August 1, 2011 Recent News




Another state with far left tendencies is having problems finding physicians to care for their Medicaid population.  Hawaii pays far less to the physician than private insurers and therefore physicians fill up their schedule with private patients.  Add to the low reimbursements a load of red tape and you have a prescription for disaster.  Physicians in the state have difficulty with referrals and many times are paid below contracted rates.    

The AMA has an article about the rewards of private medical practice versus employment.  Last year 65% of established physicians and 50% of those coming out of residency are being employed by hospitals.  The main reason to go into or to stay in private practice is autonomy.  You get to design and run your practice in a manner that best suits you not some faceless corporate big brother. You get to hire and fire your staff.  The same politics that you have in private practice are increased in a hospital practice.  Most hospital contracts with physicians give the power to the hospital and they may fire you.  The time of working 24/7 has gone by the wayside with the advent of hospitalists.  You can make good income in your practice and if you work harder and follow the four As you will make even more money.    

The USA Today states that providers? are embracing ACOs.   The article then talks about hospitals forming ACOs.  They do not mention the physician so they must be employed.         Top


The OIG is planning to focus on potential fraud and waste in nursing homes that charge for specific procedures.  They say that the norm is $3.50 per patient per day.  Some nursing homes are billing up to $160 per day.  

In another Obama flip flop he originally stated that there would be no push against the use of medical marijuana but indeed there is.  The Justice Department continues to make raids on state legal medical marijuana use, sale and growth.  The states do not know how to proceed.  The New York Times has a story about New Jersey and their lack of providing the drug despite legalizing it several years ago.  It seems in New Jersey the Republican Governor is the one in the way.

In a frequent state of stupidity the feds have denied Illinois the ability to ask for those on Medicaid to prove they deserve it by looking at their finances and their state of residence.  This opens up the state to massive Medicaid fraud.  The state is willing to do this using their own data bases for residency and working with business for financial eligibility.   

The National Federation of Independent Business reports that 1 in 8 small business will jettison their health care plans when Obamacare takes effect. The organization also stated that about 20% will change benefits after the law goes into effect either raising payments for employees or reducing benefits or both.  

Federal Auditors will soon begin to investigate health insurance rates in Alabama, Arizona, Idaho, Louisiana, Missouri Montana, Wyoming, Iowa Pennsylvania and Virginia.  The feds state that these states do not adequately regulate insurance rated for small business and/or individuals.  The feds as usual did not give any deficiencies just generalities.  

Starting in 2013 Medicare will require ASCs to report quality measures in order to be paid.  Some of the measures are the usual idiotic federal ones such as how many of each procedure is done at the center.  In rural centers fewer procedures may be done so this may mean that patients should travel long distances to have them done in tertiary centers.

In the Canton, Ohio, area hospitals are putting liens on patients for their hospital bills.  They currently have liens on over 2000 homes in the county.  Usually patients do not know liens have been placed on their home.  They do know they have been sued by the hospital for unpaid bills.  

JAMA reported that Medicare Part D was responsible for less hospital spending.  In 2010 Medicare spent $62 billion for prescription drugs and paid about $1200 less in hospital costs for each of the 10 million people lacking employer based health care.  There seems to be some bias in the report.  

According to the CBO health spending will increase to 20% of the economy by 2020.  Obamacare will not reduce this and will increase this by 0.1%.  The White House spins this news to say that more people will be covered for the same amount of money.  It may not be more but just different people.  The federal actuaries state that Obamacare will increase pharmaceutical purchases by 11% in 2014.  Health insurance premiums will go up 4% over what it would be without Obamacare.  The actuaries go on to state that hospitals will get 1% more than if there was no Obamacare and physicians will get 4% more.

It appears that both Obama and the Republicans agree that Medicare needs to raise its age of enrollment to 67. This should be a slow increase over 20 years. The Democrats will never go for it as they have painted themselves as the protector of the senior no matter the cost.

The GAO has reported that CMS was wasted $48 Billion on improper payments in 2010.  This includes all wrongful payments and underpayments as well.   This is more than any other part of government.  The response is a new waste and fraud committee that will cut waste throughout government.  The Board is made up of the various heads of the Departments that are wasting the money.  Government stupidity knows no bounds.        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.