November 15, 2010 Recent News





The Baltimore Sun has an article about electronic medical records and its potential for a major breach of privacy and how patients are treated.  MedChi contends that EMR has the potential for a major privacy breach and also to not allow physicians to decide how to treat patients.  The more that records get shared the more potential for a breach of confidentiality.  The State is considering allowing patients to determine which physicians may see their records or opt out entirely.  Of course, if they enter an ER that could be disastrous.  Some records are kept by drug companies and insurers.  Could this mean they might deny services or influence care due to cost?        Top


The elections are over.  Now what will Congress do in regard to SGR.  All know it does not work and that will never be implemented.  However, the money it was supposed to save must be made up from somewhere.  The Democrats specifically left the physician payments off Obamacare since they knew the money would make the policy even more unpalatable than it was.  The pols now have only several weeks of the lame duck Congress to delay or change the law prior to the December 1 deadline.  If they don't watch out for physician rebellion.      

The Chicago Tribune reports that physicians are continuing their disinterest in primary care.  Only 45% of primary care residency slots were filled this year.

As a corollary to the above, the AMA reports that more primary care physicians are joining the concierge movement. This is a small but steady push to get out of the hands of government and insurance companies and back with taking care of patients. 

All know how stupid politicians are, but some are dumber than others.  Washington DC is full of a lot of things among them the dumb politicians.  They had a plastic surgeon working with the city's jailed youth, found he wasn't qualified and but him on administrative leave for two years.  He was paid $350,000 for doing nothing while on leave. They have now laid he and two other physicians off and replaced the three with one physician in order to save $400,000 per year. 

At the other end of the scale is New Mexico which is willing to give physicians and other healthcare workers second chances. They will hire physicians and others for their state programs even if the providers have troubled pasts such as drug addiction.  They monitor closely and if any problems come up they handle it quickly.  Hats off to them.     

Arizona Central has an article regarding the increasing number of surgeries that are being done in the physician offices. This includes plastic surgeons with their own ORs, surgeons doing hernias under local and sedation.  The physicians, if qualified, can do the procedures safely, quickly and cheaply as compared to hospitals or standard ASCs. As a urologist I did all cystoscopies, vasectomies and other like procedures in my office.  If a biopsy was needed of the prostate or bladder or skin, it was done in the office.   

The Wall Street Journal has an article about employed physicians.  There are an ever increasing number of them these days as more physicians are finding higher overhead and less reimbursement.  Of course there are trade-offs.  What happens in several years as hospitals who are now purchasing these practices see there bottom line decreasing?  Answer- physician take less and less and do more and more.  You have a contract.  That's nice but we are changing it due to changed circumstances. This is really true for the new bundled payments that are being considered.  Not to wait that long, CMS has just announced a decrease in RVS for hospital based physicians.  With the hospitals getting less, guess who the loss will fall upon?  Those physicians in independent practices are getting an increase in RVS units. The other thing is that with a boss you will order less tests and have less autonomy.  It is not that the tests are not needed but that they cost money and take away from the boss's bottom line.  When I quit private practice, I went to work for an HMO doing office urology.  In patients that had rising PSAs and a negative prostate biopsy, I believed that prior to a second biopsy a test called a "free PSA" should be done.  The HMO I worked for did not do the test and would have to send the test out, paying money.  That was unacceptable and I was told just to repeat the biopsies which I refused to do.  After several months of being hassled the HMO finally started doing their own "free PSA" and the problem was solved. If I was a true employee of the HMO, I probably would have been fired but as a outside contractor on a hourly fee and much needed they had to do what I believed was good patient care even if it cost more.  This made me into realizing that employed medicine is bad medicine.  I am glad that California and some other states do not allow physicians to work for non-physicians. 

Dr. David Ring in Boston, a hand surgeon, has gone public about a mistake he made on a patient.  The reason for the public airing is that others may learn from his error.  Congratulations to the physician.  His actions are commendable.       Top


This is what Americans want??  In British Columbia there is now a disagreement over whether Orthopedics should be a class I emergency or class II.  The difference is the response time and the call money.  The orthopedic surgeons have decided that they will decide, not the government.  Those with the most serious will be seen first.  Now an ankle injury takes five days to be surgically treated.

It is being reported at about 30% of business will reduce benefits and about 22% will increase benefits in the near future.  Many will shift more costs to the better paid employees.  They are making tiers within their companies and those with higher salaries will pay more to reduce the increases on those who get paid less.

The Washington Post posits that even in the situation where the Republicans take both houses they will not have the votes to repeal Obamacare.  They can stop the 115 appropriations needed for the law to take effect.  They will probably allow some of the popular provisions to take effect such as the preexisting conditions, lifetime limits and children on adults until age 26.  The main thing that all agree on is the 1099 requirement must go. The problem again is that the law was supposed to bring in revenue and where is that revenue going to come from.  There is only one place and that is to decrease benefits.

Finally there has been a study to show that minimum CT scans on high risk patients may pick up lung tumors at a time when they may be cured.  This finally may be allowed after many years of all knowing that it was true but expensive.  It was originally thought that a full CT must be done.  That is no longer the case as a low dose scan for several hundred dollars may suffice.

The Obamacare people expected to have about 350,000 sign up for their ridiculous plan by the end of the year.  They have about 8000 nationwide. The plan is too expensive for the benefits received.  Now the feds want to lower the cost but only for the plans they control.  They have no control over the state run plans.  They are willing to increase the tax on all Americans to make sure Obama doesn't look stupider than he already does.

All know that the Republicans want to repeal Obamacare but this is not feasible with the Democrats holding on to over 60 Senate seats and the presidency.  They will have to defend multiple Republican attempts at taking the law apart piecemeal and this will hurt them and Obama in the 2012 election.  The Republicans will attempt to allow health care insurance to be purchased across state lines and get rid of the possibly illegal tax if one does not purchase insurance.  Of course, if any one part of the law is deemed unconstitutional by the courts the entire law is unconstitutional since the Democrats forgot to put in a severability clause.  

When Obama stated that you can keep your physician it was false.  When he said you could keep your insurance, it was false.  The Washington state Medicare Advantage program is in shambles with 40,000 looking for new insurance and physicians due to companies leaving the program.  Some counties will have no plan available for them.        

Iowa Wellmark announced that they will stop offering child only policies in the state.  This is a direct result of Obamacare. 

With the Republicans now controlling many more Governorships, they have the power to delay the onset of many of the clauses of the Obamacare plan.  It will be up to the states to run the "exchanges" and they can do them how they wish.  They will set up task forces to see how to implement the law.  These may take a while to report.  They will probably opt for more free market approaches to the plan instead of rigid rules and regs.        

The municipalities in the People's Republic of Massachusetts have figured out the costs of their healthcare plan has taken away all new money.  This means that the new roads and bridges will not occur.  Watch this same thing happen on the big stage. 

The left coast is soon to be heard from.  The Dems now have control of both houses of the legislature and for the first time in years a liberal Governor.  The activist Nurses Union played a part in the election of Brown so now they want their pound of flesh.  They want Brown to sign a measure giving California universal health.  The state is so far in debt that it is an unreasonable request. 

Pete Stark has penned a letter to the insurers asking them to lower their premiums since they are making a lot of money.  Ford is doing well and therefore they should lower their prices as well.  At least he is asking and not threatening like Sebelius did when she knew she had no power. 

There is a problem with the high Democrats.  Pelosi stated that the Deficit Panel recommendations were unacceptable since they tread on Social Security and Medicare.  Obama chastised her by stating that one should hold their fire since many tough choices will be needed to reduce the huge and growing deficit.         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.