May 15, 2016 Recent News






A new study shows that of the those who have joined Obamacare could have obtained insurance without the massive new program.  They were already eligible for Medicaid but just never signed up.  They never knew they were eligible or did't need to since they just went to the ED.  

We now know what it takes to qualify for quality health care.  Cheaper costs.  Medicare has paid bonuses to 231 hospitals with cheap costs but low quality.  This came from a study in the Journal of Health Affairs.  The bonuses were very small but should not have been at all.  CMS is considering revising their criteria for the bonus program.  They won't.

The Medicare proposal to cut payments or at least to change the way physicians are paid for their drug usage in under fire from many quarters including both sides of the aisle in Congress.  Watch for a redo.

The US had about 20,000 deaths in 2014 from Hepatitis C.  A new record.  It is hoped that with the new drugs to combat and cure the disease these numbers will be almost zero in the future.  Of course, the insurers have to agree that paying the money to cure is better than death.

The VA continues to be under fire.  Vets at the Oxnard clinic say wit times for scheduling are among the worst in the country.  Only about 67% were schedules within the standard of 30 days.  The clinic is under staffed due to the inability to retain physicians and nurses.

The NYT reports that Obamacare rates will again increase dramatically next year.  They expect many to go over 10%.  The feds say this doesn't matter since the patients are subsidized.  Nonsense.  Somebody pays.  Iowa Well point is looking for increases between 38% and 43%.  Florida insurers are looking for an increase of about 18%.

At the same time Medicare has been found to be terrible in overseeing the taxpayer money.  They overpaid Medicare Advantage insurers by $70 Billion between 2008 and 2013 and are not getting any of it back.  They pay on unsupported information about patient health.

After the above Medicare was found to also pay $125 Billion in improper payments between 2013 through 2015 for fee for service claims.  The problem is coding and paperwork errors.  The largest problem was in home health which is also the largest area for fraud.

Kaiser Family Foundation says that employers have been cutting out health benefits especially retiree health benefits.  Since 1988 large firms that offer active workers health insurance have cut retiree health insurance about 40%.  This is causing a rise in Medigap policies which tend to drive up healthcare costs.  

Humana is joining United Health in dropping out of Obamacare insurance in some states for the next year.  (also see story below on Alaska)

Alaska now will have only one Obamacare individual insurer in the state.  Moda insurance is dropping the plan leaving Blue Cross as the only one left. 

Aetna will stay for another year in 15 states. 

The FDA has done an about face with the recall of 2800 hospital scope cleaning machines made by Custom Ultrasonics.  The System 83 Plus can still be used to clean duodenoscopes.  This decision has been questioned by a past director of infection at the company.  

Oregon is in trouble as all its insurers are wanting double digit premium increases for their Obamacare products next year.  They range from 14% to over 32%.  Watch for this trend in all states as the insurers need more money to continue in the program.

The junior physicians in England are again holding talks with the government over a new contract.  The contract being crammed down the physicians throat needs to be changed.  If not there will be more strikes which include emergency care.  The government is using flawed data according to the Oxford University.          Top


Four orthopods in Salinas, Kansas have resigned from the Salinas Regional Health Center since the hospital requires call and will not pay.  The physicians will use their own surgical center to care for patients.  The hospital is a trauma center.

The ABIM announced that in 2018 internists will have a new option to remain certified instead of the unnecessary MOC ten year exam.  They will add an exam annually or so as well as the 10 year option.  This comes at a time that the ABIM is under fire not only from their own members but also the states.  Oklahoma has decreed that the exam can not be used to keep people from the hospital or insurers.  Kentucky said the exam can not be used for state licensure.  It should be noted that the ABIM gets almost all of its income from this exam.

The Pennsylvania Medical Society is against the Highmark attempt at castrating their physicians that see Obamacare patients.  They want to pay them 4.5% less than they get for other patients.  The insurer like United Health is losing money on the program and is trying to recoup by gouging the physicians.        Top


Sharp Grossmont Hospital in the San Diego area is under fire for taking motion sensor videos of patients undergoing surgery without their consent or knowledge.  They were attempting to find someone taking drugs but the fall out is worse.  They say they did find the culprit but they will not release to the anesthesiologist's attorney the full tapes so they can see if he really took the propofol for his own use or to give to emergency patients as he claims.  It may also be exculpatory and show other anesthesiologists doing the same thing.  The physician is now up for having his license removed but the hospital will not give the ALJ the remaining videos.  The hospital refuses to say if the patients gave consent or under what regulation they used to obtain the videos.  

In an op ed that rails against the big hospital mentality for placing efficiency above patient care an author tells of her sojourn into the time at a large hospital that did everything by the high tech I-pad book.  They only forgot to tell the patient the times and places she was supposed to be.  She finally got so exasperated she left and went to a different hospital for care.

Tacoma General Hospital had a visitor.  A patient took a pet python to the hospital and lost it.  One month later the snake fell from the ceiling.

Is this good or bad?  St. Charles Health System is changing EHR systems again.  This fourth one will be Epic.  This will require 100 new jobs to implement.  Good for the economy but bad for the hospital who needs to pay for it and them.

The NYT reports that nursing homes are evicting patients that are difficult.  They do not get cited or fined so they just do not care.  

In an article that tells hospitals how not to do things it was reported that the Cheyenne Regional Medical Center in Wyoming is shutting its urgent care program.  The physicians that staffed the program are opening a private clinic in the town.  The hospital is now grasping at straws to find another partner after they would not contract with the providers.        Top


Florida Blue Cross and Shield is under fire for bait and switch tactics.  Patients signed on the plan to see certain physicians but the physicians were not on the plan.  The plan is double speaking to get out of the controversy.  This company leads the state in complaints about the service received by almost triple.

The San Francisco Business Times reports that Kaiser Permanente profits plummeted 50% in the first quarter as revenue increased by 9%.  The HMO added over 300,000 new members but costs increased over premium rates.  Kaiser is more interested in growing membership than high profits at this point, but wait.

Allegheny Health also lost money in the first quarter but most of its losses were due to its putting in an EHR.  They went $12 million over budget.        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.