June 15, 2011 Recent News






It appears that the people who agree to be on the Board that will cut Medicare without Congressional approval will also have to give up their usual job to avoid any conflict of interest.  They will need to be conflict free for the entire term of six years.  They will also have to be confirmed by the Senate and that will not be pretty.  The Republicans are against the Board and if they can not get rid of it legislatively they have threatened to hold up all the appointments in the Senate.  Obama will then have to do recess appointments and they will only be good for a short time.  

The AMA has proposed their own SGR replacement ideas.  They want to get rid of SGR, implement a five year period of positive Medicare payment updates based on payment costs and test and transition to multiple payment models designed to enhance the coordination, quality and appropriateness of care while addressing cost concerns.  

As he did with the passage of Obamacare with no reading of the bill and a hurry up plan, the administration is again doing the same tactic.  This time it is for the arrangements to coordinate and pay for healthcare for seniors.  They think that ACOs could start in the fall even though the major medical clinics have stated they probably would not join and neither will individual physicians.  Hospitals are having problems with the system as the costs to start an ACO are now predicted to by huge multiples of what was thought in the past.

States with Republican governors are having a moral problem whether or not to start their own exchanges or let the feds do it when Obamacare hits in 2014.  

It is weird that 20% of the waivers given by CMS to date for a one year delay on the caps for health care benefits mandated by Obamacare has gone to businesses in Pelosi's district.  According to the San Francisco Business Times this may be because San Francisco has another law mandating health care for all employees working in the city or paying into a fund.  It is the only city in the country with this type law. 

Sebelius is stepping away from her role as a supposedly political neutral and overtly helping the Democrats who nominated her to fight the Republican passed House Medicare law.  She contends that the new bill, which stands no chance in the Senate or with Obama, will affect seniors now as well as in the future.  The reason is that the new law continues the Medicare Part D doughnut hole which saves Medicare large amounts of money but may cost some people like me money when we reach the doughnut cusp.

There are 75 Regional Health Information Organizations (RHIOS) in the country.  To date, only 13 meet the basic requirements for meaningful use and none qualify completely.  This is after they have had funding by the feds to get started.  Now think of the hospitals and physicians trying to do the same thing and how many will succeed and get the promised money. 

The New York Times has an op-ed by a San Francisco University Professor against doing tests and procedures based on age and "guidelines".  She does not take into effect that many people over her arbitrary age limits are in much better shape medically than those ten years younger.  She needs to get out of the ivory tower and into the field. 

Five years ago ten well integrated medical groups began an experiment that would pay them money for increasing quality and saving Medicare money.  It is equivalent to what is today called an ACO.  It turns out these physician outfits did not save Medicare any money but some did get bonuses.  If these well integrated organizations can not save the government money what will happen to the new organizations? 

Coming soon to you.  England's NICE, the organization that decides on what drugs patients receive, has turned down three expensive drugs that help leukemia patients live longer and better lives.  Can't wait for Obamacare.        

There may be hope.  The Medicare pay board is losing proponents from both sides of the aisle.  Even the Dems don't like the Board's ability to make decisions and then only allow Congress to overturn it by a supermajority. 

As we come closer to the start of Obamacare, the McKinsey group has polled many employers and found that a large percentage (30%) will stop offering insurance and pay the fine.  The more the employers know about health care the higher this percentage gets with it going up to 50%.  This will save them many thousands of dollars a year.  Top


Some South Florida OBs have stopped taking obese females due to potential risk of complications.  This is perfectly legal and probably good medical practice but some do-gooders say it goes against ethics.  Ethics can get you sued.  

In one of the most unethical articles I have ever read in a newspaper is one by Jay Hancock of the Baltimore Sun.  It talks about the one urology group in the state that has its own IMRT.  It implies that the group is sending patients there and making significant money off the machine.  The article recommends that if sent there people should get second opinions to see if it is the best place and the best treatment.  It impugns the character of the physicians.  I am not always even on an article but I am not a newspaper that goes to the general population.   

