November  1, 2016 Recent News



Physicians and Nurses


CMS has stopped allowing insurers to "seamlessly convert" their insureds who reach Medicare age to their own HMOs without telling the patient.  They are supposed to but do not give the patient a 60 day notice of the switch.  Therefore when a patient seeks care and believes he has traditional Medicare he is in for a rude awakening.  

The federal auditors, GAO, have found that the administration had violated federal law by paying insurers more than allowed under Ocare to hold down premiums.  The money going to the insurers should have been going to the Treasury.  The administration acknowledges that they cheated in order to hold down premiums. will add more plans this year, standardized plans for the basics with no deductibles.  These are also to be expensive as they continue to have the same dumb mandates. and are regulated by the states.  It is also up to the states if the plans will be offered or not.  These plans also do nothing to the co-pays which would be $30 for a primary care physician, $65 for a specialist, $15 per generic drug, $50 for a preferred dug and $100 for a nonpreferred band name drug.  The patient would also be responsible for up to 40% of the cost of specialty drugs.  

The country's state insurance regulators have approved higher premiums in order to allow the insurers to remain in the program.  In eight states they allowed premiums above what the insurers wanted.  The NYT says that premiums for midlevel health plans will increase an average of 25% next year.  Is this the Affordable insurance that Pelosi promised?  About 20% of the population will see only one plan offered next year.  Is this the competition Pelosi promised?  As insurers drop out of the program, four states will have only one carrier, about one million will lose their Ocare plan and need to switch to another possibly also another physician and hospital. Is this the portability Pelosi promised?   

Deductibles are going up for the Ocare plans.  The individuals in the low price plan will average about $6000 in deductibles this coming year.  Families in the bronze plans will average $12,393. This deductible is prior to insurance kicking in.  

The administration has predicted that there will be a 9% rise in enrollment in Ocare.  This would mean that 13.1 million people would get coverage.  The administration has been wrong in all their predictions to date as much fewer have actually signed up and paid their premiums.  The insurers are saying that the people are signing up and then dropping out after receiving expensive care.  Burwell wrongly blamed the GOP for the Ocare woes.  She said that they had to  overcome partisan attempts to repeal the law.  That is true but has nothing to do with the problems with the program.  The administration is trying to reach and convince the uninsured to join this boondoggle with the use of social media including marketing on Instagram and other gaming and social media sites.  

The NYT rebuts the above in an article saying the people would rather buy beer than opt for insurance.  They will accept the penalty rather than pay the ridiculous price for the insurance.  

The insurers are lobbying Congress to do something agaisnt the administration regulation that would regulate how much fixed income plans would pay per service.  The law says that the plans could pay different depending on the service and Obama wants to change that o force no one buying the plans and have them only buy Ocare plans.  This is the second attempt by Obama to skirt the law.  Several years ago he ruled that the plan may only be offered to people with minimum coverage in Ocare.  The courts threw that out.

The VA is playing shuffleboard with their managers and at the same time says they have new leadership.  They don't.  They have the same ones in different positions.  The VA states there is new leadership if only one person of its top management has transferred from another center or job.  The VA can not get outside people to join due to low salaries and a terrible hiring process.  Obama say they have fired a "whole bunch of people who are in charge".  Wrong.  They have fired five.  

The VA is also short changing the vets by allowing clinical pharmacists to see primary care patients.  It shortens the waiting lists but also shortens the care for the vet.  The VA is hiring the clinical pharmacists instead of physicians.

The Ocare law states that whatever the Preventive Task Force recommends as a preventative service it must be covered without deductibles or co-pays.  This leads to intensive lobbying of the Force to include items such as the EpiPen.  The Force does not like nor agrees with this link.

The new MACRA is not all the feds say it is.  Yes, there will be less reporting that originally but it will still be over 20 hours a week per physician to report with physicians needing to spend almost 5 hours a week reporting.  Small practices under 10 physicians can band together for reporting but not until after the first year.  The group will decide on the reporting metrics.  It is almost impossible to be exempt from the reporting in MIPS unless you are a low volume Medicare provider meaning under 100 Medicare patients and under $10,000 in Medicare claims.  Even those hospital specialties that have no patients will need to report.  If you decide to not participate initially the penalty will be 4% but will rise to 9% .  

Minnesota's Ocare has a huge increase in premiums, up to 50%,  and the insurers are also capping the number of people they are taking for the individual market.  The pols want a special session of the state legislature to address the problem possibly giving people state subsidies to help ease the premium pain. 

