November 15, 2015 News

The NYT reports that many with the overprice Obamacare feel their insurance is useless due to the large deductibles. The administration only talks about the premiums and the subsidies not the costs to the patient for treatment. About half of all the products on healthcare.gov have deductibles of $3000 or more. In Miami the median is $5000, Jackson , Mississippi is $5500, Chicago $3400, Phoenix is $4000, and Houston and Des Moines is $3000. This causes the smart ones to drop their policies. The Affordable Health Plan isn't.

UnitedHealth says it is not making money on the individual Obamacare plans and therefore may drop out of that program in 2017. This is the largest health insurer in the country. It should be noted that it also stayed out during the first year of the Obamacare program.

Another Co-op is closing its doors. This time it is Meritus Health Partners in Arizona. See story above for consequences.

Patients with Medicare Part D are also getting a rude awakening. Premiums are going up in 2016 significantly.

The AP reports that the sudden collapse of the New York co-op Health Republic leaves physicians, hospitals and others holding the bag. they are legally required to continue to treat those patients to the end of the month but will probably not be paid. Some who have gotten checks fro Health Republic have had the checks bounce. Why do "providers" get into this mess? They should not take co-op patients in the first place and should not take Obamacare patients from any insurer that is not very solvent.

The NYT reports that some employers are not growing due to the Obamacare requirements of mandating coverage when they reach 50 employees. The costs would eat up profits. At present only 54% of companies with 3-49 employees provide health insurance. The cost is approximately $6,100 per employee for insurance and $16,600 for a family. This does not include the new IRS regs on reporting for those businesses with 50 or more employees. Some owners are amazed that when they offer insurance the employees refuse due to the cost.

Medicare has kept the test in place for the payments of joint replacement. This is in about 800 hospitals in 75 locations. This will start on April 1, 2016. The payments will be bundled.

Obama continues to show he has no idea about the military. On Veteran's Day he made his usual speech and said that the backlog had been reduced about 90%. This is either an intentional or unintentional misstatement. In fact, the backlog has grown significantly according to the Secretary of Veterans Affairs.

Obama is a joke. He has allowed the VA to spend $6.1 million on brochures etc. for Obamacare for which vets are automatically enrolled. The money could have been used for decreasing the backlogs instead of the politically motivated junk.

Many from both sides of the aisle as well as over 100,000 online signatures are urging Obama to fire Chuck Rosenberg, the acting head of the DEA. Rosenberg angered many by dismissing medical marijuana as a joke.

Fewer males are being diagnosed with early stage prostate cancer since the idiots at the USPSTF said not to do screening. Now treatable cancers are being overlooked. Dumb. As a corollary to the recommendation CMS is now considering penalizing physicians who order a PSA test for prostate cancer screening. This will further allow more cancers to grow to the point of being incurable when diagnosed.

Medicaid has gone against CMS and in many states are denying hepatitis C drugs for the patients. The rates of denial are up to 50&% in the Medicaid population but only 5% in Medicare and 10% in commercial plans. They are denying the treatment with those who do not have evidence of cirrhosis. They also are betting on the come, that the patient will be on Medicare by the time they need the meds or transplantation.

Both sides of the aisle are mad that Pfizer is buying Allergan and doing an inversion. They are mad for different reasons, however. The Dems are mad because they believe the company is screwing the public. The GOP is mad because the country will not lower the tax rate to keep companies for using the tactic. The comapny will save since it will pay a 16% tax versus an effective 25% tax.

California has accused Blue Shield of reneging on its promise to donate $140 million to charity in order to win approval of the takeover of Care1st Health Plan. Blue Shield says it only pledged $14 million and is under no obligation to give more than its usual $35 million to its own foundation. Why would California trust or believe the scumbags??

Iowa Governor Branstad is attempting a spin on a bad situation. He is happy that his state's Medicaid people will be cared for. Well, they may not be. Only one of four managed care companies have agreed to manage the program. Only one third of the state's providers have agreed to see the patients. The ability to care for all the people is really questionable. There is no hospital that has signed up.

Hello Everyone

These days there are many challenges we face, with some defying logic and common sense. We rely on experts to give us worthy information, yet sometimes there is secondary gain behind their opinions. Magnifying this is the injection of legal complexities which must be filtered when it comes to making personal decisions about ourselves and our loved ones.

Medical care has evolved into a multi-billion dollar industry, invoking fear business decisions have overwhelmed physician decision-making. The posting below adds another layer to this controversy, and hopefully raises your antennae to the onslaught we face obtaining worthy healthcare.

Gene

I Am DNR

I am DNR - do not resuscitate.

Legally should I be hospitalized, I have signed paperwork stating there will be no CPR (cardiopulmonary resuscitation) including chest compressions, no medication to restore my blood pressure, and no artificial machine to breathe for me. Also I have documents designating a power of attorney to speak for me if I am not able to speak for myself. These were signed over a decade ago.

