August 1, 2016 Recent News






The people at the USPSTF have again been proved wrong.  Again it has been shown that since they have recommended against standard PSA testing for prostate cancer in 2008 there has been an increase of aggressive prostate cancer.  Rates of metastatic prostate cancer have increased 72% in the past decade and the aggressive form has increased 92% in men 55 to 60 years of age versus other ages.  The late diagnosis are more costly than PSA tests and biopsies and incidentally also are better for the patient.  Early state cancer has close to 100% survival and late state is only 28%.

The most expensive health insurance has just gotten more expensive.  Covered California, the California Obamacare insurance is raising its fees an average of 13.8%.  In San Francisco the increase will be 14.8%.  Blue Shield rates will increase an average of 19.9% and Blue Cross will be 17.2%.  The out of pocket expenses will also increase.  One of the problems is the lack of enrollees.  they have less than 1.4 million.  This isn't as bad as some other states where there is a 30%-40% increase in premiums.

In an article that very few believe and has no references, Health Affairs says that  premiums fell with Ocare.  They did the study of the 2014 premiums.  They say people are getting more for less.  The comment section after the article was published in the mainstream media disputed that.  The study used only the average of the silver plans in the individual market.  They say the premiums were between 10% to 15% below the what was charged the year before when there was no Ocare.  They go on to say that even this year the prices are lower than in 2013.   

California Obamacare insurers are now having to designate a primary care physician for every enrollee who does not have one but the designation is not binding.  They want more integrated care in their narrow networks.  The assigned PCP would help the enrollee with the program.  Most physicians do not understand the program themselves.  Some of the physicians also may not be taking new patients. 

Covered California has yet another problem.  A new study showed that 4.3% of the patients enrolled in Blue Shield or Blue Cross Ocare plans were rejected by physicians who were supposedly accepting new patients.  This is over 3 times more than those rejected who are in plans outside of Ocare.

A new study has shown that insurers lost an average of 4.2% in the individual marketplace during the first year of Obamacare.  This is after the reinsurance payments. 

With the above as a prelude it should be noted that Humana is following UnitedHealth out of the Obamacare program.   It is dropping out of the individual market in eight states. This leaves 11 states where it will continue to do business.  It will also stop in 4 states offering individual plans off Obamacare.  This comes on the same day that it was announced that the feds would sue to stop Humana's planned merger with Aetna.  Also it was announced the same day that Humana would get the lucrative VA Tricare contract.  UnitedHealth had that contract for many years and was dropped this year.  Retaliation for dropping out of Obamacare??

Anyone ever heard of seamless conversion??  This is where insurers, automatically enroll their insureds into their Medicare Advantage plan when they reach age 65 unless the person actively opts out.  Yes, it exists in all states and with all insurers.  They send the consumer a letter about it and give them 60 days to opt out.  If you throw away mail from insurers you are screwed even if you enroll in traditional Medicare yourself.  This is legal and sanctioned by the feds.  Consumer beware.

Arizona has lost Health Choice for Obamacare.  This leaves less options and probably higher premiums.  They follow UnitedHealth and Humana out the door.

The UK is showing us in the US how it will be done.  They are rationing hepatitis drugs to only 10,000 people per year.  That should play well here.        Top


The Portland, Oregon, paper had a story about a woman who graduated from UO medical school but did not match.  She is now homeless and working for $11 per hour as a medical scribe.  Her classmates blame the school for not giving her enough resources to be successful.  She was a mother with few financial resources.  She had to sell her car to afford the matching program fees and travel costs for interviews to apply.  She also had problems due to a learning disability and needed an additional two years to finish medical school.  She also flunked the Part I of the licensing exam.  She has also finished a MBA course, a Public Health program and all three parts of the licensing exam.  

In Southeast Pennsylvania there is a new ACO made up of small independent practices.  It has about 100 to date and will hopefully add more.  

Yet another report on EHR show they may not be worth much.  Physicians Practice reports that states that almost half of those surveyed are seeing less patients a day due to EHRs and almost 75% state they have not seen a return on their EHR investment.  EHR has increased documentation and can be used on a smartphone.

Modern Healthcare states that salaries for physician are increasing dramatically as competition for new physicians increase.  The biggest gainers are non-invasive cardiologists up 14% year over year.  Those at the other end are orthos at 0.3%, derm at 0.6% intensivists -1.3% and plastic surgeons -1.4%.  Ortho was the top payer at $550,000 followed closely by invasive cardiologists and radiation oncologists.  The lowest paid are the hospitalist at $260,000.  

In a major shift of power about 400 physicians from Hallmark have left Physicians HealthCare for Tufts.  This is after about 20 years of affiliation.          Top


Two people are dead after a shooting at Titusville, Florida, Parrish Medical Center.  A person went via the ED to an upper floor and shot two people in a room.  He is under arrest.  The hospital had a plan and followed it which may have helped save others.  

The Desert Sun reports that hospital facility fees are making patients mad.   They should know as one of their hospitals have some of the highest in the country.  Eisenhower Hospital is notorious for their fees that they place on patients who visit physicians that they own. The other player in town, Tenet, also charges facility fees. The real rub is that when a physician is purchased their fees should go down since they no longer pay for rent, office staff nor malpractice insurance.  This doesn't happen.  The fees are on top of their usual fees.  The hospitals have until now also reaped more money by billing as if the procedures were at the hospital but in fact were at a physician office owned by the hospital.  Medicare has finally stopped that fiasco.  

The nation's best hospitals as judged by consumers and physicians are not the best as judged by CMS.  They released their 5 star ratings to a chorus of boos from the hospitals and the Congress.  There were more 5 star hospitals in Fresno, California, than in Boston.  Nuff said.

To no one's surprise only 68% of the country's hospitals are HIPAA compliant with regard to their EHR.  Any wonder why there are so many hospitals paying either patients, credit agencies or the feds for lapses.

Ozarks Community Hospital in Springfield, Missouri, is laying off 200 people, a lot for this small town.  They have closed their surgery department and emergency room.  The CMS has terminated their Medicare agreement since they say they are not a hospital.  They do not have inpatients.

Missouri is losing their nurses.  There is a record turnover of nurses at the state's hospitals with over 17% leaving, an uptick from over 15% last year.  In mental hospitals the turnover is 29%.  The vacancy rate is over 8%.        Top


ProPublica has listed over 300 letters that the OCR has sent about various hospitals and others regarding HIPAA violations.  Most of the letters were about the VA and also CVS Health (CVS Pharmacy) as they are the most complained about organizations.        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.