Home / Healthcare Updates / Healthcare Update — 01-18-2016

Healthcare Update — 01-18-2016

As if stool transplants weren’t bad enough … Now some people are recommending urine cocktails to treat illness. Retiree in London was diabetic, had kidney problems, and swollen ankles. After starting to drink her own urine, she is suddenly cured and looks like Taylor Swift! OK, she really looks like Bea Arthur, but her kidney problems went away. Article tries to legitimize the urine drinking experience by noting that women already take medicine made from urine of pregnant horses – Premarin. Another person interviewed for the article rubs urine on his face every day as a skin treatment. Oh, and drinking urine is supposedly in the Bible, too. As I told my kids … “Urine BIG trouble if you ever try this.”

Florida’s Medicaid managed care becomes more like Medicaid managed REFUSAL of care.

With private companies now operating the system instead of the state, the added requirement of prior approval for many services and dealing with a myriad of billing procedures and rules are just two areas that are far more complex.

“In this area, there are four different plans with four different sets of rules, four different provider handbooks, four different billing processes,” said Maggie Labarta, the president/CEO of Meridian Behavioral Healthcare, which provides mental health care and substance abuse counseling services in 10 counties. “For us, the administrative burden attached to billing has grown much more complicated. It is a lot of paper and a lot more bureaucracy.”

 Some of the insurance plans will only pay for one day of the three days required for involuntary psychiatric admissions. Most plans require pre-approval for many routine services. As a result, Medicaid has become “more cumbersome and more difficult.” But don’t worry because the patients have INSURANCE!

Award-winning screenwriter, producer, and director goes to Quebec hospital with abdominal pain. Later found unconscious in waiting room ultrasound showed ruptured aortic aneurysm. Newspaper claims patient was “denied potentially life-saving surgery.” Hospital reportedly revoked the privileges of its only vascular surgeon as part of Health Department reform and budget cuts. Patient was transferred to another hospital but died before he could make it to surgery. This patient had insurance, too.

Interesting concept. When state laws become too onerous for doing business, companies close shop and leave. GE leaving Connecticut due to Connecticut’s high-tax, high-regulation, and anti-business policies and moving to Massachusetts which is presumably more business-friendly.

California’s MemorialCare Health System wants to close a hospital and emergency department in San Clemente and replace it with an outpatient medical center and urgent care center – that wouldn’t be required to take ambulance runs. I wonder why that is. San Clemente residents fighting the proposed closure of the emergency department. California legislators refused to allow the new facility to operate as a stand-alone emergency department. As a result, there will be a 40 mile gap between the next closest emergency departments. Quite a bit of extra travel. Hope they have extra ambulances ready. When seconds count in a medical emergency, help will only be 30 minutes or more away. I’m sure a lot of those patients have insurance as well.

Is that a hernia under your shirt or ….  Leicester patient finally has 8 in x 12 in hernia repaired. Before the repair, he was arrested for shoplifting when store clerks thought he had merchandise under his shirt. Yes, this patient had insurance, also.

Shocked. Shocked I am. The Unaffordable Insurance Act continues to implode. 49 of 50 states will see premium hikes in 2016. The reporter is a little math-challenged, noting that “more than one in three states, or 17 percent” will see premium increases of 20% or more, but it doesn’t take away from the fact that “The Affordable Care Act has driven up costs across the board.”

9 comments

  1. The question of course would be how great the insurance rate increases would have been without ACA. Back around 2000, our practice was seeing an annual employee insurance premium increase of 37% a year. If anything, it seems that ACA has held down the projected increases. Back in 2005, the hospital was projecting that their insurance premiums would double every other year in 2015.

    • Steve,
      I had affordable insurance for 16 years and then my spouse lost his job. COBRA was going to cost me $800-1200/month. I declined because I could get a plan for $420. We stayed on that plan for 6 years. When ACA passed, my premiums immediately went from $486 to $632. I had to drop the coverage because we could not afford that. in 2012, I tried again. The premium was $841 for absolutely nothing. ER Copay went from $75 to $200. And office visits were $50. Deductible was $7200(another Obama lie). In 2013, I tried again. Hahaha. The premiums were $1580. Again, nothing covered until the deductible was met. I could not afford it then and I cannot afford it now that my spouse is unemployed again. But I will not get ACA. I was one of the people who was responsible to pay for what I thought my family needed. And now, I am one being forced out so others can use and abuse OPM. (otherpeoplesmoney) They contribute nothing and get something. I would rather burn in hell or buy antibiotics made for fish, because that law is the biggest scam since Welfare and medicare.

  2. I’m sure that the rates would have increased without the ACA as well. The issue is that the ACA was created to “make health care more affordable” and it obviously isn’t doing so. In addition, it has created monstrous regulatory hurdles, has changed the market to one of high-deductible narrow-networks that make access to health care even more tenuous, and is even affecting the employer/employee relationship as employers change work hours to avoid its regulations.

