September 15, 2016 Recent News





Ocare must be in real trouble.  HHS chief Burwell is stating that it is viable.  All knows when the feds say that the opposite is true. 

Soon after Burwell lied Obama pled with insurers to stay the course.  He came to a meeting between Burwell and insurance CEOs to personally plead his case.  He also sent a letter to all CEOs of insurance companies asking for their help in fixing the exchanges.  

Obama may attempt to bail out some insurers by yet another executive order.  This is via the risk corridors that have now reached their life span.  Congress has passed a law forbidding other sources of money to be used in this corridor.  CMS is therefore attempting to use all the money collected in 2015 to pay off the monies owed from 2014.  This is a legal maneuver and would pay off all those who have sued the feds for the payments owed.  They would however also use money reserved for legal settlements to pay off the debts.  This is quasi legal and has not been done before.  The administration in the past has sent a memo stating this money would not be available for these payments.  

Insurers are trying to save more money by putting in more plans with limited networks of physicians.  The WSJ reported that in 18 states and DC there would be only 25% of plans with larger selections of physicians.  

Cigna announced that it can not sign up any new Medicare Advantage customers due to being investigated by the feds.  The CMS found widespread and systemic failures in their business.  Cigna said it would not fix the problems by the time for enrollment next month.  Existing customers will be able to renew. 

Obama praised Dartmouth as the way Obamacare should work.  Dartmouth has severe monetary problems and is now laying off hundreds of employees.  

The 17th of 23 co-op formed under Ocare has been ordered to close.  The latest is Health Republic in New Jersey.

A report shows that Ocare state based exchanges waste millions of taxpayer dollars.  The administration has handed out to these exchanges over $4 billion and four exchanges lost $239 million in IT work.  Slavitt said over $200 million in unspent grants were to be returned but only $21 million were.  Five of 17 exchanges have closed or about to close.  These have received $1 Billion from the feds.  This clearly shows a lack of oversight by the administration, as they did with the start of

The uninsured rate has fallen with Ocare but there is still significant poverty due to Ocare.  About the same number of people insured under the plan are in poverty due to out of pocket expenses.  

The VA has quit sending data on quality to a national database, Hospital Compare.  Is their quality is so low they would be embarrassed?  This is even in the face of a law directing the VA to report the data. The day after the USA Today broke this story, the VA said they will again participate starting October 1. 

H. Clinton said that if elected she would create an oversight panel to protect consumers from large price hikes which could include importing alternative products.  The idea got a big ho hum from both sides of the aisle in congress.  All know she could not do this.

Idiocy is nothing new to medicine but his goes over the top.  CMS is upset that the global payments for surgeons may not entail as many pre and post op visits as they are paying for.  There fore they want to pay only for the day of surgery and have the surgeons bill the office visits separately but on 10 minute increments.  This was shelved by MCRA but the CMS was asked to o a study.  They are asking (telling) surgeons to bill "G" codes on their patients for 10 minute increments, for no payments.  Surgeons say no.  If they don't then CMS will withhold 5% of the payments.  CMS will issue final rules in the fall.

Can you imagine that in California, 70% of the health tab is paid by the small amount of tax payers in the state.  This is due to the massive increase in Medicaid.  Approximately $260 billion of the total of $367 billion of state total healthcare money comes from the taxpayer.  This is contrasted to 45% or 65%  (in dispute) paid for by taxpayers nationwide which include Medicare.  The California amount included subsidies fort employer based health insurance (12%).  Prior to Ocare most of insurance in California was private, employer based. This study by UCLA will be used to push national health since it is almost there already.  

Canada is slowing their production of molybdenum 99 the precursor to technetium 99.  This may result in shortages of the isotope for use in hospital nuclear med departments for bone scans, heart perfusion studies and other radioisotope studies in gamma cameras.        Top


Last issue I wrote the following about Wayne State:

"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. "

Since then Detroit Medical Center is looking to plan B should Wayne State talks go away.   They are looking to other physician groups to cover their patients and do the teaching.  

October 1 is the date of payment adjustments for hospitals that did not successfully attest to the MU program  This is about 2% of the nation's hospitals. 

UCSF-John Muir joint Venture has just signed a long term lease in Bezerkley, California, for an outpatient and urgent care center in Sutter Health's back yard.  

UCSF continues in the news but not for anything good.  They are eliminating close to 100 IT jobs and shipping the work to India. The laid off employees are expected to train their Indian replacements.  This is all secondary to decreased revenues from Ocare.  Thanks Pres.        Top


All physicians know EMR is a massive time waster but this has now been quantified.  A time motion study in four specialties in four states were surveyed and it was found that physicians spent two hours on the computer for each hour of face time with patients.  Many do this outside the office while at home.  the study showed that 49.2% of office time was spent on computer nonsense which included about 48% of the time in the actual exam room was spent on non clinical activities.  After hours work was about 1.5 to 2 hours while at home.   

In corollaries to this, a study showed that the number of hospital owned physicians has gone up 50% in the last four years.  This means more not less EMRs and of course much higher prices for all.  Also another study showed the more of EMRs the higher the burnout rate is for physicians.  

Did you know that when physicians bill electronically they are charged transaction fees?  Roughly 25% of physicians pay this fee.

Three physician associations in San Diego County have formed a new group, Health Excel Inc.  The founding associations are XiMED IPA, MutiCultral Primary Care Medical Group and Greater Tri-Cities IPA.  They will remain separate for now but will share best practices and collaborate on contracting.

In Vermont independent physicians are trying to open the Green Mountain Surgical Center but are running up against huge opposition from the non profit hospitals of the area.  They say it would be a negative impact on the area (their business).  This would cut out the high prices at the hospitals and the immoral facility fees.  The hospitals as they always do are acting in an anti-competitive mode.

Aren't you glad you do not work in Illinois?  Since the pols there decided to drop the temporary income tax they are spending more than they receive.  I didn't realize the state was the same as the feds but they are both Democratic.  The physicians seeing state patients are owed mucho dinero and will not receive it for mucho anos. They already have not been paid for about 18 months.

The junior physicians in Britain have called off their five day scheduled strike.  The reason is the potential impact it would have on patients and service.  The problem was the lack of advance notice to the NHS, only 12 days.  The doctors will resume their strike attitude but with longer advance notice.  

The British Medical Association has recommended a 15 minute limitation on visits and have physicians seeing no m ore than 25 per day per doctor.  The appointments are now 10 minute slots.  The NHS says that the length of visits is up to individual practices based on patient need and there is no national limits.  Therefore, just do it.        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.