October 1, 2015 Recent News






Advocates are not happy that this year the administration is actually following the law on Obamacare.  This means they will lose enrollees due to immigration and citizenship issues.  They blame the system for a problem with checking documents.  Of course, the people enrolling had nothing to do with it.

Obamacare has some problems to work out.  Besides being prohibitively expensive without subsidies they need numbers to make it work.  It ain't happening.  By next year the projections were for abut 20 million people t have the expensive spread.  The numbers are actually below 10 million to date.  The administration is hoping the new tax imposed on those who do not have the insurance will force many many more to sign up.  However it is so much cheaper to pay the tax than buy the insurance watch a minor tick up.  This has forced the administration to pare back their initial estimates to make sure they meet the numbers.

I wrote last issue that the ACO program is making money for the feds but not those who actually do the work.  I was wrong.  I new report says that the feds are not making money either.  I did not take into account the money the feds are spending by paying the ACOs that are making some, if little, money.  Taking that into account the fed actually lost $3 million on the program.  Like HMOs, they can lose on the individual and make it up in volume.

In a good news bad news scenario, the CBO reports that if the Obamacare individual mandate were repealed taxpayers would save over $305 Billion over the next decade at the cost of 14 million more uninsured. Without the mandated insurance or pay a tax fine the people would not buy the stuff.  If the tax penalties were scrapped the feds would get all of $6 billion less.  

in another article the uninsured rate has fallen by 3% from 2013 to 2014.  This means that in numbers the amount of uninsured went from 41.8 million to 33 million.  All states plus the District saw a decrease in uninsureds.  Whites were insured at the rate of 92%; blacks at 88.2% and Asians at 90.7%.  Hispanics came in last at about 80%. 

Good news.  Bad News.  Good is that wages and health premiums are growing modestly.  The bad news is that Obamacare deductibles are growing seven times as fast as wages and inflation and thrice premiums. Love the most expensive health insurance on earth.  

Healthcare.gov has remained out of the news until recently.  It turns out they, according to the IG, really screwed up.  They failed to train their employees, they kept sloppy records, and they failed to identify delays and problems that contributed to millions in cost overruns.  Most employers who did this would be gone but this is the government.  They do not answer and usually get promoted.  

To add to the problem the HHS paid CGI Federal $4 million to fix their own mistakes.  Good overseeing of the taxpayers money.  

The next (3rd) Obamacare signup is coming soon.  The HHS is going to focus on signing up blacks and Latinos in Dallas, Houston, Chicago, Miami and northern New Jersey.  This is where there is a large amount of uninsureds.  

Gee, there has been a drop in prostate cancer diagnosis since the USPSTF has recommended to stop screening for prostate cancer.  Does that mean there is less cancer?  NO.  This means that men will go from cancer that can be treated to cancer that can not be treated.  Great forward progress.  But, less spent so I guess that is OK.  After one year the amount of curable cancers has declined by 30%.  Really good.

The presumed Democratic nominee, at least until Biden decides, H. Clinton wants to "improve" Obamacare by requiring insurers to cover three sick visits without counting toward a deductible.  That should raise premiums nicely instead of deductibles.  She also wants to threaten states that do not stop insurers from raising premiums.  Typical federal interference in state business which eventually will go the way of the 65 mph speed limit foisted on the states and then repealed.  She is trying to out Bernie Bernie.

In what is poetic justice, the federal healthcare plan for the fed employees and retirees will rise by 7.4% for next year.  This is the largest increase in five years.  

While all this nonsense is happening the Pope is visiting and causing a commotion by having a non scheduled drop in with the Little Sisters of the Poor.  In case you forgot they are the ones suing the feds over the Obamacare contraception mandate.  He also called for strong religious liberty protections when he met with Obama.

In a good case of what public opinion can do the CEO in charge of Daraprim, the front line drug for Toxoplasmosis, raised its price and then quickly lowered it.  Maybe this is the way to battle high drug prices.  Maybe Bernie can do it with regulations that will never make it through Congress.  

