July 15, 2016 Recent News




Seems like no body is happy with Washington.  The hospitals are mad that CMS is taking away their money for physicians they own seeing patients in their offices.  they were getting paid mucho dinero for that sleight of hand.  Now organized medicine is mad for the feddies taking away money from physicians for treating patients with high cost meds in their offices.  

The Office of the National Coordinator for Health Information Technology (I never knew this existed) has decided to measure the interoperability of physician EHRs.  The office plans to measure the number of providers who are sending receiving from outside sources and the number of providers who report using that information for clinical decision making.  They plan to get the data from secondary sources, the AHA survey of hospital health IT usage and the Center for Disease Control and Prevention survey of office based physicians.

CMS may and hopefully will delay if not cancel the onset of MACRA.  Slavitt alluded to the delay while testifying before the Senate.

A Congressional created commission has released a report on fixing the VA system.  It says the system has profound deficiencies.  It goes on to say an independent committee should recommend closing underused or redundant veteran facilities.  They also need an updated computerized record system. The major recommendation is to have  network of physicians including private physicians that any vet could see without prior authorization.  They think that 60% of vets would be using private care by 2034.  However, this could cost $100 billion more if not managed.  Several of the committee wrote dissents to the report.  They want the VA to become a huge non profit like Amtrak.

Donald Trump made a statement about the VA stating basically the same thing as the above report.  He was criticized by the usual culprits who have no plan.

Obama on making Obamacare better.  He says Congress should enact even larger subsidies and create a public plan such as Medicare to compete with private insurers.  This would make sure competition existed.  This is a sure way to continue to put the US into even more debt.

H. Clinton has continued her pandering to the left.  She now proposed to increase money to federal health centers.  Soon after she did this Bern endorsed her.  She wants to have them get much more money a she has for all her proposals.  M. Thatcher once said that socialists are great until they run out of other people's money.

As a follow -up to that the latest report on healthcare says that it is projected to increase in costs by 6% per year.  This means the percentage of GDP will increase from 17.5% to 20.1% by 2025.  Now estimated healthcare expenditures have reached $3.2 trillion.  CMS is happy that the rte of increase seems to be slowing from 8% in the preceding two decades.  It is still too high as it is now over $10000 per year per person.

As a follow-up on the last article the Washington Post reports that of the original 23 co-ops only 11 are still in business and of those only seven will be available on the next Obamacare open period.  

The first people of note (medical people) are beginning to question Obamacare's solvency.  In South Carolina the CEO of a major university hospital is pointing out the obvious.  As competition disappears prices will increase.  In this state United's pullout of Obamacare leaves only one major player, Blue Cross Blue Shield.  If prices are not allowed to rise to care for the sick and to allow the company to make a profit, the company will withdraw from the state.

More unsuspecting senior citizens are enrolling into Medicare Advantage plans without realizing what they are giving up.  They are going strictly for price as it is cheaper.  They are sacrificing provider choice and in some cases quality.  The Kaiser Family Foundation found that provider data was frequently out of date and difficult to review.  It also found that cancer centers are often left off the list of approved facilities.  

In yet another rebuke to EHR the Journal of the American Medical Informatics Association has an article that although EHR is more thorough it is less accurate than paper records.  They found the EHR had an error rte of 24.4% versus 4.4%.  On the other hand physician exam was omitted in 41% of paper notes versus 17% of electronic ones.  Which would you rather have quality or quantity?

Israel Stinson, a several month old boy, has been in Central America since being released from Kaiser in California.  He is brain dead but the parents will not face that.  He is being returned to the US to be along side McGrath, another California child in the same pickle.

England is in a pickle.  First they vote to leave the EU and now will be facing an all out strike of its celebrated NHS.  The NHS junior physician have rejected an agreed upon contract between the NHS and their union.  The vote was 58% against to 42% for the agreement.  The NHS is now going to push a new contract upon the physicians whether they like it or not.  This will force the physicians into a strike.  It will be interesting what the new government will do.        Top


In a muckraking piece of yellow journalism, an atlanta paper (they do not deserve to be mentioned nor capitalized) has a series on sexual misconduct and the physician.  One of the articles focuses on a physician who was found innocent by his medical board and was never even brought to a civil court.  Find something else to do. A report in general is fine but not specifically to one physician who was innocent.

The Boston Globe had an article on a new phenomena to me.  It is the concept of hiring physicians not as true hospitalists but as night physicians.  They see the patients during the night and the regular physician takes care of them during the day.  This relieves the hospital of some money problems and also allows the attending physicians to get some well needed sleep.  

In an article that does not surprise me, almost 50% of physicians have never heard of MACRA.  Self employed or small practice physicians are more knowledgeable than employed ones.  About 80% favored fee for service over alternative payments.  Physicians did agree that the new alternative rules will spur consolidation.

The feds have announced that they are raising the cap on how many patients a physician can treat for opiod addiction.  The cap has been raised from 100 to 275.  Those that want to treat more will have to apply to be allowed to see patients. 

An article states that as of now 25% of this country's physicians were born elsewhere.  Also over 20% of the nurses and other personnel are foreign born.  The article goes on to state that the American born physicians are doing sub-specialization leaving the primary care to the foreign born doctors.  They say that credentialing requirements of the states and the federal immigration system are impediments to more foreign born physicians coming to America to help with our primary care shortage.    

In an article about physicians in Tennessee, several hundred applied for extra money from TennCare with which they improved their practices and took on more Medicaid patients.  Now the government wants the money back since the physicians are physicians.  They did it on their own and screwed up.  The physicians to get the money needed to be board certified or if not have a percentage of their practice in certain EM codes.  Well since they are rural physicians they also do x-rays and labs which are not EM codes.  Some have to pay back hundreds of thousands of dollars.  This will cost Tennessee physicians in their rural communities who will retire rather than pay back the money.   Bad physician reading and not getting advise.  Bad state for not making things clearer.  Bad feds for not making regs so one can read them.         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.