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The AMA is never loved. This time they praised the Trump pick of Tom Price as the head of HHS. Soon after a letter signed by over 3600 physicians voicing an opinion against the AMA position. These physicians may or may not be members of the AMA. I would not be surprised if the letter was not printed after the election and the only thing left blank was the name.
The total spending on health care in the US is almost $10,000 per person. This is 17.8% of the US economy. This is a 21% increase in the past two years since Ocare has been active. The administration has tried to put a spin on it by saying that this is lower increase per year than prior years. The feds are now spending 29% of the total health care dollar, more than anyone else. This is due to both Ocare and the rising age of the population with more on Medicare.
With all this spending and Ocare the length of life of the average American dipped from 78.9 in 2014 to 78.8 last year. That is first decline in two decades. It was due to higher deaths from heart disease, stroke and diabetes, the three diseases that the Ocare was supposed to help with more outreach. This is unique to the United States.
The hospitals are again crying wolf that they may not make as much money. The last time was when they wanted the physician hospitals to be banned because they took away their best patients and they could not compete. Now it is the worry of having their money jerked away if Ocare is changed. The money hungry hospitals want their pound of flesh by asking for reimbursements be restored to pre-Ocare times if the law is repealed and not replaced immediately.
Not to be outdone the insurers have given Congress a list of what it wants to stay in the marketplaces. They want subsidies to be continued but they do not define the level of subsidy. They want rules to force the young invincible to apply for insurance. The ex-head of CMS Tavenner said the insurers will not fight the repeal and replace but want as long a delay between repeal and replace as possible. She has changed her tune depending on her title from the law is the greatest thing ever to the law needs to be improved. The insurers are also willing to give up the individual mandate if there are strong penalties for late enrollment and waiting periods. They are also OK with the HSAs.
With the advent of Ocare there has been a large uptick in copays and the physicians and hospitals want to make sure they are paid. They are asking for them upfront prior to treatment. Some of the patients who are used to the dole of Ocare are not happy about paying in advance. They have a legal right to object when the ED is involved as EMTALA prohibits talking about money as a condition of getting emergency care and stabilization.
Obama is not giving up without a fight. He has sent HHS Chair Burwell to meet with the Dems of the Senate and House to fight the repeal of Ocare. She warned about repeal without replacement and about repeal and replace later.
A recent article from Kaiser News tells of the problems with patients still not able to see physicians in the insurer's networks because the directories are wrong. This is also known as bait and switch. The insurers state that a patient's physician is in the network but he is not and then they say that these physicians are taking new patients but in reality they are not. If the patient sees a patient outside the network they must pay out of network fees and this adds up. The feds continue to threaten but do nothing to protect the consumer as no plans have been fined or removed for their acts. California has fined several insurers for their network errors.
Minnesota continues to have problems with fed med. For the second year in a row about a half million Medicaid recipients will need to find a new health plan. Medica dropped out of the state program and now the state is scrounging up a new HMO for the care. This is effective on May 1. they will lose $150 million this year on the contract and would lose an additional $100 million in 2017 on the rates paid by the state.
Kenyan government physicians are on strike for the promises hashed out in 2013 for more money and better conditions. They marched on the capitol and had tear gas lobbed at them. The government never honored the deal. Sounds like a government. They say they will remain on strike until the deal is implemented. Top
The ABIM is finally considering getting off its collective butts and doing something about the ridiculous MOC. They are planning multiple shorter tests for the physicians instead of the once per 10 years huge one. If physicians do not do well on the small tests the 10 year test is still present. Also those who have lost certification and want to regain it will have to take the 10 year test. Many feel this is just a money grab by the organization and physicians would be better served by just doing continuing medical education.
The Physicians Foundation reported that an increasing amount of doctors are getting burnout. A survey showed now 49% had often feelings of burnout and would not recommend a career in medicine to their children. A total of 54% had negative morale and 48% plan on cutting back on hours, retire or switch to concierge medicine. The reasons are the shortage of physicians, MACRA, corporization of medicine and everyone's favorite ICD 10.
Partners Health Plan put up a huge $108 million loss in the past fiscal year. Most was do to its purchase of Neighborhood Health Plan, a Medicaid insurer, four years ago. They are now under the gun to make it profitable or get out of the insurance business.
Small Connecticut hospitals are having problems recruiting physicians. They can not compete in nights on call as well as equipment and lower volumes. They also do not have the pull with training programs as large hospital systems do. Of course, this state has its own problems such as bad malpractice climate, a high cost of living and certificate of needs . They also pay zippo for Medicaid. Top
The university of Iowa had an Epic problem due to an electrical problem. The system was down for 6 hours but a read only version was available.
I love Broward Health in Florida. They continue to make my day as the worst health system in the country. With all the turmoil the CEO was abruptly fired at a meeting of the Board where the firing was not on the agenda. A board member who was not at the meeting has sent a letter to the board criticizing the act which was a 4-1 vote. The CEO may have been involved in a kickback from physicians to get on the on call list. Who did the board name in her place until a permanent person is found but a person they removed from the position earlier in the year.
The following week the Broward county supervisors who are sick of the problems at the system decided to punish it by withholding for at least one week $8.5 million contract for Broward to provide care to the poor. The Broward board is under investigation by the county State Attorney office for a violation of the open meeting law for their action. 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.