July 1, 2016 Recent News





The Washington Post says consumers may be facing sticker shock in 2017 due to very high Obamacare premiums.  They report that the popular Silver plan will go up about 10% on average.  Insurers say the reason is that the insureds are sicker than expected.,  Also a program to help insurers with the costs of coverage for the very sick will end in December, 2016.  The HHS is downplaying the story since they insist that most will not pay the increases due to subsidies but in fact they will with taxes.  People may get policies with no increases but by switching plans with the possible change of physicians.

The White House is starting to panic earlier than usual.  They are putting out multiple releases about how the Obamacare premium increases will not affect most of the people.  They continue to not state that the subsidies are paid for by the people.  The administration is so panicked that they are now giving the states about $12 million to help them go against the insurance companies. 

The feds report that about 1.6 million people dropped the expensive Obamacare program after initially signing up.  That is about 13% of the total.  The administration is happy since they reduced their expectations initially.

CMS will be giving $100 million over five years for Medicare physicians to get training and education on the new MACRA.  

The House Republicans have announced their Obamacare replacement.  The initial thoughts include the usual selling of insurance across state lines, HSA  and high risk pools.  They would also slowly increase the age at which Medicare would kick in starting in 2020.  Medicare would have a free market based model with fee for service competing with private plans.  The mandate for all would be eliminated and replaced with a flat tax credit regardless of income or premium. States would get a fixed amount of money per beneficiary or a lump sum for Medicaid.  States would be allowed to establish work rules for those on Medicaid.  The insurance for all provision of Obamacare would be retained by the GOP but only if continuous coverage.  Employer health insurance would be taxable at the most generous plans.  There would also be age stratification for premiums which would reduce premiums for most. The details would be later in committees.  The Dems railed.

The administration is up against it since the young invincibles are not buying into the Obamacare program.  They are now going to use the IRS as  a club for the 18-34 year olds to try to attract them to buy the overpriced insurance.

The Washington Post has a story along with others that Americans are paying more for health care costs.  This is due to rising deductibles and co-pays.  The out of pocket costs of hospitalizations rose 6.5% each year from 2009 t0 2013.  This also plays out in employer sponsored insurance.  The feds who use their own methods found the rise to be only 1.2%.  In 2014-15 the rise was 13%.

The GAO has said the backlog of Medicare claims is getting worse not better.  The number has increased greatly but the funding for ALJs has not been raised.  The time for a case to have a decision rendered by an ALJ is supposed to by 90 days but the actual time is 2 years.  The main reason is the RAC getting paid for their denials of payments even if the denial is reversed.  Therefore it behooves he reviewers to make sure to deny as much as possible.  

The GAO has announced that the Medicare fund will now be depleted and will only cover 87% of the hospital bill as of 20128, two years earlier than previously thought.

The MACRA rule is now closed to comments.  However, prior to its closing CMS found out not many like it.  The AMA and HIMSS want it at least postponed for a year.  There is also a need to much more education of physicians on the rule and the reporting will not be over burdensome.  

The Mayo Clinic Proceedings printed a study that showed the use of CPOE and EMR directly contributes to physician burnout and lower satisfaction rates. The reason is the huge increase in clerical work.  This may lead to lower quality of care and fewer physicians due to cutbacks in their practices.   

The dichotomy continues.  Executives believe that PCPs have the tools to succeed in a value based? society but the physicians do not agree.  A recent Quest poll showed that 44% of executives and 29% of PCPs believe physicians are ready to succeed with value based payments.  The problems revolve around the medical record and the non-sharing of same.

The USPSTF has issued another wonderful statement.  Now they are saying that people can choose whatever colon cancer screen they want, not what is best.  The reason for this is that 75% of the uninsured and about 40% of the insured are getting screen currently.  The choices the group is using is between colonoscopy,  stool fecal immunochemical testing, high-sensitivity fecal occult blood, flexible sigmoidoscopy with fecal occult blood or CT colonography. 

The USPSTF continues to issue rash and controversial edicts.  The latest is that pelvic exams on women without symptoms are not necessary.  How do you find things early if you do not examine.

Senator Bitter is going to hold up administration appointee for the head of OPM until Congress gets rid of its special dispensation on Obamacare.  He wants, and is right, for Congress to pay for their health insurance like the rest of the country without subsidies.  Congress voted to exempt themselves from the Obamacare due to the "fear of loss of key staff members".  Hogwash! 

