September 1, 2016 Recent News





Aetna has stuck a stake into Ocare.  They are pulling out of 11 of the 15 states where they offered individual insurance.  This added to the prior departures of Humana and UnitedHealth leaves major voids.  There are many counties where there is only one insurer and one county where there is none.  This means many people will have to change insurers and maybe physicians with the narrow networks that have been adopted.  Aetna stated they are leaving due to the lack of young healthy individuals in the exchanges.  However, the Wall Street Journal reports a letter sent to the feds that states if the venture with Human is thwarted they will pull out of the exchanges.  The venture is being looked at for antitrust by the Obama administration. No matter the reason they have every right to pull out. 

Oscar insurance is also pulling out of Ocare in some states. 

The Washington Examiner states that one in six Ocare customers will lose their plans and have to switch.  A lot depends on whether or not the young health continue to shun the world's most expensive insurance in the next cycle.

Bloomberg reports that Ocare is a money loser for insurers who are leaving the exchanges.  They say United will lose $850 million this year on Ocare and Aetna, Anthem and Humana will lose in the $300 million each.  This means the Ocare will lose any hope next year of competition and lowered prices.  This also means those that buy the insurance will see an average of 24% increase in their premiums.  The young are not signing up for the program leaving only the older sicker people on the exchanges.  Obama has floated several ideas all of which will never fly with a Congress that opposes the law.  They will give the program no more money.  The mergers were to help economies of scale but with those being challenged the insurers see much more red in their future.  Whoever is president next will have severe problems with the program.

The feds are running scared.  One can tell when they attempt to deflect reality with noise.  The NYT says the administration will attempt to advertise to get new people to join the expensive insurance.  They will send letters for the first time to those who paid the penalty instead of wasting money on the exchanges as well as using testimonials to attempt to attract people.  The feds are also making the insurers angry by stating the untruths that there is less demand for services and more consumers are entering the fray, both lies.  The bottom line is the Affordable Healthcare Act isn't.  Since only 11 million are in the exchanges most people will not be impacted.   

The other way the administration is attempting to spin the higher cost of the highest insurance premiums is to say that subsidies will take care of the problem.  Not only is that a lie since about 25% are not covered by subsidies and someone, namely the taxpayer, is still paying the high premiums.  They need to rethink the mandates to lower premiums and make it available across state lines.

The NYT has an article about who the uninsured are.  About 40% are Hispanic up from 29% several years ago.  About 41% are white and 12 % are black.  Only 6% are Asian and other races.  About half are under 34.  About 58% are male.  About 39% are very poor and live in states that have not expanded Medicaid.  Over 50% of the uninsured have either full or part time jobs. 

Business Insider reports the Federal Reserve Bank states that 20% of New York companies are hiring fewer people due directly to Ocare.  About 17% of the people in the service industry reported the same.  About 40% of the people responding said they were making modifications in their coverage.  This includes raising deductibles and increasing total premiums.   

The Washington Post states that enrollments in Ocare is about half of the initial forecasts.  The upshot of that is that next year 1 in 4 counties will have only one insurer.  Originally in February 2013 the CBO predicted that 24 million would have insurance thru all exchanges by this year.  Really only 11.1 million have the insurance via individual markets.  The problems have been the high costs and low penalty along with the usual government red tape.  

The USA Today has a story about the probable backlash to Ocare this year as over 2 million of the 11 million insureds will need to switch plans due to their insurer leaving the market.  

H Clinton has put out yet another policy.  This one is on combating mental illness.  As with all her policies she never says anything about the cost or how it will be paid for.  

The feds released a report that the use of ACOs has saved the feds $1.29 billion since 2012 including $466 million in 2015.  What it does not say is that only about 1/3 of ACOs got any money last year.  So it is a boon for the insurer but it is more hoops and a pain for the provider with no financial rewards.

