August 1, 2011 Legislation




There might be a light at the end of the tunnel.  The Senate Gang of 6 has proposed a solution to the debt ceiling and the spending.  One of the items proposed is the end of SGR.  This $300 Billion item would be paid out of healthcare over 10 years.  The plan would also get rid of CLASS that both sides find unpalatable.

Kentucky has passed a law allowing Optometrists to do some surgeries.  the University of Kentucky would not give privileges to any optometrist to use a laser or a scalpel in their institution.  There is nothing in the law to say anything about the training required or the proctoring necessary.  

If your office or hospital uses Advanced Diagnostic Imaging you have to January 1 to be certified.  If not certified you may not bill or be paid for the technical component of the procedure.  I suggest that you go to


CMS continues to give out waivers for insurance at a quickened pace.  They are now up to about 1500.  I guess their ideas were not so great.  It will be interesting to see what happens when these waivers run out.

Obama again speaks with both sides of his mouth.  He states he is in favor of the wealthy paying more for Medicare but does not give any particulars.  Is it the current top 5% that already pays more or is it go down to the ones making under $85,000 for an individual or $170,000 per couple.  No one knows what he thinks, including him.  He also wants to cut some payments to the drug industry but how much and how are left up to anyone's imagination.  

The feds have given out $3.8 Billion so non profit co ops can be up and running by 2014.  the hope is that they will have less cost to the patient than insurance companies. All surplus revenue must be used to increase benefits or reduce costs.  There is a question has to whether this amount of money is enough.  It is slightly above what the taxpayers lost on the Chrysler deal, $3.1 Billion.

The NIMBYs are at it.  Senators from the People's Republic and six other Senators have written to the CMS not to cut imaging reimbursements.  These Senators have imaging making institutions in their states.

There is now a bill in the House and the Senate to scrub the provision in Obamacare that allows social security not to be counted when one applies for Medicaid.  This would save about $13 Billion between 2014 and 2021.

Bipartisan support from the house is evident in a letter to CMS to reverse cuts to hospiitals.  CMS proposed a 3.5% decrease to hospitals plus 2.9% to offset the way claims are filed.  The Senate also sent a similar letter.

CMS has revised the Medicare forms the providers use for enrollment.  The new form asks whether they take new Medicare patients in their practice.  This is to take the place of the failed "secret shopper" approach earlier thought of. 

The IOM has recommended that women get free contraceptives, sterilizations and patient education.  There was no mention of free vasectomies for the male half.  Sebelius loved the recommendations that should cost no small amount and raise everyone's premiums.    

The Hill states that Obamacare has the propensity to make many middle class families very unhappy in 2014.  That is when businesses may not drop coverage but could raise the price up to 9.5% of a person's salary.  Those people can not drop out and join a cheaper insurance or obtain any subsidies according to the law.  The cost for a family plan is not important and can be as much as 20% of a paycheck or more.  If the administration changes the current meaning of the law it could cost an additional $50 Billion per year.

In yet another look at what is in store for the US with Berwick and Obama, the Japanese breast cancer drug Halaven has been rejected by Britain's NICE due to cost.  Is it any wonder that the European nations have such a high death rate from cancer versus the US.  It would cost about 68,000 Pounds per year for the drug.  The US approved the drug but said only after the patient has failed two other chemotherapy regimes.  

However, NICE is not all un-nice.  The British organization has just said yes to decamethasone eye medication for arterial occlusion, Bivalirudin for STEMI patients getting PCI and thalidomide for Multiple Myeloma.

Maryland has passed a law that starting in October hospital must randomly review all medical procedures for appropriateness.  I never realized hospitals had a license to practice medicine. 

The People's Republic continues to have problems with money since they went to insurance for all.  Now Baystate Health has announced the loss of 354 positions due to lack of money.  This is due to less money from Medicaid.  Hospitals in the Republic have shed thousands of jobs in the past few years.

California has put Obama in a tough spot.  Governor Brown has asked that California be given permission to reduce Medicaid spending by 10%.  CMS and Obama must decide whether to help a friend in the state or allow the poor to be trampled upon.     

The medical people of Minnesota have just woken up.  The state has been closed for a while due to haggling over the budget.  That has been settled by cutting payments to HMOs and county based groups that take care of Medicaid patients.  This decrease is part of a $11.3 Billion health budget.  Since no one likes the cuts they must be good.   

Oregon has cut physician pay for Medicaid by 11.5% on average.  Anesthesia will be cut almost 40%   They are attempting to bring the pay in line with 72% of Medicare.  It will be interesting what happens to access.   

Pennsylvania passed a law allowing HIV testing to be routine unless a patient opts out.  This follows two years of haggling.  There must be consent either orally or in writing for the procedure and this needs to be documented in the patient's chart.  Positive results can be given over the phone but patients must be given the opportunity to have a face to face visit regarding counseling.

North Carolina has overriden the Governor's veto and allowed non economic damages to be capped at $500,000 unless the patient can prove the physician was grossly negligent, whatever that is.  Another override was to allow ALJs to have the final word on disputes between providers and the State Department of Health.       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.