January 15, 2010 Recent News
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After Obama praised the Mayo Clinic as the way medical care should be done, some of the branches have stopped taking new Medicare patients in their internal medicine departments. This is due to the lack of adequate payments by the feds. The patients are welcome to continue with their physicians but they must pay cash. It will cost $1500 per year for a physical and three other visits plus $280 administrative fee annually. Patients at the Glendale, Arizona clinic, where they are instituting the two year pilot program, will not be allowed to switch to another clinic.
It seems likely that one of the compromises to be included into the final healthcare bill is CLASS, the plan to provide insurance for in home assistance to the elderly and disabled. It would partially be funded by voluntary payroll deduction plans ala Social Security. A majority of Senators voted to strip the provision from the final Senate version but the vote fell short of the required 60 votes. Those who pay into the program would need to wait five years prior to any use of the program but there would be no pre-existing conditions. There is worry that not enough would sign up for the new entitlement therefore depleting the federal budget more. Premiums will be very high, up to $240 a month for a $75 per day allowance. The program, according to the Senate, must be self sustaining but we all know how that goes by the wayside.
Two Democratic Senators have decided their popularity is so poor that they will not run for re-election. They are Senator Dodd of Connecticut and Senator Dorgan or North Dakota. It looks like the Democratic nominee from Connecticut will be AG Blumenthal.
In the People's Republic of Massachusetts the Governor held a conference on rising health care costs and none of the hospitals attended. The same thing happened with the insurers a month ago. They came but refused to answer some pointed questions as to why they pay some hospitals three times what they pay others for the same service.
The swaying President continues depending to whom he talking. He recently talked to the unions about the taxing of "Cadillac" benefits and stated that he may change his mind on the tax. The week prior he was all for it at the present figures. When warned by the AFL-CIO that votes are at stake he stated he may be amenable to higher limits. He needs the tax to generate money so the government will not be out too much for the boondoggle. The unions want an excise tax on those who earn more than $1 million per year. That had been turned down in the Senate. The Dems are listening to their masters and may put a tax on investment income for individuals earning over $200,000 and couples earning over $250,000 in place of the tax on medical benefits. The "final" compromise is that the tax would apply to those whose health care package would cost more than $8900 for individuals and $24,000 for families but those covered by collective bargaining (union members) would not have this tax until 2018. They really did hear their master's voice.
The CMS has found the Senate bill to be feasible monetarily and cover 34 million people. They were critical of CLASS, the long term benefit, which would be financially OK in the first few years but would run into major deficits later. It will raise Medicare spending by 0.6% over 10 years and may lead to access problems. This 0.6% is still an increase and not a decrease as Obama had promised and this is for the cheaper Senate bill.
Kansas has lowered Medicaid payments to physicians by 10%. This was found to be illegal in California. This will lead to major access problems and more use of hospital EDs. Top
Jackson Health in Florida has stopped taking poor people for dialysis. They have found others to take care of all but 41 of 175 patients. The safety net hospital states they can not take the financial hit any longer. Other hospitals will have to pick up the patients as they come to the ED for medical care. Many of the patients are illegal immigrants and not eligible for payments. Jackson is banking on getting the patients sicker so they can be admitted and then there will be payments as opposed to doing the dialysis as an outpatient.
The US Catholic Bishops have issued a decree to the Catholic hospitals which goes against many state laws. The new mandate is to give all patients nutritional assistance even if there is presumable irreversible conditions. They state that if the patients or their surrogates do not want nutritional assistance (food and water) they should be transferred to another institution that will cater to their needs. This decree will apply no matter the religion of the patient or any wishes in the advance directive. The only exceptions to the decree are of it would cause " significant physical discomfort" or "excessively burdensome for the patient". All transfers might be "excessively burdensome". Top
H. Edward Hanway, the CEO and chair of the Board at CIGNA will retire with a $73 million package. His compensation in 2009 was about $12 million. Remember that according to CMS, physicians were supposed to get a 21% decrease in payments in 2010. Please relate the two. Top
The Center for Studying Health Systems Change has found that EMRs are better for billing than for care coordination. I hope they didn't spend much money coming to that obvious conclusion. They found and reported in the Journal of General Internal Medicine that although set up for coordination between practitioners it is much better for billing proof. They found a "real disconnect" between policy makers expectations and reality. The reason that they are of limited value to providers for coordination of care is due to the design and lack of standardization for information exchange.
A new survey by CDC showed 40% of physicians are using EMRs. 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.