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As I stated in this column months ago, you may get what you don't want. It is now happening to the community and academic hospitals. They took on the specialty hospitals and won a battle but are losing a war. They got the CMS to delay building for one year or so, but they will now be losing money big time. Now CMS is making all equal. They will pay all the same more for some procedures and less for others, mostly less. This is especially true for cardiac care and orthopedics. Stupid AHA.
Also, as stated in this issue Recent News Column, physicians are continuing to see Medicare patients since the payments have not dropped but increased. The CMS is taking money out of the reserve fund to make these payments. The reserve fund is starting to run low. This would mean the Congress would need to squarely face the problem and revoke the Balance Budget Act. If they don't Medicare will not be able to pay physician bills in full or on time, as they define it.
Governor Terminator of California has signed an executive order to forbid providers from billing patients when there is a dispute between the provider and the HMO. The Governor is setting up a Board to hear and settle the disputes. Top
The NCQA, the organization that does the quality measures for managed care, has set a group of new standards for specialists and sub-specialists that should become rules soon. There is currently a public comment period prior to the final adoption. The measurements require the PPOs to not only get the information from the physicians but also to get chart notes to see if the measurement was not done, was the reason recorded. Another thing the physician specialists will be very forward in giving, as they have so much time. Top
The deeming agency has stated that all hospitals, long term care facilities and critical access hospitals will offer to all employees, volunteers and licensed independent practitioners Influenza vaccine. This standard begins January 1, 2007. The new standards require an annual influenza vaccine program, access to influenza vaccinations on site, education of staff and LIPs about flu vaccines, annually evaluate vaccine rates and reasons for non-participation and implement enhancements to the program to increase participation. Top
California has decided that it is rich enough to forgo $360 million in federal funding. This is what it would have received if it had required all Medical patients, the California equivalent to Medicaid, to move to managed care. The Democratic legislature and the Republican Governor both thought managed care should be voluntary and not mandatory. The Legislature was afraid managed care would not give the disabled and serious patients the needed care. Medical does not have the specialists needed for the plans to treat these patients. Top
As all know President Bush has vetoed the approved stem cell legislation which has caused some consternation with those who were for the federal funding. I was one of those who wanted the bill to go through. However, what most people don't know that the bill would not have made much difference to the amount of work done on stem cells, only in the training of new scientists. As it happens there are two companies that hold basically all the patents for stem cell research. This effectively thwarts all incentive for others doing research since they would have to pay alot of money to one or the other of the firms if they hit pay dirt. The two patent holders are forcing researchers to go over seas to have free access to funding and the ability to reap the profits from their labor. 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.