December 1, 2014 Recent News






I realize that this is very late news but in the early November election, not only did the Republicans win all the important races but the physicians of California also won with the defeat of Proposition 45 and 46.  Prop 45 would have allowed the Insurance Commissioner to not only look and adjust insurance prices but also to see what is covered.  Prop 46 was a terrible measure with three unrelated prongs.  The first was to mandate physician drug testing. The second was to mandate the query of a data base without funding for all Scheduled prescriptions written.  The third was the increase of med mal pain and suffering payments from the now cap of $250,000 to $1,200,000.

A NBC/WSJ poll shows that 71% of people favor mandatory quarantines on health care workers that return from Africa.  The nurse who does not care about the community reached a compromise with Maine stating she will take her temp twice a day for the required time.  She was right to talk about the conditions in New Jersey but not the quarantine per se.  Workers that return here should be feted and not jailed but the fete should be in isolation.  

The OPM reports that about 25,000 federal employees will lose their health insurance in 2015 due to companies dropping out of the government's coverage network.  The workers will have the choice of switching to plans still in place.  This is the largest amount of fed workers affected in five years.  The projected increases in premiums is 3.8%.

The administration has given a very conservative estimate on Obamacare enrollment for this year.  This is due to two significant factors.  The first was the lie told last year of how many people joined.  The administration added numbers from dental insurance and now has to delete those almost 400,000 people.  The second reason is the ability to hopefully say later that more people joined than estimated.  Their estimation for this year is 9.1 million.  Last years numbers fell to 7.1 million after people failed to pay premiums and were found to be ineligible.  

Although the Obama executive action on immigration does not allow the illegals to get Obamacare, there has been a noticeable spike in Medicaid enrollment.  The immigrants now make up 42% of the Medicaid enrollment growth even t6hough they were only 23% of the population growth.  The Washington Post also has a story that the illegals can get Social Security and Medicare under the Obama action.  The taxes Obama mentioned include FICA which include SS and Medicare.  If they pay into the system will they be able to collect later?  Yes, says the White House.  

In the past month a new name has surfaced Jonathon Gruber.  He is one of the architects of Obamacare.  He also is the one who said how stupid the electorate was.  He of course, was correct as we re-elected the same idiots in 2012.  Now the Dems say that Gruber was only a bit player in the founding of Obamacare when in reality he really played a major role.  The federal attorneys defending the subsidies even cite Gruber before the Supreme Court in King v Burwell.  He actually stated that states that do not set up their own exchanges will not get subsidies.  However, the feds are quoting him saying the opposite in all their non Supreme Court filings.

In the past month, the joke of the past year, re-opened.  It did much better than last year which is not saying much.  However, the same problems with getting logged on persisted.  After the opening the feds are still not releasing data just as last year.

Numbers released by Gallup show that as of the opening of the second year of Obamacare, the approval rating is a whopping 37% and 56% disapprove.  This is split along party lines.  These numbers came after the Gruber information came to light.

Wall Street has blasted the California Obamacare insurers WellPoint and Blue Shield for their lying about their provider networks.  Cigna says the two should spend less fighting the charges and more on networks.

Bloomberg had a great article on the costs to develop new drugs.  The cost has almost doubled in the past decade to about $2.56 Billion per drug.  This is due to government requiring larger clinical trials and many more regulations.  Also added into the cost is how much is spent on drugs that do not make it.  In a revelation it is also stated that the numbers come from the drug companies.  Another study from Tufts stated that it costs just over $1 Billion per brand name drug.  

McDonald, the new head of the VA, has stated wait times have improved greatly.  Clinic hours have been extended and sent out mobile units as well as begun the hiring of more providers.  Over 1.4 million more appointments have been scheduled in the past four months over the same period last year.  

How meaningful is meaningful use when no one is meaningful.  To date only 38% of hospitals and 2% of providers are certified in meaningful use.  When one looks at Stage 2 the numbers are even less meaningful.  Hospitals 17% and a grand total of 11,478 providers.

