January 1, 2015 Legislation





The Senate barely confirmed the surgeon general after 1.5 years.  Dr. Murthy was approved by a 51-43 vote.  This was done with the help of Cruz who stupidly allowed a weekend session.

The Medicare Hearings and Appeal has decided to forego hearing appeals from non beneficiaries for two years in order to cut down the amount of beneficiary appeals.  There are about 900,000 appeals awaiting decision.  Is this legal?  Should Medicare be hiring more people to hear the appeals and not penalize providers?

At the same time hospitals are appealing RAC denials in an ever increasing rate.  Now 48% of all denials are appealed.  The hospitals are winning about 70% of the appeals and are spending above $10,000 on the appeals.

Congress stuck in the recently passed and signed budget bill, a rule to decertify all EHRs that do not share information.  ONC must report to Congress within 90 days about the extent of vendors and/or hospitals involved as well as the strategy on how to address the issue.

On the ACO front, many organizations are willing to risk their money for a chance at some free federal money.  An additional 89 organizations will join the Medicare Shared Savings Program bringing the total organization number to 405.  In this program an organization gets to keep some of the savings it generates but after the first three years organizations pay a penalty if they do not save money or under an optional tract organizations assume the risk of penalties in the first three years in exchanges for a larger potential bonus.  None of the new ones picked the later option.

The screw ups at the US Preventative Services Task Force are again doing dumb things.  After saying breast and prostate screening for cancer is not good they now want the physicians or practitioners to not do routine blood pressures.  They should only have their blood pressure taken once a year if they are Black or have risk factors.  Otherwise only do the BP every 3-5 years.  They then go on to state if the office blood pressure reading is high, the patient should wear an ambulatory BP cuff for 1-2 days to rule out "white coat syndrome".

The FDA is proposing lifting the lifetime ban on blood donations from gay men instead going to allowing donation if they have had no sexual male encounters for at least one year.  This is a difference without a distinction.  It is still a lifetime ban.

The California Insurance Commissioner  believe that Aetna's rate hike for small employers is excessive.  He can do nothing about it, except to say naughty.  Aetna believes their rates are good due to expected medical costs.  The 10.7% rate hike is well above the 2.7% hike the commish wants.

The Vermont governor finally got his sanity back.  He has abandoned plans to have Vermont have a universal publicly funded health insurance program.  Why, one might ask?  It is too costly for the state.  It would require a 11.5% payroll tax on businesses and an income tax of an additional 9.5%.        Top


Massachusetts has fined Steward Health $1000 per week fine for failing to send their consolidated financial statement to the state.  The system does not want to send it since it contains information that is none of the state's business.  Accidentally, the fines, which now total $12,000, happens to coincide with Steward's decision to close Quincy Medical Center.

The IRS is giving a Christmas present to the management companies and investor hospitals that own physician practices.  They will allow them to write off physician practice losses against taxes on other income.  This is even if the state is a corporate practice of medicine state.  The profits also would be combined with those of a company's subsidiaries and subject to taxes.  This is a big deal in Texas, California and New Jersey that actually enforce corporate laws.

The IRS is not so nice to non profit hospitals. If they want to keep their tax exempt status they need to stop asking for money from uninsured patients in their rooms, or selling collections to third party unless they have made reasonable efforts to offer financial assistance.  They also must do community health needs evaluation twice a year.        Top


The time of easy money is up.  All you suckers still taking Medicaid will get a 46% shave unless your state has agreed to step up and continue the Medicare payments.  To date fifteen states accounting for 15% of Medicaid patients will pay some or all of the lost Medicare payments.  There are 24 states accounting for 3/4 of the Medicaid patients who played Grinch.

The People's Republic is at it again.  They again make laws to make laws which will raise the cost of healthcare, at least in the short term.  The new mandate by Massachusetts is to require physicians to discuss with terminally ill patient how they wanted to be cared for at the end of life.  That should be interesting in a state dominated by Catholic teachings.  They also put in a rule that all physicians will be proficient in EHR.  The slaves (physicians) can prove to the master state that they are wonderful people by being associated with a hospital that has been certified as Meaningful Use, participate in Meaningful Use on their own or take a three hour CME program.  The rule is for all with licenses even those out of state.        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.