June 1, 2014 Recent News




A top VA official who was retiring fell on his sword to protect Shinseki.  Mr. Pertzel resigned after he testified at the Senate hearing on the VA problems.  Pure politics.  It is meaningless since he was planning to resign anyway. Obama says he vows to clean up the VA mess but he stands behind Shinseki, just like he did with Sebelius.  Let's hope Shinseki follows the lead of Sebelius.  Obscurity.  

The  VA is now sending more vets to private practice in order to get rid of the backlog.  They should send almost all and close the duplicative expensive service.  Last year the VA spent about $4.8 Billion on healthcare outside the system .  This is about 10% of the entire amount of money spent by the VA system.  This is a good step is solving the VA problems.

Several weeks into the scandal the IG has agreed that the VA clinics have lied about wait times.  When the report came out more people from both parties are wanting Shinseki to step down or be fired.

The Phoenix VA missed care for about 1700 vets.  They were kept off the official waiting list for appointments.  The average time for an appointment was 115 days which was 91 days more than the VA reported.  The IG found similar problems in all the VA facilities they investigated.  The cause of this is the bonus system where bonuses are paid if vets are given appointments within 14 days of their desired days.  The scheduler just gave the vet the next available date and made that the desired date.  

Obama says that all the furor about the VA is "troubling".  He continues to have faith in Shinseki.  As with Sebelius that was the kiss of death.  Both did not want to retire and funny thing, both did.  Shinseki's resignation was with "sincere regret."  Right.

Nobody believes the change at the top of the VA will make any difference. The latest report by the IG on the Phoenix problem is the 19th one since 2005 showing how bad the VA is.   There are two main problems.  The first is the union control of the VA.  They do not want the vets to be able to get care outside the system and do not want to work.  The second is the bonus system.  To pay government employees bonuses for productivity encourages lying, especially when those evaluating the productivity are also going to get bonuses if those beneath them are shown to be productive. Why are bonuses need at all.  Some of the reasonable thoughts so far are to combine the VA and Pentagon health, only allow vets care for those diseases or conditions received in the service (why should the VA pay for an enlarged prostate, a natural aging event not tied to any military service), get rid of the VA completely, hire more physicians or at least allow them to work normal shifts and not be forced to have the last surgery end at 3 pm for the union employees to leave.  All except the hiring of physicians instead of mid level administrators does not need more money thrown at the system.

The WSJ has an oped from a physician who argues as I have for the past five years, that the VA should be abolished.  He states that physicians that have rotated through the VA during training know what a mismanaged organization it is and he gives concrete examples.  There is no argument from me.  I think there should be regional institutions to care for the vets with traumatic amputations as they really do that well.  The remainder of the system should be shuttered.  It is duplicative and poorly functioning.  

In a breach of health privacy that makes sense, the government is mining the data obtained from Medicare health insurance claims to determine potentially vulnerable people and share the information with local public health.  The local authorities are then finding where these people live (what floor on high rise buildings).  They are interviewing them if allowed by the individuals to determine what their resources are in case of a disaster.  If the individual does not want to talk to the authorities they do not have to.  Some of the information is used for data to prevent "frequent fliers" or to remind parents to vaccinate their children.  When the authorities went to the homes they found many with machines had no back up generators and those with oxygen had no back up tanks. There are some advocates who do not like the program.  They are afraid the disabled will be evacuated to shelters that cannot accommodate them.  They would rather see them die at home.  The feds have said they will not name those with mental illness, intellectual disabilities or obese.   Guess I will not be pointed out.  

The Washington Post reports that the feds have again screwed up.  They have erred in the payments of subsidies to over one million people.  The payments are either too much or too little.  The feds can not fix the problem as yet as their computers are not capable.  Another example of Sebelius' poor judgment.  The people entered incomes when they applied for insurance that was either higher or lower significantly than that on IRS forms.  The information people sent in to justify their income will be looked at not by a computer but by hand.  That will start after those naturalized citizens who were blocked by the computer from obtaining insurance will have their information also looked at by hand.

There are now four states that have Obamacare contractors paid to do nothing.  The latest one is Arkansas where they are still hiring people to do nothing.  They are really hired to process Obamacare paper applications.  In reality they are ordered to do no work and be on the clock with overtime.

Remember the great day?  October 1, 2013.  Obamacare opened with great fanfare.  It turns out that for the entire day there was (drum roll) one person successfully enrolled out of a total of 43,208 accounts created.

