September 1, 2014 Recent News






The new VA program to send vets to private physicians may run into some snags over the laws requirement to pay no more than Medicare rates.  HealthNet and TriWest are paying below Medicare rates to private physicians.  They say that is OK since they are paying on time and accurately.  They and all insurers are supposed to do that.

Hospital association are starting to look after number one.  The associations in Wisconsin, New York and Florida are seeking money from hospitals to help people pay their Obamacare premiums.  The insurers are not happy about this since this may skew the sicker poorer patients into the system driving up costs and raising premiums for the others.  Of course the hospitals want the sick patients in the system so they can be paid more.  Hospitals have helped with premiums in the past under Cobra but with the strange 90 day grace period under Obamacare hospitals and physicians may get stuck with no payments if the insureds do not pay their premiums.  The administration as usual is waffling on this issue with little guidance.  

About 10% of large employers are offering their employees a Obamacare compliant insurance plan and a "skinny plan" that does not comply with the law.  These plans cover preventative care and no other care. This is a win win.  Employers will not be penalized since they are offering an Obamacare compliant plan and the employees do not have to pay large premiums for a plan they do not want and still get out of the tax.

The hospitals are also decreasing charity care as Obamacare takes in patients.  They say this is to push patient to Obamacare.  It makes sense if a person who should be on Obamacare isn't, they should not get free or charity care.  At BJC Healthcare there level of giving charity discounts has gone down requiring more to pay more.  

Sine the inception Obamacare has faltered under the administration led teams.  Finally there is a head of the Obamacare exchange, Kevin Counihan.  He has been the head of the Connecticut health exchange which has a good reputation.  One wishes him well as he will still be beholden to the idiots at CMS.

The left leaning Institute for Policy Studies issued a report on an obscure Obamacare law that targets executive pay at health insurance companies.   In the past companies have been able to deduct salaries up to $1 million.  That has been lowered to $500,000 and removed the carve out for stock options etc.  Last year this meant $72 million into the treasury. The law has not stopped the continued increase in chief exec's payment as in 2013 they saw a 7.1% raise to $5.4 million.

The potential for problems is large again in the next six months for Obamacare.  The IRS has to get out the new form 1095-A which people are supposed to list all the people in the house that have health insurance and how much subsidy was given to them.  It is doubtful if the agency will get the form out on time and this will mean any refunds due may be delayed.  Each state that had their own exchange must send out letters to each person as well.  This information will have to jive with the IRS information to get the refunds.  If they got too big a subsidy (income changed during the year) they will have to repay part or all of the subsidy.  It is expected that millions will have to pay some money. 

The MassHealth Medicaid exchange is having problems in the Cape Cod area.  The primary physicians will not take the Medicaid patients.  This is due to the state regulations that require physicians to either take all or no Medicaid patients in their practice.  To the clinics they go.  

MassHealth is also under financial duress.  The state did not fund enough money to cover the costs of the Medicaid program.  Therefore the insurers want more money next year to fund care for the Medicaid patients.  

Massachusetts Obamacare website was a total disaster last year.  As a result about 267,000 people were enrolled in an insurance plan whether they qualified or not.  These people must reapply this year and it is costing the state almost $19 million to try to get them enrolled.  They also have 100,000 people enrolled in another program that is ending, so they also need to be reenrolled.  These people probably do not know they need to reenroll in the now off the shelf exchange whose cost is now up to $ 254 million.  It is good to see how they spend other people's money.

In leftist California Obamacare has just over half of the registered voters polled liking it.  Just under half reported paying more for the coverage than they paid prior to Obamacare, this means they had insurance and were forced to switch.

Hawaii's largest insurer Hawaii Medical services Association has pulled out of the business exchange leaving only one insurer for employers to select.  Too much hassle with the exchange.          Top


Don't you love electronic medical records.  Chinese hackers stole personal  information including social security numbers on 4.5 million people.  All those referred to or seen by a physician with an affiliation with Community Health Systems were affected.  The hack happened in April and June of this year.  They are going to offer identity theft  protection to all.  It is a good thing they have insurance for this as the fine by OCR should be huge.  Community Health did it to themselves by not patching the "heartbleed virus" timely.

About 90% of hospitals and clinics have had some loss to hackers.  Not a ringing endorsement of EMR.  There have been about 30,000,000 patients having their records breached since the start of EMR.  This is also not a ringing endorsement.  Face it.  Healthcare has not kept its end of the EMR bargain.         Top 


Atrius Health in Massachusetts is breaking up.  Two physician groups Reliant Medical and Southboro Medical have left the large alliance and are considering forming their own central Massachusetts group.  Two other groups Dedham Medical and South Shore Medical are also thinking about leaving.  This would leave Atrius with only Harvard Vanguard and Granite Medical or 60% of the total physicians today.  The defections were probably due to problems with governance.  

On August 12, the internet experienced a "brownout".  This caused many physicians who use Practic Fusion to be unable to reach their cloud based information.  as a result not only did they not know who was coming in and their demographics and co-pays but they also could not access any information about their medical care.  Some physicians cancelled a whole day of visits.  Other physicians with other vendors had no problem since they have redundant systems in case one fails.  The old adage is true.  You get what .....

The American Medical Group Association found the there is a high 6.8% turnover rate for physicians.  The reasons are a better economy allowing the freeing of physicians and in 2013 the main reason was retirement.  It seems the two go hand in hand.  

Is an ACO worthwhile?  The answer is still forthcoming.  CMS has compared a four year pre-ACO window with a five year ACO and found a whopping $171 saving per assigned beneficiary person year.  Bonus payments were $89 per beneficiary person year.  Therefore Medicare saved $69 per patient year.  There was a savings of 9 hospitalizations and a reduction of 14 ER visits per 1000.          Top


One wondered why the SEIU was so adamant about not having Prime Healthcare purchasing Daughters of Charity Hospitals in California.  The San Francisco Business Times broke the story about SEIU being worried that the $700 million pension plan may to away if Prime takes over.  Both Prime and Daughters deny that the pension plan would not be kept.

Prime has sued the union for racketeering for their unjustified continued harassment and then the union stepped up their smear campaign against Dr. Reddy, the CEO of Prime.  Remember the main driving force is the union's fear of Prime winning the bid for the Daughter's of Charity hospitals.

Sharp HealthCare in San Diego has seen the light and dropped out of the Medicare Pioneer ACO program.  This was a potential money loser for the organization as it has been for the other nine hospitals that have left the struggling program.  This leaves 22 of the original 32 programs and more seem to be on the verge of leaving.

Parkland Hospital should be getting used to this.  CMS has again socked it with an "Immediate Jeopardy" notice.  This apparently involves one psychiatric patient but no one has stated exactly the problem.  They had another one of the same problems in 2011.

Las Vegas University Hospital, a county hospital, is slowly closing.  They have a terrible payer mix and can not continue to function doing all for all.  In April they laid off 105 people and closed four clinics.  Now they are laying off an additional 285 and closing their outpatient oncology, outpatient pharmacy and some clinic services.  The union doesn't like it.  Guess who a lot of the problem is?        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.