January 1, 2015 Recent News





Some physicians still use paper records.  About 257,000 will get a 1% pay cut from Medicare and Medicaid for not using EHR meaningfully.  Of course they saved hundreds of thousands of dollars and many man hours of frustration by not converting to electronic records.  About 400,000 will get some bonuses for meaningful use, whatever that is.  This is a Pelosi, Reid, Obama program.

Physicians your 2016 Medicare payments are being decided now.  They depend on what you enter in your now due 2014 PQRS.  If your stuff is not up to snuff you will be penalized 2% of your Medicare and Medicaid billings.  This is a shift from a bonus payment to a penalized payment.  If you think this is improving quality, you are mistaken.        Top


It's that time of year again.  This is the time that Obamacare does not reach its goal and the insurers and governments decide to let more time pass from the deadlines. Those who did nothing will be reenrolled in the same plan as last year in healthcare.gov.  People still have to February 1 to enroll to be covered from February 1 onward.  The January 1 guideline passed on December 15.  If people miss the February 15 deadline no insurance until the next open period unless Obama decides otherwise as he did last year. Some insurers are allowing some late payments to count toward the January deadline.

Kaiser Health reports that small employers continue to drop coverage in favor of Obamacare.  Anthem lost over 300,000 people last year in their small business plan who got individual insurance with subsidies via Obamacare.  Others are keeping their old plan that they had prior to Obamacare which are much cheaper than Obamacare plans.  These old plans all expire by 2017.

Revised data showed that in 2013, a year prior to Obamacare, healthcare spending hit a 53 year low.  There was only a 3.6% growth in healthcare spending as opposed to a 4.1% increase the year prior.  The reasons are the recession and the canceling of employer insurance, less spending by those insured and possibly some waiting to be insured under Obamacare.

Medicare realizes that insurers are screw-ups and therefore are allowing some seniors in Medicare Advantage whose insurers change providers on them a special three month window to go to traditional Medicare or join another plan where their old physician is now practicing.  Only Medicare and not plan members may state when there will be a new window.  This is a direct slap at United Health, who last year cancelled contracts with many physicians.

The cover-up at the Phoenix VA went up the chain of command.  Not only did the CEO Sharon Helman know but so did her boss and those above her.  It appears that all including Shinseki knew.  Helman contested her firing but lost after it was found that not only did she know about all the problems but she also accepted perks from lobbyists.

Covered California has extended its deadline to to December 21 to be able to buy health insurance to begin on January 21.  Why?  It is either because there is a great demand or problems with the site.  Which one is not known.

Amgen will charge a whopping $178,000 for two cycles of its new drug Blincyto.  This drug will help those with Acute Lymphoblastic Leukemia, almost all children, who have failed other therapy.  This new form of therapy is very expensive as the two drugs for melanoma cost over $150,000 per year for treatment.

At the same time AbbVie has an approved drug for Hepatitis C, Viekira Pak, to go against Gilead's Sovaldi or Harvoni.  The Gilead meds sell for $84,000 and $94,500 respectively.  AbbVie's will sell for $83,319 at retail but Express Scripts has negotiated a "significant discount" for only using that drug.  Viekara is approved only for genotype 1 hepatitis, about 70% of those with the disease.  It also may require the use of ribavirin, that have significant side effects.  Lives vs cost, the age old question.        Top


Medicare has cut the rates it pay to 721 hospitals by 1% because they have high rates of infection or injuries.  This is one out every seven hospitals in the country.  The big names include Cleveland Clinic, Brigham, and Geisinger.  They are in the lowest quartile.  The CMS has also fined 2610 hospitals for having too many patients return within one month of discharge.          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.