July 1, 2009 Recent News



Electronic Records

Healthcare Reform



The last of the major insurers has officially given up on the biases Ingenix database.  Health Net was the final major insurer to agree not to use the disgraced database and to pay into a fund to make a new and fair database.  The only problem is that these insurers only agreed to give up the database in New York after being threatened by the State Attorney General.

The US Senate has released a report that states Ingenix is a fraud on the American public.  

The three largest insurers in the country testified to Congress that they would continue to practice rescission.  The execs were blasted by both sides of the aisle for their practices but refused to bow to voluntarily curtailing their practices.  If it were not for the costs and political clout of the insurers, this hearing would have insured that there would be a public insurance company if there is "health reform".        Top


Mercy Medical Center in Redlands, California has been accused of patient dumping.  When Prime took over Mercy's competitor, they did their usual canceling of insurance contracts and charging all out of network charges.  The Blues responded by sending a letter to their insureds telling them not to go to Prime hospitals.  This flooded the ED of Mercy.  CMS is not stating why it is targeting Mercy but they probably did something wrong due to the flood of patients.    

The AHA is not happy about the proposed 1.9% reduction for their historical illegal coding.  They believe that this would decrease the hospital take by about $23 billion over ten years. This is actually a drop in the bucket as to what they will lose under "reform." 

The "prestigious" Massachusetts General Hospital has been cited by the ACGME for working their physicians too hard and long.  They routinely went over the mandatory 80 hours allowed per week. The hospital is one of many that struggle with the ability to follow the rules put in for patient safety.  The ACGME now wants new rules added.  They want a mandatory five hour nap for residents when they have night call.

The Advisory Group that works for hospitals is telling their hospital clients about the physician oncology ventures that are taking money from the hospital.  They single out urologists as doing their own imaging and radiation therapy. It has always been my contention if the hospital wants all they should get none.       Top

Electronic Records

The VA's Vista electronic records were touted as the best.  It turns out that they are just another bad system, one of many.  The VA is attempting to overhaul its system to make appointments easier and to save money.  Of course, the VA and the DoD systems do not talk to each other so any and all information must be in paper.  There is now a backlog of about one million disability claims.        Top

Healthcare Reform

The Congressional Budget Office (CBO) has stated there will be no monetary savings with healthcare reform and that all the current healthcare reform policies on the table would worsen the long term budget outlook.  An expansion of coverage will increase the healthcare budget by 10%. The CBO went on to criticize Obama's plan to neutralize the budget over ten years as a plan to increase the budget thereafter.  The CBO also could not quantify the stakeholders promise to try to increase savings by $1.4 trillion in the next ten years.

The CBO went on in another statement to state that to insure only an additional 16 million individuals would cost over $1 trillion over the projected ten years.    That is $62,500 per person over the ten years or $6500 per person per year.  This is much more that the current cost and is typical of government thinking and it doesn't even take into account the proposed public plan. The White House has also stated that by 2040 there will be 72 million uninsured.  I wonder if that will because of all those people being out of work due to Obama's fiscal policies.

The Senate finally got the message and now has a plan that is at the $1 trillion range, that is if you can believe them.  They state this would cover 95% of those now without insurance but none of those who will lose insurance in the future.  They are also now going against the public option in favor of member owned cooperatives.  

Another problem that still vexes the Dems is how to fund this boondoggle.  They will decrease payments to providers, tax employee health benefits, have employers help pay for low income employee's insurance.  This is not going over well with the middle of the road Democrats, The Blue Dogs.  At the same time the Congressional Budget Office is warning all that the current fiscal Obama policy will dramatically slash tax collections as spending is dramatically rising.  This would cause the debt to rise to over 100% of the GDP by 2023 and over 200% of the GDP by the late 2030s. 

The United States public in a poll by Kaiser of 1200 adults say 61% want the public plan. Most adults (70%) stated that they wanted an insurance exchanges to help people purchase their own insurance.  Of course over 50% were not willing to pay anything to expand insurance to cover the uninsured.  Let the government do it.  They forget the government is them.

The House under the capable leadership of Pelosi, put out a draft resolution that would cover all the uninsured but with no mention as to payment for the plan.  All money legislation must originate in the House.  Therefore, this is more smoke. 

