March 15, 2010 Recent News





In Oklahoma the physicians are getting a 3.25% Medicaid pay cut.  The state recommended a 6.75% cut.  A survey stated that 1/3 of the physicians will stop seeing Medicaid patients leading to a problem with access. In fairness Oklahoma is a rarity in that its Medicaid rates are equal to Medicare rates and not the usual 72% of Medicare as in other states. 

Boston Hospital was in financial difficulty.  The medical department chiefs decided to take each a $27,000 pay cut.  This saved about $350,000 and allowed most jobs to be saved.  The hospital is now in the black and the physicians employed are getting 3% pay raises over their 2009 pay.  

Neurosurgeons are a stubborn lot.  They have decided that unless the SGR is eliminated that they will cut back on seeing Medicare patients and the procedures they perform on them. This is from a survey of national scope.  This has already started in the Southwest where access to neurosurgical care is difficult.

Tennessee physicians are also being forced to stop seeing both TennCare patients and Medicare patients due to lagging fees over inflation.  There is also a rise in physicians forming larger groups and going the hospital employed route to continue getting money.  

A story in the Ventura County Star in California state that some physicians are cutting out new Medicare patients because of the potential for the 21.5% cut.  This allows more time for other patients or to have leisure/family time. 

A story at about a family physician in North Syracuse, New York, talks about his finances.  He sees 130 patients per week and 30% are Medicare and 65% have private insurance.  His fixed costs without salary for himself is $60,000 per month.  His revenue is $800,000 per year which includes $100,000 in income.  If a third of the money is cut the 21% he loses $5,000 per month. Since fixed charges are fixed the deduction needs to come from what he clears per month.  Since Medicare pays about 65% of billed charges, it now turns into a losing proposition.  He then becomes a minimum wage earner, eligible for food stamps.  

Physicians are also complaining that the new EHR meaningful use rule will make them lose their productivity.  The MGMA believes the goals of the meaningful use are not doable.  It would take so much time to do the necessary things involved that new staff would need to be hired and the physicians would lose time with their patients making access harder.  There are those who believe that there is not an EHR that meets all the criteria for meaningful use.    Top


I don't get it.  The People's Republic of Massachusetts has put in universal health care but has forgotten how to fund it. They now want federal money to help fund their hospitals.  If the federal government puts in universal healthcare who will they want to fund that which they can not.  I believe you are looking at him/her.  Several nights ago I was speaking to some Canadians sitting next to me at a show.  They love their health care but go to the next province for urgent care they pay for and pay almost a 60% taxation. When they come to the US they must return every 60 days to continue the special insurance they purchase to come out of Canada.

The Republic also wants to review all insurer requests for increases that exceed 4.8%.  The insurers have asked for rate hikes for between 8% and 32% by April 1, 2010. The insurers state that if they don't get the raises they will have to cut payments to the physicians and hospitals causing some hospitals to close.  

Duh!  The Republic hired (yes, paid them) consultants to come up with the startling conclusion that there are alot of imaging being done and the cost is going up.  The biggest jump has been in digital mammography and the doing of imaging in lower cost settings to higher cost hospitals.  The cost of care for a Republic person is the highest in the country, as well it should be as they have less incentives to try and control their usage.  It was found that EMRs are instrumental in getting physicians to send patients for MRIs to hospitals than to independent entities.  The MRI cost double in a hospital.

The lawmakers of the Republic are finding that again they are running low on cash to fund their Obama lite program.  They will "tweak" who should pay a penalty for not having health insurance.

State insurance commissioners are telling Obama that his self appointed panel of people who will be setting insurance rates is not feasible.  The states are the ones who have to balance how much an insurer charges with their ability to stay in business.  They state that artificially low premiums are bad as that would mean less insurers and more out of pocket.  The commissioners want anything the panel does to be a floor and not a ceiling.  Anybody believe that Obama is listening.  If so, there's a bridge I want to sell you.

The panel will also be looking at comparative effectiveness.  Currently there is no studies of note on this subject.  Medications and procedures are benched against placebos and not each other.  

The seniors that have Medicare Advantage programs will see double digit inflation on their monthly costs.  This comes at less money flows to the Advantage plans from Medicare.  

The American Cancer Society has come out with a rehash of their old prostate recommendations with one major addition.  They continue to state that physicians should discuss PSA with their patients prior to doing the test.  Of course, patients already know about the test and will go to another physician if their physician will not give it to them.  The new wrinkle is do not do any further mass screenings as it does not add life span to the patient.   

Nurses are complaining that they are spending three hours of a 12 hour shift (why are they working 12 hours?) doing non nursing paperwork.  They also were wasting time to secure equipment and supplies.  The survey also found a disconnect between CNOs and front line workers.  

Secretary of Health Sebelius has again exceeded her authority for political gain.  After WellPoint Anthem Blue Cross gave Obama a talking point on a silver platter, Sebelius at first ordered the insurers to justify their premium hikes.  She has no authority to do that.  She then urged the insurer CEOs to justify the raises voluntarily. 

California insurers were doing thousands of patient rescissions and the Dept. of Health stepped in with regs top heavy in favor of the insurers.  To no one's surprise very few people have gone through the process to settle with insurers. The Department of Insurers will not look into the reasons why people have not gone through the process. 

I do not understand why New Jersey is surprised to find that the resident physicians they train do not want to set up practice in the physician unfriendly state.  They can get better offers with less med mal problems elsewhere and are.  Only 1 in 3 residents plan on staying in the state.       Top


The Salt Lake Tribune has found that retained foreign bodies are rare.  They occur mostly in OB/GYN procedures.  The paper found the problem in 25 of 200,000 surgeries in the past year.

Public Citizen, the political activist, physician hating organization, has now stated that med mal payments have gone down and that this coincides with a decrease in reports to the NPDB about how many pay out money for med mal.  They then extrapolate and make their usual political bull stating that "litigation accounts for a minuscule fraction of health costs, small enough to be a rounding error."  They seem to forget how much money is spent to prevent loss of time and publicity defending a med mal law suit even if the physician wins.        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.