Then there is the VA the wonderful organization that should not be.  They continue to say they are getting better when in reality they are doing worse.  The cost for facilities are twice that of the private sector and the wait times for the Vets is getting worse.  Now that the vets can go to private hospitals it is found that in 6 of 10 patient centered measures are significantly better at the private hospitals.  Who would have guessed?  

An article in Modern Healthcare states that independent medical practices that are purchased by hospitals are seeing operating costs go way up due especially to EHR costs.  The MGMA thinks this is great if it is updating the technology.  

The AMA is not happy about the problems with EMR and neither are the physicians in the states.  All know that the programs add time to the workday, do not work across platforms nor knowing what treatment one should use.  The Massachusetts Medical Society held a town hall to talk abut the problems and see how the records can be fixed.  This is similar to the one held in Georgia several months ago.

Government medicine is not what is used to be.  In England the junior physicians are getting off the sinking ship.  Over three days 1644 physicians applied for overseas immigration.  This occurred after the government changed the definition of a work week.  It now includes evenings and Saturday.  The British Medical Association rejected it and sent it back to the government.  This has set the idea of going overseas in motion.   

Still in Jolly Olde Cambridge University Hospitals National Health Service Trust lost their CEO and CFO.  The reason is that the Epic EHR system they are putting in has cost so much money.  The hardscape from HP will cost L 140 million, the Epic L30 million and an additional L20 million for the trust's costs.  This whole monstrosity was overseen by the CEO.  An investigation has been launched as to the current trust financial difficulties and the new system.     Top


In a fascinating article on Politico, they had done an investigation of all the major EHR companies.  They all seem to have some restriction built into their contracts limiting what physicians and others may say about their problems.  This includes non-disparagement clauses.  Therefore if a person has a problem and an investigation shows the EHR was partially to blame, one can not disseminate that so the problem can be corrected.  Others will not know the problem exists.  One of the major taboos is sharing screen shots.  The companies are afraid that others will learn secrets but this leaves physicians as not able to show exacting what went wrong.  Congress is now looking into the problem but of course nothing will be done.

Two articles came out almost the same day.  The first is from Newsweek.  They talk about the problems physicians have with the American Board of Internal Medicine's (ABIM) MOC junk.  There has been a rebellion by the nation's physicians against MOC in general and this one in particular.  Many believe that is is only to line the pockets of the ABIM.  This has forced the organization to make some changes to the program but they are small and too late.  The physicians are demanding the the ABIM and its parent American Board of Medical Specialties use outside people to prove the MOC is really making a positive impact on patient care.  To date they have not done so.  Several subspecialty groups are urging its members to boycott the ABIM MOC tests and consider using the new recertification group, the National Board of Physicians and Surgeons.  Many prestigious hospitals are now accepting the new recertification as valid for their physicians.  The American Board of Anesthesiology has recently dumped its recertification to allow its members easier access. The American Board of Pediatrics is also considering the same.  The article also accuses the ABIM of responding with lies and innuendos.  

The next article in Medscape states the ABIM is considering finally scrapping the MOC junk with more relevant testing.  They would finally go to open book to mimic the real world where physicians look up things they do not know or don't remember.  The problem is the organization did not say when it would make the necessary changes and the costs involved.

Non Board Certified Cardiologists do as well as Board Certified ones in complications of cardiac intervention.  They fall down in the important measures of the patient dying in the hospital by 10% and a much higher percentage being referred for CABG surgery.  The investigator said that maybe certification is being erroneously used for hospital requirements and is keeping some high quality out.        Top 


The San Francisco Business Journal reports that Kaiser which has been under a huge cloud for years for their lack of adequate mental health providers and has been fined several times by the state for this, is now hiring as many therapists as possible in a short time.  Since 2011 they have hired 500 in the state and are looking to hire 350 more in the next few months.  They are also spending some money, but not much, to spruce up their mental health clinics.        Top


Forest Park Medical Center, a physician controlled hospital in Frisco, Texas, is filing for Chapter 11.  They are an out of network facility and are being paid less by insurers.  This is part of a chain of hospitals and is now being sued by a group of physicians in Kansas City to get their money back.  they invested into the building of a hospital but it is not going to be built and the money they say was transferred to Frisco.        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.