In Orange County, California, a mother who lost a son to sudden cardiac arrest is attempting to teach all CPR and get AEDs into all the schools.  She is being successful.  It is a same that she has to do this as it should be mandated that all schools have AEDs on campus and ready for use.  Sudden cardiac death is a field which I am committed to and have been involved with for the past ten years.  We have AEDs in all schools in our county and the state has them in all fitness centers.  We teach hands only CPR to all students in either junior high or high school in our county.  We go to various schools and do health heart screenings consisting of a questionnaire, blood pressures, EKGs, cardiac auscultation and cardiac ultrasounds for those with questionable preliminary exams.  We have caught at least on person per screening who need further testing.

California has issued fines in excess of $17 million to hospitals since 2007 but the amount of errors has not decreased.  The fines are for "immediate jeopardy incidents".  

Several states are considering legislation to force pharma to explain how the get the pricing for their major drugs.  This is their attempt to limit ho much the state is paying for drugs.

The British physicians, which are government employees, are warning on the potential for problems if Britain leave the EU.  The say that the NHS would have a reduced research budget and pose a risk to physician recruitment. The British are served by about 10% of physicians from other EU countries and 5% of the nurses.  The Brexit folk say the country would save so much money that they could funnel 5.5 million pounds into NHS each year.  

The NHS has denied the country the Roche combination therapy for melanoma.  It is too expensive.  It did give the OK to a rival combo med from Novartis.          Top 


The AMA is attempting to manage the news to protect their partners in crime.  An article in KevinMD by Meg Edison, MD chronicles how the AMA is managing the information.  She states that the AMA passed a resolution calling for the immediate end of any mandatory, recertifying examination by the ABMS or other certifying organizations as part of the recertification process.  The AMA did not report this when they reported to the public the results of the AMA session just ended.  They used doublespeak reporting.  Is it any wonder why the AMA is losing members daily? 

Health Data Management reports that physicians are not enamored with EHR for many reasons but one that they focus on is the non-communication between physicians.  The EHR is not capable of sharing information outside the practices.

Crain's has a story about how hospitals are upping the pressure on senior physicians.  It states some people also want state medical boards to have some way to judge medical competency when the senior physician re-applies for his/her license.  Neither the AMA nor the ACS has recommended mandatory retirement ages.  they both believe there should be some baseline testing about age 65 and then at some interval thereafter.  

The VA wants and needs at least 1800 more physicians.  However they take months to vet the hires which means they go elsewhere.

The Oceanside, California Tri-City Emergency Medical Group physicians have a 44% error rate in their billings according to one audit.  This borders on criminal.  The group says that other audits invalidated the Synergistics audit.  The audit came one day before the CEO was terminated and paid $500,000.  He had problems with the medical staff.  The Emergency Medical Group has been purchased by TeamHealth.     

Medscape has an article about "mass exodus from Medicare when MACRA hits.  That is very unlikely since most physicians are on salary from hospitals and do not pay any attention to where that money comes from.  However, in rural communities I do think you will see physicians seeing less Medicare patients due to the onerous requirements.     Top 


Alameda County in California has gotten its hospitals together to do a mega data combine to share emergency room records.  This will prevent the frequent fliers and doctor shopping.  To date six hospitals have joined and hopefully other will join soon.  Some hospitals would rather get the fee for service payments and redo all the labs and x-rays rather than do what is right.

California has a new aid in dying law.  The problem is that some hospitals and their paid physicians are opting out.  Most hospitals will probably opt out but they can not write the prescriptions in any case.  The hospitals are also mandating that their employed physicians also opt out no matter how the physicians feels about the law.

In a merger of St. Joseph health and Providence Health will create the nation's third largest nonprofit health system.  It has been blessed by the state Attorney General.  However, there will be conditions for the merger.  These have not been made public as yet.  The merger will affect hospitals in California, Texas, Alaska, New Mexico, Montana, Oregon and Washington.

Virginia Mason Medical Center in Seattle did not get full accreditation by the Joint.  They were out of compliance in 27 areas.  This was a follow-op inspection after the May inspection found a condition that posed a threat to patients.  They will be fully accredited soon.  

The vice chair of surgery at the University of Louisville Hospital in Kentucky has blown the whistle on potential problems with patient safety since the hospital was taken over by Catholic Health Initiatives' KentuckyOne Health. The health system said the hospital is wonderful.  I wonder who I would believe?        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.