July 15, 2009 Recent News






Blue Cross and Shield have announced a large increase in recovered fraud money over the past year.  They have recovered about $350 million or 43% more than the year prior.  The fastest growing part of healthcare fraud is medical ID theft.        Top


HHS asked the Congressional mandated IOM to help with comparative effectiveness in healthcare reform.  The IOM listed the top 100 priorities for the HHS.  The list was all inclusive and listed hospital falls and removal of antibiotic resistant bacteria in hospitals.  It also included teenage and  emotional problems.  The committee will now use the list to find the most cost effective ways to treat the conditions.  The studies must include typical patients and not just the very ill.  

CQ Healthbeat reported that if Obamacare comes in Medicaid enrollment will rise by 30 million people.  About half would be those adults without insurance and the rest would be children.  That shouldn't cost the feds and the states much money.

Hospitals have agreed to help Obamacare to the tune of $155  Billion.  Most of this would be by the use of technology to treat patients more effectively not by cheaper rates.  The hospitals get for this higher rates if a public plan is approved plus a reduction of physician owned hospitals.  There is no written agreement to this and not all hospitals have agreed.  Congress has already said it will not be bound to agreement with the behind the scenes agreement between the White House and Pharma.  The same is probably true for the hospitals.  Some to the $155 Billion would not be from cuts in payments but from slowing of Medicare increases in payments. Some would be offset by more patients becoming insured and so $50 Billion will no longer be needed for critical care hospitals.  By the way the $155 Billion is only about 1.5% of the money the hospitals are to receive over the ten years.  According to Dennis Smith, a senior fellow at the Heritage Institute, this whole thing is a shell game.

CongressDaily has released the latest projections of Obamacare.  For the Congressional bill the cost has risen to $1.5 TRILLION over a decade.  This would be paid for by raising taxes on people making over $250,000 and taxing sugary drinks.  They do not intend to tax health care benefits due to their union masters telling them to say no.  The House also wants Medicare cuts of $500 Billion and get employers to kick in an additional $250 Billion.

The government has reached the highest debt in history, $1 TRILLION.  They expect to DOUBLE this by October 1, THIS YEAR.  This is without adding any healthcare costs.  The interest on our debt already is a far greater part of out GNP than healthcare. It boggles the mind that even with the expense of the war in Iraq winding down and without the full brunt of the war in Afghanistan yet in view that the administration and Congress are continuing down this road.  Politicians are not business people and their only intent is their next election. 

An article by Dr. Van Eaton, a professor of economics, states that the politicos have not determined why health care costs are rising and how much of the rise they have any control over.  If the government has little control over the reasons, why allow them to have more control in general?                   

The Senate has proposed that those people that refuse to purchase health insurance will be fined $1000 per year.  The Dems hope to raise about $35 Billion with this. There would also be a charge to the employer of $750 per person if they do not cover the employee's healthcare.  That would be really cheap for the employer.

The Wall Street Journal has an editorial titled "of NICE and Men" It discusses the dreaded British NICE, an organization that does not allow treatments for people that cost over $$22,000 per year of life.  This is what Obamacare is trying to emulate. It tells how the five year survival rate for cancer in the US is significantly higher than other European countries and especially England.  This is due to the rationing of services deemed too expensive.  There is no patient choice the treatments are just not available.  

Some letters to the Editor regarding the above editorial believe that the US already rations care due to private insurance not paying for needed care.  The difference is that the US insurers are susceptible to pressure from the employers and the state attorney generals, NICE is pressured only by Parliament.  Another letter talked about the higher death rates for certain things in the US compared to the socialized countries.  The writer did not discuss the reason that most of the high death rates in the US are due to personal choices such as illegal drugs. 

The House has put forward a 1018 page document for healthcare reform.  How many Representatives will actually read it and how many will understand it.  The answer to both is probably under 10. Top


The IRS commissioner has stated that they will look hard at non-profit hospitals that claim no taxes.  The hospitals will have to prove they do meaningful charity work and not just accept those without insurance and bill them individually.  Taking Medicaid will also not count.

CMS is proposing multiple changes in payments to hospitals.  Starting 1/1/10, hospitals may bill for pulmonary and intensive cardiac rehab done as an outpatient.  Pharmacy will be paid at ASP plus 4%.  Physicians supervision of outpatient departments will be required but the physician will not need to be in the department, only in the hospital.  ASCs will continue to be paid equally to hospital outpatient departments.  

The AHA has reported that a large number of hospitals have either stopped, slowed or significantly changed their IT program build out due to the economy.  This will cost them the government handouts to eventually put in their electronics.      Top


While hospitals are getting more money next year, CMS has reverted to the old payment protocol which never takes place.  They expect to pay physicians 21% less next year for Medicare services.  This will never happen as Congress always steps in and overrides the CMS or Medicare recipients will find no physicians.

CMS also wants to change the amounts different physicians are paid.  They want more money (up to 8%) for the primary care physicians and are planning to get that by cutting the specialists payment by up to 30%.  CMS also is planning to discontinue consultation codes and use the standard E/M codes instead.

Massachusetts Blue Cross Shield has given out $27 million to physicians for reaching cost goals.  They also said quality but all know that is a lie.

There continues to be legitimate physician resistance to EMRs.  Hospitals now want to increase physician buy-in to the required CPOE system but they need to make it user friendly, which most current systems aren't.

George Washington School of Medicine has come up with a figure of 45,000 physicians will qualify for Medicaid HIT payments over the next six years.  This means the physicians will need a mix of at least 30% Medicaid patients in their offices.  If they have that many Medicaid patients they deserve the money since they are now losing money.

Dr. Jose Mejia of Woodhull Hospital in Brooklyn, NY, has been accused of falsifying and altering charts to get better report cards for the hospital.  He added information retroactively to charts after patients left the hospital to make the hospital look better.

California's Medical Board is finally doing part of its job.  It is making a real effort to go after unlicensed physicians in the state. They had not done any investigations since 2003 due to budget restraints.  They chose instead to make silly rules that did not help anyone.  

A Seattle clinic has gone bare. Qliance, a new clinic made up of physicians who are fed up with insurers has gotten financing by venture capitalists to open its doors.  No insurance will be excepted.  It costs patients $99 to join and a flat monthly rate of $39 to $119 depending on the age of the insured and the level of care.  There are no pre-existing conditions and the patients can resign at any time.  The patient must also go to an outside broker and get catastrophic insurance coverage.      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.