I don't know where this goes.  There is not a category for stupidity.  Los Angeles DJ Casey Kasem died many many months ago.  The wife spirited the body to Canada and then to Norway.  According to TMZ it is still in Norway rotting without embalming so that no autopsy showing elder abuse by the wife could be done.  The children continue to file suit to get the body back to the US.          Top


Missouri primary care physicians will lose their Obamacare increase in pay at the end of the year.  They will then have to decide whether or not to continue to see and treat Medicaid patients in the state.  The difference in pay may be up to half of what they got for the two years of Medicare rates. 

The AMA delegates again get their foot in their mouth.  A resolution to censure Dr. Ezekiel Emanuel for writing his opinion about end of life care in The Atlantic was actually forwarded to the House for a vote.  The delegates saw through the stupidity and voted to play nice.

The NYT had an article on private oncologists being forced out of practice.  The article focused on the purchase of these physicians by hospitals to get more money from insurers.  Once the physician is purchased his office is no longer his office but an outpatient arm of the hospital and higher charges prevail for the same services.  The higher charges are not only for the physician services and place of service but more importantly for the drugs given.  The hospital can buy the drugs under the law at a significant discount from what the physician alone could and turn around and get more money than the physician for the drug itself.  This increased the cost of a per dose of med by just under $150.  Add that to the other increases and the hospital makes out like the bandits they are.  The government is to directly blame for this as they reduced the prices they paid the private oncologist for drugs so that if a patient became too sick for a treatment the physician would have to eat the cost of the expensive drug.  This huge increase in overhead is intolerable for the usual oncology practice.  

Medscape had an article on the sixteen states that do not require criminal background checks on physicians obtaining licenses.  It highlighted one case in Maryland where the physician had been convicted of raping a woman at gunpoint.  His application read that he was convicted of assault while intoxicated and he was granted a license.  The physician continued on his path of self destruction and harm to patients.  Eventually he gave up his license just before it was to be taken from him.  The boards sometimes have a problem with the rule because they say it costs more money and it delays in issuing licenses as well as the rareness of any significant finding.

I continue to learn the wiles of physicians and how to make money.  An article in Pathology News tells me that urine testing for pain drugs is big money.  Medicare allows significant money for the testing and some pain physicians make much more in their offices doing testing than they do seeing patients.  They are billing for mass spec of classes of drugs.        Top


The Ponemon Institute has done an interesting study.  They have found the average out of pocket cost per individual in a data breach is $18,000.  This includes the cost of identity theft which occurred in 36% of the patients breached.  Those costs are for identity protection, credit reporting legal counsel expenditures on medical services due to lapses in insurance coverage and reimbursements to healthcare providers for services provided to identify thieves.  While credit card numbers sell on the street for $1, health records go for $50.        Top


Although not just a hospital chain, San Francisco Business Times reports that Kaiser Permanente added 422,000 more enrollees in the first three quarters of this year.  This ups the total to 9.5 million.  The revenue in the third quarter up over 8% to $14.3 Billion.  Operating Income went up 48% to $766 million.  Profits shot up a huge 49% to $900 million.  Not a bad quarter.  Expenses were down due to the completion of hospital seismic retrograde builds.  Much of the increase in enrollment was due to Obamacare exchanges.  Kaiser rates to enroll in PERS and Covered California will be lower next year.

Texas Health Presbyterian has bit the bullet and settled with the family of Duncan, the Ebola patient who died under their care.  They also are starting to make a comeback as patients are beginning to come back to the hospital after the Ebola scare has calmed.  

Prime Health is back in the news.  The controversial hospital system CEO gave an interview to the San Francisco Business Times stating that Prime is the only option to save the Daughters of Charity Hospitals.  The unions don't like Prime and are still attempting to scuttle the sale.  They would rather see they system go under than allow Prime to get the hospitals. The union also has accused Prime of overbilling Medicare.  Prime says the data is fabricated.  Prime also continues to purchase other hospitals.  They just got from CHS Dallas Regional Medical Center, a 202 bed hospital that CHS just got this year from HMA. 

All is not seen thru plum colored glasses at Nebraska's Lexington Regional Health Center.  They have lost a large part of their medical staff, the Plum Creek Medical Group.  The physician group practices at several sites and all left the hospital staff in protest to a long standing dispute regarding peer review being handled by lay people and not medical ones.  The medical group and the hospital administration and board had been in mediation for several years with no results.         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.