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California Blue Cross and Blue Shield (two separate companies in California) are charging safety net patients significantly more than the state allows. Blue Cross is charging 36% more than the state allowance and Blue Shield is 55% higher. This is for COBRA insurance. When this was pointed out to Blue Cross they immediately corrected the problem. Blue Shield, which was started by the state physicians before the corporate takeover, refused to acknowledge they were at fault and would not change their pricing. Blue Cross will send refunds to those overcharged. The state has a statutory method to determine rates that blue Shield has continually ignored. Blue Shield said they would only change if ordered by the state.
The Preventative Services Task Force run by HMOs who want to save money stated that colonoscopy only need to be done every 10 years or a sigmoid exam performed every five years with fecal occult blood testing yearly in-between or just yearly with fecal occult blood tests. This will save alot of money for the insurers that run the task force at the potential for harm to patients. Yet another reason for physicians to think and not follow directives blindly.
Cigna has developed and many physicians are using a new program that estimates the patient's share of a visit. The provider may then charge the patient and collect immediately for the service. This is happening more in both physician offices as well as hospitals. The patient has always had to pay the co-pay at the time of service but now also any share of service. Patients are now being told about this payment at the time the appointment is made. Top
The wonks now believe all is well with physicians utilization of electronics. They are wrong. The stimulus bill did indeed help with the cost part of the problems but the more important detrimental parts are still present. The problems with less face time with the patients, more work to learn the system and further costs in the future to continue to upgrade at the whims of the wonks. These upgrades will be at the physician costs and will be expensive. The Advisory Board that works for hospitals and care nothing about physicians have stated that most data is now in a useless format. This is true for both hospitals and physicians. They want pure electronic data abstraction for the ability to get more money from the feds. They don't care about whether or not the systems are interconnected. The important thing are the insurers which reap the benefits without paying money. The physician will get nothing for their change to EMR.
In a recent article in Medscape Family Medicine, a non clinical medical writer told about the physician problems with EMR. Many of them were the takeover of the system by administration and the omitting of the medical and nursing staffs from input. This left nurses to be typists and not bedside people for which they are trained. The clinical people complained about the time it takes and the lack of effectiveness of the programs.
Healthcare IT News states that a survey shows 2/3 of the hospitals surveyed are reducing or cutting out any IT programs due to the economy. Also just over 1/2 of the hospitals have an IT hiring freeze in place.
Time has an opinion piece by a physician who believes that the set up costs of EMR is only a drop in the bucket of the total cost of the use of electronics. Not only will the upkeep be very expensive but the most bothersome is in the decrease in the quality of medicine. He believes as does many physicians that EMR is only good for insurers and administration. It poses significant hassles on physicians. CPOE makes practicing even harder. One does not know if the computer input is ever seen by a real person. One can not enter things like "patient can wear own pajamas" or "please get the x-ray I ordered for yesterday". Electronics is good for billing but also may be used to have billing tell the clinician what to say or do to justify the billing a higher code, such as examine a separate body part than what the patient came in for, even if not necessary, so we can bill a higher code. In money savings, physicians know how electronics save money, denial. Top
The healthcare people who deal with numbers and not people say that there are too many uninsured and they are growing. This may be true but it isn't relating to the uninsured being admitted to the hospital. A recent study by the Agency for Healthcare Research and Quality have showed that the number of uninsured that are admitted to the hospital are up 34% IN 10 YEARS. Most hospitalizations of the uninsured are, as one would expect, from the ED. The most common are for deliveries. The study went on to state that only 60% of the uninsured were from the poor. The other 40% are from the middle and rich classes. The average hospital bill for the uninsured was about $19,000. All know that the bills are not real but made up numbers. This does not take into account the money the hospital actually receives from payors.
Kaiser Permanente is in financial trouble according to the San Francisco Business Times. They lost $794 million in operations in 2008. The plan is started the process of not using outside consultants and laying off their administrative staff, which was very top heavy.
The Massachusetts General Hospital had an outbreak of nausea, vomiting and diarrhea on one of the hospital's floors. They did not inform the communicable disease organization of the city for four days. They will get a major fine for this.
The AHA continues on its quest to stop competition since they can not win in that arena. The problem is the charge on this issue is being led in the Federation of American Hospitals by the well financed large for profit chains. The other hospitals want to start focusing on other issues such as reimbursement. This is causing a rift in the organization.
The People's Republic of Massachusetts deserves an A for being able to survive with their idiotic care. They have found that the state's OBs are not enough to cover the population due to late hours, work life balance, poor reimbursement, and high med mal premiums. They have entered the states with something called laborists. These are OBs that only spend a shift on duty at a hospital. They have no private practice and have never seen the woman they are delivering prior to the delivery. It would help if the woman's OB would explain the procedure to the patient during the pre term visits.
The Republic also has an organization called BTE that gives out money to physicians who by the use of electronic records show that they are inexpensive and abide by the guidelines. This year 240 physician have received money from the organization. The article does not state how much is given per physician, only that they have given out $2.5 million to date, whatever that means.
Public Citizen and Physicians for National Health Program, two organizations that want socialized medicine have come out stating the Republic's health plan is a failure. They are against the use of private insurers. They have let their biases get in the way of their logic. I agree that it is a failure but because it is costing the people of the Republic much more money than they were told it would cost. I dislike lying governments. That is my bias.
The Obama regime has learned from the Clintons. The era of secrecy is out. Obama has appointed a new Secretary of HHS and named Nancy-Ann DeParle to coordinate health policy. There are many strong personalities already on board and of course to date there is not anyone that actually practices medicine on the committee to redo medicine. This was one of the major problems with Hilliarycare. Top
A report in Pediatrics complains that state medical boards are too lax on renewing licenses. They complain that in peds one of eight physicians have been away from the practice for over one year and may be clinically incompetent. The Federation of Medical Board have to date not pressed the issue. They will recommend that physicians applying for re-licensure fill out a form that attests to their medical knowledge and be tested in their practice area. Each state would be responsible for initiating its own rules. That has some drawbacks as do many sweeping rules. Some physicians may be becoming re-licensed not to practice but to do administrative medicine. Top
Two nurses at Lake Geneva, Wisconsin, Mercy Walworth hospital were fired for taking a cell phone picture of a patient's x-ray and putting it on the internet. The x-ray taken by the two nurses separately was of a sex device placed in the rectum. 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.