June 15, 2015 Recent News





Medicare has released the new report on spending.  It shows the most money was spent on hospital procedures.  It also showed that oncologists were the biggest beneficiaries of the public largess.  However, it also took into consideration this time the money that physicians got for drug costs.  The top hospital charges were for knee and hip replacements with significant variation in the various sectors of the country. The top garnering physicians are ED docs, anesthesiologists, pods and ophthalmologists.  The release does not count Medicare Advantage programs.  

Medicare Advantage is costing taxpayers mucho dinero due to upcoding.  The upcoding is because Medicare Advantage plans get more money for risk scores. This is not true in fee for service.  The Advantage enrollees have a 6% to 16% higher risk score than they would under traditional Medicare.  

Insurers across the country are seeking major premium hikes due to the high losses due to drug costs and better data on how sick patients are.  The administration believes that states will tamp down the requested increases as the fed as no power to influence rates except by shaming.

Of those that signed up for Obamacare this year about 13% have left by not paying premiums.  This left enrollment at 10.2 million, not the 11.7 million originally claimed.  This is an increase over the previous year.  Out of those 8.7 million are receiving subsidies with an average of $272 per month.

Next year promises to even more challenging for Obamacare.  The federal exchange, if it still exists, will raise rates by over 5%.  The state insurers are raising rates an average of just over 12% and about 14% on the most favored silver plans.

The above goes along with the knowledge that healthcare spending has increased 7.2% in the first quarter this year compared to last. This is due in the most part to increased hospital charges.

Even with Obamacare the gap insurance market is flourishing.  Gap insurance is short term non compliant insurance.  They are high deductible high out of pocket costs that usually cover hospitalization.  These jumped to 140,000 signing up this year versus 60,000 last year.  A report states that of the $5 Billion price tag for health care about 30% is wasted on inefficient billing such as the use of paper records.  Of course if the small office billed on electronic they may fall under HIPAA and incur a huge bill for all the wasted nonsense required.

Those under Obamacare are still skipping care due to the high co-pays.  The high co-pays are a direct result of the mandated care and high premiums.  Several states have gotten rid of co-pays by increasing premiums.

The VA whistleblowers have gotten together to push for changes within the VA system.  They contend there has been window dressing but no substantive changes.  They also say there is little hope of significant change as long as the same managers that fire whistleblowers are still in place.  They say the VA moves them around but does not fire them.    

The Samsung Hospital in Korea has suspended services due to the MERS epidemic there.  To date 145 cases have been identified and 15 have died.   The outbreak started when a businessman came back from a trip to the middle east and was hospitalized at another hospital.  The Samsung Hospital allowed an employee working in the ED with symptoms to continue working.  He has infected many others.       Top


Partners Healthcare in Boston has just laid out $1.2 Billion for a new EPIC system.  What a waste of healthcare money.  

The height of stupidity is healthcare going like lemmings to the EHR instead of simple computers for billing.  Now that billions have been spent getting these records, Billion s more must be spent to protect them.  Politico states that each stolen record is worth $50 on the black market and it costs about $20 for each record hacked.  Currently it is costing about $6 billion per year due to hacks.  Hospitals do not do what is necessary to protect the EHR due to money.  Hospitals should be spending about 10% of their IT budget on security not the 3% they are currently spending.  There is also a need for top security people in the healthcare industry.  The salaries are now in the $250,000 range.  Now that government has been hacked maybe money will be spent to get the hackers and protect computers.

Big brother is here.  Some hospitals and surgical centers a re taping all surgeries.  The tapes are then sent to outside reviewers to determine if the surgeon is any good.  I wonder who looks at the reviewers?

A study in Health Affairs states that 50 hospitals in the US charge uninsured more than ten times the cost of the care provided.  The hospitals are mostly in Florida and owned by Community Health Services.  They are mostly for profit.  Most hospitals charge at 3-4 times actual cost.  To determine the actual cost of care the researchers used the Medicare allowable costs, a skewed starting point.          Top


There was a recent article in Medscape detailing a problem with a physician who was not allowed to see her billing records.  The author is anonymous since she is being sued by her employer for breach of contract.  The physician found that the employer was upcoding her records and falsely adding information to the medical record.  The physician resigned and is being sued for the breach of contract.  Could this happen to you.  You bet!!  I personally know of a physician who was barred from Medicare just because his number was used by the employer.  All should be allowed to see their own billing records and all should do this periodically.  If one is applying for a job and the contract will not allow you to see records go elsewhere.

There was a recent article in our local paper regarding Stanford senior (over 75 years old) fighting and winning an argument over whether or not they all should get mental exams and physicals.  The aged ones felt that they knew when their facilities lagged and it was time to quit and a specific age was not the answer.  The University backed down on the mental exams (the physicians were all major grant getters) but they still need to get physicals.        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.