ABC, owned by Disney, is being accused by the Republicans of allowing Mickey Mouse Obama infomercials for his health care plan.  They are giving him prime time to go to the people to try to get his plan passed.  It is now somewhat stalled due to the huge costs and debt.  The main stalling point is the public option.  He could probably get almost all else through the Senate with some bipartisan support.  This support will not happen with the public option.  His own party is not entirely for the plan. Obama on the infomercial stated that he is open to removing the public option to the chagrin of the leftists. 

Several weeks ago the New Yorker magazine ran an article on the cost of medical care in McAllen, Texas.  It slurred the integrity of the physicians in the community.  They are now fighting back but I fear too late.  They accuse the New Yorker author of bias, probably true.  They also have explained about their community that has a huge amount of uninsured and Medicaid people that are obese and diabetic.  The percentage is huge compared to the communities they were compared with in the article.  The community has 30% with no recourses and therefore the hospitals get a large amount of disproportionate share money from the government.  They also have 35% Medicaid.  These all add up to alot of government money coming to the area.  There is a large amount of new equipment and a heart hospital in the community but they have been there less than five years and so would not impact the statistics unless the author used different time frames for different communities.

As an example of the government folly, the People's Republic of Massachusetts is spending about $820 million to save $250 million in uncompensated care.  The New York Times not only said the above but also stated that costs for the state are going up faster than other states.  They are attempting to keep the costs down by decreasing payments to safety-net providers.  Are you listening AHA??  

The MedPAC has entered the fray and reported that expanding access will not solve any cost problem.  They say money paid to providers of the care must be reduced.  They do not say how this is to be done.  Congress is paying attention since the House Dems are voting to increase payments to physicians by 1% to 1.3% in fiscal 2010.  Then Obama went to the AMA and left without anything.  He was against the med mal caps so that he stayed true to his trial lawyer payors.  He wanted other changes that he knows will never get through Congress.  The AMA is now between a rock and a hard place since some of its members want the public insurance plan and some don't.  The AMA originally went against the plan and then backed off somewhat.  In either case the AMA will lose members and clout.

Obama wants to slow even more the increases to hospitals and other providers so they will deliver more cost efficient care.  They will probably deliver less care.  He especially wants to reduce the amounts paid to safety net hospitals as the amount of uninsured falls.  He foolishly believes this will save $106 Billion over the next decade.

Obama and Baucus also spun the pharmaceutical deal as a great thing for his "reform."  In fact, it will in itself do nothing for government Medicare spending.  Pharma agreed to pay half of the cost of meds for some but not all people who reach the Medicare Part D doughnut hole.  The government paid none of this anyway.  The feds also say that Pharma agreed to some kind of measures (not named) that would give the Treasury more money (no amount given) under federal health programs.  They said that Pharma agreed to pay higher rebates to Medicaid for some but not all drugs and those fund would be used to pay for uninsured.  The only thing this was was a PR campaign to show that the Obamacare was not completely derailed. 

The June 25 Wall Street Journal had an opinion piece by a physician at the American Enterprise Institution which showed how all government run healthcare rations care.  He stated that Obamacare has a "medical advisory council" buried in the HELP bill.  This council will have the authority to recommend a benefit package based on standards set in the law.  There will also be a commission to help develop treatment protocols based on government directed research.  Unlike normal advisory boards this would be binding unless Congress quickly overrode it in its entirety.  This will be one size fits all in its scope and makes sense so people can blame some board and not the politicos for the rationing that is sure to come.

California is back in the news.  The legislature controlled by the Democrats but without a 2/3 majority again is failing to eliminate programs to get California out of its currant $24 Billion debt that is growing by the day.  The state may soon issue IOUs instead of money to its employees and have its ability to borrow money reduced costing more in interest and furthering the debt.     Top


A New York law that takes effect July 14 has physicians scrambling to beat the deadline.  The new Patient Protection Bill requires physicians to upgrade their offices or find new space.  The bill will regulate office surgery and will require the offices to be accredited or face penalties if they do office surgery.  Some physicians will need large elevators, better ventilation, backup power and other mechanical items.  This is specially true for plastic surgeons.  Some physicians can not meet the time line and are joining the few surgery centers in Manhattan or planning to do their procedures at the hospital outpatient settings.

The courts have ruled that medical residents pay is subject to Social Security taxes.  This is due to a 2005 ruling that anyone who works 40 hours a week is a full time employee and subject to social security taxes.        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.