Tuesday, November 9, 2010
The company says the employee was fired for multiple reasons.
The NLRB says the company violated the employee's rights, and that further derogatory comments from her and other employees were "concerted activity" protected by federal labor laws.
The new and marvelous age of technology.
Tuesday, November 2, 2010
Dropping Medicare rates down toward Medicaid rates will do severe damage to some practices. Given the fixed/variable cost structure of physician practices, short term the only practical cuts are in staffing (and that is tough) and physician incomes. Are some physicians gaming the system? Sure.
Conspiracy theorists believe the administration wants to destroy most private practices and drive docs into hospital employment relationships. This could have some benefits, but could also do severe damage to quantity and quality of care, not to mention many hospitals do a lousy job of managing physician practices. This sort of integration can be done fast or right, but not fast and right.
Yes, we need health care reform. Fast and stupid is not the reform we need.
Saturday, October 23, 2010
Friday, October 15, 2010
Thursday, October 14, 2010
These groups often combine computer hacking, identity theft and bill-and-run phony front offices.
Now a little bit of a new twist.
Today (October 13th) the federal government arrest 73 people charged with racketeering for creating more than 100 phony clinics in more than a dozen states and billing Medicare and Medicaid something like $163 million. The crooks, allegedly with an Armenian "godfather" in charge, stole the identities of both doctors and patients before blitzing the feds with phony billings from non-existent clinics. The "godfather" is in lockup today.
Meanwhile the feds are auditing legitimate providers with contract auditors and cranking up requirements for compliance work. Maybe the feds should pay more attention to internal controls before paying crooks?
(reported via several major wire services)
(1) from The Godfather (part 1)
It is no secret premiums are going up, and some are going to way, way up. This will likely induce recession-battered employers to pass more costs on to employees, effectively a cut in net pay for employees. The memos will be passed through organizations in the next few weeks, and employers will have meetings with grumpy employees.
PPACA (Obamacare) requires more lives covered in the group and more services (especially preventative) covered by the plan. This plus the usual issues of utilization and cost are driving up premiums.
This was all very predictable.
Some day these changes may start to bend the cost curve, but probably not soon enough for President Obama.
Do not stand in front of the fan.
Thursday, September 30, 2010
This research is designed to apply statistical, economic and clinical analysis to care and treatment to encourage effective care and block ineffective treatments.
It is highly likely, based on current research, the statisticians will recommend less screening and much less treatment for prostate cancer. As one doc said, "almost all old men die with prostate cancer, almost none of them die from prostate cancer." Screening will likely be focused on younger men and more aggressive forms of the cancer.
With men being somewhat nonchalant about such matters, and prostate cancer being something less than a celebrity telethon issue, it is unlikely there will much of a fuss. Money can be saved and the resulting increased mortality will be slight.
At the same time, current recommendations about breast cancer are suggesting a lot less mammography, and there is an uproar.
Breast cancer hits many women, hits many younger women, and the results are horrifying. The blowback from advocacy groups has been and will be fierce.
So can we get past gender and emotion to become more efficient and effective? Whatever sounds good in the abstract, many of us will go with emotion.
Tuesday, September 14, 2010
"There will be zero tolerance for this type of misinformation and unjustified rate increases."
The issue is premium increases and the cause of the premium increases. Most of us are not in love with insurers, but we should stay connected to reality.
PPACA (Obamacare) requires more lives on some policies and more coverage broadly, so no wonder premiums will be going up in the short and near term (some of us predicted this).
There is little likelihood of bending the cost curve for at least five years, as the various and numerous programs in Obamacare phase it and ramp up. And then, who knows.
Understanding that politicians must be nature take care of politics, this seems a little shrill and over the top.
The official version.
Friday, September 3, 2010
A phenomena many of us have noticed over the years (hard to exactly quantify though) is that recessions pull nurses back into the labor market. Nurses (about 94% female) often have husband or significant others who lose jobs or hours.
Also, some of the staffing pressure is off at the hospital level because elective procedures are down and that takes pressure off the nursing staffing.
Recessions are not the desired means of correcting the shortage though.
The discussions of shortages go back at 20+ years, and amazingly little progress has been made during that time.
There are some new and expanded programs, but a big problem now is the lack of nursing faculty. Unlike many PhD qualified professors, nursing professors are in big demand for management positions, usually in hospitals and health systems. So we are cannibalizing our own nursing pipeline.
University nursing programs are labor intensive, resource intensive and not nearly as prestigious as producing more MBAs, lawyers and economists.
While universities will get into bidding wars over top flight business, science or law professors, the willingness to play in the nursing salary market seems muted (perhaps if nursing was 94% male???).
The shortage will persist; the average age of RNs is climbing, the boomer nurses are heading for the exit while the boomer patients are becoming seniors, clinical skill requirements are accelerating, tighter reimbursements leave providers with less flexible budgets, and at times up to half of all licensed nurses are not working in direct care nursing - - all which seems to be a perfect storm.
We can send a man to the moon, but we can't figure out how to solve this problem in a country where lots of people need new careers (and yes, lots of people are not suited for nursing). Maybe when we have to shut a lot of hospitals?
Saturday, August 14, 2010
A reporter dropping some trash at a landfill in Massachusetts stumbled on a huge pile of medical records. It seems a former billing company for pathologists who served four hospitals had dumped the records without bothering to shred them. Now the hospitals and pathologists are on the hook – ouch.