The site turned out soso.  However, it is better than some of the state sites.  Nevada is the latest state to give up the ship.  They have gone the way of Oregon, Maryland and Massachusetts in allowing healthcare.gov to take over Obamacare processing.

The American College of Emergency  Physicians polled over 1800 members and found that 46% had more people coming to their ERs since January 1, the start of Obamacare.  About 27% of those polled said the visits were about the same and 23% said the amount of visits decreased.  Over 80% of the physicians polled said that over the next few years they expect the number of visits to the ER to increase.  The best quote was "coverage does not equal access".

About half of the uninsured did not get Obamacare.  The reason was cost and not realizing subsidies were available.  The feds hope to almost double the enrollment next year.

Oklahoma is considering following California into the dark ages.  They want to cut provider pay for seeing Medicaid patients.  This has caused private practice physicians to stop seeing patients in California and the same will be true in Oklahoma.  The cut in Oklahoma will be 7.5%, less than the 10% cut that devastated Medicaid in California.

The WSJ has a front page article regarding insurers giving bonuses for each patient oncologists place in a standardized treatment protocol.  The insurers state that this will not take away choice if an oncologist wants to treat a certain patient differently, especially if the genetics dictate.  The insurer will review and update the protocols every three months.  

Most employers have been having their employees pay more of their healthcare costs with higher deductibles and co-pays.  This is according to Aflac.        Top


Physicians are the lowest paid of the healthcare hierarchy.  The average family practitioner makes about $185,000.  The average surgeon makes $306,000.  The average hospital administrator makes $237,000.  The average hospital CEO makes $386,000.  The average insurance CEO makes $584,000.  This does not include the massive amount made in non-salary compensation.  Think also of all the hospital Vice Presidents and how much they make.  Ladies and Gentlemen, the physicians don't wag the dog they carry the dog.

California Blue Cross has opened up its networks.  The insurer has added about 3800 physicians and some major hospitals to its Obamacare network.  The spokesman for the insurer states that mostly it is the physicians who are contacting the insurer to get on the exchange and take the low offered prices.  

Physicians at Athens (Georgia) Regional Hospital have taken on the administration and left the administration with egg on their face.  On May 15, two weeks after the roll out of the new EHR, twelve physicians on the staff sent a letter to the administration powers stating how they are screwing up patient care and losing physicians due to a rollout of a new EHR.  A physician then leaked the letter to the press and the administration is doing back flips to attempt to keep the public in their favor.  They do not admit the EHR they are putting in is terrible and their rollout was precipitous and premature.  The medical staff was not impressed and delivered a no confidence vote on May 22.  Several days after the story broke in the local paper, the CEO "resigned".  The new CEO is the CMO. 

At Lawrence + Memorial Hospital the physicians are also upset at the administration.  Forty four of the physicians, including hospital owned ones, signed a letter stating there needs to be better cooperation between the hospital and the physicians.  The state the hospital is not doctor friendly and because of that at least 18 physicians have left for greener pastures, including rival hospitals.  The Board is holding meetings with the physicians on the list to see how they can improve.  A consulting firm hired by the hospital stated that there are too many veeps.  The physicians agree but doubt that any will go.

The headline reads "Study shows doc discipline cases on rise in NY" and is somewhat accurate.  The Medical Board did discipline 468 physicians in 2013, a rise of 155.  However, the infractions were minor.  Only 14 of about 83,000 physicians had their license suspended or revoked.  The Public Interest Group, do gooders, want to regulate physicians to tell patients when they have been hurt by a medical mistake.

Physicians all over the land are committing fraud.  The HHS has paid $6.7 Billion to physicians for incorrect codes or for services lacking adequate documentation.  How much of this overpayment is due to the physician finally coding correctly with EHR that the government pushed not for patient care but for data collection.  The data from the OIG said as much when they audited the high Medicare earners and another group who are just regular docs.  The HHS wants the information to determine if they should go after any physicians.

If you did not know when a physician sues a hospital for loss of privileges and they lose, which is almost 98% of the time, they can be ordered to pay attorney fees to the hospital if the hospital or others follow the rules and the suit is frivolous.  The question is should the hospital be allowed to recover attorney fees if the attorney is in-house.  An excellent article on this appeared in the AHLA Weekly. The reported answer is split but usually yes they are able to recover and the basis of the amount is lodestar, not cost plus.        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.