  3. Steve M: Just to clarify what was promised from President Obama:

    From http://www.factcheck.org/2008/06/obamas-inflated-health-savings/ (not exactly a conservative website) Obama (Bristol, Va., June 5): “In an Obama administration, we’ll lower premiums by up to $2,500 for a typical family per year. And we’ll do it by investing in disease prevention, not just disease management; by investing in a paperless health care system to reduce administrative costs; and by covering every single American and making sure that they can take their health care with them if they lose their job. … And we won’t do all this twenty years from now, or ten years from now. We’ll do it by the end of my first term as president of the United States.”

  4. WC…you hit my sore spot. Spouse got a job and we got insurance. In two years, the plan went from good coverage to absolutley fu*ing nothing. And, since they closed two practices down in Charlotte and DC, he’s now unemployed.
    Guess what I will pay now? 28K before anything is covered!! The only thing I would not have to pay for is a physical. Whoop. So they take the rest of my money and give someone else sh*t for ‘free’. I am going to pay the penalty, seeing as that amount of money will at least keep me in a house. I know there are exceptions but I will damned that I will take ACA coverage. No. Not. Gonna. Do. It.
    Also, 15 of the exchanges are now belly up, but at least my manic SIL finally has some coverage after her 5k income was too much to qualify her!! groan…
    On another note…remember the hiker who sawed off his own arm? (Between a Rock and a Hard Place was the book) he survived by drinking whatever Urine he could produce. If you haven’t read that story, you should.

  5. Natszofast, Doc. You’ve been hornswoggled by this story.

    Saddleback Memorial isn’t closing because of ACA issues. Anything but.
    They’re closing because of otherwise-unheard of “under-utilization”.
    I.e. no one in their right mind goes to 73-bed (AKA Teeny Weeny by OC standards*) Saddleback Memorial, because there are bigger and better hospitals just up the road.
    Losing that ED and inpatient hospital is literally a huge nothingburger.

    Mission Hospital ED is maybe 5-10 minutes away, and is the Level I Trauma Ctr. for that whole end of the county anyways, one of only 3 in the county. So it isn’t like potential patients will be underserved with this closure.
    And that “40-mile gap” the abysmally clueless OC Retchister drone blathered about includes 25 miles of USMC Base Camp Pendleton, all of it in San Diego County, as it has been for about 100 years. Nothing to see here.
    The gap is simply 5 minutes further north. With typical ED sat closures, that’s a negligible problem.

    Also, the nearest thing to a rough part of town in San Clemente is Santa Ana, 30 miles and 5 hospitals in between distant.

    This is nothing but the rich old geezers and helicopter parents in uber-rich S. OC pissing and moaning because now they’ll have to drive in their Beemers and Mercedes SUVs to Hoag in Newport 15 minutes away, or Mission Hospital 5 minutes up the road, and mix with the hoi polloi.
    And contrary to their Thurtson and Lovey Howell prior experience, maybe even have to >gasp!< wait to be seen. For their sore throats times 20 minutes, and headaches times 20 years. The horror!

    And the state simply wasn’t asinine enough to set precedent by allowing an unattached ED with absolutely NO ancillary or support services, like a cath lab, ICU, OR, CT scan, telemetry unit, etc. (you know, what most patients and doctors think of when they hear “hospital”) to operate and receive patients, because they aren’t abysmally stupid. Because 100% of admissions will have to be turfed via ambulance or LifeFlight to Somewhere Else (which is mega-stupid, and totally unfair to the hospitals nearby receiving the fresh outflow of crap), and some of the patients won’t be stable for the trip, so they’ll either die en route, or die in place. Generally frowned on in medical circles, either way.

    There’s plenty to carp about in healthcare around here.
    I’m one of the biggest koi in that pond.
    Closing tiny Saddleback Memorial isn’t part of it.

    If you want to wonder instead whyinblisteringf**k ETOH went from a law enforcement problem to a medical emergency, and why the local PD aren’t waiting with cuffs to arrest Joe The 207-visits-this-year Alcoholic and incarcerate him for public intoxication, and get him six months – with no booze – shoveling hot tar on the streets in an orange jumpsuit, I’ll hold your coat, subscribe to your newsletter, and contribute to your election fund. Just saying.

    *(73 beds and a small ED would be a big deal in Podunk or BFEgypt, I’m sure. In OC, it’s practically a converted house-and-attached garage-size DocInTheBox hospital. There are some EDs hereabouts that are nearly as big as that entire hospital is. And it’s not like there’s any shortage of job openings for everyone who works there within 15 minutes. I’m routinely working 5-shift weeks here, and I could be working 14-shift weeks, if I could figure out how to go without sleeping and such.)

    • This is awesome commentary – as usual. Thanks for the perspective.

      • Happy to croak about the pond my lily pad sits in.
        I’m a giver like that.

        Glad you’re cranking out content more regularly again.
        Some weeks, you’re better for staying up to speed on this biz than the journals.
        And always more fun to read.

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