A close second is in the AHLA recent Medical Staff Publication by a lawyer in the Midwest who was a hospital administrator.  This administrator attorney writes about the disruptive physician and never identifies himself as a prior administrator.  As one can imagine the article is very biased against the physicians.  He contends that the time between disruptive incidents which he does not define is many years apart they should add to the totality of the circumstances against the physician.  I would think that if a physician did something disruptive that interferes with patient care once every ten year it should not be cumulative. He does state correctly that all incidents should be documented and if there is a huge breach the physician should be dealt with immediately.  He is worried that if all is not documented and kept forever in a file that the potential physician discipline will not stand up in court.  He doesn't worry at all about the consequences to the physician.

Another article in the same issue was interesting explaining that the feds have come against the hospital for false claims if the physician is unqualified to perform the procedure billed for.  The first case, US v Azmat, the Georgia District Court is looking if Dr. Azmat was not qualified to do endovascular procedures but did them anyway and was not stopped by the medical staff or the hospital.  This is after the hospital had been warned by the nurses stating Dr. Azmat's non qualified action. The hospital should have stopped the physician from doing the procedures but didn't. The physician and the hospital both may have to repay monies to the government. This is a new avenue for the government to get money under the False Claims Act.    

As all know the Obamacare legislation, thanks to the AHA's money, has prohibited physician owned hospitals.  Some of MedCath hospitals are divesting themselves to owners who want the income.  However, Dr. Murphy in Little Rock, the same one who fought and won against Baptist Hospital, has found a way around the ban.  He and his cohorts have banded together to purchase the shares of MedCath for their hospital.  Dr. Murphy will run the hospital and give up temporarily his medical license.  Since he is no longer a physician he can own the hospital.  Go For It!!!   

Physicians pay about $1500 per year for continuing education.  They are not willing to pay more to attend education that is not sponsored by companies.  Without pharmaceutical funding the cost would more than double for the same conferences.  The People's Republic of Massachusetts has just rescinded a law forbidding any pharmacy based lectures for their physicians.  It cost them convention money.  Now we know where their ethics are: the dollar. 

MGMA has stated that almost all physicians get signing bonuses as described by a guaranteed salary.  Primary Care physicians get about $160,000 and specialists get about $100,000 more as a first year guarantee.

An official for South Carolina has found that since the state reduced the money they were paying providers by 3% there have been no reduction in the amount of providers.  The state health department has been working with providers to help them reduce waste and therefore keep the same net money.  They don't give a definition of providers, if they are hospitals or physicians or both.  

As prices paid to physicians go down ancillary bills go up.  Many more physicians are now charging for filling out forms for camps or schools.  The charges run from $5 to $20 per form.

An interesting study in the New York Times show that the usual conservative physician is changing along with his/her employment.  The physicians in private practice usually are Republicans and the new employed physicians are usually Democrats.  Conservatives are not entering medicine in any significant number since medicine is no longer running your own shop but being an employee.          Top


WellPoint has changed the way it will pay hospitals.  The insurer is now going to use its own 51 indicators of quality to determine whether a hospital will get an increase in payments.  Normally the hospital gets an annual increase of about 8% per year.  Those hospitals that do not score well will not see any increase.  The formula is made up of 55% health outcomes, 35% patient safety measures and 10% on patient satisfaction.  All new contracts with the insurer will have these parameters.  This will allow WellPoint to reduce payments by 3-5% per year.  They have been experimenting with this approach since 2004.        Top


In the past twenty years almost one third of the EDs in the country have closed.  The reasons are simple the people are uninsured and not paying the bills. The study came from the  left leaning University of California at San Francisco.  They conclude that market based approaches to health care do not ensure that care will be equitable distributed.  Of course, in the People's Republic of Massachusetts they have less and less physicians since they put in their version of health care reform.   

Dr. Jesse Cole who recently won a $4 million settlement against St. James Healthcare for illegally firing him has now claimed that the hospital is guilty of financial malfeasance.  He states that $50 million of bonds meant for building is unaccounted for.    

The Boston Globe continues to report that some prestigious hospitals are paid much more than community hospitals for the same procedure.  An example is Mass General gets $10,000 for a simple C-Section and Cambridge Health Alliance gets only $5000 for the same procedure.      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.