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The People's Republic of Massachusetts is at it again. The Governor wants the logical step of having the uninsured pay $3-$5 co-pays. this would include the state's "free care" program. The Governor does not want the "free care" program to be more attractive than Medicaid which costs nothing since it is paid by the fed and state government. The "free care" program cost $500 million from taxpayers, hospitals and health insurers. The Governor's proposal is logical to all those who do not follow the socialist script. Top
CMS has announced the new physician rules for 2006. The highlights are:
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CMS is proposing a 4.3% reduction, in response to the existing law that ties the conversion factor to the sustainable growth rates, i.e. it automatically reduces payment rates if volume exceeds budgeted projections.
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Nuclear medicine is added to the Stark list of Designated Health Services. This includes PET and PET/CT. This means a physician can not refer a patient to a scanner if he/she owns an interest. One must now consider either unwinding or using equipment leasing arrangements. CMS is now considering how to best have the unwinding occur with the least disruption. Another way to keep involved is to move into the building with the scanner so the "in office" exemption would apply.
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Payment rates are "reformed" (i.e. reduced) for multiple diagnostic procedures on the same day. If two or more procedures done the same day, the first one is paid 100% and the second at 50%. The professional component will still be at 100% per reading.
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ESRD payments for drugs and biologicals are proposed to be paid at ASP plus 6%.
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Telehealth services will be expanded to include nutrition therapy.
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Refine RVU computation to more accurately reflect overhead and malpractice costs.
The GAO has issued a report on Concierge Medicine. The report states that there are enough physicians that continue to take Medicare patients to not make concierge medicine a threat to the care of the Medicare population. Top
The National Fire Protection Association has caved to the pressure of the American Hospital Association in allowing flammable alcohol wipes for sterilization in the operating room. There is really no need for this as there are other ways to disinfect the surgical site that do not involve a potential patient fire. Top
The IRS is starting to examine the non profit 501 (c) (3) hospitals to determine if they truly qualify for the charitable or private use of less than 2%.
CMS has decreased the DRGs for some cardiac procedures that will hurt both the specialty and community hospitals. As all know CMS is under alot of pressure from the AHA and the AMA has been lax in putting pressure on CMS.
Single disease guidelines promulgated by plans and hospitals may not be good for patients with multiple diseases. They may cause pharmacy problems and end the patient in the hospital. This is important because of the pay for performance that is becoming more in vogue. Also the polypharmacy may not be possible due to the number of pills required throughout the day and the costs involved. 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.