November 1, 2014 Recent News





The California Association of Oral and Maxillofacial Surgeons sent guidelines to its members stating they should take a history including travel history on all patients with viral symptoms.  They were also warned to make sure they protect themselves with the needed protective precautions.  

Ebola continues in the news this fortnight with the revelation that CDC allowed the second Dallas nurse to fly on an airplane and she probably had symptoms at the time.  Also, the CDC agreed they did not do enough with the primary Ebola case in Dallas.  They now will send SWAT teams to any hospital that admits an Ebola patient.  The CDC continues however to play softball with the disease.  They have asked the people on that flight with the nurse to call them instead of actively seeking them out and quarantining them.  How did Nigeria and Senegal get rid of the disease when it was found in a solitary individual?  They actively isolated all contacts for 42 days and their countries are now Ebola free.

Nurses are not happy campers over the Ebola virus.  About 75% have said that their hospitals have not communicated their policies on what to do if a patient arrives with Ebola.  That speaks volumes about hospital readiness even though they state they are ready.  I have just read my hospital's information on Ebola.  It is interesting that there is no nurse on the steering committee.

Lancet has published an article that states that up to three Ebola patients a month could travel internationally.  They state that most travel will be to low middle income countries who do not have the resources to cope.  (See also New Legislation for more Ebola news)

As all know a fourth person, a physician that treated patients in Africa, has been diagnosed with the disease.  This has prompted the Governors of New York, New Jersey, Illinois and Florida to issue isolation bans on all people coming to their states from the Ebola Africa countries, including those that have gone there to help.  Also the police in New York were spotted throwing their outer protective gear into the normal garbage.  New Yorkers need to be afraid.  

One nurse who was with Doctors Without borders has been quarantined in New Jersey.  She was quarantined inhumanely and does not like it and the wonderful ACLU doesn't either.  Tough.  It is the right thing to do but under better circumstances than in a tent with no toilet or shower.  It is what Senegal and Nigeria did to rid their countries of Ebola.  See Below

After the quarantines and monitoring were announced the idiot in chief wants the states to give up their sovereignty and stop the surveillance.  He will as usual waffle again. The idiot in chief several days ago defended his handling of the Ebola scare.  It was tightly choreographed as opposed to his usual more casual style.  

Christie blinked and after being threatened by a federal law suit by the nurse idiot allowed her to be released from the hospital but still on quarantine.  Having said that, he is considering letting her fly to Maine on a private plane.  Maine has a mandatory 21 day quarantine in the home. The nurse idiot is not worried about the public and has threatened a suit if she is continued on mandatory isolation, she then went after Maine by going bike riding knowing that she could not be arrested without a signed warrant.   She should be treated as a public health menace and forcibly confined if necessary.  I agree that the New Jersey quarantine was terrible in the tent but this is in the home.  Three weeks may seem like a life time but it is not unless you infect someone else.

Italy is not influenced by our "leaders" and have "quarantined" the United States troops returning from Africa.  They will be held for 21 days and then allowed to return to the US.  None have had symptoms.  

Poor Texas Presby.  Not only did they get a black eye over their treatment of Duncan and the nurses but it has cost them mucho bucks.  Revenue at the hospital is down 26% due to the treatment of Duncan and the nurses.  Their ED patient visits dropped by 53%.  Inpatient was down by over 90 patients per day.  Patients are switching elective OB and other procedures to other hospitals and the clinic visits are down significantly.  

Obama has inserted himself in the issue of isolation of people from the Ebola countries.  He does not want to isolate them automatically as he wants to encourage people to go to Africa to help.  This is laudable but goes against public fear of the disease.  

Not all political news is about Ebola.  It should be noted that Joe Biden's son was kicked out of the Navy for cocaine.  He is now in an investment firm.  

Obamacare only lives due to subsidies.  If the subsidies were cut off then about 11 million people would lose their insurance.  This is important because of the law suit now winding its way to the Supreme Court that challenges the ability of the government exchange to offer subsidies.  

Obamacare has sent premiums up by as much as 78% according to the independent HealthPockets.  This is true for the 23 year old non smoking male.  for the 30 year old the rise is 73% for males and 35% for women.  63 year olds were 27% and 33% for men and women.  This was done not considering subsidies which are paid by someone, not necessarily the policy holder.  They found the obvious that the premiums are increased due to the benefit mandates and the taking of those with pre-existing conditions.  

