July 1, 2010 Recent News
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A recent study has shown that the top seven insurers have paid claims by physicians inaccurately 20% of the time. This is a horrible record. Coventry Health was the best at 88% accurate and to no one's surprise Wellpoint was the worst at 74%.
A study by the Journal of Health Affairs shows what happens when an insurer cuts what they pay to physicians. They see more patients or do more to the patient to make up for the lost income. The study states that oncologist who were paid less for chemo merely put more patients on chemo instead of sending the patients to the hospitals for treatment. This was a study on lung cancer patients only.
The Milwaukee Journal Sentinel has an article on guidelines. The article is balanced and discusses the pros and cons of the guidelines. The final thrust is that guidelines are good but not for all. Physicians must still use their own abilities to diagnose and treat.
The physicians in some states like New Mexico are getting sued by their hospitals. The employed physicians are sued for med mal and the hospital pays as the one with vicarious liability. The hospitals are then suing the physicians to recoup their losses even if the hospital settled the case without the physician's consent.
Mount Sinai School of Medicine has found that 91% of physicians order more tests than necessary to protect themselves from med mal suits. These same physicians believe they will continue to do the same thing until there is a large shift in the liability in this country. How much does this cost the country in healthcare costs depends on who you ask. The government states $60 Billion and the AMA states $200 Billion. The real figure probably is somewhere in between.
The New York Times has an article about physician offices who make patients wait overly long to get an appointment or make you wait when you get to the office. There are some new physician offices in two cities that promise same day appointments that are longer than normal and start on time. Of course there are only five of these in the country. Doesn't help much in Peoria. The article doesn't say that access will be much worse in the days ahead. Top
Believe it or not the nurses at Washington Hospital Center in Washington DC, have not all got their jobs back. The 18 nurses were fired by the hospital for not showing up during one of the worst snow storms on record. This occurred even if they were sick or attempted to come in but couldn't. The union is still fighting for them. Nine of the nurses have been reinstated and five of the remaining nine have at least part time jobs. This looks terrible for a hospital with a poor reputation to start with.
Now the nurses at Washington Hospital are accusing the hospital of poor patient care. Of course, the nurse's contract is up and they want more nurses as well as more money. They will be voting on a strike.
California has been criticized for not checking nurse's credentials. The state attorney general office is now going through all the names and records to see who has been disciplined in other states. They will triage the expected 2000 nurses to see who are the biggest threat and go after their licenses first. The Nursing Board has been in trouble in the past for their negligence. Top
Price Waterhouse has projected a 9% increase in commercial premiums for 2011. The reason is EMR purchases and decreases in Medicare payments. They expect deductibles to increase to about $400 for most employer plans. They also found employers are planning on sharing the healthcare costs with more employees. Approximately 40% of employers will boost employee contributions, another 40% said they will increase deductible and copays and 25% stated they will increase drug copays. Retiree benefits will decrease also.
The National Center for Policy Analysis recommended that physicians and patients set their own fees and not have government intervention. The payments would be in the form of vouchers from the feds with Medigap plans liberalized. Like that is ever going to happen.
Obama, a constitutional attorney, warned the private sector not to increase healthcare insurance rates. He knows or should know he has no say. The law does give all the states who look at the insurer's rates a grand total of $250 million. This is not per state.
The physicians are aware that California has a whooping cough epidemic. The insured are getting screwed. Those without insurance can get the vaccine from the federal program or Medicaid. Those with insurance will pay at least $450 for the shot.
San Francisco is getting what it deserves. They are anti-business and recently passed a law requiring cell phone manufacturers place on their radiation levels on all phones sold in retail stores. In retaliation the industry will not hold any conventions in the city and are pushing other mobile phone companies to do likewise. That includes Silicon Valley companies Apple and Cisco. In the past five shows over the past seven years San Francisco received almost $80 million in revenue. When asked how he felt about the boycott, the head of the Convention Bureau stated that it might be hypocritical to object to a boycott of us because of a decision we made, while boycotting others for decisions they made. Hello Arizona. Top
A study of med mal in Connecticut show that 48% of the claims over the past four years resulted in no payments to patients. The number of claims and the amounts paid out are less. However, 79% had legal expenses to defend and those are now up to $70,000 per case. There is no information on how the physicians reacted to being sued, the increase in their ordering or their psychological trauma. Top
CalPERS, the largest public insurer in the country, recommended premium increases of 9.1% in 2011. They want the state to contribute an additional $600 million to the plan. This would go against the Obama rules and may cost the plan their grandfather status. (See Recent Legislation).
Aetna is the second California insurer to find multiple math errors in their deciding to raise their health insurance rates. Wellpoint found theirs earlier. What this says is either they are liars or incompetent.
The New York Times has an article about the nation's health insurance rates and how the individual rates have increased at a 20% clip. After either negotiating or switching to less benefits they still paid 13% more. The other thing that was found was when people buy insurance on their own they have larger deductibles.
The Republic of Massachusetts is finding out that people are smarter than politicians. The people are joining the Republic's healthcare program only when they need to use the system. They then drop the system when they are well. This raises the price of healthcare for the remainder. The legislature is considering only allowing the purchase of the Republic's insurance one month a year. 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.