May 15, 2015 Recent News





Medicare pays out in prescription drug claims a huge amount of money, $103.7 BILLION.  However, as with most things in healthcare a small percentage spends a huge amount of the total.  In this case 1% of the claims accounted for 26% of the spending.  These were for the high ticket items such as Revimed and Copazone. The largest drug by total cost is not one of the huge priced ones but lowly Nexium.  It was prescribed to 1.5 million people, a travesty.  Obama wants Medicare to be able to negotiate for drug costs, a reasonable request.  Congress relies heavily on pharmaceutical lobby payments so they will not be so rapid to give in.  

Nearly half of the state insurance exchanges and their brokers have financial problems due to high costs and not so high enrollment numbers. In the past year the state exchanges only rose 12% and the fed rose 61%. This is causing consideration of the states turning control over to the feds and getting out of the business. If the Supreme Court states that Obamacare subsidies are legal at the federal level one may see the states accelerating the transfer to the feds.

A growing number of rural hospitals are closing due to a multitude of conditions.  A total number of closures since 2010 is now up to 50.  There are an additional 235 rural hospitals teetering.  Most of the closures are in states where Medicaid has not been expanded under Obamacare.  The urban hospitals have been closing at the same rate but there are usually alternative means of treatment available.  When a rural hospital closes physicians and maybe businesses leave.  Almost all the hospital closures have in common the need for government subsidies under Medicare and Medicaid.  These are too small for the hospitals to succeed.  

Since Obamacare has been in place the rend toward the use of EDs has increased.  The reason is there are not enough physicians willing to take the low paying insurance.

Over 500 groups have signed to urge a repeal of Obamacare's IPAB.  Almost all are provider groups that realize the panel will cut payments to providers (used to be physicians).  There are currently 222 bipartisan sponsors to a bill in the House to repeal the agency.  

Insurers are supposed to pay a tax on the number of people covered.  The tax is to go to PCOR an organization for research, if you call what they do research.  The insurers are not paying the tax and the IRS is not doing anything about it.  They did do the required reporting but failed to pay the tax.  Many of those that do pay the required Obamacare taxes pass it on to the insured by raising premiums or put it into the Medicaid pocket.

Since its inception Obamacare has allowed almost 17 million individual to become insured.  These are people that had no insurance.  This is mainly in the Medicaid market but the employers added a large number as well.  The lowest amount of new enrollees are from the Obamacare marketplaces. 

However, 25% of those covered will forgo medical attention since their deductibles are so high.  This affects the lower and middle income people the most.  High deductible plans (over $1500 per year)  are prevalent in the employer community. Over half of the Obamacare plans have the high deductible.  The plans are also very very very expensive.

Speaking of insurance and insurers, Assurant Health is going out of business because of Obamacare. 

The IRS made a business decision not to have processes and procedures until 2016 to be able to monitor Obamacare recipients for subsidy appropriateness.  Since the law mandates they can not impose penalties or liens, who cares?  

Avalere Health reports that the new guidelines from our friends at the UPSTF to limit mammograms to over 50 years of age would deprive 17 million without coverage.  The august body again put a C grade on the study on women between 40 and 49.  Obamacare says coverage should be for A or B grades.  The American Cancer Society says the test should be started at age 40.  I believe them  and not an organization without an oncologist.

Johnson and Johnson is forming a committee to decide who should get unapproved meds. The head of the committee will be Arthur Caplan.  I feel sorry for the committee as I was on the committee in the 1960s and 1970s to determine who should get dialysis.  It is a terrible position to be in.  The FDA almost always grants the drug companies permission to get compassionate use drugs that have not been approved by the FDA.  If approved the patients would receive the drugs free but not any ancillary costs.

The San Francisco Business Times reports the California Daughters of Charity hospital group whose sale to Prime was effectively cancelled by the California Secretary of State Harris has signed a six month contract with the hospital unions.   This six month contract basically means the end to the hospitals in that time.

The SF Business Times also reported that the California Obamacare exchange is cutting back on spending and enrollment expectations next year.  They plan to cut marketing and outreach by 1/3 and spending by $58 million (15%).  

Massachusetts' health insurers lost a combined $124 million in the first quarter due to Obamacare taxes and fees.  These taxes were paid in the first quarter and are not paid again during the year.   They are planning to pass the charges down to patients.     Top  


An article in Politico states that electronic record errors are a growing problem in lawsuits.  A study by The Doctors Company shows that med mal cases that mention EHR doubled from 2013 to 2014.  They allege a rage of mistakes and information gaps such as typos leading to med errors, voice recognitions that dropped some key works, physician reliance on faulty records and nurse misinterpretation of drop down menus.  There are also discrepancies between patient obtained records and the data on the screen leading to big payouts due to physician being discredited.          Top


Texas has 35 counties with no physicians.  That is none, zero, nil , nada.  There are 185 counties with no psychiatrist.  There are 158 counties with no general surgeon.  There are 147 counties with no OB/Gyn.  This is a state with a good track record in recruiting physicians.  The problem is maldistribution of the physicians. Also Texas is second in the country in percentage of physicians who are independent private practitioners.  Some are now turning to hospital employment, part time work or concierge medicine all of which reduce the hours and accessibility.          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.