December 15, 2010 Recent News
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If you want to know why the government is poor in overseeing healthcare, you need to look no farther than Medicaid paying $6.2 Billion for medications that were not approved. This is about 1/3 of the money spent on drugs by the agency in 2008.
Flexible Spending Accounts are being affected by Obamacare. They don't like people being able to spend their own money on what they want instead the government wants to tell them what they want. The beginning of the year means that people with FSAs will not be able to spend their FSA money on non prescription items. They will have to pay for these with their own money and let their FSA sit idle.
Obama has told the Governor of South Carolina that he would not repeal Obamacare but would consider allowing South Carolina dropping out of the program providing they keep some of the key provisions. The Governor also wants the state's money that they contributed to the Nevada nuclear waste site that Obama closed returned.
The permanent or a one year SGR fix must be paid for in order to pass the Senate. The current Senate Democrats can not come up with the money. The Republicans want the money to come from the Obamacare program, especially the Prevention and Public Health Fund that would make bike paths and farmer's markets. This would cut $2 Billion per year for the physicians and would totally offset the multibillion dollars necessary to pay the physicians over the next decade. Another possibility is to push back the start of Obamacare a year and this also would pay for the SGR. (See Recent Legislation)
The Wall street Journal published a biased article against urologists owning their own IMRT radiation therapy. They connected the fall of urology income due to loss of Lupron payments to the increase in the IMRT business. This evolution of IMRT did come just as or just after the 2001 Lupron debacle. At one part of the long article they intimated that Medicare would have paid a group of urologists millions less if they did not have their own machine. That may be true but it is meaningless since they would have paid the extra money to radiologists and their machines. This is budget neutral. They do also intimate that although it is perfectly legal for urologists to own their own machines, there is something sinister in it. They talk about a urology practice in Oregon that put in a machine at the same time as the local hospital put in a Di Vinci Robot. They then started a large media campaign stating that they could take care of all urological prostate cancer needs in one place. They got very busy and the Portland based Providence Hospital is not happy, which is good. The article thought this was not good. Indeed, it is only a better mousetrap and taking business from a poor loser competitor. It showed the urological group was smarter than the nearby hospital. The article went on to discuss how most of the urology IMRT units were in three of four states and those states had the highest usage of the units on Medicare patients. It never said the usage was inappropriate only more. I believe that as long as it is legal and that the physicians are not treating patients that do not need treatment, this is just ingenuity.
Healthwatch reports that even though the new reform law will require cooperation between physicians and hospitals 20% of physicians do not trust hospitals and 60% of hospitals believe it will be difficult to get information from non-employed physicians to improve patient care. The study was done by Pricewaterhouse. The lack of physician trust was from competing goals, not enough physician leadership on hospital boards and lack of transparency, communication and similar incentives.
In an interesting but non productive article in HealthLeaders they discuss geographic variations in Medicare spending. They talk about physicians ordering too many tests versus hospitals upping prices. The AHA weighed in against the study and stated it was the true geographic differences and that the study only focused on the end of life. These were valid points. The author ended her article by stating that since ACOs are modeled after Mayo that physicians are responsible for the differences in price. She goes on to say that even if that is true, hospitals are the big players in the areas and therefore will be the ones to divvy up bundled payments. I am hoping that physicians set up their own ACOs and then shop them to hospitals.
Almost 3/4 of EDs in the country are struggling to find physicians in all specialties to take call. The physicians of today are under more pressure of med mal and making money so they do not want to take care of uncompensated patients. In days past the physicians were in practice by themselves and would build their practice by doing ED work. Today, thanks to the system, physicians join groups and have patients waiting for them. They no longer need to do ED work. This means patients must be transferred to hospitals where there are specialists on call that day to care for them.
In a story that is hard to believe, the British have just now allowed their GPs to order cancer tests directly including chest x-rays, ultrasound, sigmoidoscopy and colonoscopy. Welcome to the 20th Century. Do you believe they had to send the patient to a specialist just to order a test? What a waste of time and energy.
To show what could happen if federal medicine is carried to an extreme is the British system. They are focused on money and not individuals. A recent British study at the Radiological Society of North America showed that if the British dropped their mammogram age to 40 instead of the current 50 almost half of all mastectomies could be avoided and lives saved.
To add to the above the British have stopped PSA prostate screening in the elderly as defined as over 50 years of age. They state that if a man asks for a PSA he may get one but it will not be part of the routine.
In California the cost for employer based healthcare is rising dramatically. In the past six years rates are up 40%. Much of this is due to mandated benefits and much is due to medical inflation. This is not a California problem as many other states have much higher rates than California. This is not due to Obamacare since it does not touch any costs for service at this time. Top
HealthLeaders has a story about a report in Physician Foundation which states that in a response to a questionnaire 2400 physician replied. Out of these 24% stated that they plan on continuing practicing as is for the next few years. The remaining 76% said they would change their practices radically or retire. The physicians stated they wanted to get their viewpoint across. They do not trust the AMA as they feel they were sold down the drain for a system they never wanted. They also talked about the obvious SGR and their leaving Medicare.
Illinois is seeing the result of their Supreme Court's dismantling of the med mal caps. They are now losing over half of the graduating physicians to other more physician friendly states.
The Las Vegas Sun has a story about physicians no longer taking Medicare patients. They stated that in a normal year 1-2 physicians would drop out of Medicare but this year 12 have left the program. This is due to the SGR and Medicaid. All know about the problems with the SGR but it should be noted that Medicaid rates have fallen almost 50% in the past 20 years. These physicians who have dropped out cannot return to the program for several years. The seniors in Nevada are already feeling the pinch as they are having problems finding physicians to see them. The paper states that 38% have already limited the number of Medicare patients they see and 42% are considering opting out if the SGR is not fixed.
In a hard to believe story the AP reports about a pilot who for years has posed as a cardiologist with no credentials. He went to medical school for several years but did not graduate. He has led a session at the American College of Cardiology. He has been on the staff of the William Beaumont Hospital in Michigan. He has had articles published with MD and PhD after his name, both phony. It seems like nobody did what they were supposed to check out his credentials. He never did treat any patient just give seminars.
A story in Medscape tells that physician disruptive conduct affects hospital financial health. It is written by Dr. Alan Rosenstein who disclosed no relevant financial relationships. While technically true, Dr. Rosenstein really makes all his money by talking to hospitals on this subject. He has made a good living at this for years. He always blames the physicians since the hospital is paying him. In this latest article he stressed the cost of training a new nurse when nurses leave hospitals because of physician conduct. How does he find out if a nurse has left due to physician conduct he asks the hospital. I can guarantee that if a hospital knew that a physician was causing a nurse to leave the hospital would get after the physician. I remember one case where a physician was disciplined by a hospital for making a nurse leave but no one had ever asked the nurse why she left. She did not like the physician but her husband was transferred. Dr. Rosenstein, in this article, makes some good points on how to address disruptive behavior. If it is the first time have someone with seniority talk to the physician and see what was the reason. Many times the physician did not even know what they did was considered disruptive. This is especially true with the poorly written Joint Commission definitions. He talks about sending the physician for sensitivity training which is a good idea if the problem is ongoing. Top
Obama's paragon of the way healthcare should be delivered, the Cleveland Clinic, has decided that they can no longer afford to give away all their care. They have now limited their charity care to the Cleveland area and the surrounding 150 miles. Also all insured patients will be asked how they intend to pay for any elective care that their insurance does not cover. This will be done pre care. The patients may be set up with a payment plan again pre care. 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.