The physicians of Puerto Rico are leaving the island in droves leaving the people with no medical help.  The reason is simple.  The decade long recession means no pay.  They are coming to the mainland to earn a living.  The island has no money and therefore are late paying physicians and are cutting the amount they are paying.  The physicians that remain do not accept Medicaid.  

What goes around comes around.  In male healthcare PSA testing to prevent prostate cancer has been said no have no survival benefits and should not be done routinely due to potential for side effects from biopsy and treatment.  Now in female healthcare the same is being shown for mammograms.  A study in the NEJM says that only one in four women need the treatment now performed.  The other are having too much treatment and should be watched.  The mammograms lead to overdiagnosis.  The researcher said based on hard data mammograms can help a few-a very few- women but it comes at a real human cost including people undergoing treatment unnecessarily. 

A woman in California states that her insurance company denied her request for chemotherapy for her terminal Scleroderma but would pay for her drugs to kill herself under the state's End of Life Option Act.        Top


Geisinger Health is paying patient whose experience in  the hospital has been short of optimal in the nicer and compassionate categories.  To date they have paid north of $400,000. When a patient asks for a refund the hospital does a study and resolve issues to prevent it in the future.  The issues do not include differences of opinion in medical care.  Too date they have learned that wait times in the ED are too long, too long wait times for appointments some phone systems not working and not all employees introduce themselves and communicate clearly. 

UPMC pays their physicians by base work and productivity and whistleblowers think this is illegal.  They hospital has already paid the feds a penalty of $2.5 milllion to settle some of the allegations and are now fighting in court to stop paying more.  The hospital is defending its position with oranges when the allegations are apples.

The NYT reports on a charge by a father of a newborn at Utah Valley Hospital in Provo, Utah, that he was charged $40 for holding his newborn son post C-Section. A  nurse took pictures.  The hospital said the charge was for bringing an extra nurse into the OR while the parents held the baby.

The University of Louisville has notified KentuckyOne Health that it owes them over $46 million.  KentuckyOne manages the Louisville hospital and some physicians have recommended that the cord be cut.  There also have been many complaints regarding the quality of care since KentuckyOne took over the management with reduction in nursing.

The feds have moved to prevent nursing homes from forcing claims of elder abuse or other similar torts into arbitration.  All nursing homes that receive federal funding are barred from requiring that its residents resolve any dispute sin arbitration instead of court, the NYT reports.  The industry believes and may be right in stating that this goes beyond the statutory authority.  

A psychiatrist has accused Westchester Medical Center in Valhalla, New York, not only retaliated against him for chronic patient abuse reporting.  He states that the hospital that poor adolescent patient were routinely provoked into acting out to extend the Medicaid payments.  The hospital says these claims are false and that he raised them only after being disciplined for behavior and terminated from the fellowship program.  

Broward Health, the worst hospital system in the country, is again in the news.  An outside report has nailed them.  They report a lot of back stabbing over the massive $70 million federal fine levied against them for a secret compensation agreement with their physicians. The board has stopped the search for a new CEO indefinitely.  They refused to cooperate with the outside investigation and failed to investigate problems.  There needs to be a complete change in the board and management.  

Wills Eye is no longer a hospital but an ambulatory surgical center.  The CMS has denied their status request.  They will work with Thomas Jefferson for their patients that need 24 hour care.    Top

Physicians and Nurses

When patients move to the a Medical Advantage plan under seamless conversion  the patient loses a physician and the physician loses a patient due to now being out of network.  This is terrible for the patient physician relationship and the physician pocketbook.  

The feds have finally come to same conclusion that all physicians already knew, the doctor listings in private Medicare Advantage plans are rife with error.  They found errors in about half of the plans examined.  

Pennsylvania has joined 17 other states to allow intrastate physician licensing.  This should start in January, 2017.

Physicians see maintenance of certification (MOC) has having low value and high burdens.  This is across all specialties.  All of 15% felt this had value whereas 81% felt it was a burden.  

In Minnesota the Allina nurses were on strike for over a month after negotiations broke down on a new contract.  The issues centered on Allina insisting on the nurses giving up their health insurance which they refused to do.  Finally the governor intervened and the nurses finally ratified a contract. The strikes have cost Allina over 40 million for premium pay for temporary nurses. The nurses lost the negotiations regarding their health plan and are moving to a less expensive corporate health plan.  

California now has the highest wages in the country for nurses.  The average salary is now $100,000.  The national average is $71,000.  San Francisco Bay Area pays an average of $133,000, the highest in the country.  One of the reasons is the cost of living and another is the inability of LVNs to do many things they are allowed to do elsewhere.  California also has the ratio law which mandates how many patients one nurse may care for.        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.