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Yep, the administration lied again. When the federal and some state exchanges opened for business the administration said the crashes were due to the overwhelming crush for help. Nope, it was the usual government SNAFU. They were told months in advance that they were inadequate and did not listen. The worse place in the nation was Milwaukee, Wisconsin, where exactly zero people got signed up due to the fed SNAFU. After one week they still had enrolled no one. Hawaii, after two weeks has not opened their exchange. Eventually the feds will get it together but how much disillusionment will lead to less signing up remains to be seen. To date the feds have not released any data on how many have enrolled.
A week and a half after the opening of the federal exchanges for Obamacare, the feds still don't have it right. The reason is that they do not hire the best and the brightest, but hire the lowest bidder. CGI Federal won the contract for the bargain basement price of $93.7 million. To date the site has cost $664 million, a 577% cost override. The websites that started the social networking revolution cost a fraction of what this website cost and they worked. Private versus government. They continue to say the glitches will be fixed soon. That is more believable than their original lie that it was due to volume. They still have not stated how many have been enrolled.
The liberal New York Times states that from the start the administration knew there were problems with their federal exchange and did nothing. They state the problems are severe and due to financial, technical and managerial problems. Of course the paper did cast some blame on Republicans for blocking some federal funds and the President for issuing the rules late after the last election. When it became obvious that the tech was not ready for prime time the administration dug in it's heels and said we are going forward no matter the cost, a dreadful error. The administration was its own worst enemy by insisting that it coordinate all the contractors and information. It had not the expertise to tackle this type job but like its leader refused to admit it. The administration is now stonewalling reporter questions and the contractors are distancing themselves as much as possible from the disaster. Even the former Obama aide Robert Gibbs agrees the roll-out is embarrassing.
As Obamacare rolls out the USA Today writes about the loss of jobs in the healthcare sector and connects the two. To date the sector has lost over 41,000 jobs directly or indirectly related to Obamacare. There is a possibility that some of the jobs will be added back with the high paying Medicaid patients coming into the system. No one really believes the young uninsured will join until services are needed.
Californians who do not use the federal but the state site are not having the same problems as those attempting to use federal sites. They are having other problems such as language and especially knowledge. They have announced that after one week 16,000 have enrolled.
The San Francisco Chronicle reports that when people get on the site they suffer sticker shock when they see the new coverage being a lot more than their old coverage due to government mandates that are required even though the individual does not want or need them. Top
HealthLeaders has a good article on why physicians will not be the leaders in change. The answer is they don't know how to lead. They have never been schooled in leadership. The article quotes David Nash, a longtime advocate of training at the American College of Physician Executives. He states that CEOs do not want to spend money to teach physician how to be leaders since they might later lead a competing organization. He states that it has to be up to the Board to fund the non-employed physician to either go to classes or have in-house teaching.
Did you know that the VA has proposed a rule that will require all Certified Nurse Anesthetists to practice without supervision or not at all in the VA system. Remember, this is a system that has far more sick patients than the non VA and there is no opt out for the nurse or the patient for that matter.
In an article in the journal Health Affairs, researchers found significant differences between what physicians are being paid for the same service. This is the first study that actually looked at payments and not billings. They concluded that since the people who gave them the data would not give them locations that perhaps about 1/3 of the differential, which may be as much as twice, may be due to location. In places where there were not much delta in the data it may be due to market power by the insurer. The important and take away parts of this study were that great differences exist and they are not due to the usual things one thinks of such as generalist versus specialist or between different types of specialists.
Wow! Someone did a study and found that independent physicians do not want to join ACOs.
Another did a study on physicians joining exchanges. Half of the physicians in the country have not made a decision whether or not to join an exchange. They are worried about low reimbursement and collecting from patients.
Are physicians employees under Obamacare? If so, they may take a play from the Irish playbook. The "junior doctors" of the country have gone on a one day strike essentially closing all the hospitals except for emergencies. They are working over 100 hours a week for low pay. They say this compromises patient safety. Top
United Health in Connecticut is dropping several thousand physicians from it's Medicare Advantage roster. This will force patients to choose between their physician and their wallet. They will either change physicians or switch to one covered by their plan. The change is based upon the feds giving 5 star ratings to those plans that decrease costs. Nobody cares about the patient. This is the beauty of belonging to an HMO.
The opinion page of the Wall Street Journal has some interesting factoids on what they call Obamacaid. This is the expanded Medicaid that the feds have put on the states, should they choose to accept and 24 have. They state accurately that states are wary of increased costs in several years. The feds have promised to pay for the new Medicaid patients for the first three years of the program only. Next year alone the Kaiser Family Foundation estimates that the fiscal obligations will increase about 13%. They state that about 2/3 of Medicaid spending now goes to the elderly for nursing home care. They continue with the factoid that 60% of those in a nursing home are on Medicaid. They also state that a randomized study in Oregon showed no improvement in care between the uninsured and those on Medicaid. Top
The two midnight rule went into effect and means that if one is in the hospital for less than two midnights the time will be counted by the feds as an outpatient not an inpatient stay. This means that patients will have to pay more money out of pocket as they are responsible for the 20% that Medicare does not pay. This will be a lot more than the initial co-pay for the first hospitalization of the year. The hospital will also be paid less under this new rule. This means that hospitals that are truly efficient will get penalized or start discharging patient at just after the second midnight. It is a true lose-lose situation. The Medicare inspectors were told they can not question the need for hospitalization in those patients that spend less than two midnights in the hospital until the first of the year. The real question that will need to be answered is if the patient is in the hospital but does not stay the two midnights will EMTALA be affected. If the patient is sent home before the second midnight he was never really hospitalized and the hospital may be on tap for an EMTALA fine if something happens after the discharge. Also what about the EMTALA transfer laws? 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.