August 15, 2015 Recent News





The White House again speaks without any heft.  This time they want the states to weigh in on the large Obamacare increases for 2016.  They forget it the premiums are not too much for the mandates they created.  They also forget that the insurers must give back money if they do not spend at least 80% of premiums on medical care.  Therefore the cost of the care must have risen due to their own laws.

Obamacare continues to cause problems for individuals.  About 1.8 million people are about to lose their subsidies due to either not filing a tax return or had errors on the return.  This is due to the subsidies being tied to IRS filings.

The Washington Times reports that about 66% of Obamacare enrollees are unsatisfied with their coverage and especially the costs.  A study was done by Deloitte.  They felt they could not get care when they needed it and were not prepared for future costs.  They asked 3800 people about the exchanges.  The results were much different in the people with Medicare, Medicaid or employer plans where the satisfaction was much much higher.  Much had to do with the narrow networks under the cheap plans and the high co-pays and deductibles in those plans.

The Washington Examiner states that the feds have failed in their scrutiny of screening applicants for Obamacare.  They did not screen as to whether or not applicants were citizens or in jail.  Non citizens and those in prison are not eligible for the program.  This was a study by the HHS OIG.  HHS said they plan to address the issues.

The CDC has announced that in the first three month this year 29 million people in the country lacked health insurance.  This is an improvement of 5.2% since 2013.  The percentage of uninsured is now 9.2%.

A new study by HHS shows that about 940,000 people joined Obamacare this year after the open enrollment ended.  This was due to life changing events such as losing a job or having a child.  There was not a mention of how many of these people actually paid for a months premium.

Medicare continues to defy itself.  It has a rule that providers banned from Medicaid programs in one state for fraud or other serious reason may not do business in other states, but they do.  The states have no real way to communicate with each other in this matter.  There does seem to be a national data bank for these folk but the states do not partake as it is only encouraged not mandated. 

The VA continues to confound all efforts to open them up.  Now a secret document was garnered by a whistleblower showing about 35,000 combat vets have been denied enrollment due to a computer error.  The computer erroneously asked them to submit to a means test which is not needed for them.  Some have been pending for over five years.  Combat vets lose their eligibility for free health care after five years.  Another leaked document showed that about one-third of those 847,000 with pending applications have died.  The VA is mum about this.

The American Action Forum has released a study that shows EMR has the potential to modernize healthcare but it comes at a significant cost.  Implementing an EMR may cost a single physician up to $163,000.  As of May 2015, CMS has paid $30 billion to providers in financial incentives for implementation of EMR.  Data breaches have cost the healthcare industry about $40.6 billion since 2009.

Physicians in the office have not kept up with all the EHR requirements.  The total amount of physicians in ambulatory settings that are now compliant with federal requirements has dropped by 12%.  Also, less than 1/3 of office based practitioners have managed stage 2. The reason is the need to upgrade for substantial money just to be able to do stage 2.  The other reason is the need to have 5% of your patients use and view and transfer their records.  Dumb criteria and therefore rightfully ignored.  CMS is now working on stage 3 when stage 2 has failed.

The White House with no authority has warned several states that their anticipated defunding of Planned Parenthood may be illegal. They contend that Medicaid beneficiaries may obtain contraceptive services from any qualified provider and that includes PP.  Of course if PP is no longer certified in the state that is moot.

IBM's Watson is being primed to help find abnormalities on radiological exams.  They are buying Merge Healthcare who has about 30 billion images which can be used to train Watson.  This is already being done by others such as Yahoo and Google.  IBM is looking for a large cut of the healthcare pie.        Top


Yelp is going into the hospital rating business with the ability to look up wait times for the ER, noise levels in the hospitals and which nursing homes have been fined.  Yelp has partnered with ProPublica, a nonprofit news organization.  People may look more here than at the Medicare Hospital Compare website since they already choose restaurants by their Yelp review.  As an aside, Yelp stock just plummeted due to very poor performance.  

California for profit hospitals and their non profits give the same amount of "charity" care.  Researchers from UCSF did the study.  This does not bode well for the non tax paying non profits.  Many could and should lose their non profit status.  They try to justify their care by using the bad debt care and writing off what Medicare and insurers reduce their inflated bills by.

Community Health Systems with the nation's largest number of hospitals will get rid of 38 along with its consulting business Quorum Health Resources to form a new entity Quorum Health Corp.  This is after adding 70 hospitals last year.  This makes for more agility and quicker turnaround in decision making.

Maryland's Laurel Regional Hospital will close and be replaced with a new ambulatory care center.  The change is not uncommon with the switch to less hospital and more outpatient care.    

In an interesting switch St. Alphonsus Health System in Nampa Idaho have offered to the state a portion of their hospital.  They are building a replacement hospital but will keep an ED, physician offices and labs.  This is one of the two hospitals fighting in the area over physician control.        Top


Five of the largest independent groups of physicians in Ohio have joined together.  This includes the entire state, 400 physicians and 450,000 patients.  The new organization is called Ohio Independent Collaborative (OIC).  They want to decrease costs with buying power and more effective delivery of care.  This also allows them to remain independent of hospitals and insurers who are buying up physicians. 

The WSJ had an article on multiple startup companies throughout the country are looking to provide healthcare in place of the standard physician office or usual home visit.  These companies do not take insurance and will send either a physician or more likely a nurse to the home. They charge a standard fee for either an individual or a family. The out of pocket money was worth it for not having to take time off work to go to a physician office. 

I read an oped from Dr. Tara Bishop, internist, regarding the real cost of the MOC.  In 2014 the MOC was expanded to force physicians to do at least one MOC activity every 2 years along with increased fees and failure rates.  This year after significant criticism the ABIM relented and removed some arduous activities.  Much uproar has been about the costs for this un needed certification.  The direct costs are only about $2350 per physician over ten years.  Then there are the indirect costs as published in the Annals of Internal Medicine.  These are the costs of the time to due the MOC activities.  The researchers believe this is an additional $21,000 per physician over ten years. Cardiac electrophysiologists and hepatologists may sink $48,000 over the decade.  This adds up to a total of $5.7 Billion per ten years in the country.  Great for the ABIM but not so great for the practicing physicians.        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.