March 15, 2016 Recent News






The four largest Obamacare insurers in the People's Republic of Massachusetts are losing money due to both Obamacare and the rising costs of prescription drugs.  Maybe they can make it up on volume.  Lahey also lost money due to their installation of an Epic EHR. 

Mayo also went to EPIC and is planning to spend $1 Billion.  Think about the patients that could treat.

Medicare is losing about $3 billion per year due to the packaging of oncology drugs.  The manufacturers package the meds in vials that have more than the need doses.  The remainder must be tossed.  In Europe some are packaged in smaller vial sizes.  Non-cancer drugs were not included in this study.  

Oscar Health Insurance system, a startup Obamacare insurer, lost $105 million in 2015.  They lost $92 million in New York and the rest in New Jersey.  Some of the loss was attributable to startup but the majority was due to  costlier customers and a shortfall in fed programs.  Oscar is now entering California and Texas but with limited networks.  Oscar continues to raise money from angels.

Health Care Service, the parent of Blue Cross of Illinois, lost $1.5 Billion in 2015 in its individual book.  This was due to Obamacare.  They will be raising rates and narrowing providers enough this year to not book a reserve.  

Last year the average Obamacare premium went up 5% after financial assistance was factored in.  Before assistance the increase was 9%.  This is for the people not the states who often saw double digit increases.

A poll by the left leaning NPR says that only 15% of Americans have personally benefited from Obamacare and just over 1/3 say it has helped the people of their state.  Over 56% have not been affected at all and of those that have been affected 26% say have been personally harmed by Obamacare.

The chief supporter of the expensive insurance that bears his name again stretched the truth.  President Obama in Milwaukee said that Obamacare had 20 million insured.  Well, that 2 million includes the Medicaid expansion and the young adults who stayed on their parent's insurance until age 26.  

The Hill reports that Obamacare only fell 2.5% below target.  What they do not say is that the administration changed the target and made the target very low. 

Obamacare will rate insurance plans by how many physicians and hospitals they include in their networks.  They also increased the out of pocket costs in both individual and family plans.  This is on

After all  the hoopla by CMS on how they are going to change the payments and after Obama says that 30% of Medicare payments are now in alternative means of therapy, it turns out that 95% of of provider visits are fee for service.  The remaining are capitation.  This was a recent study based on 2013 data.

CMS is setting up a real problem for the oncologists.  They had been paying at 6% of the average sales price.  This means that the provider gets paid more to use the higher price drug.  These high price drugs work so well that account for the majority of Part B drugs. They will now experiment with about six different ways to pay.  

The WSJ has an article on buprenorphine (methadone), a medication to treat addiction.  They say that only 32,000 physicians in the country can write prescriptions for the drug.  It can only be prescribed by physicians who have taken an eight hour course and applying for a special license.  Originally they could only prescribe to 30 patients but they law now allows up to 100 patients at a time.  The feds want to lessen the hurdles to be able to prescribe the drug but the physicians are not flocking to apply to prescribe it.  Only 2% of the physicians are licensed to prescribe the drug.

The Washington Post had an article on the dreaded physicians who comprise the USPSTF.  These are the ones that determine whether or not your insurance will pay for the PSA or mammogram and they are not oncologists.  This august organization was created under Reagan in 1984 and originally only met rarely and did not issue sweeping proclamations.  It was meant to have non cardiologists and oncologists on the panel.  They really got into trouble in 2009 when they raised the age for mammograms from 40 to 50.  This required a back-pedaling by Sebelius.  Even Congress voted to waive the guideline.  

The culture at the VA never changes.  The whistleblowers state that the wait times are still being manipulated by the institutions.  The IG also states that the investigations were incomplete.

California insurers wants to have a huge health information exchange.  The providers of care do not share their vision and are not willing to share their information with the state.  Cal Index was formed by Anthem, Blue Shield and Kaiser.  They want to pay single fee as opposed to per member per year.  They believe they can save 2%-3% per year by getting rid of duplicative testing.

