February 15, 2016 Recent News





The era of idiocy continues with Hawaii's largest health insurer.  They are requiring physicians get a third party OK for approval of diagnostic imaging exams.  Now they routinely deny most heart and x-ray tests.  Prior to December 1 most physicians were deemed to be appropriately ordering exams but after that date all physicians must get authorization.  The physicians are getting around the hassle by sending their patients to the ED where authorization is not required.  Higher costs for all.  

A recent study by the Studer Group showed that about 90% of physicians have some sort of burnout much of which is caused by EHR and meaningful use.  These along with ICD 10 and the other mandates are getting to the physicians.      Top


The Cleveland Clinic is under fire as are all hospitals who do the dreaded facility fees.  The patients are getting hammered by these fees and insurers are rightly refusing to pay for them as they do not add anything to the service.  Cleveland Clinic says they notify Medicare patients each time they get a service about service fees as required by federal law and those with private insurance get notified once a year.  There is a law on the books that will not allow these fees for outpatient facilities acquired in the future but continues to allow them on present facilities.  

The Philadelphia Inquirer had a major story on newborn cardiac surgery in the area.  Apparently two hospitals do this surgery, St. Christopher and Children's Hospital.  The paper states the death rate at the former hospital is triple that at the Children's Hospital.  The paper states the mortality rate is at 24% versus 8.5% at Children's.  

In something I have never seen before the Columbus Dispatch says that Nationwide Children's hospital has a non-compete clause that extends for 100 miles and lasts for two years.  They do not know if it has ever been challenged in court but it should be.          Top


Anthem, Cigna and Aetna have all notified their insurance brokers they will cease paying broker fees for people signed up for Obamacare who qualify for new coverage outside of the normal enrollment period.  Cigna and Humana have also stopped paying brokers fees when they sign up Gold plans.  These enroll sicker people.  United has stopped paying for any Obamacare plans.  Insurers are not as dumb as the politicians hope they are.  The people have been signing up for the expensive plans when they need care and then dropping the plans.

Many company health plans do not cover outpatient surgical care.  This is strange since 2/3 of surgery is outpatient.  This may be a violation of Obamacare law but it has not been legislated not tested in the courts.  Companies are trying to keep costs down and still give insurance to their employees.  They are also trying to stay in business.

Peter Lee, the head of California's Obamacare, lashed out against UnitedHealth for blaming Obamacare for their own screw-ups.  The prior official in the Obama administration said their problems were that they used broad provider networks and high prices which led to  more utilization and more costs.  I guess Lee also must include Anthem who also said Obamacare was not a great business.  He also need to consider Aetna who has serious concerns about Obamacare's sustainability.  

The end of Obamacare is never when it is supposed to be.  The January 31 deadline in California was extended until February 6th to allow the late comers to get insurance.   The administration continued its lies about the program that was supposed to end on 1/31.  they said they would not have extensions and then weeks later announced an extension to March 31 for those who missed out on the over expensive coverage because of confusion regarding the insurance and taxes.  When will they learn not to lie???  This is causing consternation among the insurers and the potential for insurers to drop the program.

Let us hope that no money was expended on the study by the University of Arkansas at Little Rock that showed that Medicaid does not pay enough money for common surgical procedures and that the low pay may threaten care.  They found that Medicaid paid much less than Medicare for the same surgery.  Duh!!!

In 2011 the USPSTF recommended not to screen for prostate cancer using PSA.  The primary care physicians have decreased the screening leading to higher degree of cancers being found but the urologists have not decreased the screening at all.  

The San Francisco Business Times reports that Kaiser Permanente's profits are down 40% in 2015.  At the same time revenue increased 8%.  The cause is loss of income on investments.  They had a 6.7% increase in people.  That is 650,000 more to a record 10.2 million.  Permanente, the for profit arm, does not report.

The junior physician strike in Britain is back on.  The physicians had called off their strike to allow more time for negotiations but that did not happen.  Another 24 hour strike with  emergency care is planned for February 10th.  The NHS is threatening to impose a new contract on the junior physicians unilaterally.  This strike has cost about 7000 surgeries to be cancelled over the two days.   If a contract is imposed it is possible to see many more strikes.  The health secretary did impose the new contract which would not pay more for weekend coverage.  The response should be interesting to observe.        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.