As insurers attempt to limit costs providers are finding new and inventive ways to bill for items that were gratis or non-existent prior.  An example id charging for a refraction when it was included in the past or a splint for a sprain.  New charges may be for administrate charges in psychiatric offices.  These may or may not be  not paid for by insurance.

California has an insurance commissioner and a proposition system.  The proposition on the ballot, Prop 45, would give the commissioner the ability to challenge and reduce premiums.  The current commissioner has decided two weeks prior to the election to blast Blue Cross over some of their rates.  Politics?  Not in California.

Can you imagine that in California if you go to a physician owned group practice your costs will be 10% less than if you see one owned by a local hospital.  If you go to a physician group owned by a large hospital system your costs will increase by 20%.  This blows up the idea that hospital and physician mergers will drive down costs.  that may be true internally but not for the consumer.

UCSF did a great piece of research.  They counted the number of alarms at patient beds for one month.  There were 2.5 million hours of them at the hospital in the month.  Anyone not believe in alarm fatigue?    They looked at 1.1 million arrhythmia alarms and found that 88% were false due to computer error.  I can attest personally to the problem.  I was hospitalized overnight at my local hospital and had 3-4 wrong alarms go off.  I finally had the machine shut off.

Last issue I wrote about Orange County, California, Mission Hospital only stopping elective surgery when they were threatened with de-accreditation for surgical infections.  They stopped the elective surgery for 10 days and then re-started.  They will now be re-inspected.        Top


Mission Hospital in Orange County did not stop all elective surgeries when the Joint looked at them for an outbreak of post surgical infections.  Four patients who had Ortho surgeries got infections.  The hospital continued doing surgery until  threatened by The Joint with de-accreditation. They are attempting to find the culprit but the only thing found so far is an increase in temperature and humidity in the one room involved.

Prime Healthcare continues to expand.  After the purchase of six hospitals in California several weeks ago they completed the purchase of two Kansas City hospitals.  The two were from Carondolet Health.

Prime also purchased Monroe Hospital in Indiana out of bankruptcy.  They will pledge about $2 million to the hospital's operations in the first two years.  The hospital has $100 million in liabilities.

In a recent survey 92% of nurses polled were unhappy with their EHR.  The survey included 14,000 nurses throughout the country and with all systems.  They blame the hospital administrators who picked the systems based on government incentives without input from the nurses.  The problem causing systems are decreasing bedside nursing and nursing communication with others on the staff.        Top


The old Confucius saying "may you live in interesting times" is coming again to the Rochester, New York, area.  Two large cardiology groups are now negotiating where they will practice.  The vying hospitals are The University of Rochester Medical Center and Rochester Regional Health Center.  The cardiologists are looking to see where under Obamacare they will get the best deal. 

USA Today reports that exchange patients are finding some of the same problems with access as Medicaid patients, no physicians.  The exchanges are paying in some cases below market rates and therefore some physicians either are not taking exchange patients or limiting how many they take.  Others are afraid because of the potential of being stuck with no payments due to the 90 day clause.

Can you believe some are still doing research on the problem with EHR.  Two physicians just did a study that EHR is taking up 16.6% of the physicians work week outside of the time they see patients.  Think of how much more physicians could be productive without EHR.  Those with only paper records spend significantly less time on administrative tasks than those with EHR.  

Gee, someone did a study and found that less competition between physicians led to higher prices.  I wonder how much they spent on that one.  As physician unite they may have better processes to optimize care but also charge more.

It has been found to no physician surprise that less than half of the nation's physicians listed on insurance "lists" are actually available for patients.  This puts a spotlight on the "narrow networks" that is actually narrower than the insurers believe.  

Remember when Obama attempted to get more primary care physicians to take Medicaid patients by increasing Medicaid rates to Medicare rates for 2 years.  Well, the states have now decreased the rates back to the old rates since the payment has now fallen back to them.  A few states will actually continue the increased pay or some intermediate increase.  In those states where Medicaid is run by HMOs there may be no significant drop in providers.        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.