New York has a law that not only requires electronic prescriptions but fines physicians who use paper.  The physician must also check a central repository before e-prescribing a controlled med.  The easy way to game this is for a patient to misspell his name for the physician so nothing will show up on the registry.  If the pharmacy does not have the prescribed medication the physician will have to cancel it by phone and e-prescribe it again.  Written prescriptions will be allowed if technical problems, not for a medication or if filled out of state.  

Puerto Rico is losing physicians fast.  They are leaving for higher pay on the mainland.  Almost 2/3 of the population is covered by either Medicare or Medicaid and pay far below what other states pay.  Patient waiting period to see specialist may be up to six months.  

The British NHS has many problems.  Their nationalized system of healthcare allows for the countries physicians to strike.  They have done so.  They also have the opposite problem than in the US.  they have nurse and physician posts vacant.  This is a recruitment crisis for the country especially if you combine tit with the potential of losing some of their junior physicians due to their NHS stubbornness.  There has been a 50% increase in vacancy rates for nursing and a 60% increase in physician vacancies.  The lack of nurses has made the hospitals rely on agencies which has led to a financial crisis in the NHS.  The NHS is now recruiting from abroad.  The NHS continues to stonewall, like all governments.        Top


The feds announce a long needed policy adopted by nearly all companies that provide digital health record and 16 of the largest hospitals an health systems to adopt a universal language and to allow patients to monitor their own information.          Top


New York public hospitals are in personal doo doo.  They are losing so much money that they are in danger of having to be bailed out or close.  Things are not getting better since Obamacare decreases the payments for disproportional share.  

Denver Health is a level 1 trauma center for now.  That should change soon with 3 of the 5 neurosurgeons on staff quitting.  They have also lost their CMO and the chiefs of Medicine and Surgery.  The article in the Denver Post had multiple comments by nurses and physicians who say the administration is the cause as they have switched to a bottom line strategy.  They all believe the hospital is headed for ruin.  In a separate article in the Pueblo paper it details the death of a person who was transferred to Denver Health and that death is under evaluation.

Kaiser Permanente stated several months ago that they want to build an non conventional medical school.  they have now chosen Pasadena for their school due to proximity to their hospitals and the diversity of the area.

Kaiser better get this up soon since the nurses at the Los Angeles Medical Center are going on strike for more money and better care.  This is one of the hospitals that Kaiser is planning to use for its new medical students.

The San Francisco Business Times reports that Sutter Health had a massive 80% decrease in profits.  This in spite of an increase of 9% in operating revenue.  They lost major money on investments due to the stock market decrease and an increase in expenses by 10% due to salary and benefits increases.  They also spent $712 million more on treating Medicaid patients than paid for the services.

Emery Hospital in Atlanta reports that two pharmacy employees stole about one million doses of controlled substances over four years.  It is inconceivable that the hospital did not catch the illegal scheme earlier.  This speaks poorly of the administration.

Puerto Rico's Santa Rosa Hospital, a small privately owned coastal hospital, had its power cut off by the Electric Power Authority.  The hospital owed $4 million.  A judge then ruled the power company must continue to supply the hospital. When that may happen is unknown.        Top


MGMA did a survey and found to hopefully no one's surprise that reporting quality measures for physicians is not only costly but not helpful.  They found that in four common specialties 785 hours per physician was spent.  This translated into $155.4 Billion or $40,000 per physician per year wasted.  This meant that 12.5 hours of physician and staff time per week was spent on this activity and getting worse.  Only 28% of practices surveyed used the quality scores to focus improvement activities and 27% said the current measures were moderately or strongly representative of the quality of care.  When you read this in context the reporting is really dumb.

Physicians are supposed to receive bonus payments from CMS for doing high quality cost effective care.  In reality only 1/10 of 1% are receiving the money.  Why bother to report and waste time and money???

It appears that PCPs take some recommendations seriously.  They have halved their use of the PSA.  Fortunately urologists only reduced their use by 4%.  

I normally do not include obituaries but there is always an exception.  Dr. Quentin Young recently died at age 92.  I knew him while I was in my internship and residency at Cook County Hospital in Chicago.  While our politics differ, he was a strong advocate for the ending of discrimination in Chicago hospitals and a single payer system.  Above all he was a very good and compassionate physician.  The world was better for his being in it.  RIP.        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.