October 1, 2010 Recent News







It looks like physicians are taking it in the rear again.  A story in Medscape states that any fix to the physician Medicare payments will not happen until the new Congress is seated.  The current 23% drop in payments is supposed to start December 1.  It is expected that the lame duck Congress will only pass an extension of the current moratorium.  It is possible that a change in the SGR system will also not take place as long as Obama is president.  This is due to the threat of a veto for any decrease in healthcare reform to pay for the physician payments.  In the meantime, physicians are continuing to limit their exposure to Medicare patients.

The USA Today had a story about the new physician patient relationship.  The new model is "shared decisions".  With large co-pays patients are now questioning physicians as to whether that test or medication is really necessary.  It is becoming more important to tell the patient why a test is necessary, what you are trying to gain and what are the cost and risks. 

The recession continues.  Physician visits were down 7% in July.  This is the fourth consecutive month of dropping visits.  This leads to a decrease in labs and diagnostic testing as well as elective outpatient surgery. 

A study in the Archive of Internal Medicine states that people picking physicians by using the state medical board listings of med mal and other information may be led astray.  They feel that that the only way to pick a good physician is how they follow guidelines.  The study was via the Rand Corporation and was biased in the thought.  They ended up stating that those that were the high quality physicians were female, board certified and graduating from a domestic school.  In other words there are no good parameters for picking a good physician nor what is the definition of a good physician.

The feds and some insurance companies may start to pay more to physicians who not only are board certified but who have been recertified even though they are grandfathered in.  This in an article in The Columbus Dispatch. 

An article in the Pittsburgh Business Times tells how the physicians are hurting with rising account receivables.  The article doesn't say it but it shows that physicians are poor business people.  They do not collect the deductibles and co-pays up front so they don't get paid.  

According to Health IT News, physicians do not care about the penalties of 1% reduction in Medicare payments for not having EMRs.  The reason is that the cost of purchasing and training are more important than the decrease in one aspect of their fees.         Top


The People's Republic of Massachusetts again has found out it is stupid.  They just found that they have been paying their Medicaid providers more money for CT and MRIs than Medicare pays.  They try but are not successful in blaming the paying so much total money on allowing physician self referral.  They have no data to support the claim.  There is data to support the stupidity of the Republic.

The Obamacare program for providing insurance for those who have not been insured for the past six months and who have pre-existing conditions has started.  In Ohio 330 patients are now covered.  They have all of 25 more applications pending.  There are approximately 1.3 million in Ohio without insurance.  Maryland signed up two people the first day.  Iowa has signed up all of 32 people.  At this rate the program does not have to worry about running out of money before 2014.

Most of the large insurers have stopped selling individual insurance policies to children.  They require that the child be on a policy with a parent.  

Health insurers plan on raising rates to pay for the new required benefits under Obamacare.  The raises will be for individuals and small businesses and will range between 1% to 9%.  The White House doesn't like it but has no say.  The Republicans love it and will make this a major jolt to those who supported Obamacare and who are running for office.

Sebilius states that all is well in the Medicare Advantage arena.  This means she is not in touch with what is truly happening in the country.  To date the administration acknowledges 3000 people have lost their coverage despite Obama's pledge that no one will lose their physician, a major misstatement, probably intentional.  They do not say anything about Harvard Pilgrim canceling it's Medicare Advantage plan which affects an additional 22,000 people.  Also in Minnesota five insurance companies will drop Medicare Advantage for an additional 44,000 with new insurance and physicians.  Principal Insurance will stop selling any health insurance plans affecting about 840,000 people.     

The Dallas News reports that some insurers are canceling insurances in front of the start of Obamacare.  The small carriers can not afford the coverage and the mandates so will close in some markets. 

Minnesota Blue Cross/Shield and HealthPartners have stopped writing individual policies due to uncertainty in the federal rules.  They hope to start again once they get guidance.

The USA Today has a story that healthcare spending in general is down.  The reason is the recession.  The 2.7% increase is the smallest since 1959.  If inflation is taken into account there is actually a decrease of 0.2%.  Those that have lost jobs are cutting back on medical spending.  This may mean several things.  The first and most devastating is that they are foregoing needed medical care.  The second, and a good thing, is that they are now accountable for how they spend medical money and can not rely solely on insurance to pick up the tab.  

