July 1, 2012 Recent News




The administration strikes again.  The GAO states that the National Medicaid Audit Program has spent $102 million since 2008 to collect $$20 million in fraudulent claims.  They did this by using incomplete audits and records.  The total amount of fraud for the two government programs is $60 Billion per year.  Therefore the government is not doing its job well or at all.  It has taken the program over four years to find and try to correct the deficiencies and failing.  The GAO basically said the agency was incompetent.

It's a another week and right on time each Tuesday Sebelius comes out with another "how wonderful we are" announcement.  This one is on the Obamacare mandate of young people getting on parent's insurance.  What she doesn't say is that although this is the current law, the insurance companies can say when the open period for the young people is.

The next Tuesday is upon us with another spate from CMS.  This one tells how wonderful they are with the money saved by seniors in the Medicare Part D doughnut hole.

Hopefully, now that Obamacare has been deemed legal Sebelius will be quiet.

The healthcare insurers love that Obamacare is now legal.  Watch for them to drop agents and have the public sign up directly.  They also believe that the medical people will become more efficient now (read as cheap).  The insurers will also weed out "inefficient" (read expensive) physicians in order to keep the premiums below the Cadillac threshold of $27,500 per year for a family policy.  They also want Congress to get rid of the 3% luxury tax on some insurance policies such as Medicare Advantage.

Hospitals are not admitting as many Medicare patients as before.  They have found the golden goose.  By keeping the patient as observation they are not subject to DRG and can charge the higher individual item prices.  Of course, it is the patient who suffers financially since they are not told they are not hospital patients or if they are told they are observation patients they are not told what this means to them financially.  The hospital can still do almost all the same procedures in observation as they can as inpatients and charge like the bandits they are.  This also means they are not qualified to for the three day stay to go to a nursing home under the antiquated Medicare guidelines (rules).  Medicare is slow but is catching on to the hospital antics.  They will start deducting a percentage of the total hospital payments as a penalty.

The Star Tribune reports that even if Obamacare passes there will be millions without health insurance.  This sounds terrible until one finds that these are illegal aliens who do not deserve Obamacare status and the people who are citizens but who can not afford the co-pays.  Obamacare does nothing to to decrease the premiums people pay but does increase the amount of people who are eligible for Medicaid to 400% of the poverty level.  That is $90,000 for a family of four.  Ridiculous.

Steve Larson, the HHS top insurance regulator, left to work at United Healthcare.  The question is why?  Is it frustration that the states are not moving forward fast enough with exchanges or for the money.

Courant. com reports that in a recent JD Powers survey almost half of the employers in the country will stop paying for health insurance for their employees.  Instead, they will give money to the employees to purchase their own insurance, usually through the state exchanges.  This will go along with the expected switch to defined contribution pension plans.

The federal health actuaries expect more money going to healthcare in the coming years.  They expect more money going to pay physicians and other practitioners as well as hospitals.  This is due to more people coming into Medicare age.  This is yet another blow to Obamacare and goes along with the People's Republic healthcare plan.

The AMA has taken on the idiots at the US Preventative Health on their poorly thought out non-thought on mammography and PSA.  The AMA wants the organization that has no specialists on board, only some primary care and preventative health people, to get input from the physicians who actually know what is happening in the community and the world. 

CalPERS, the largest public pension plan in the country, is worried about the costs of medical care.  They see an increase of just under 10% over the next year.  The people of California are worried about the unfunded pensions in CalPERS which is bankrupting the state.         Top


In Racine, Wisconsin, seven primary care physicians owned by Aurora Health, have admitted to the local non-Aurora hospital, Wheaton Franciscan.  They have now switched their admissions to Aurora's hospitals in other cities due to "better hospitalists" (or Aurora's pressure).  The seven now never need to go to the hospitals and can stay in their offices to see more patients and make more money for the system.

Physicians are increasingly using EMR in their practices.  As the use becomes increased so does the dissatisfaction with the process.  It is becoming even more clear that the records do not help the patient or the physician, only the wonk.  I hac lunch with one physician this week who told me that the use of the EMR has added three hours to his day and that now he comes into the office on weekends to get his electronic records ready for the following week.  Another physician told me the same and so decreased her patient load so it would cease adding so much time.  Of course the physician EMR also does not talk to the hospital EMR or other physician EMRs.  The hospital is changing so all will need to get in line as there will be an ACO.  This will cost mucho dinero and who is paying?  It ain't the hospital nor the wonks.  The article telling of the physician dissatisfaction around the country came from the Washington Post.  

Modern Healthcare states that money is the largest challenge to physicians.  This includes the mandated spending of practices to get ready for the ICD-10 provisions and the meaningful use provisions.  This is also fueled by the SGR and the unknown of Obamacare.

California Healthline states that 70% of the California physician EMR does not comply with the meaningful use requirements.        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.