August 1, 2015 Recent News







The pols never get a real job, they go from political position to political position.  Marilyn Tavenner is the latest.  She is transitioning from the head of CMS to the CEO of the America's Health Insurance Plans, the organization she regulated.  She was the head during the terrible roll out of  I look for her to be a powerful leader for the troubled organization.

Kaiser has been accused of prioritizing its reputation over medical mental health care.  An organization has run ads to say the above on BART trains in the Bay Area. Kaiser denies the allegations, BUT.....  Kaiser has been fined by the state for poor mental health care and a recent report in the LA Times states that patients still have very long wait times to see MDs or mid levels.

The insurers have found a loophole in paying for care.  If there is a whiff of possibility of illegal action causing the medical condition they usually have clauses that state they will not pay.  There does not have to be any court decision that the insured committed an illegal act nor even charges being filed.  This came to light in a NYT article where a person was shot by a guard while possibly trespassing.  The insured was paralyzed and the insurer refused to pay for the care.

Watch out physicians and hospitals.  The payer field is changing and not in your favor.  Anthem is purchasing Cigna for $48.4 Billion.  This narrows the field to three major insurers after Aetna buying Humana and the stand alone UnitedHealth.  If approved it will be the largest insurer in the country.        Top


The beleaguered Daughters of Charity have finally been purchased, well maybe that is the wrong word.  This is the organization that was purchased and then de-purchased by Prime due to the Attorney General's mistaken call. The new manager is a new organization called Integrity Healthcare.  This is not a purchase but a transaction. Their backing is a private equity firm Blue Mountain Capital Management.  The deal will include all the obligations for Daughters and an infusion of $250 million in cash.  That amount does not even cover the real estate..  There will be an independent board of directors made up of one from Blue Mountain and the other four from Daughters.  There is no guarantee that the deal will keep all the hospitals open since Daughters is losing so much money per month. The new deal must be approved by the same lame Attorney General.

Some hospitals are asking for problems.  The Summa Health System has announced a dress code for all employees.  It states that no bright red or blue hair will be allowed.  Women must cover their legs with no bare skin allowed.  Men will have to have their beards trimmed to half an inch or less and all are required to wear underwear. Not only that but only two earring per ear and no open toed shoes.  Also tattoos and body piercings will have to be covered.   I wonder who the Gestapo will be in this system and what the punishment will be for non-compliance.

The New Roseland Community Hospital in Chicago will begin to close in less than a week if the state does not process Medicaid funds.  There is currently a budget  impasse in the legislature.

Douglas, Arizona, Cochise Regional Hospital has lost Medicare funding due to serious problem with basic nursing care.  They are suing to keep the funding intact.   They have since announced they are closing.

Charleston Area Medical Center has announced that any medical provider, used to be physician, that is not trained in the ICD 10 system will not be allowed to use the hospital's EMR.  The hospital is also moving from the Sieman EMR to Cerner due to the purchase of Sieman by Cerner.  The CMO has said that of the 1200 "providers" only 25 have not completed the training on the ICD 10 system.        Top


An article tells that about one third of the waiting veterans have died.  One way to lower healthcare costs.  The stupidity is that the VA has no way to take deceased people off their lists that date back decades.  The VA believes that many of the vets not at the VA are those with other insurance.  Right.

Another article says the the VA has 41,000 unfilled medical jobs.  Why would that be so?  Could it be the pay or the distrust of the system or the cumbersome hiring procedures?  There are about 5000 physician openings, 12,000 nurses and 1200 psychologists needed.  

The VA has said it will have to close some hospitals if they do not get immediate funding of $2.5 Billion.  

Alevere has shown that Obamacare health plan has an average of 34% fewer physicians than typical commercial plans.  This is broken down to 42% fewer oncologists and cardiologists, 32% fewer mental health personnel and 24% fewer hospitals.  This shows that the most expensive insurance in the country has the fewest capabilities.  

Another recent report has shown that 7.7 million people, about 10% more than originally anticipated, have paid a penalty rather than join Obamacare.  The average penalty paid was $190, a bargain.  Another 10.7 filed for exemption from the penalty.  About 8 million signed up in 2014 for Obamacare with 2.6 million filing for premium tax credits.  This was about a $3000 average.

Another article stated that over 700,000 people claimed tax credits for buying health care but did not file tax returns.  This potentially cost the feds about $2 billion in bogus payments.  Most of those who did file owed money averaging about $800. Those who did not file have been asked to file. There are some people that were overpaid subsidy money in the thousands.  The IRS has said that about $350 million will not be collected from the cheats.

About half of the state run exchanges are considering going federal.  They have fewer than expected enrollees and higher than expected costs. Nevada, Oregon and Hawaii are going the federal route.  New England is looking to a regional exchange.  Minnesota, Massachusetts, Maryland, Vermont and Colorado all are in a precarious financial positions.

The GAO made up 12 fictitious applications for terminations of coverage on and was able to automatically re-enroll 11 of the 12.  This showed the system has the potential for fraud and needs to be tightened.  HHS states it continues to improve but it seems as if the organization is more intent in giving subsidies than providing appropriate health care.

