February 15, 2012 Recent News






HHS states that Medicare Advantage programs have decreased premiums an average of 7% and that there has been a 10% increase in enrollment in 2011.  Sebelius stated that this good trend was due to Obamacare even though she has no idea whether or not that is true.  Obamacare will reduce the budget to these programs after the election, in 2015.  The CBO predicts that after this happens enrollment will sharply decline and premiums will increase. 

Hospices can only receive a cap of $25,000 per patient which equates to about $125 per day for the six months allowed.  This was set up by Medpac who forgot about the patients who may live longer than expected.  Some, especially for profit, hospices owe large amounts of money to the feds.  Are they going to repay the money?  No, they simply go out of business and open up another one under a different name, just like contractors do.  They can do this because the contracts are between the government and the hospices, not the individual owners.  One in Oklahoma owes $27 million and closed Sojourn and opened Roserock Healthcare.  Some of the patients went to the new facility and others were left to find other care.  The government has ceased collection efforts since the law does not permit them to collect from individuals unless there is criminal action.

The Washington Post has a story that the success of Obamacare hinges on getting 30,000 more primary care physicians by 2015, an impossible task.  They break down the hourly expected pay for new doctors and show that specialists will receive $50 an hour more than primary care physicians.  Sebelius wants to give away $9 million to help physicians pay back loans providing they go to rural areas.  

The RAND corp. has put out a study that shows that only a minority of small business will bypass Obamacare if it is found legal.  

Congratulations to Medicare.  The recovered $4.1 billion from those who committed Medicare fraud.  This of course years after the fraud and the time value of money is not counted.  Also it is estimated that there is between $60 Billion and $90 billion per year in fraud.  Knowing this the feds should not crow about their small dent.

HIPAA breaches have now reached over 19 million.  How many more than when paper records were used?  Stupidity is the basis for most of the breaches.  This includes lap top thefts and hacking.  In the past year nationally the number of medical record breached is up 32%. This was due mostly to human error.  

The Minnesota Attorney General has sued the Accretive Health debt collectors for allowing a laptop with patient information from two hospitals to be stolen and not having the data encrypted.

Allergan, the makers of the Lap-Band for obesity, has severed its ties with the 1-800-GET-THIN organization in southern California.  They will not sell them any more equipment to any facilities affiliated with the organization.  Allergan's stock dropped significantly after the announcement.          Top


UCSF Hospital in liberal San Francisco has denied a person a kidney transplant because he is an illegal alien.  The person has insurance at present and a willing donor.  The hospital will not do transplants on people that do not have the ability to get the necessary post transplant care.  He will probably be on Medicaid soon as he lost his job for being an illegal alien.  Medicaid will pay for dialysis but not the meds necessary post transplant.

Insurers are changing the way they are paying for those out of network visits and procedures.  They used to pay "usual and customary" fees but have now switched to a percentage of what Medicare pays, which is less than previously.  This puts more payments on the shoulders of patients.  The patients are usually put on notice about this change in their patient notifications but almost no one reads the fine print nor understands the differences.  This means hospitals and physicians will have to go after patients for the differences which they probably will never collect.  It would behoove the hospital to explain the costs to the patient in advance but they don't and so lose out on a lot of money.

Hospitals have begun to look at their own data and outside purchased data to promote their high cost programs.  One hospital in Illinois sent out fliers to all people around the hospital promoting lung cancer screening.  They want those with high pay insurances.  The screenings many time lead to more tests and procedures.  In the Illinois case the lung CT was negative for cancer but showed calcium in or on the coronary arteries.  This is now being followed by a cardiologist with more tests.

Des Moines, Iowa, Mercy hospital has seen the light.  They have elevated medical personnel (physicians) to equal positions as administrators in their service lines.  They are also paying the physicians for their added duties.  

In the People's Republic of Massachusetts Steward Health continues to grow by hiring physicians from other organizations.  The latest is a group of 20 doctors affiliated with Manet Center in Quincy, Massachusetts.  The physicians used to be affiliated with Tufts.      Top


There is a long article in the Star Tribune about the problems with the Minnesota Medical Board.  Apparently they are extremely lax in disciplining physicians.  The article states that 46 physicians have escaped discipline when their licenses have had problems in other states.  Also half the physicians who had their privileges removes never had any action taken against them by the Board.  This could be that the hospitals did sham peer review and the board recognized it. Also the state has no law that requires hospitals to report physicians to the Board that they have disciplined.   The Board also does not put on a website any actions including med mal decisions against physicians.  The Board states that they are after correcting problems and not punishing physicians.  To Minnesota's credit they are at the bottom of the anti-physician Public Citizen list.          Top


To no one's surprise physician payments will become lower.  UnitedHealth is going to pay physicians in a "new way".  They will pay for "value based" items which it has not identified.  This applies to all physicians and hospitals.  If the medical providers do not comply then they will receive less than the already low pay.  They will not make this compulsory but elective.  They will do this by having the payment schedule in the patient contract.  If you want the patient you will agree to the terms.   

The Orthopods of the country state that about 30% of the tests they order are only for defensive medicine.  This equates to well over $2 Billion per year just for this group.  This included about 7% of their hospital admissions for purely defensive reasons.     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.