December 15, 2014 Recent News






Sebelius in no longer in the administration but continues to spout.  She now states that Jonathan Gruber never met with her in a small meeting and was only the architect of Romneycare, not Obamacare.  She does acknowledge the low insurance IQ of the American public.

After two weeks Obamacare in the central exchange has enrolled 765,000 people.  Last year it was closer to 10.  Half are new and half are returning enrollees.  The predict that only 9.1 million will enroll, not the original 13 million.  

Consumers in all forms of insurance will pay more for specialty prescription drugs in 2015.  The insurances require consumers to pay not a flat price but a percentage of the cost.  As the costs increase the out of pocket increases as well.  These are the big ticket drugs like Humira, Gleevac and Solvaldi.  These specialty drugs are only 1% of the total drugs but account for about 25% of the spending on drugs.  This may mean more people will reach their maximum this coming year.

HHS reports that over 1 million have signed up in the first month of  About half were repeats and the rest newbies.  If one wants to be covered by January 1 one needs to enroll by December 15.  It does not seem as many are interested.

In California, enrollment in Obamacare is a whopping 49,000 in the first month.  This is better rate than last year but still very short of the goal.

Obamacare is now mandatory for Senate Republican staffers.  Democrats have not followed.  The law actually required them to have Obamacare but most were deemed exempt.  Of course, the Dems passed a rule in the past allowing 75% subsidy of the premiums if they buy insurance on the DC small business exchange.  The Republicans want to cancel that but were blocked by the Dems.  The House GOP will not have their people get Obamacare.

Prior HHS chief Sebelius says eventually the name for the federal insurance must change since Obamacare is associated with a negative brand.

California has attempted to move their Medicaid and disabled into managed care products.  Not all has gone well.  Some were shifted erroneously and others never told they were now in a managed care plan.  Many, about 1/3 opted out of the managed care idea.  The state says the plan will better coordinate care and improve health.  Then it states the real reason, it will save the state $300 million per year.  Also, to no ones surprise, physicians are not flocking to the plan.        Top


The CDC has issued a final report stating circumcision is good and should be performed.  The cite the decreased risks of AIDS, UTI and HPV.  They stopped short of recommending it for all newborns since this is a personal decision.  They do state that insurers should pay for the procedure.  

The long term ERSPC study has been released.  To the chagrin of the idiots at the US Preventative Health it showed without doubt the reduction in death by the use of PSA screening for prostate cancer.        Top


The fight between insurer Highmark and UPMC is at an uneasy truce.  The hospital corporation has agreed for now to continue to see Highmark Medicare patients if Highmark does not cancel the contracts of over 700 UPMC physicians.  Mediation is ongoing.  How does UPMC contract with these physicians if they are not in the large network.  Contracts may or will need to be changed.  This is especially true for productivity standards.

Orange Park Medical Center in Florida is in the center of a terrible public relations scandal.  They have been sued for $300 million by a physician who accuses them of covering up medical errors and patient deaths.  Other suits for the same thing will be filed in state court.  The suit accuses the hospital of retaliation on those who fought for patient safety.

In the same vein, a headline in the Washington Post was "Hospitals are killing tens of thousands fewer people".  The article itself states how hospitals are having many less adverse events due to unknown causes.   The Medicare rules regarding penalties for readmissions etc. may have something to do with it.

Thirty five hospitals across the country have been named by the CDC as those who should care for Ebola patients.  

Only in California.  The California unions have purchased the Democratic legislators and the water carriers are doing their bidding.  Eighteen purchased Dems have petitioned the Secretary of State, another Dem, to not allow Prime Health to purchase six hospitals owned by Daughters of Charity.  Of course, it the hospitals are not purchased they will be closed.        Top


The physicians and hospitals of New Jersey have joined to fight the insurers who want to limit their billings.  The problem is basically balance billings.  Presently, the RAPEs may not be the same network as the hospital and the patient is getting a bill not covered by the insurer from the physicians.  There is a move afoot in the legislature to stop this and do as other states have done and make the problem between the physician and the insurer and leave out the patient.  The state hospital association is doing nothing with its notice to the patients that physicians may not be in their plan and it is up to the patient to find one that is.  This is doomed to failure. 

Walgreen's in California and Michigan can now contact a physician 24/7 via an app for diagnosis and treatment of conditions that do not require a physical exam.  The visit cost $49.  Convenience over safety.

A report by HHS OIG shows that half of all physicians listed on Medicaid plans are not available.  If they were avail able appointments were far out, some over two months.  CMS Tavenner agreed with the report and said lists need to be accurate.

Physicians, there is hope.  A new company, Augmedix, has developed a process of using Google Glass to data process and enter info into EMR.  This will save hours per day of mindless data entry.        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.