December 1, 2010 Recent News
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The AMA reports that since hospitals want to have physicians with them and physicians want to go to hospitals but the hospitals are paying only small amounts, other considerations are taking hold. The physicians are getting the practice set ups they want in lieu of higher compensation for their practices. The physicians want and are receiving power to manage their own practices. They also want EMRs that work seamlessly with the hospitals. Other physicians want only outpatient work and never want to step foot in the hospital.
Medscape has an article stating that physicians need to form and lead any ACO in order to protect their profession. They point out that for physicians to lead they must collaborate across specialties, hire skilled managers and raise capital for EMR. If physicians form their own ACO they will get not only the fee for service payments but will also share in any savings. The physicians will also have to partner with a hospital to control costs during admission and for coordination of care. They state that if hospitals control the ACO, the hospital will get the savings and physician income and status will decline. There still are no actual rules for setting up ACOs.
Hugh Greeley, a foe of the physician and independent medical staffs, has written an article on ACOs. The premise is that hospitals will form these and hire physicians to work in them. This will take away any need for organized medical staffs since all will be done by contract. Let the medical staffs beware and alert to not let this come to pass.
MGMA has published an article that shows independent physicians make significantly less than their hospital owned counterparts. Part of this is the way the hospital accounting is set up but a significant amount is real. There is a 44% difference in specialists between the two but primary care physicians made slightly more in the hospital based setting than in private practice.
The Washington Post has an article regarding the starting of physicians rationing care to Medicare patients due to the current fee. If the SGR ever goes into effect the physician revolt will be strong except for practices that are under salary.
HealthLeaders writes that reform will endanger independent physician practices. They write that the Physicians foundations states that physicians will become employed, part time, administrators or leave practice. In Contra Costa county, California, Muir Medical is attempting to capitate all their physicians in their IPA. The primary care physicians are on salary in a foundation. The rheumatologists have already declined to participate, so they have one for 65,000 people. The ophthalmologists have also been refused to be bargained with so there are now two for the same amount of people. Muir states that they are doing this to get ready for reform but in truth they are doing it for control and money. Top
The Wall Street Journal reports that the more affluent Medicare recipients will pay more for their coverage and for Part D. There will also be less plans to choose from as the insurers consolidate plans and remove them from certain areas. Also changing for the better is the benefit section under traditional Medicare. There will be allowed annual physicals and screenings for cancer. The times allowed for switching plans are also being changed.
Another story from the People's Republic of Massachusetts again shows that most people of the Republic are insured but they can not see a physician. The EDs remain full due to a lack of physicians staying in the Republic post training.
A report from Bloomberg states that the health insurers have paid just over $86 million to the US Chamber of Commerce to oppose Obamacare. They were successful in getting rid of the Public Option.
The New York Times has an article regarding the starting of mergers of hospitals and doctor groups that may tend to increase costs and decrease care so the medical combines can profit share. These new combines called Accountable Care Organizations are focusing on getting the anti-trust laws changed so they can start to get to gouge the public. The other thing that is happening is the formation of integrated regional networks that will also be able to command more money. As Confucius said, "May you live in interesting times."
The AMA has come out against prior authorization as it is detrimental to patient care. It also is expensive to administer costing physicians between $28 and $31 Billion per year.
The Washington Post reports that the limiting of funds to the Medicare Advantage plans is going well with no real problems. They are taking the 20,000 foot approach. However, back on Earth there are problems with both seniors and commercial enrollees unable to access their long time physicians. The grand scheme is that there are less plans in less locations giving less benefits. Most of this was in the works prior to the passage of Obamacare. This means that about 1/10 of the people in the Medicare advantage program must choose new plans with potentially different physicians and definitely different benefits. This is for 2011 when the decrease is only 2% instead of the 12% by the end of the decade.
The head of the Royal College of GPs in England is warning that physicians may expect demonstrations outside their offices due to the placing of responsibility for life saving drugs on the physicians. It is my opinion that the physicians who do not stand up for their patients should not be in practice. I hope the physicians in England have more spine than their leader. Top
All know that hospitals are not a place one wants to be. Now we know why, especially for the over sixty-five set. A study from the Office of the Inspector General for HHS has shown tat one in every seven Medicare patients who are hospitalized are harmed by a medical error. The most common are med errors and the least common are wrong sided surgery. Approximately 44% of the errors are preventable. This does not endear one to the hospitals and their management.
A study came out showing that hospitals if they have enough clout get higher fees than their competitors. Guess what? The hospitals disagreed with the report calling it deeply flawed. The report also found the hospital reputation contributed to very high payments compared to peers.
Maryland is studying hospitals that place cardiac stents. They will try to identify those that require further study. They are looking at the amount of stents done as opposed to the need. The investigators should use the material available at the National Cardiovascular Data Registry which is more detailed. 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.