March 15, 2018 Recent News





Some states have made Medicaid expansion contingent upon the recipients paying some of the premiums.  This was to have people get some "skin in the game".  In Arkansas very few, only 20%, are paying the $13 per month premium for those whose income is above the poverty level.  Enrollees in the other Medicaid states that enacted the same rule are finding the same thing.  In Michigan just under 50% paid their premiums.  The key is there is no penalty for not paying.  Arkansas and Michigan will attach the non-payers income tax refunds.  

Healthcare just got more expensive when Cigna agreed to purchase Express Scripts for a large premium over it latest stock price.  This continues the vertical integration between pharms and insurance companies.  Anthem had already said it was dropping Express Scripts.

The WSJ had an article exposing the Medicare Advantage scams on the feds.  When they get their payments the amount depends on how high a ranking or "stars" they have.  The higher the ranking the more the payments per patient.  What the Advantage plans do is when they have a low ranked plan they merge it with a higher ranked plan to increase the payments.  The term for this is "crosswalking".

How could two breakdowns of refrigeration units in two areas thousands of miles apart happen simultaneously?  This happened this week in San Francisco and Cleveland.  This damaged thousands of human eggs stored for fertilization.  Several suits have already been filed.

ProPublica has an article that insinuates the firing of civil servants at the VA is a bad thing.  It is not.  They used the article to bash President Trump because of new law signed last year allowing the easier firing of VA workers.  They attempt to say that just because only four out of 1704 employees fired were VA top officials.  The others also were bad apples and needed to be gotten rid of.  If there is any problems with the law it is letting the whistleblowers be fired.  Wouldn't it be wonderful if this would work in all federal agencies to get rid of the deadwood in civil service and get back to merit based hiring.

Why does the US lead the world on healthcare spending?  A report by the Commonwealth fund and reported in JAMA says we do not use significantly more services, we do spend an good amount on social services to prevent health problems, we do not have too many specialists and not enough primary care physicians, and fee for service is not a problem.  The reasons for our high spending is our prescription drug costs, our administrative costs are very high and the granddaddy reason is healthcare is just expensive.  

Great Britain may not be great in the medical field for long.  When GB leaves the EU some of the physicians and nurses from other EU countries may also leave GB.  About 20% are in the process of selling their homes and looking for other jobs elsewhere in the EU.  About 10% of physicians and 7% of nurses are EU nationals.  The EU nationals have a sense of rejection by living where they are not wanted. 

In Kenya, about 700 registrars walked out of Kenyatta National Hospital in Nairobi because a registrar was punished for the erroneous cutting open the skull of a wrong person for neurosurgery.  The registrars believe that the attending physician should be held liable as should the hospital protocols or lack thereof.     

Zimbabwe physicians have gone on strike for better pay and working conditions.  The country has a new president and is mired in unemployment (over 80%) and cash shortages.  The physicians state the hospitals do not have drugs nor sufficient equipment.  All public hospitals are effected by the action.       Top


California Healthline is doing the hospital's bidding.  They did a hatchet job on surgery centers for not having 24/7 medical response.  They reported on Kaiser Health News report that pointed out that physician own the centers and therefore get money from the operations.  A true statement but loaded with innuendo.  Local hospitals must back-up surgical centers even if they are not next door.  Another true statement is that surgical centers sometimes do patients that should not be done due to pre-existing conditions.  That is not a surgical center problem but a physician problem, both the surgeon and the anesthesiologist.  Sometime it is also a problem of insurance making the patient be treated in the outpatient facility.  Most problems from centers are not the centers but the personnel.  They want the patient out early so they can go home.  This could lead to problems with respiration and blood pressure problems.  What is not said in the article is many of the surgical centers are actually owned and or run by the hospitals with no physician involvement.  They also do not talk about insurance companies demanding that certain surgeries be done in a surgical center and including more complex surgeries in their demands.  Are there problems?  Yes there are but most are due to physician or nurse error which could happen even in a hospital environment. The article used multiple incidents over a large period of time and throughout the county but the total percentages are very small.

The VA continues to be in the news and not for good.  This time it is the Washington DC VA.  The VA IG found medical supplies in unclean areas and bad staffing problems.  They also found million of dollars spent without any controls to see if they were necessary.  

Powell Valley Healthcare in Wyoming is coming out of bankruptcy.  They filed for protection in May 2016 because of about 20 med mal suits filed against them and a surgeon Dr. Jeff Hansen, who left in 2014.  For the patients that filed suit against the hospital they will split about $6 million under the bankruptcy plan.  Half will come from their insurance company and half from them, or the taxpayer of the region.  Other insurers are still potentially on the line.

In the last newsletter I talked about the CEO of Sparrow Carson Hospital in Carson City leaving after the hospital was found to be deficient in infection control.  The findings were after a whistle blower nurse who complained of high infection rates by orthopedic surgeon Raymond Allard was removed from the hospital and has sued.  Now the CNO Barb McQuillan is also gone and good riddance to them both.    

All know that Illinois is riddled with greed and political corruption.  Now the University of Illinois is at the center of a new probe.  This one is about the University choosing EPIC over Cerner.  Cerner is saying that the University's choice is going to cost the taxpayers of the state an additional $100 million over the use of Cerner.  The University is stonewalling the reasons for choosing EPIC.  The State Procurement Board will have all parties in to explain themselves.      Top


North Carolina's Atrium Health is having their employed physicians take pay cuts.  They want their 2000 physicians to come into line with national compensation benchmarks.  But these are not for all but only for those who are fungible, the primary care physicians.  Atrium has said only a small percentage of physicians have left their employ to go to a rival hospital.  The rest are specialists and being paid good money or sheep.

Neuroscientist Thomas Jessell at Columbia University was removed from his administrative position and the school will not say why.  This has led to bad publicity and a student and postdoctoral fellows to petition the University for answers.  It is speculated that the action may have been due to problems with harassment.

In an interesting turn of events, one which would not be seen in the US, about 500 Canadian physician is Quebec province say they are being paid too much.  They want their pay raises rescinded for the good of the health system.  They think the money should go to the nurses, ward clerks and patient care.        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.