January 1, 2010 Recent News
The Senate continues to bob and weave to get their 60 votes. Lieberman put the kibosh on Medicare for the 55 year olds. The White House then cornered all the Democratic Senators and told them to get it done no matter how it turns out. The White House also did their own look at the cost of the Senate bill and contrary to the CMS found that it would decrease the cost of healthcare over the decade by 1% per annum. This is no surprise as all will find what they want. The neutral CMS or CBO are the only ones that matter and to date they have stated that the House and Senate bills will raise not lower healthcare costs.
Senator Reid now believes he has his needed 60 votes and on Saturday, December 19, has introduced the bill on the Senate floor for debate. The bill must be read aloud to the Senate prior to any debate. The plan is, even though no one has read the bill, to vote to pass the bill on Christmas eve. The bill passed and will go to a conference committee with the House. After the compromises and depending on what they are, the bill will then go to Obama for signature. The Senate bill has no public insurance. The abortion issue was settled by allowing women to pay for it out of their own funds and could be banned by any state. It should be interesting what the more liberal House will say about this bill.
The New York Times states that even though both the House and Senate bill would remove about $500 Billion from Medicare over the next decade to help pay for the uninsured, federal accountants also say the money would shore up the Medicare trust fund to continue paying hospitals. This makes no financial sense unless there is double counting or simply fraud on the American people.
In a major scandal, Israel has admitted scavenging Palestine and other foreign nationals as well as Israeli bodies for organs without the consent of the families. They took corneas, skin and other organs. The illegal harvesting took place in the 1990s. Dr. Jehuda Hiss was the person responsible at an institute in the town of Abu Kabir. Even after he discussed it in 2000 and removed for the practice as head of the institute he remains the Israel's chief pathologist. All criminal charges against him were dropped. This is a disgrace to medicine and to Israel. Top
The Journal of American Informatics Assn. published a study of 1000 physicians in the People's Republic of Massachusetts regarding EHR. About half were using EHR but over 80% said it would improve quality of care and 70% said it might cut costs and save time. However, 16% were very concerned about potential for breach of confidentiality and an additional 55% were somewhat concerned. The physicians were not willing to pay $150 per month and most said they were not willing to pay anything. Those that dealt with psychological conditions were unwilling to be forthright in entering information in the EHR. Also 80% stated that if they were a patient they would not want their mental health records to be able to accessed by providers routinely. Top
Two hospitals in Riverside County, California, have been warned that their Medicare certification is in jeopardy. Southwest Healthcare's hospitals Rancho Springs Medical Center in Murrieta and Inland Valley Medical Center in Wildomar are in deep doodoo. They have both been warned in the past about violations in food preparation. Top
Physicians have power if they are willing to use it. An article in HealthLeaders tells of the ousting of two CEOs when they tried to cross swords with independent physicians. The CEOs Sensor of Alegent Health and Damore of Mission Health wanted to employ more physicians against the wishes of the specialist physicians at the hospitals. The physicians started to take their patients elsewhere which led to a vote of "no confidence" and the end of Sensor. The same thing happened several years ago at Southern California's Community Hospital where the administration and hospital attorney along with the board attempted a coup of the medical staff. The hospital lost their CEO and like with Alegent their CMO as well.
The AMA was purchased for special deals in return for stating they support the Senate plan. They previously were purchased for the House plan. The forty pieces of gold were getting rid of the tax on cosmetic procedures and a tax on physicians to enroll in the Medicare program so they can lose even more money. Also they got dropped the specialty cuts to pay more to primary care physicians. Now Obama and the Dems can state that the physicians are for it. Remember that the major state medical societies have already spoken against the bill.
Ah, there is more. The Chicago Tribune reports that the real reason behind the AMA support is the AMA exclusive contract for RVS codes. The AMA updates the codes yearly for free to the government but makes millions on selling the codes to providers who must use the codes on all billings. This is the main source of revenue since most physicians have left the organization. One outside group in the 1990s created a supplemental billing code that included alternative providers. This code was tried in two states and saved several Billion dollars. It was estimated that if all used the codes that the government could save just over $50 Billion per year.
Florida, CMS and Senator Grassley have all been wanting information on one psychiatrist in Miami, Dr. Fernando Mendez-Villamil. He has been writing huge amounts of prescriptions, more than twice the number of the second place winner in the State. He is writing at the rate of 150 per day, seven days a week for a 21 month period. CMS stopped paying him in the spring.
The Medical Board of California has been criticized for being too lax on physicians who have a substance abuse problem. The physicians used to be able to go to rehab and return to practice with no mention to the Board. The Board put the kibosh on that several years ago which lead to less physicians going to rehab. Now the board will increase the standards the physicians must meet to get tested twice a week. The California Medical Society has gotten a bill passed in the Assembly to create a voluntary physician health program without going to the Board, the same as prior. The bill is now in the state Senate. The Board has a request before the Assembly to eliminate all diversion programs and put all on probation. Other states question the logic of California's Board enforcement only program. Top
California Blue Shield decided to cut back the time consumers had to pay their insurance bill. They give a 28 day grace period and then an additional 15 days. They were going to cut off the 15 days. The company received bad publicity and alot of feedback about the new policy and changed back to the original.
The Minnesota Star had an interesting article about nurse anesthetists who sued Allina Health in the 1990s because Allina was allowing Anesthesiologists to bill for work done by the nurse anesthetists. The physician would come into the room for several minutes and bill for the procedure so the hospital could not bill for the services of their employee nurse anesthetists. They also sued accusing the hospitals and physicians of defrauding Medicare of millions of dollars. The two nurses that started the suit were along with their organization the plaintiffs. The nurses had an agreement with the organization that they would be compensated for lost wages and benefits due to the suit. In 1998 one of the nurses was gone after a hospital reorganization. The other nurse lost her job a year earlier. In 2003 a settlement was reached and Allina paid $2.3 million to the government for the fraud. They also paid $8 million to the association which after legal fees and loan repays went to $2.7 million. Medicare also changed its rules after this case so physicians and nurse anesthetists are paid equally when they work together on a case. The association refused to pay the nurses what they owed them due to fear that the IRS might take away their non profit status. In 2009 the nurses filed suit against the organization and finally got their money. Their are still about 10-15 other nurses that are waiting for money from the organization. The organization may lose money on the suit when all is over. 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