A government study from the office of the chief Medicare actuary states that Obamacare will have negligible effects on healthcare spending as a nation. There will be about 32 million people now covered under the new plan that needs to be paid for. They will be paid for by Medicaid, cuts in Medicare spending and a tax on the " Cadillac health plans".  The health spending will increase by 6.3% instead of the current 6.1%.  See story below.

 As a follow-up to the above stories McClatchy reports that employers are continuing to shift costs to employees to get rid of Cadillac plans.  This is good because now the people will have more of a stake in the costs.  

As all know Donald Berwick, the new appointed but not confirmed head of HHS, has a love affair with the British medical system.  I wonder how he feels about the editorial in the Wall Street Journal that describes the systematic starving of patients in the British hospitals.  Those that came to the hospitals in a malnourished state left the same way plus an additional 86,000 who came nourished but left malnourished.  The reason was not the food but there is no one to help feed the elderly and frail.  The editorial states that this is what happens when the hospital administrators listen to politicians and not patients in a single payer program.    

The Chicago Tribune has a story regarding the new Obamacare and the possibility of narrowing of patient choice for hospitals and physicians.  The new law requires higher quality standards which is good.  The insurers are usually pretty good at skipping the quality determination for their preferred lists and only going with the lower price providers.  They believe that quality care as they define it reduces costs.  This is not a true statement.  Money will be very important since the law requires an 80% expenditure on medical care.  What about those who routinely see the higher medical needy population.  They will be penalized?

As the elections near Obama and his cronies will be out on the trail touting Obamacare.  The problem is that the Democrats running for office do not want to be associated with Obama or his health plan.   

The London Telegraph has a story about the hospitals who had a total ban on smoking and then reversed it.  They found patients smoking in bed under the sheets and were afraid of the potential fire risk.    Staff were also smoking in inappropriate places.  Rather than sticking to the ban and strictly overseeing it they bowed to smoking. 

The Vancouver Sun ran a story regarding Radiation therapy.  They find that many Canadians are not receiving the therapy when indicated.  The reasons are that the primary physicians don't know the benefits and don't send the patients.    Top


The Sacramento Bee, never known for its reporting, has a story regarding California licensure.  They state that physicians that do not fall into the fraudulent or sexual predator category usually do not lose their license but are placed on various probations.  This is true but is it wrong?  If a physician has a problem and can be rehabilitated, should not the physician be allowed to do that.  No, according to the Bee.  The Bee focused on eight physicians in the state with very questionable records.  They did not touch the other over 1000 physicians reported yearly to the California Medical Board.  They did not discuss the Medical Board's role in rehabilitation.  They did not discuss the Medical Board's furlough policy.  They only did a hatchet job based on shoddy reporting.        Top


Modern Healthcare discusses a Health Affairs article where the researchers state malpractice costs are over $55 Billion.  This total is 2.4% of the annual healthcare spending.  The article states that the defensive medicine portion is $45.5 Billion per year or 80% of the total.  This will not change until physicians stop being reported for all med mal payments to the NPDB and other like punishments.  As long as physicians feel their livelihood is jeopardy due to med mal claims they will practice defensive medicine.  The researchers agree that capping payments are not the answer.  They really had no answer to the problem.  

The Trial Lawyers love the above since it shows that caps will not solve the med mal problem.  What they don't state is that since 80% is defensive medicine, if caps go away many more tests will be ordered and the total bill will increase. 

The News Press, a Florida paper, has an article regarding med mal in Lee County.  It talks about the med mal caps which caused a decrease in premiums for physicians and a decrease in law suits.  It then balances that with the continued practice of defensive medicine.  An ER physician stated that the numbers are deceiving since med mal carriers left the states several years ago depriving the high premium physicians of med mal insurance.  The premiums in Florida are still higher than other states.  With these high rates there will be a significant amount of defensive medicine practiced.       Top


The large (over 400,000) California HMOs are seeing a rise in complaints along with a drop of enrollments. Small HMOs had a drop in complaints and also a drop in enrollment by 22%.  Kaiser had the most complaints, over 40% of the total.  The biggest complaint was in coordination of care.        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.