June 15, 2013 Recent News





The LA Times reports that California insurers Blue Cross and Blue Shield owe small firms millions of dollars in rebates.  Blue Shield need to reimburse $24.5 million and Blue Cross $12 million under Obamacare.  The insurers did not spend the minimum 80% of premiums of health care for individual and small business.  Last year they paid $74 million so there is some improvement. 

A 2006 California law is paying dividends.  The law determines a cap for how much a hospital may charge an individual who is uninsured and earns less than 350% of the federal poverty level or whose annual medical expenses exceed 10% of their income.  The cap is the Medicare payment the hospital would have received for the same treatment.  California being on the left coast has a stronger mandate that Obamacare which only states that not for profit hospitals should play nice and give discounts to people who qualify for financial assistance, whatever that may mean.

California Kaiser has become the high price spread.  They are going to change more than the other major insurers for Obamacare patients.  This is probably to keep out patients that would overwhelm their supply of physicians or to not use up their resources on sick people.

It appears New York City has finally woken up.  They will be hit with the significant "Cadillac" tax under Obamacare.  It is a 40% excise tax for bloated insurance programs.        Top


QuantiaMed has a study that shows about half of the country's physicians can and will not take on Obamacare patients.  These physicians are currently full.  California again led the way wit 55% stating their practices are full.  The People Republic is on the opposite end with 56%  willing to take more patients.  Most of those physicians are employed where California forbids employment.

The Annals of Internal Medicine reports that 55% of the nation's physicians are not meeting the meaningful use standards for electronic medical records set by the government.  My only comment is that they are smart not to fall for the EHR nonsense.

The AMA had a story about how prepared physicians are and should be regarding Obamacare and it's surrounding facts.  They need to know what insurers will offer insurance in their state or county and if they are a member.  They need to know how much they will be paid and if they want to participate in exchanges.  They need to know about the Sunshine Act and what this means to them.  They need to know about EHR and bundling.  They need to know about ACOs and when they may become the primary care provider even though they are a specialist.  They need to know when insurers do not need to pay them and they are on the line for the bill.

The AMA had another article on the unfunded physician mandates that will take a lot of time and for which the physician will be paid nothing.  These include the new home health mandates under Obamacare which requires special forms as well as face to face visits either 30 days prior or 90 days after signing a form for patient home health.  Don't forget the old stuff as well such as the physician must pay for the and not ask the patient for money for interpreter services.  

CMS has sent it's annual email to physicians asking them about their pay.  This time it is more crucial since their will be a change to quality of care measures, whatever that may mean.  The physician will have to show improvements of health by what the physician has done.  For example, if a physician orders a HbA1c test and it is abnormal, the physician will have to show an improvement in the test.  In reality no one knows to what extent the feds may go and how many physicians will leave practice because of it.

Jackson Healthcare has done a survey and found to no one's surprise that 42% of physicians are currently dissatisfied with the practice of medicine.  The survey of almost 3500 physicians showed that the major problems were decreasing autonomy, low payment and administrative hassles.  Add the current level of dissatisfaction to the new CMS payment issues and watch the doors swing as the physicians move to retirement or other parts of medicine away from insurance.        Top


Health Affairs has a study that Obamacare will take the 48 million uninsured and change that to about 30 million of which almost all will be American citizens.

Expect to see many items about how good Obamacare is and how great the exchanges are in the next several months as we reach the October 1 start of registering for the exchanges.  The Kaiser Family Foundation has stated that people who purchased their own medical insurance in the past year have saved a total of $2.1 Billion.  This is due to the requirement of 80% of premiums must be used for medical purposes and not administration.  This may also be because of several years of less use of medical insurance and health care spending due to the poor economy.  Many of the administrative cuts were done to the individual insurance brokers, not the ones needed for group insurance.

Obamacare will probably be unaffordable to minimum wage workers who will remain uninsured.  The law states that employers must offer affordable policies but these may be too expensive for low wage earners.  The employee must still get insurance under the law.  Now comes the exchanges and their high prices.  No insurance there.  If they make over $15,900 no Medicaid.  Now comes fines.  This is directly tied to not taking the law prior to passage to a House Senate committee to work out the kinks.  

The IRS conducted a raid on a large healthcare facility and obtained the medical records of 60 million.  There was no warrant and no judicial approval.  There is no way of knowing how the IRS will protect the privacy of these records.  The reason for the raid was to investigate a former employer of a health care provider.  

Who loves the VA?  The numbers are shrinking fast.  They have in retaliation for the Gulf War Board going against the VA in recommending research that may lead to higher VA benefits, gutted the Board.  The Board was independent but will now be staffed by VA people.  The great transparency of Obama just got very very foggy.        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.