinued the contract to do the tests.  The hospital is now back on financial life support.

A nurse at Kaiser Sacramento opined, as is her right, on Facebook that Stephen Clark got what he deserved.  Now she is finding out what happens when you exert your right to speak.  She got fired from the hospital after a woman found the post and exercised her right to speak that nurses are not to be happy when someone dies. There is a very good chance she can not win any legal case against Kaiser. 

Summa Health will try again to get a ED residency.  They had it yanked away several years ago when the hospital changed ED groups which led to the removal of the hospital CEO.  The ED is almost up to speed with new physicians and they want to again have a residency program.  

Kern Medical Center in Bakersfield, California, has lost its general surgery residency program.  They will close on June 30.  There are currently 13 residents and five will graduate with the remaining and new residents needing to find new programs.  The program has had problems finding adequate instructors for the residents in subspecialties such as vascular.  

Hospitals love to kill the golden goose.  They overcharge for most things and wonder why insurers are starting to have their patients get tests outside the hospital.  A case in point is at Lee Memorial in Ft. Meyers, Florida.  A man had abdominal pain and went to his internist.  The internist sent him for a CT Scan at an outside facility which cost him out of pocket $216.  The test was negative.  Several months later he again was not doing well and called his physician.  A nurse sent him to the ED for suspected appendicitis.  He was examined by a nurse and told he did not have appendicitis but was told to stay for more tests including another CT scan.  The tests were also negative.  He received a bill for $10,174.75 including $8897 for the CT Scan.  It is understandable why the hospital is more but that much is out of line.  He ended up responsible for $3394.

Togo physicians are on sstrike over the deplorable conditions at the hospital.  The air conditioning went out, no supplies and patients need loans to purchase supplies from surrounding pharmacies.  The main hospital is call "the morgue".  In one case the electricity went out during a neurosurgical case and the surgeon did the surgery be the light of a cell phone.        Top


The physicians of the Mecklenburg Medical Group have broken the chains of slavery.  Their threat of a law suit against Atrium Health scared the system enough to make them give the 92 physicians their freedom from the restrictive non-compete clauses.  The 92 will form a new medical group.  

The Annals of IM has a report that almost 50% of physicians spend less than one minute reviewing the form certifying home health care plans.  Physicians have no time for admin.

The NYT has an article regarding the decline of the primary care physician.  The number of visits to PCPs has declined even as specialist visits have increased.  The patients are going to the clinic in the drug stores.  

Dr. Steven Chae is the sole practitioner in his office and as is his right has political messages on his walls.  A visitor to his office took pictures of the messages and put them on line.  The social media debased the doctor and probably for good reason as the messages were vitriolic.  Since the din Dr. Chae has revised his messages and toned them down.  I respect his right to place the messages but he would alienate any of the opposite party.

Hooray for the new generation of self absorbed kids who love selfies.  The addiction, and that is what it is, will be wonderful for the plastic surgeons of today and the near future.        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.