March 1, 2012 Legislation





Sebilius has announced the delay of the dreaded ICD-10 to a date later than the original date of October, 2013.  Hopefully they will delay it forever or until a Republican can get in office to can it for good. For some reason the HIT people are upset over the delay.  Could their concern be financial in nature?   

The House and Senate have agreed on another band aid for the SGR.  This one will last 10 months and will be paid for by taking money from Obamacare and the hospitals.  The hospitals will see their bad debt allotment go from 70% to 65% beginning in 2013.  Critical Access hospitals would get less money as well.  The AHA got what it was really seeking no loss of funds for EM systems done at the hospital, the true boondoggle and the AHA unjust thumb on the physician owned hospitals. The physicians got no increase in pay and Obama's wonderful and unpassible budget got rid of the SGR but of course said nothing about how that would be paid.  This will lead to another game of chicken in December after the election.

The administration has come up with a loophole for Obamacare freeing states to ignore the US mandates.  The states, in order to opt out, must set up their own government health plans and they must meet or exceed the feds coverage and consumer protections.  This means they do not need to have the individual mandate. in their state.  This would take place in 2017 but some states have applied for the opt out in 2014 when Obamacare takes effect.  

The House will vote soon with bi-partisan support to get rid of the IPAB.  It will pass the House but who knows what will happen in the Senate.

Obamacare has a little known rule that states providers who are overpaid must return the money within 60 days.  If not the provider is subject to the False Claims Act with the whistleblower action.  Overpayments include payments for services not covered by the program, too much payment for the services rendered, errors in non-reimbursable expenditures and cost reports, duplicate payments and payments from Medicare when another payor is primary.  This law includes a 10 year look-back window. (See below under physicians.)

The HRSA has proposed that the HIPDP go out of business and transfer all its information to the NPDB.  

Three Senators have asked the OIG and HHS to investigate the state licensing boards.  The Senators who have no knowledge of healthcare licensing believe the junk that one organization is spouting.  The organization believes that the only licensure action is suspension. It will be interesting how the OIG says it has jurisdiction to do this.    

The Obama administration who is pushing their health program for political gain has stated that the law has helped 50,000 people to date.  This is in the pre-existing condition insurance program.  They were supposed to have had almost 350,000 join by the end of 2010.  They did not because the costs were so high.  They then lowered the costs and voila people joined.  The government put aside $5 Billion for the program but as usual it is costing twice the cost per patient as expected.  The enrollees have 8 times the number of hospital admissions as the federal employees and more than 3 times as many ED visits.  

The new Stage 2 meaningful use EHR requirements are out.  Hospitals and private practice physician will need to use CPOE for over 60% of pharmacy, lab tests and radiology to be in compliance.  That is double the current requirements.  There are many more nickel and dime requirements in order to get your miserable payments.

Oregon has passed a new health bill in both houses and it will be signed by the physician governor.  It is hoped but not expected to lower the costs for taking care of the state's Medicaid population.        Top


If physicians have not yet attested for the 2011 EHR incentives it is officially too late.  The last day was yesterday. Also HHS is considering mandating physicians and hospitals keep their records for ten years so they can go over them for overpayments.  I'm sure all physician's offices will comply.  

Congratulations to the physicians of America!  The Congress and President have just given you a 32% decrease for treating Medicare patients starting in January, 2013 unless their is another stop gap measure against the SGR.  Every time the idiots delay the permanent fix it gets more expensive to do so.  The probability that the lame duck Congress will only do a two month fix in December is very high.  For this year the physicians and hospitals will have their Medicare and Medicaid rates frozen.

The Accreditation Council for Graduate Medical Education (ACGME) is changing the way it looks at residency programs.  The new way is to have residents meet educational milestones in the required competency points. If the programs reach these milestones they will be freed up to become more creative in their programs to get better outcomes.  The untested program will start this July for neurosurgery, urology, pediatrics diagnostic radiology, ED, IM and orthopedics.  The remainder will start in July, 2014.  This goes along with the MCATs getting more social programs into their testing.          Top


The Idaho Senate has passed unopposed a bill forbidding hospitals from denying privileges to physicians for anti-competitive reasons.  The House will take it up.  It has support from the state hospital industry.

California has order Kaiser to pay for and stop denying physical, occupational and speech therapy for their patients.  Kaiser states that the state misunderstood their policies and will continue to allow medically necessary payments as they define it, not how the state defines it.  There have been over 100 complaints filed against Kaiser with the state for Kaiser's denials.  

California held a one day hearing by a Senate sub-committee about the policies of Prime Health.  At the end of the day the chair said he will look into the matter in more depth, whatever that means from a politician.

The New York Depart of Health has shuttered Peninsula Hospital after an inspection of the lab showed immediate jeopardy to the patients.  The hospital is shut for 30 days so they can bring their lab up to where it should be. 


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.