November 15, 2011 Recent News




In Houston and across the US ambulance companies are at times crooks.  They charge to pick up and transport non emergency patients to neither hospitals or other acute settings but to medical offices or other non acute settings.  This happens mostly when there are competing private ambulance companies in an area.  Where there is just one and it is under contract to the county this would not occur.  In Harris County, Texas, or Houston over $500 million went to private ambulance companies.  New York City only had $7 million for the same time period.  As usual CMS will not comment and seems not to care how much they spend for unneeded services.  The ambulance companies give and receive kickbacks to or from community health services or dialysis centers to bring unneeded transportation to the "centers".  The area seems rife with fraudulent assisted living centers, therapy offices and ambulance companies.

The hullabaloo about not getting PSA testing in symptomatic men will again come to the fore as President Obama has just received a PSA exam as part of his routine physical.  It was low.

There is also a 40% 5 year survival difference between the US and Britain where they do not do routine PSA exams and base their diagnostics and therapeutics on price not efficacy.  They only have the modern therapies for the cancer in the private sector, not under the NHS.

After the poor decision by the federal Agency for Healthcare on mammograms, Pap smears and PSA, they have now decided that there should be no routine glaucoma checks.  They state that there is no published link between early detection by screening and effective treatments.  They are either idiots or only wonks.

Finally there is some equality.  Boys, aged 11 and older, can be vaccinated against HPV the same as girls.  It is the same virus and causes cancers in boys the same as it does in girls.  The CDC will give its blessing soon.

Surprise!  Seniors are not availing themselves of the Medicare rating systems.  Of course not.  Patients go where their physicians suggest and go to physicians that they can get an appointment with or has been recommended by friends.  The rating systems will not replace that. It is also a confusing jumble as one would expect from the government.

CMS is crowing that it has recovered triple the money that it did previously from Medicaid scams.  They should be eating the crow to allow the scams in the first place.  See the first article in this section.  They recovered $1.85 Billion by increasing the money paid to state fraud units to $205 million.  They do not state how much they did not collect since it was uncollectable or never found.

HealthLeaders has an article stating that even though the new ACO rules have been finalized with less problems, they still will be a hard sell.  There does not seem to be enough bang for the buck.  It is still too expensive to go through all the hoops required for reporting and governance.  Also patients have no skin in the game.  They can leave the network for any care they want.  Also is the uncertainty of the economic conditions and what will happen if a Republican wins the White House.

A study in Health Affairs states that health reform may be in trouble if they are to use bundled payments.  So far, the three pilot studies paid for by the feds and three years in the making have yet to have one bundled payment.

Currently just one in ten hospitals meet the criteria for getting money for the EMR system promised by the government.  However, there is the upkeep of this system and no one but the hospitals will pay for that.  It is much more expensive than the original purchase especially when the new ICD 10 comes in.

A new federal (IOM) study states that hard to use EHR are a threat to patient safety.  They recommend a study of injuries due to IT.  They recommend that hold harmless clauses be dropped from sales contracts as this limits the questioning of the software errors.  

In Iowa employers are going toward high deductible policies aligned with HSAs. This is to encourage people to have more of a stake in their spending of health care resources.  Wells Fargo has started this recently and others have also joined in.   

The People's Republic of Massachusetts has fined between 48,000 and 49,000 people for not having either purchased any insurance or purchasing less insurance than the Republic thinks they should.  One couple was fined $3000 for having purchased a $750 health insurance policy and the Republic thinks they should have purchased a higher policy.  This will soon be a national problem if Obamacare passed legal muster.

In another article a group of physicians who originally were for the Universal health program in the Republic have now come out with a report that states rising health costs are disproportioning lower classes of people and it has only switch prior patients in the "free care pool" to private plans which are more costly.  It has also led to employers putting more costs on the employees and a huge increase in high deductible plans.

The Republic is continuing to face increasing shortages of physicians in eight specialties.  This is the same as in the rest of the country but just more of it percentage wise in the Republic.  Could it have anything to do with the Republic's health plan?

The poor Republic.  If the debt ceiling goes through they will lose about $680 million in federal research funding in 2013.  This could hurt the Republic's ability to keep researchers in place.  They still would get about $7 Billion so don't feel to sorry for them.  

Kaiser Permanente has reported that revenue raise 7.2% from a year ago but lost over $500 million in non operating profits due to poor stock markets.  They made a loss in the quarter of $46 million.  The above comes from the San Francisco Business Times.   It should be noted that enrollment is up year to date by about a quarter million.

In an interesting twist, Victor Valley Community Hospital was denied by California to be purchased by Prime Health.  They instead signed a management agreement with Prime which the state is also attempting to block.       Top


The country now has a new medical organization.  The non profit American Medical Society has been formed.  It has been established to fight for patient and physician rights.  It has two offices, one in New Orleans and one in San Diego.  The president is Dr. Adam Dorin who states that the mission is to have a neutral bi-partisan approach to improving medical care in the country. Some have said that this organization is positioning itself to take the place of the waning AMA.  I wish them well.

The AP has a story that CMS takes away a lot of licenses from physicians for Medicare fraud.  They then give them right back after appeal hearings that are not attended by anyone from the government.  At the same time CMS has failed to collect any money from security bonds allowing physicians to flee at the first sign of a problem.  Even the OIG is not happy with CMS for their pay and chase paradigm.

The OIG is going to study those physicians who opt out of Medicare to make sure they do not bill Medicare for any care provided.  They are also going to study whether any area of the country has more opting out that the remainder of the country.  They have found a higher percentage of across the board E and M codes which is not surprising with the increased use of computers which make it easier to get to the next level.   

Physicians are being warned about technical problems with GE Centricity Practice EMR.  The flaws will give erroneous reports for meaningful use.  GE hopes to have it fixed by the end of this month.

Ventura County, California, is having problems signing up anesthesiologists for the local Medicaid program.  As they are independent contractors and not employees of hospitals they make their own decisions.  This means some patients either need to switch hospitals or wait for surgeries until the contracted doctor has an opening.  The Medicaid dropped their payments 10%.

California Kaiser mental health patients are waiting longer than the required 10 days for being seen.  The HMO has asked its employees to lie to make it look like the patients are seen in the requisite time.  Also patients are given group sessions since there are not enough clinicians to see patients individually.  The patients are pushed into the group sessions to try to meet via the fraud the 10 day rule.

Rhode Island physicians are finally going to get money owed them from MEGA Insurance.  The company has been ordered to pay and not sell any insurance in the state for three years. 

Steward Health of the People's Republic of Massachusetts has scored a coup on Beth Israel Hospital. They purchased 150 of their physicians in an IPA which might net the physicians an extra $3 million next year.  Beth Israel is claiming possible anti kickback problems but the for profit Steward says it is all legal.  Steward realized that physician bring the business not the hospitals.  Steward wants to get business away from the big hospital systems and keep the business local.     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.