Then a psychiatrist on the west coast left his laptop on the back seat of his car, and to his surprise (?) it was stolen, and the laptop contained demographic and billing information on thousands of patients.
Friday, August 6, 2010
In health facilities the stakes are much higher.
Now is the time to develop policies and educate the staff, BEFORE something bad happens.
** Facebook, MySpace, Twitter, and of course email is also a problem.
Monday, August 2, 2010
Among those who ponder the technical aspects of health care reform, there is strong sentiment for more use of Integrated Delivery Systems (
This is hardly a new concept, being decades old, and it may well be the concept of the future.
The first big
The idea is that if a central entity (an insurer, a hospital, or a hospital network) owns and coordinates services there will better care coordination and cost savings.
The successful integrations so far have largely focused on family practice, internal medicine and ob-gyn (the OBs assistance with malpractice premiums and 24/7 coverage issues).
An interesting change is surfacing, the acceptance of specialists and surgeons into
Why the change? Fear of dire economic consequences of staying in a traditional group practice model. Preliminary numbers from the
So, any problems?
Hospitals are notoriously bad at managing physician practices, physician contracts must be structured carefully, physician productivity sometimes drops off with a steady paycheck, and the process of merging practices and/or converting ownership is a great deal of complex work at no small cost. Also, making this work in rural areas is tough.
Biggest question, will
Sunday, June 20, 2010
As of Friday the Senate has passed a six (6) month patch to counter the Sustained Growth Rate formula cuts to physician fees.
The House will consider the patch next week, and is likely to pass the necessary legislation.
CMS contractors will process claims from June 1 forward - someday.
Wednesday, June 2, 2010
The act defines most medical providers as creditors.
The new effective date is January 1, 2011.
Sunday, March 21, 2010
The passage of the health care reform bill is a major milestone for U.S. health care services.
With passage, we will need to unravel the bill and the real story and prepare for the intended and unintended consequences of this massive effort.
The legislation is neither as bad as the Republicans make it out to be, not as fabulous as the Democrats claim. The bill changes the health care system to an amazing depth and breadth, and despite the proclamation of economists, politicians and policy wonks, we do not really know the full impact of the bill.
Reform is needed, we will soon be hitting the point at which employers have trouble providing health insurance to employees at an affordable price, the alternatives being dropping coverage or taking more from employees pockets.
President Obama will be hammered by the political right for going too far too fast, and by the progressive left of his own party for being timid. The left wanted a single payer system, was willing to settle for a public option, but left the table with only hope reform will be revisited, as it will.
The amount of misinformation, overgeneralization and plain old hot air tossed around during the debate make a calm analysis difficult, and will leave citizens and patients confused and alarmed, probably more than required. The bill is full of slow phase-ins and long transitions as we attempt to turn around one-sixth of our economy and attempt to attain several seemingly contradictory goals.
A great deal of the debate has focused on the budget impacts, and specifically the positive or negative impact on the deficit over a ten year span. The bill is full of wiggles and gimmicks, and as the vote drew near the Congressional Budget Office (CBO) estimated a positive deficit impact of about $140 billion in ten years.
Truth be told no one has any real idea what the bill will do to the deficit over ten years. Anyone who has studied the history of Medicare and Medicaid knows the legislative budget estimates tend to melt in the face of annual politicking and lobbying.
There are problems needing immediate attention. State budgets, hammered by the recession will have to be cut Medicaid benefits, a backwards step. Medicare physician reimbursement formulas, problematic for a decade, are being patched again while Congress dances around a permanent solution. Private insurers and employers will have to adjust quickly to new regulations and cost structures. Changes in Medicare are inevitable.
We can improve coverage and contain cost, but the reforms have to be constructed so carefully it is unlikely any political process has or will do so.
Now we know when the journey begins and the direction it is going. The details will be tough to work out, and there are many battles ahead, but decision making improves as certainty increases. We may get a good place, but not without many bumps and bruises.
Tuesday, February 23, 2010
The plan, close to the Senate version but with concessions to the House version, will be pushed hard by the administration and Democratic leaders in the Congress.
The plan is long, complicated, has many moving parts and is liekly to change significantly.
More details to follow as we parse the plan and Congress begins to move.
Tuesday, February 2, 2010
Medicare physician reimbursement based on Sustainable Group Resources (SGRs) have been controversial and generally considered unworkable since being passed. The solution has been an annual fix rather than a permanent fix. The House bill had a permanent fix, but went nowhere.
As a result of not being fixed, some physicians will see draconian cuts in Medicare reimbursements as of March
Primary care docs will see a small increase in rates. Or there may be a fix, or maybe not.
Physical therapists who provide Medicare services are now subject to a cap, amounting to rationing, for elderly patients. This capping system was instituted in 1997 but an annual fix has prevented implementation. Now that too is in limbo, and therapists may be “donating” services in 2010, while waiting on an answer. If the cap remains, services will have to be rationed..
Seniors are very dependent on various forms of therapy to regain mobility and self-sufficiency after fractures, surgeries and strokes. Would we prefer nursing home placement instead?
If health care reform enlarges the role of the federal government, and this is how the feds do business, this could prove interesting.