The Boston Globe has a major story about how healthcare in the People's Republic is manipulated and the cost raised by collusion. Partner's Healthcare and Blue Cross of Massachusetts made a deal to increase the payments to Partners in return for a promise that other insurers would not be allowed to pay less. This occurred in 2000 on a handshake since they were rightly afraid of antitrust problems. Partners then used the deal to extort more money from several other insurers and the escalation in fees was on. Since 2000 Partners has receive a 75% increase from the Blues, much more than any other hospital or group have received. It should be noted that Partners was established in 1993 by consolidating Mass General and Brigham and Women's Hospital. There was no state or federal oversight of this consolidation. The consolidation was supposed to save about $250 million per year but in fact only saved this much over a five year period. They did this with administrative savings and did not combine the clinical arms which would have made clinical and monetary sense. This consolidation has since led to potential antitrust actions by Partners such as the removal of almost 300 physicians from its network for sending patients to other hospitals. Even though it would be difficult to prove the feds should look into the relationships between the Blues and Partners.
The GAO reported the enrollees in the private fee for service plans (Medicare HMOs, PFFS) tended to be younger and healthier than those in standard Medicare. These are basically a hybrid between regular HMOs and standard Medicare. Significantly more fee for service Medicare patients enrolled in these plans that give greater access to physicians and less hassle than standard Medicare Advantage plans than regular Medicare Advantage patients (81% v 65%). The patients in PFFS plans have more pre authorization requirements as well as occasional denials of services not authorized in advance. In 2007, PFFS enrollees disenrolled at a 21% clip versus 9% in standard Medicare Advantage plans.
In a fascinating article the McKinsey Global Institute had an article entitled "Why Americans pay more for health care". Their study showed that we pay about $650 billion more for healthcare than other comparable countries. The largest component in this surprising was outpatient care. The reason is that this encompassed much of not only physician and hospital visits but also lab and radiology. The second biggest portion was no surprise, pharmacy costs. The next two were administration and insurance. The group suggests that if the US wants to change healthcare it must get buy-in from all the players, not just the political ones. They believe that all must be changed including demand with more knowledge of costs by the consumer of healthcare. Supply must also change with not passing as much profit off to the next person. The group likes DRGs and not fee for service as a way to hold down costs. The group does not believe that fear of med mal is a major contributor to the gross spending and only contributes about $30 billion. That sounds like alot to me. I believe in Ev Dirksen, the silver toned Senator from Pekin, Illinois, who said "a billion here, a billion there and pretty soon you are talking about alot of money. I recommend this article to all who believe medicine must change.
The Republic's health plan is also causing consternation for seniors who need or want basic home care. Budget cuts have changed no waiting time to an unknown wait time for the home care. I do not doubt that home health is cheaper and better for the patient but I do take exception to the statement by an advocate that "elders have a civil right to be cared for in the least restrictive setting appropriate to their needs."
Minnesota's Hennepin County will stop its a hybrid HMO fee for service provider. The fees were so low that no physicians would accept it.
Have you ever heard of personalized medicine? It means patients will get genetic testing to make sure the prescribed meds will work on that patient. Can you see insurance companies allowing this expensive testing? Can you see physicians having the time to talk to the patients about the testing? Top
The Condell Hospital in Illinois CEO resigns after the hospital is named in a settlement with the feds for paying physicians to refer patients to the hospital. The hospital is being purchased by Advocate Health and while doing its due diligence found that the hospital had been giving physicians under fair market rate rent. The hospital paid a fine of $36 million.
Boston Hospital has financial difficulties despite the healthcare for all. Most of the hospitals patients are the low paying sort and the state is cutting them back $114 million. The hospital will cut back basic services as well as personnel. Many of those laid off are interpreters so people who need these services will need to wait longer to be seen. It will also sever ties with Quincy Hospital, another hospital of last resort.
