California Anthem was scheduled to raise its premiums to over 600,000 individual members by an average of 18%. Nobody said they were stupid. The regulators who have no power in California got on them and Anthem relented all the way down to a 14% increase which is where they wanted to be in the first place, although Anthem states that even the full 18% raise would cost them money due to rising health costs. Some subscribers will still see a 25% increase in their premiums. The HMO premiums will go up about 15%. Top
The LA Times has an article about the potential for significant rate increases when the exchanges start in January, 2014. This is especially true of the young people without insurance through work. They will pay the majority of the premiums for the older sicker non-Medicare patients and the new required benefits. California has written to the feds warning them as has Oregon who expects a potential 30% increase in premiums. Since the law precludes insurers charging the sick and elderly more than three times what they charge the young and healthy, they need to charge the young and healthy more to cover the elderly. If the insurers charge the young too much they will drop out and pay the small penalty. This will leave the older sicker patients in deep doo doo. The states want to avoid this by having the rates come in over several years. This can not occur since the people who passed the law without reading it said it must come in at once.
The New York Times has an article about companies self insuring to get away from Obamacare rules. This is especially true for companies with young workforces who will pay substantially less for the self insurance than for Obamacare. This has already started with more and more companies starting to self insure but with secondary stop gap insurance. The feds are thinking about putting in new rules to prohibit this but have been warned by the Republicans that they will not let it pass.
Obama is again stretching the truth to its breaking point and possibly beyond. His rhetoric against the upcoming sequestration continues to escalate. He is becoming to sound more like Hitler in that if you tell a lie often enough the people will believe it. He wants the people to think that the cuts will be instantaneous and dramatic. They will not be according to the New York Times. They will "ripple" across the federal agencies. Officials have said Obama's statements are bogus although more nicely since he is their boss. Even the impartial CBO has stated the cuts will probably be only half of what is predicted by Obama. Top
InformationWeek is stating that physicians are finally pushing back against IT workflow demands. They no longer want to just follow protocols but to use the protocols along with their own thoughts.
Seventeen Medical groups have compiled a list of procedures that they deem overused and potentially harmful. They agree that these procedures are necessary for some but not all. The LA Times did not list the procedures except for doing too many pediatric head CT scans for trauma, early C-Sections and Pap smears for middle age women.
Physicians beware! The feds are looking after your billing more than any time in the past. They are using the old fraud laws coupled with the new Obama laws to closely scrutinize the billings. If the feds come to you, you must be able to show your compliance with all their rules, most of which you have never heard of. It would be in your best interest to be proactive to make sure you are compliant in all aspects of your business. The best way I know for you to do this is to contact people knowledgeable in the compliance field such as Dr. Wilner of New Orleans or the more expensive compliance attorneys. You need to do certain things that includes to become knowledgeable of general fraud rules and those specific to you, get to know your risk areas, get a compliance plan, create a code of conduct, make sure that all your staff know the plans, audit and update the plans on a regular basis, have a system to respond to problems and impose standard discipline for violations.
Physicians are not rushing into the ACO scheme. Those that are on salary don't care but those that were and are independent care a lot. They do not wish to go from the familiar fee for service to the nebulous value pricing. This is especially true for specialists. It becomes difficult for physicians when and if they are told the truth that they will be an ACO but their patients will not. They are free to go to whatever physician they want, unless they are in an HMO, and the ACO will be responsible for the quality of their care. Top
I am happy that Mass General is so wealthy. They had a 11 minute video they wanted their employees to see but did not want them to take time away from work. They wanted them to see it during their off time. They decided to pay each employee who went to watch the video $250. That translates to just under $900 per hour per employee. About 20,000 employees watch the film so the total cost was $500,000. It should be noted that this is compulsory in other hospitals. As an aside they paid $50 to each employee who received a flu shot. 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