January 15, 2012 Legislation




The Alliance for Medical Specialties (11 medical societies) have called the 2012 CMS physician fee schedule bunk.  They state there was no transparency in the development and irresponsibly lowers payments for diagnostic imaging services.  They accuse CMS of not justifying why they did not use the recommendations of their own advisory panels in developing fees.  CMS took 10 pages to attempt to justify its policy on diagnostic imaging and failed.  CMS also failed to justify the difference between whether a physician directed, influenced or contributed care to a patient as each are valued differently.   

California's regulators have ordered Anthem Blue Cross to pay physicians and hospitals for outstanding bills.  Anthem has already paid a $500,000 fine for their lowly actions and may not comply with this since they believe the issue was closed with the fine.  The insurer would have to go through 2.6 million claims to see what is owed to whom. The other insurers who were treated the same have paid the fines and have begun the repayments to the providers of the services.

CMS has stated that processing all checks electronically can save providers almost $5 Billion per year.     Top


Here, unlike what they did with the physicians, the CMS has proposed changes in hospital staffing for their conditions of participations (CoP).  All their items met with resistance from some groups for either a turf battle or because the new rules do nothing for patient safety or actually potential injure patients.  CMS would allow one governing body to oversee hospitals in a single healthcare system.  This would take governance further away from patient care.  The only major group for this is the AHA.  CMS would allow hospitals to grant privileges to persons who are not physicians who are practicing within their state's scope of practice.  This CoP would also allow physicians not on the hospital staff privileges possibly to the detriment of those on the staff and without supervision.  This also takes away self governance of the medical staff.  The ANA backs this so nurse practitioners may be on the staffs of the hospitals and be part of the committees and have admitting and discharging privileges.  CMS would allow those other than nurses to administer meds. Another bad idea.  CMS continues with discontinuing blood typing prior to organ recovery and the infection log now required.  There are many times that one wonders who the idiots are in the organization. 

The CBO has reported that Medicare could save $148 Billion by gradually raising the Medicare age to 67.

MedPAC has decided that the work done in the hospital ED is no more important than the same work done in physician offices and all should be paid alike. Therefore they have reduced the amount they pay hospital E/M clinic visits to be the same as physician as for offices.  The AHA is not happy which means it was a good decision.

Obama did a sneak attack.  Two days after referring two names to the Senate for confirmation for the NLRB the Senate went on possible break.  During the possible break he appointed the two and another person to the NLRB to bypass Senate confirmation.  This means he will get no appointments through the Senate during session for as long as he is president.  The NLRB is now made up of a majority of union people or supporters. 

The new NLRB has wasted no time.  They filed suit against Steward Health Care in Boston who has been gobbling up physicians from the major health players.  The suit was for the firing of a nurse they claim is for union organizing reasons.  Steward says she is a past medication abuser and is on probation with the nursing board as well as the claim that she intentionally changed a physician's order, committed an intentional medical error and did not report an unauthorized morphine injection to a patient.  Sounds like the NLRB is backing a loser for political gain.

HHS is again doing the futile exercise of chastising an insurer for daring to raise their premiums more than the artificially allotted 10%.  The insurer states it has legitimate reasons to raise it rates and will do so as the feds have no way to prevent it.

Nine states have requested more federal money for the Obamacare promise of insuring the people with pre-existing conditions.  There are few people in the program but they are very costly, much more than the feds realized when the program was started. 

The People's Republic of Massachusetts has been told by the state supreme court that it must cover legal immigrants in its healthcare program.  The state attempted to omit both legal and illegal immigrants from the program to save money.  They attempted to give less benefits to the immigrants but that has failed and all will get full benefits.  This will add about $150 million to the annual costs.  Since it is a People's Republic they won't mind paying more taxes to finance the folly.

Montana has found out the feds did not plan well with their pre-existing conditions insurance.  They also have run out of money due to the costs involved.  They have not registered many people into the program but the ones they did are using the resources.

Minnesota has stopped giving medical aid to non US citizens.  This includes those from our northern socialist neighbor.

England's NICE has again rejected a drug the is beneficial to cancer suffers over price.  This time is it is Cabaztaxel for prostate cancer.  We have a lot to look forward to in this country.

Sebilius may be softening us up for the same thing.  She just issued a notice that 1% of the population is costing 20% of the total monies spent.  I wonder if she is suggesting we should do away with the 1%.  She and her boss need the other type of 1% to pay for everybody else.  

Several more European countries are advising their women to get any breast implants of PIP removed.  England is also going to investigate whether tighter control of the cosmetic surgery of the country is warranted.      


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.