In its third year the premiums of the Obamacare insurance is going up dramatically.  Some are going up as much as 30% next year.  This is true in Missouri where the largest plan is raising 29%.  Proponents of the plan will say the real cost is less due to subsidies but one must look at the unsubsidized cost.  It is true that the massive volatility that now surrounds the terrible cost will flatten as companies can be surer of the makeup of their clientele.  

Non profit co-ops are full of red ink due to lack of sign ups.  Only 1 of 23 made money last year and one was shut down due to financial concerns.  Taxpayer have provided $2.4 billion to this hornswaggle and will probably not be repaid.

Medicare will run out of money in 2030 according to the Medicare trustees.  When that occurs they would only be able to partially cover its obligations.  The trustees for the Social Security Program also said that the money needed to pay for the all of the disability benefits will run out in 2016.  At that time it will be able to pay about 81% of the benefits.

The fed predict the slowdown is healthcare spending is over. They predict that it will rise faster than the economy but not dramatically as it did in the past three decades.  

The grand experiment to save money by providing "medical homes" has fallen flat.  The $57 million has not been well spent as only 69% of the clinics that have not dropped out achieved full accreditation.  The hope was for a 90% rate.  Expenses rose in the homes as did ED visits.  The experiment folded as it showed increases in costs not decreases.

Medicare screening of providers got a slap in the face by the GAO.  The report showed that 2.3% of providers enrolled in Medicare as of March 2013 listed illegal addresses.  About $60 Billion went to these fake addresses.

Planned Parenthood was thought to be a good organization that helped women get abortions.  It turns out that they also are selling fetal parts for big bucks.  There are undercover videos of clinics selling to the buyers.  At the same time the organization has been hacked and the database of employees names and addresses have been published.  

One of the Phoenix VA whistleblowers, Dr. Katherine Mitchell, has testified before Congress that would advise new physicians not to work for the VA.  "They still care more for their image than patient care", she states.  Another physician, Dr. Lisa Nee, a cardiologist states a panel of physicians performed unnecessary by pass surgeries and implanted unnecessary stents just to pad patient files.  In a typical Democratic move the President has said that if a bill that allows the VA to fire people easier comes before him he would veto it.  

The activists attorney have sent a letter to DHS complaining that the women and children illegals being detained in Texas are not getting adequate medical care.  Some waited up to 14 hours to speak to a health professional (not a physician) and got no medicine.  Sounds like a local HMO.

California's impotent director of the Department of Managed Health has said the Aetna's proposed 21% price hike for 2016 is price gouging.  This is the fourth time they have said the same thing but the beat goes on.  Watch for some more increases as the insurance companies merge and competition is less.

Covered California has stated that the premiums will go up about 4% on average in the state.  SoCal will go up about 1.8% and NorCal will go up about 7%.  This is due to more plans in SoCal and more competition.  About 2% will see premiums go up over 15% unless they switch coverage.  United Health will offer no plans in SoCal.

Blue Cross and Shield of Texas will drop all of its individual PPO plans in the state for next year.  They will continue to offer HMO in all counties but the physicians and hospitals will not accept the HMO plans.  They lost $400 million last year in this PPO sector.  They will continue to offer PPO Group plans.  They will also ask for a 20% increase in premiums.  

America has an aging population.  At present about 10,000 people a DAY are enrolling in Medicare.  This is expected to last for the next 15 years and lead to a doubling of Medicare beneficiaries in the next 20 years.

The FDA has ordered the Miami blood bank to cease operations.  They neglected to tell 120 people that they tested positive for HIV nor did they do any double checking of the results.  They also failed to tell several donors that they were hepatitis positive.  

The WSJ has an article about the ridiculous number of fetal scans being performed just for the enjoyment of the new mothers.  They are becoming so prevalent as to be at every prenatal visit.  They are supposed to be only to help in the care of the mother and fetus but in the "me" society they are part of scrapbooks.  The FDA has warned only to get ultrasounds if it is medically needed.  This is in response to some idiot mothers who want to "bond " by going to non-medical ultrasound emporiums to get he high energy pics of their fetuses.  The studies showing no danger were done in the 1990s when he machines were not high energy as they now are.

New Hampshire has a new law that welfare recipients can not use their benefits to purchase marijuana, cigarettes or tattoos.  Good on them.        Top


Wasn't the win by the US Women's soccer tem terrific.  They deserved the ticker tape parade with confetti strewn on them.  The problem was the confetti was shredded medical records including protected prescriptions, patient names and addresses of physician offices.          Top


The WSJ had an interesting article on European physicians especially those in Germany.  The local physicians are fleeing the country at a rate of about 3000 per year to greener pastures in the UK or the USA and foreign physicians are taking the lower paying positions in the country.  German imports are now about 10% of the physicians in Germany and 19% in France.  The article states that in the countries with the higher pay for physicians like the US about 25% are foreign born.

In this era of stupid PC and watching what you do, the nursing registry has given a gift basket and some tickets to physicians that referred patients.  This huge gift has caused a lawsuit stating this is a kickback and against Stark.  The suit was bought by two former registry employees who are looking to make trouble.  It is hard to fathom but the government did intervene and the registry lost summary judgment.        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.