January 1, 2012 Legislation




Physicians have been spared the onerous 27% Medicare payment cut for two whole months.  But the physicians also have to make a decision about continuing as a Medicare provider for the coming year by 12/31.  This type of action by the Legislature (both sides) will increase the flood of physicians wanting to be on salary and not in private practice. Pelosi has named Democratic Representative Allyson Schwartz of Pennsylvania to the committee for working out the details going forward.  Schwarz is an advocate for the removal of the SGR.  She wants a six year transition period with fixed payment updates.  After the six years CMS would be tasked with coming up with four different payment methods that physicians may choose from depending on location and payment mix.  Good luck to the physicians of the country.

The ABIM and it's subsidiary organizations have agreed to to join forces to develop evidence-based lists of tests and procedures for patients and physicians to query as part of a campaign to be named Choosing Wisely.  The oists will be unveiled in April, 2012.  

The Maine AG has filed an antitrust claim against a hospital, Maine Medical Center, that is attempting to purchase two cardiology groups, Maine Cardiological Associates and Cardiovascular consultants..  This would give, according to the AG, the health system controlling market share in interventional cardiology.  Maine Medical Center is the largest hospital in the state.  The two cardiology groups are in southern Maine and are the two largest competing groups in the area.  A consent decree was reached and should be heard and approved any day.  The decree would restrict for five years the hospital can not raise its fees for cardiology services nor can they change the services offered.  The hospital must allow non employed cardiology physicians access to the hospital if they are eligible.  The cardiologists may not have a non compete clause and must be allowed to be in other physician networks.  Sounds like the hospital just bought a lot of air. 

Kentucky has been deemed lenient on pill pushing physicians.  The Courier Journal has a huge article on the leniency of the Medical board on physicians disciplined in other states and given licenses in Kentucky as well as those physicians instate who were convicted and kept or given back their licenses.  Up to 2010, Kentucky was ranked in the top five by the non-entity organization that does the ranking.  It, even with it's apparent faults, is now ranked 12th in the country.         Top


The ACGME has cut resident on duty time to 30 hours on call and not over 80 hours per week.  Then they said first year residents could work no more than 16 straight hours.  The Joint commission has now set up standards for fatigue and back-ups when naps occur.  The surgical specialist trainers do not like all this and believe it is counterproductive.  However, if their hospitals want to remain certified they will comply.  

Politifact, a fact checking site, has deemed the "Lie of the Year" goes to the Democrats who stated that the House GOP reform of Medicare would "end" the program.  This was patently false because the law would exempt those age 55 and older who would enter the program in the next decade.

Sebelius has told the states they can set up with their exchanges any coverage they want.  The states can use what is presently in their local markets to set up what is covered.  There will be no mandated coverage.  The states can choose the coverage of the most popular federal employee plan in the state, the most popular state run plan, the largest plan to offer small group insurance or the largest HMO in the state's market.  If a state does not set up a plan then the feds will.  the fed will use one of the largest local small group plan operating in the state. The Obamacare law states that any and all plans must cover emergency services, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehab, lab, preventative services, pediatric services including oral and vision care and hospitalizations.  States will have leeway in acupuncture, autism, chiropractics and infertility.  

The first or "pioneer" ACOs have been named.  They range in size from the large Partner Healthcare in Boston to the small physician run HealthCare Partners of southern Nevada.  They are supposed to boost the quality of care and save about $1 billion in five years.  The major problem with the program is that six are in California and five are in the People's Republic of Massachusetts.  There is only one in Florida with its large senior population.

CMS has clarified, as they always have to do, their position on the annual wellness exam.  It is not a physical exam it is an assessment of the patient's health in a format that may be transmitted to CMS for their manipulation of the data.  They wonder why more physicians and patients don't do it.  

Sebilius has offered her wonders of the Obamacare law.  It is amazing that they have to justify the law at every turn.  If a law is truly good there is no need for self bloating.

If California ever wonders why small businesses leave the state they can look to their Legislature.  They have passed a new law that women who take off work for four months and work for a business with 5 or more employees must have their benefits continue until their return.  The old law was for employers with at least 50 workers.  Another law requires all group health policy to cover maternal services. Other California laws are to plan and develop processes for implementation of Obamacare, decries discrimination based on current sexual orientation and not sex assigned at birth, in the prescription drug field a health plan must use a standardized prior authorization form and if the provider requests authorization it is automatically deemed accepted if the plan does not answer in two days, all EHR must automatically record and preserve any change to any EHR and the law regarding destruction of medical records includes both written and electronic records, requires a peer review body of hospital A to respond to an inquiry about a provider by hospital B with relevant information but the information is not subject to discovery and must be made available to the provider who has given an acceptable release to hospital B and licensing unprofessional conduct now includes not showing up for requested interviews.  

Colorado has a proposed law that would require all healthcare workers to get the flu vaccine.  Those that refuse would be required by law to wear a mask while doing any patient care from November to March.  The AAPS has written against this rule not for the silliness of the legislation but for the punitive retaliation on those who do not get the shot for any reason.  They also point out that about half of the healthcare workers in the country do not get immunized each year.     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.