November 15, 2009 Recent News






The Georgia insurance commission fined UnitedHealth as the parent company $750,000 for slow or non pay of legitimate medical claims.  More fines are expected soon.  

Oregon Medicare Advantage members are losing some of their plans and the largest plan, Regence, is raising rates 45%.  About 16,000 people will be shopping for new coverage at higher amounts as more insurers stop their coverage.

The LA Times states that the People's Republic of Massachusetts has almost universal coverage but the four year old law did not address costs.  Most people have the same quality of care as prior and are paying more for the privilege.  The insurers continue to raise premiums significantly.

The Republic is also reporting a major increase in ED waiting times since the onset of their universal care.  This is due to an increase in insured patients but not physicians willing to take them.

A study of the Republic also shows that not all businesses are paying what they owe.  The businesses state the rules are so confusing as to invite error.  The companies are supposed to have at least 25% of their employees insured by them.  Some companies can not comply since the employees are either young and still on their parents insurance or on Medicare.  This makes no difference to the idiots who state they are avoiding the spirit of the law.

The Mayo Clinic was said by Obama to be the way medicine should be.  The Clinic has now accused of charging low amounts per Medicare and Medicaid patients due to high prices charged to private insurers and bias in patient selection.  They have also stopped taking Medicaid patients from Nebraska and Montana.  At the same time the Arizona Mayo will stop accepting Medicare patients seeking primary care.  

Kaiser reports its 3rd quarter operating income rose 2.9% over a year prior.  Their net income also went up over a loss a year ago.  They did this by cutting back on capital spending by almost 3% since they lost 69,000 members in the first nine months of the year.  Kaiser gets most of its patients via businesses and with the poor economy there are less people employed and therefore less eligible for paid for insurance.

The San Francisco Business Times reported that Kaiser also has a for profit spin-off called Archimedes.  The company uses very high tech methods to forecast health results for multiple large health companies.  Archimedes was featured a month ago in the American Journal of Managed Care.  The company charges range between $100,000 to millions depending on the complexity of the question asked.  The company, being for profit, will not discuss it's finances.

Medicare HMOs in the country with private fee for service plans will be dropping out in 2011.  The reason is the fed mandate that these plans develop physician networks.  This may affect about 500,000 people. 

It is always good to see a company that was never very good go down.  The San Francisco Business Times has an article regarding a company once called California Medical Review Inc. and then CMRI both bad review companies.  They then changed to Lumetra and was a Medicare quality improvement organization.  It lost the Medicare business and went from a $28 million business sliding to a $4 million.  They are now trying to do other things such as become consultants for the people they injured early in their being.       Top


Hospitals surveyed are finding problems in attempting to put in quality measures since physicians have less affiliations with hospitals and are more reticent to donate time.  It seems as more physicians are employed they now have the time to work on quality measures and not on patient care.

Hospital & Health Networks has an article "Beyond Health Reform" that tells hospitals what to expect and what to do with the probable reform legislation.  The author says that about 25 million will be newly insured.  He then goes on to state that deficit reduction will be on the backs of hospitals.  He recommends the stop to cost shifting and the use of cost discipline.  He follows with the widening of hospital risk envelope which can be taken care of with hospitalists etc.  He believes there will be an accelerating collapse of private medical practice with physicians coming to the hospital for help.  He recommends paying physicians per hour as if they were working 80 hour weeks.   

Long Island Jewish Hospital System is offering physicians $40,000 over five years if they switch to EMRs.  This is on top of the $44,000 offered by the feds for the same thing.

The San Francisco Business Times reports UC San Francisco stopped their installation of General Electric EMR due to multiple delays.  They are going with Epic, the system for Kaiser, Sutter Health, UC Davis and UC San Diego.  UCSF has written off about $18 million on the GE contract and the Epic contract will be about $50 million.  

In the recently passed health reform plan Hawaii was excused from complying from the plan since they already have their own comprehensive health plan. A report by Ernst and Young shows the hospitals in the state are all losing money.  The reason is government interference with free enterprise.  The hospitals are losing money on their contracts and must pay their employees according to union rules.  They all are in deep doo doo.   Top


HealthLeaders state that about 2% of all healthcare providers are unlicensed and an additional 19% have a cloud on their license.  

In a study in North Carolina it was found that those physicians participating in pay for performance paid a huge price.  Initially it may cost over $10,000 for the set up and after several years the amounts per physician per year could be up to over $4000 to jump through all the hoops necessary to get the extra money.  The article in HealthLeaders did not state how much each physician received. 

The possible health reforms will greatly exacerbate the shortage of primary care physicians states an article by Bloomberg.  They quoted the president of the ACP.  They point to the longest waiting time in the country of 63 days which happens to be in Boston with the universal care and the largest concentration of hospitals in the country.  Projected health spending in the Republic is expected to double by 2020 and insurance premiums were up 10% this year alone.  In England there is one primary care per specialist whereas in the US there is one for every three specialist.  It will take many years, if ever, to reach the one to one ratio.  The article goes on to state the pay for primary care physicians went up 18 per cent in five years as opposed to 46% for orthopedic surgeons.  The health care policies in the US legislature is allotting more money to primary care but is doing nothing for those who choose to work less with less interference from government.

The Telegraph in England tells of the primary care physicians being paid extra to not give out antibiotics.  This comes after the government paid the same physicians extra several years ago for not referring patients to hospitals.  The day prior to the antibiotic money, physicians were told they would be paid more if the met standards for flu vaccinations.         Top


Physician offices in Tennessee have been sending patient information to an Indiana businessman's fax for about three years.  Tennessee has known about the problem but has neglected to tell the physicians.  The State had given the physicians an erroneous toll free number to fax their forms. 

Blue Cross reports that a laptop containing information on thousands of physicians was stolen in August from an employee in the Chicago office.  The insurer is offering free credit checking.  This was worse in Massachusetts since the physicians there use their social security numbers as their ID numbers where the rest of the country does not.       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.