July 15, 2013 Recent News





About one-third of the hospitals and health systems in the "pioneer" ACO are exiting.  These were getting HMO style payments instead of fee for service type.  They are looking too risky at the moment.  In these programs the providers are responsible for the care but the patients are not required to stay within the system.  The other problem to no one's surprise is the government and its inability to keep the needed reports up to date.

UnitedHealth has joined Aetna is exiting the California individual insurance market.  They both will stay with large and small employers.  The insurance commissioner whose rules have encouraged the leaving of the two insurers is not a happy camper.  California has been active in mandates on insurers and these two aren't big enough players in the state to be concerned what California does.

Two thirds of uninsured people who would be eligible for Medicaid are to remain uninsured since many states will not play the maybe you will pay me and maybe you won't game of Obamacare.  

Wegman's Grocery Stores is moving part time employees who now get healthcare insurance if they work 20 hours to the Obamacare 30 hour standard.        Top


The Chicago hospital Sacred Heart has closed.  The hospital had its CEO owner, CFO and four physicians arrested for kickbacks.  The firm running the hospital abruptly closed it in spite of the law which requires a three month notice.  This is Chicago, the home of the president, so the law is of no value.

The Washington Post reports that all the alarm noise in hospitals is a risk for the patients.  Most of the alarm noises are false alarms so the staff tunes them out or turns the alarms off and pay no attention when a real alarm goes off.  The hospitals compound the problem by attempting to standardize alarms and not allow them to vary with the patient.  

The San Jose Mercury News reports that breast feeding of infants depends on the hospital where the baby was born.  Because of this California enacted a law that encourages hospitals to only use breast feeding with no formula.  Some of the hospitals with high rates such as Kaiser do not allow nurses access to formula unless a pediatrician specifically authorizes it.

Rhode Island Woonsocket Landmark Hospital may be purchased by Prime Healthcare of California.  The hospital is now in receivership and has been for the past five years.  The hospital only captures about half of the people in its catchment area.  It was to be purchased earlier by Stewart Healthcare System but that fell through.  If this doesn't go through the hospital is in deep trouble.

The American College of Physician Executives have released a report showing that hospitals purchasing physicians may not cut any costs and in fact may add to health costs.

The People's Republic of Massachusetts have seen their reported surgical errors rise in the past few years.  That seems natural in a Mecca for healthcare.  Is it due to complacency of being the best or due to more trainees?  The article made it sound like the former.        Top


Doctor, is there someone looking over your shoulder?  Yes.  The Hospital.  The WSJ has a story about not cost cutting but what they call value.  This means as more physicians go to work for hospitals and hospitals have contracts with insurers that requires them to be paid for the overall care of the patient.  Those physicians who order more tests or take care of sicker patients may break the bank and be put under hospital controlled medical staff scrutiny.  In the past era of HMOs and per capital payments the fees did not work.  Now, with the new computers and EHRs which are for the hospital and not the patient care the fees may work.  Hospitals are also smarter.  They are paying staff physicians to talk to those physicians who are spending more than their peers.  They are no longer hiring outside consultants which physicians saw as hospital stooges.  The main thing these new hospital paid physicians do is attempt by the use of data to decrease spending for unnecessary or repetitive testing and to decrease ER or hospital readmissions.  They do have more success than the consultant stooges since they are or in most cases were fellow physicians.

CMS is looking very hard at cardiologists since they account for 16% of the Medicare spending.  They are insisting that cardiologists who do stenting follow the 70% rule and that all are documented fully.  If there are non documented areas plan on being in front of a grand jury for healthcare fraud.

United Health has stated they are switching from volume based payments to value based, whatever that may mean except less money for physicians.

Another study from Jackson and Coker has shown that physicians not only do not like their profession but do not want their children to go into medicine.  The reasons are the red tape, decreased autonomy, lowered reimbursement, corporate medicine, longer hours due to EHR, and more litigation.  The breakdown of the over 3000 [physicians polled were 36% had a negative outlook and 48% were cautious.  That did not leave many with a good outlook.        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.