The latter part of my 34 years of practice has been in geriatrics, specializing in palliative and hospice care. In fact, I will join many of my Baby Boom Generation in 2016 on Medicare, with the unfortunate knowledge of what to expect medically as I age.

Digressing a moment, I have seen during my career the medical profession taken over by business. Instead of doctors making patient care decisions, they are being made based on a financial bottom-line. Health insurance and pharmaceutical companies along with hospitals have become clandestine profiteers, with proof of their executive deception seen in salaries, bonuses, and huge retirement benefits.

Some of their gains come at a cost to our patients with higher premiums, larger deductible, less drug coverage, and increased denial of care. Even more difficult are complex rules and legal jargon doctors and patients face attempting to navigate through laws written by business lobbyists and special interest attorneys.

There are many abuses coming to light being inflicted on elder seniors when they are hospitalized. Most of us already know older ICU patients have been targeted by hospitals to quickly discuss DNR status without doctor involvement. Once this is obtained, hospice as “comfort care” is advanced to whisk the patient out of the costly ICU, saving much of the hospital Medicare DRG payment which goes into their coffers.

The most recent assault is interpretation of Advanced Directives and other legal documents by personnel, including the hospital-run Palliative Care Team.

Here is a recent scenario: Mid-80s female admitted to the ICU with an acute stroke. She is obtunded and cannot make medical decisions. Her son is legally deemed to be her voice and make medical decisions. The patient has an Advanced Directive signed 15 years earlier, but there is a POLST from two years ago. Both say no artificial feeding.

The son though states everything should be done as the patient’s wishes have recently changed. However, the doctor states their HMO lawyer feels the son is not following the patient’s past documented wishes. The son advises the doctor and hospital to place a feeding tube, which initially they refuse to do. The son pushes back and threatens to sue the doctor, HMO, and hospital.

This was brought emergently to the hospital Ethics Committee where the HMO continued their assertion, and the hospital brought up Probate law to support their stand.

Fortunately during this time, the patient regained consciousness and told her son and physician she wanted everything done including the feeding tube.

There are Elder Law specialists who deal with these matters, and we intend on obtaining their opinion - hopefully in time for me when I get on Medicare next year.

I now know the hospital (as well as HMO) tactic is to throw legalese at families when they are emotionally distressed with the health of their loved one. This son knew better and pushed back. What about others who succumb to the pressure?

Here are lessons we should learn from this:

-Keep your wishes up-to-date in legal documents should you be hospitalized.

-Know you can verbally change past decisions at any time without a change in your documents as long as you are deemed mentally competent.

-Should you want to make a change in a past document, tell your appointed power of attorney immediately.

-Make sure your power of attorney knows she/he is your voice and speaks for you in any medical decision which should coincide with your wants and desires.

-Have end-of-life discussions well before illness or hospitalizations.

In a way, I look forward to being on Medicare. But I look forward even more to not only keeping my power of attorney abreast of my personal decisions, but also revamping old documents assuring no one other than myself makes medical decisions for me, even if that voice comes from my power of attorney.

Finally, I do not want hospital personnel to act surreptitiously for their financial benefit at the expense of my personal medical needs.

Gene Uzawa Dorio, M.D.

To make a comment, go to:

http://scvphysicianreport.com/

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The feds are cutting off St. Joseph's Hospital in Houston from all federal payments. This is due to a security guard shooting a mental health patient who was unruly. Initially the administrators blamed the mental health patient. The hospital has steadfastly refused to cow down to the feds demands for of compliance with health and safety regs.

Kaiser has "suggested" that its physicians reduce the number of chest CT scans and warn all patients that nodules are often identified which are most likely not cancer.

Mendocino Coast Hospital in California has severe financial problems. Tehy may need to file for bankruptcy. This would be a disaster since the nearest hospital is about 1.5 hours away over windy mountain roads. This is not unique to this hospital as other (57) rural hospitals are in the same fix. Here there is a secondary problem. The administrators are blaming the financial problems on the federal policies but the physicians are blaming the administrators. There have been four CEOs at the hospital in a year. The board is run by five people who are usually not knowledgeable about nether finance nor healthcare. The CEO wants to raise prices and the physicians want to cut costs.

The Ann Arbor VA has found that some of their instruments have particulate matter and then moved surgeries to a civilian hospital nearby. They say the vets have not been harmed yet and are trying to find the cause of the particulates. Top

The Washington Post reports that Charlie Sheen had his medical records hacked and was held ransom for $10 million to not reveal he is HIV positive. He came out on national television and said that he is now released from this prison. The story goes on with other examples of medical practices held up for ransom by hackers. Aren't electronic medical records wonderful?? Top

For those physicians that are still not employed, Medicare will drop next year the bonus program for generalists that is supposedly put in 2011. The payments, according to the CMS averaged almost $4000 per PCP. This may mean fewer Medicare patients will be seen. 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.