August 1, 2012 Recent News






A recent report talks about the states going broke.  Between the new Medicaid laws and the pension fiascos the states have no money left over for incidentals such as education.  This is not just due to the recession but has accumulated over many years.  This is making it much more difficult for the poorer people to attend college as there are less grants.  It was found that states pension needs are short about $1 TRILLION.   CALPERS, the California pension fund is based on the assumption of a 7% growth to keep up with the needs.  This past year they grew 1% which means the taxpayers will have to come up with the difference and much less money for anything else.

The Commonwealth Fund, a pro Obamacare organization, did a study and found that Obamacare brings us in line with European medical systems.  I hope they did not spend much money on this obvious conclusion.  They state that the full implementation of the law with special attention to the states enlarging Medicaid will give almost universal coverage to women.  It will also bankrupt the states but they do not care about that.  It will also lead to more stories like the one below and above.

The British physicians are not routinely prescribing statins for people over 75 for prevention of heart disease.  The older the person the less likely they would be given statins.  This is due to the guideline in use in the country focus on younger people who do get the statins.  Both sexes were treated equally.  

There is a problem in Texas.  The state's Medicaid fraud division has the authority to stop payments to any person treating Medicaid patients if they think there might be any fraud.  Sounds good but only a phone call to the state agency and before any preliminary studies are done the providers have their money stopped.  This will lead to less practitioners for Medicaid patients.

Forbes has an article on how Medicaid is expanded.  It is done by paying physicians less.  The article showed in all states held by Democrats the Medicaid has expanded and the physician pay has decreased in proportion.  There are exceptions like Delaware and Texas.

PhysBizTech has an article on how the IT systems that are required for "meaningful use" will be useless and can not be converted for ACO use.  The reason is the ACO is a business and what is needed is so different from what is needed under "meaningful use".

According to the GAO very few are being paid for "meaningful use".   Approximately 9% of the physicians and 16% of the hospitals of the country got any money under the meaningful use mantra in 2011.

It appears the usual Tuesday PR coming out of the CMS will continue until the election.  Each week there is an article or statement that comes from the talking heads at CMS regarding how great Obamacare is, many recirculated.  This last one is on the closing of the doughnut hole.   

Now, the insurers have started to return the money owed to the premium payers due to the insurers not following the Obamacare law.

A study by researchers from the U of Rochester of the data from the NCI showed that if we followed the recommendation of the USPSTF and not due PSA testing there would be triple the metastatic prostatic cancer that we see today.     Top


HealthLeaders reports that Texas Health Resources a 24 hospital system based in Dallas is going away from physician relations and more into volume growth.  It is predicted that other systems will follow suit.

The fight in San Francisco between the Board of Stupes who do the bidding of the Nurses and other unions and California Pacific Medical Center continues.  The Board was ready to not allow the hospital to rebuild due to seismic concerns under the guise of failing the environmental report.  The hospital requested and received a two week stay in which to re-engage in negotiations with the city. 

Moody's has downgraded the financials of hospitals over those it has upgraded. This tells the state of hospital health in the country.        Top


In the last edition I had an article regarding the reduction of total med mal claims and how this was debunked.  Now the AMA has an article about the steep jury awards.  A study has shown that over half of the largest med mal awards have occurred over the past five years.  The reasons are multiple.  One is the poor economic times means more sympathy to plaintiffs.  Another is that money does not have the same impact as it did in prior years.  Almost none of the high award ever are paid as after the trial there are negotiations or appeals and massive reductions.  Who pays these awards depends many times on what the physician decides prior to the trial.  In a recent California case an OB lost a $75 million verdict but since he requested the insurance company to settle within his policy limits and the insurance company decided to go to trial the insurance company must pay the entire amount eventually settled on.  The opposite is true if the insurance company wants to settle and the physicians wants to go to trial.  This will potentially lead to the physician's bankruptcy.  When these large verdicts are publicized more defensive medicine is practiced raising health costs for all.  It also adds to amount of cases filed since all want the lotto.

Several New York City hospitals are now without med mal insurance.  Some are self insured but some are just broke.  Hospitals are closing their high risk units such as OB.  If they get sued and have no slush fund to pay the award the money must come from patient care.  This is happening in the areas where there are large med mal judgments such as Philadelphia, Chicago and Dade county.  

A reader sent me the link to this article in Medscape.  Where are the med mal problems becoming more intense.  It is in discovery where the hospital uses EHRs.  If it is found that the EHR is a problem that problem is the hospitals and not the vendors.  The plaintiff attorney now hires experts in EHR to see if there are glitches in the system that may have contributed to the potential med mal.  This also puts blame on physicians since they are responsible for knowing all that happens when they push a button.  Almost none do.  Good luck to you using this terrible technology.        Top


The recent AMA news has an article on older physicians continuing in the same practice s when they were younger.  There is no one who agrees with mandatory retirement at a specific age, as is done with airline pilots.  There is unanimity of opinion that if dementia or other physical problems occur the physician should leave or cut back his or her practice to an appropriate level.  Some hospitals have routine annual fitness for duty physicals for physicians over a certain age.  This is especially true in areas where physicians are not retiring as young as prior due to the economy.   

According to a poll by Jackson Healthcare one third of the nation's physicians will not be practicing in ten years.  They can not be replaced by new physicians due the restraints placed on medical schools as to enrollment.  Jackson will continue to poll to see if this is just saber rattling or is real.

Not to worry.  Sebilius has announced a $200 million grant to train advance practice nurses.  These wonders will be seeing you in their offices in the near future.

Dr. Robert Smith is as usual a polarizing personality.  The radiologist attorney was removed from Yale, Cornell and now the FDA.  He sued all three and won settlements from the first two. He was a caustic critic of the FDA while he was there and has led to the FDA being investigated for their actions against Dr. Smith and the way they do business.  I hope he continues his openness and critiques.  He, however, will probably not be getting another job in the foreseeable future due to his "disruptive" behavior.       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.