October 15, 2018 Recent News





In a good article (oped) but one generated to get more business, an attorney in a firm that represents providers in disputes with insurers writes about the recent report by HHS.  In that report the fed agency reviewed Medicare Advantage denial appeals and found that they delayed payments to providers and care to patients by denying claims.  these were then appealed but only 1% of the millions of denied claims.  Of those appealed 75% were later reversed by the plans themselves.  The denials are a major windfall for the MA companies due to the low amount appealed and the increased profits because of the captated nature of the payments to the plans.

Humana has been fined $700,000 by the Texas Department of Insurance for not having enough anesthesiologists in three counties.  This led patients to have to use out of network physicians at a higher cost to the patient.

Now that the feds have allowed the Aetna-CVS merger what is poor Walgreen's to do.  They announced a partnership with Lab Corp to open at least 600 medical testing locations within their stores.  This is after the debacle when Walgreen's partnered with the now defunct Theranos.

Britain has agreed to start allowing physicians to prescribe marijuana for medical uses.  However, only specialized physicians can prescribe and only on a case by case basis to patients who has special clinical needs that can not be met by licensed products.          Top


It couldn't happen to a better hospital system.  Summa is seeking a merger or a sale.  They need to improve their finances.  They want to go as one unit and not be parceled out.  They also want to retain some control.  To date there have been no discussion with any suitor.  They have five years remaining on a contract with Mercy.  This all came after they axed the old ED physicians and lost their ED residency which they have not been able to regain.  They reap what they sow.

Upstate Medical Center in New York is losing their president.  Dr. Danielle Laraque-Arena will leave in December.  She will return in June, 2019 , as a faculty member and will receive a faculty member stipend.  Until then she will continue with her president's stipend as she will be on study leave.  This is the person who is part of the investigation of the mysterious $600,000 salary to the last president who was fired and was continued to be paid.

Sonoma West Medical Center in California declared bankruptcy aft was sued by Anthem for its scam of lab billing.  They also had two hospital OR rooms shut down by mold in 2017.

Detroit Medical Center just finished negotiating a contract with Wayne State physicians to cover the hospital and do teaching.  Now they fired three cardiologists from leadership positions and another has resigned after they raised concerns about the hospital poor quality of care.  The hospital says it is due to conduct violations.  Drs. Mahir Elder, Amir Kaki and Tamam Mohamad were asked to step down and Dr. Ted Schreiber resigned.  The three former remain on staff.  The hospital is owned and run by Tenet.  Watch for a suit by the quartet against Tenet.

I knew Broward Health could not stay out of the news for getting in their own way.  Now their questionable CEO Beverly Capasso, RN is stepping down.  She was given the position after her colleagues on the hospital board could not agree on any of the qualified candidates for the job.  She was also indicted for her role in violating the open meeting law when she was on the board.          Top


The MGMA has announced a new poll of 426 physicians.  They state that in the past year about 86% said overall regulatory burden has increased, 94% said that decreasing regulatory burden would allow them to spend more time with patients and 78% said they could purchase new technology.  They agree that the Medicare quality payment program is the worst burden followed by prior authorization and EHR interoperability.  Most do not view a move to value based payment as positive and that that will make the burden even worse.

The revolution is starting.  Family physicians will start a pilot program to change the MOC standards.  This will use a longitudinal assessment in place of the 10 year test.  Physicians will get about 25 questions per month which can be answered anytime over 3-4 years.  It is an open book test and clinical references may be used.  There will be no additional fees.  Physicians will be able to get the correct answer immediately for feedback.        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.