The EpiPen story is out of control.  Is the price rise a lot since Mylan purchased the product in 2006, yes.  Did they raise the price a huge amount this year, no.  They have been raising the price the same amount each year since they got the meds.  Is there an alternative?  Yes.  There are several alternatives out there and there should be many more if the FDA had allowed the makers of the delivery system to compete.  The media is also not telling that most of the price of the injector is going to insurers and not Mylan.  That does not make a good story.   

Tennessee regulators approved a 40% average hike in premiums for Ocare plans.  Avalere projected the average increase for the silver plan would be over 20% in the country.  

Hillary is a typical pol.  She is proposing another new money using plan without saying how much nor where the money would come from.  The new gambit is a slush fund to pay for responding quickly to disease outbreaks.  The idea is good but short on specifics especially if the GOP keeps at least one house.

The San Francisco Business Times reports that Blue Shield of California is having their employees take a paid week off in September due to a $275 million decrease in profits.  How this helps is unclear to me except that it makes the employees used their paid time off now and not later in the year when the signups begin.

Maine's Governor states that the low income population is on long waits for care in the state due to the legislature taking money earmarked for healthcare and diverting it to the larger cities for education and to help the immigrants.  

The British are again denying women needed breast cancer meds.  The NHS is taking away meds that are not "cost effective" even if they work.        Top


A JAMA commentary explains well the physician frustration with EMRs.  They are designed for billing and not for ease of use by those who provide care.  The say that there is bloated data that everyone must wade through.  They say the EMR is a good idea but not as presently used.

In an unprecedented move the US Surgeon General has sent a letter to all physicians to help curb opioid abuse. 

HealthData has an article regarding clunky EHRs.  They talk about the study out of Stanford in JAMA.  The interfaces are clunky and therefore do not allow the physician to interact with the patient.  They are also filled with redundant information and are unnatural to use.  The companies attempt to do one EHR for all and that does not work.          Top


Wayne State is cutting 37 medical school faculty positions.  The people will be lost either through phased retirement or termination.  The people are researchers in the basic sciences.  With less money available via the NIH for grants and productivity is defined as how much grant money one brings in the outcome is forgone.  

Wayne State does not want to keep their faculty.  After the above they are wanting to require their 500 faculty members to sign a noncompete agreement.  If they do not sign by the new year they will be disciplined or fired.  One of the contemplated clauses states that if a violation occurs the faculty member will pay the university two years of compensation plus expenses as well as termination.  The clause also forbids working for any of the competitors for one year.  It is possible, even probable, that the university is doing this as a wedge in their currant negotiation with Detroit Medical Center.  The union that represents the faculty professors is threatening to sue the university. The imposing of the clause without union input is grounds for an unfair labor charge and also may be unenforceable due to its punitive nature.  Wayne State has never done things collaboratively.  

On October 1, the one year grace period for ICD 10 is up.  If one does not use the new codes after that date one will not be paid.  

An investment letter, Retirement Millionaire Daily, written by Dr. David Eifrig, Jr., state that one chart explains what is wrong with medicine today.  The chart shows the growth of physicians and administrators salaries from 1970 to today.  Physicians have increased minimally compared to administrators.  Currently administrative costs make up about 25% of all hospital expenditures.  He quotes the NYT saying the average administrator is paid $584,ooo or an insurance CEO, $386,000 for a hospital CEO and 237,000 for a hospital administrator compared to $306,000 for a surgeon and $185,000 for a general doctor. He also states that insurers spend $600 per patient on administrative costs, more than twice as much as in any other developed country.  

Texas General Hospital in Grand Prairie has almost no patients due to its charges.  It is a new facility that caters to elective patients and has the highest mark-ups in the state.  The hospital is out of network for almost all insurers.  The hospital utilizes telemedicine to treat any patient that happens to wander into the ED and then transfers the patient to UT-Southwestern via helicopter.  It would be nice to see this place to out of business and purchased by a real hospital.

Meadowlands Hospital Medical Center in New Jersey is into birth tourism but according to a local paper are using false advertising.  This is the most expensive hospital in the country says the paper and one of the lowest rated in the area.  They have a C-Section rate of 41%, grossly out of line.  I don't understand how the physicians can look at themselves.        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.