The Baltimore Sun did a three part expose on the immoral and sometimes illegal billing practices of both the Maryland hospitals and the attorney firms they hire to sue in small claims or general court. The first part was titled "In their debt" and tells stories of the people sued illegally by the hospitals. Maryland has a law where a state agency sets hospital rates of all patients. The hospitals of the state in 2007 received $921 million (almost one Billion dollars) to pay for the free and and unpaid care. In the past five years in spite of receiving all this money the state's hospitals have sued over 132,000 patients and won an additional $100 million from the illegal suits. In the second article the hospitals look like uncaring, inefficient and sometimes plain stupid. Probably all true. The attorneys are collection mills with drones just doing their jobs with no thought. The judges do not care about anything except to clear the docket. The patients do not know that they have rights and defenses. They only hire legal aid attorneys to appeal decisions that are so egregious as to be illegal. The expose should make the hospitals ashamed but that will not happen. They will continue their practices of not doing their job and suing people with insurance that can not be sued or people after the statute of limitations has expired. I usually am against regulation but this screams for the legislature to correct the wrongs. In the third and final article of the expose the paper states that the commission that sets rates does not know how hospitals collect debts. The hospitals can charge interest on the debts at 12%, twice the interest allowed on other consumer debts. The governor is now asking for an investigation of the hospital's collection practices to be completed by February. There is a special Congressional rule an earmark by a Maryland Democratic Senator for Maryland to get money (about $500 million per year) for healthcare. If hospitals let their rates go up too fast they would lose this money. The state legislature Republicans want to take away the rate commission but the controlling Democrats will not allow this out of committee. It will be interesting to see how much clout the Maryland Hospital Association has to kill any changes. Top
New Hampshire's HHS erroneously released personal information on over 9000 people and is now notifying those affected. It recommends those notified to put fraud alerts on their accounts but the state is not offering to pay for it.
North Mississippi Medical Center is the latest hospital to abandon its EMR. This will take 3 to 5 years to get the new system up and running. The current system is 25 years old and connects six hospitals and their clinics.
This past year has seen the scandal at several Southern California hospitals and the bungling by the feds on presenting new privacy issues into EMRs. The FCC has given out grants over three years of $400 million for rural broadband to providers.
New York City is paying physicians to go to EMRs that are tied to other physicians and a central database. About 1000 physicians have in the past year converted to this system. This has cost the City about $60 million. Soon the city will give money to physicians for each patient that hits certain targets. The city is providing subsidies and training to the physicians. Instead of the usual $45,000 to implement the physician only pays $24,000 if they have more than 10% of their patients on Medicaid and only $10,000 in neighborhoods with the highest poverty rates. Top
The hospital biased Horty legal firm wrote a rebuttal to the hospital attorney's article regarding not doing precautionary suspension. The precautionary suspension is one of the hallmarks of this biased firm. They consider this a preliminary step and not a final action so no report to the Data Bank is formulated. They state that this gives time for an investigation. However, as they know it does not give the physician any hearing opportunity. They look at it as an administrative time out. Meanwhile, the physician has no income and is in limbo for the potential months it may take for the review. The Horty firm believes this "voluntary" withdrawal of privileges will not allow attorneys for the physician to intervene with injunctions. They don't like to be challenged. If the physician shifts his work to another hospital, Horty believes that all bylaws state that the physician must quickly tell the other hospital that he/she is under investigation. This may or may not be true. However, since the withdrawal is voluntary I am not as convinced that it is necessary to report to the other hospital. Again, I am biased in favor of the physician. One must look at who wrote the article and take their biases into account when one decides how much credence to give that article. Top
The new crop of physicians are being taught how to use EMR in training. They are in for a rude awakening when they come into the real world. The vast majority of small and intermediate practices have found that EMR is too expensive and not worth the benefit. The new practicing physicians want the hand holding of the EMR to check their work as they are not sure of themselves. That is because of the training programs not teaching both methods and how to self rely. Top
For the past three years med mal premiums have been either steady of down slightly over the country. Again Florida was the highest in premiums followed closely by Illinois, Michigan, New York and Ohio. The lowest rates are in Minnesota, South Dakota and Wisconsin. Texas is also coming on strong. 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