October 1, 2010 Legislation






In Colorado, the Governor is leaning toward opting out of the federal rule regarding anesthesia services.  He is more in favor of allowing the lesser trained nurse anesthetists do anesthesia without supervision.  It does have some sense in that Colorado is a rural state and some rural hospitals do not have any physician willing to supervise the nurse anesthetists and take on the liability.  Of course those who go to the rural hospital will be getting lesser quality of care.  One nurse anesthetist who did the anesthesia on the troops in Afghanistan states that when the surgeon is off the patient with trauma needs to be air evacuated to a larger hospital.  It has been shown that trauma victims do better and get quicker care if they originally go to a hospital with a trauma designation.  This is true even if the patient needs to bypass closer hospitals.  

After the above was written the Governor did opt for allowing nurse anesthetists to do anesthesia without supervision.  The anesthesiologists have filed suit.       Top


The OIG warned but basically gave permission for hospitals to perform pre-authorizations for free in lieu of physician offices performing the tasks.  They said it was potentially a problem but as long as the four reasons were present it would be OK.  The reasons are (1) since no particular physician would be targeted there would be a low risk of fraud (2) there would be no payments to physicians (3) when pre-authorization was requested the hospital will identify itself as the hospital and would provide each physician a copy of all information it submits to the insurer.  There would be little opportunity to influence referrals since the patients had already chosen the hospital (4) the hospital has a legitimate interest in offering uniform pre-authorization services.  

The Lucille Packard Hospital of Stanford University has been fined $250,000 by California for failing to report a breach of 532 patient records.  The records were in a hospital computer stolen by an employee.  The California law is a $100 fine for every day of delayed reporting after the first five days per breached patient record.  The hospital also failed to notify patients until two weeks after it confirmed the breach.  The hospital states it will appeal based on the fact that it notified the police first and only after the police notified the hospital that the computer could not be retrieved did they notify the state and patients.          Top


The Obama administration does not like criticism.  Sebilius has written a letter to the insurance people threatening them that if they don't stop blaming raising their rates on the political mandates of Obamacare they may be left out of the new health insurance markets that will start in 2014.  The threat was not subtle. This tells all what kind of people are running the healthcare system and how the Obama administration works.   

With the admonition, several plans in Massachusetts put on surcharges and stated it was due to the Obamacare mandates.  

Democrats and Republicans in both Houses are banding together to repeal one aspect of Obamacare.  No one likes the filing of 1099 forms for all those who get over $600 for goods or merchandise.  the White House doesn't like the idea of repealing this aspect since they fear that if one aspect is repealed others may be.  Maybe they should be if they are as bad as this.  The Senate agreed with Obama and turned down any changes to the onerous provision.  Seven Democrats voted with all the Republicans to reverse this but it still fell well short.

How is Obamacare going to save money?  By making new federal offices and increasing those already in business.  There will be a new HHS Office of Consumer Information and Insurance Oversight (OCCIO) to oversee new insurance market rules, the HHS Office of Delivery System Reform to oversee HHS efforts to promote new proposed payment and delivery reforms such as ACO, the CMS Center for Medicare and Medicaid Innovation (CMMI) to test innovative payment and service delivery models, CMS Center for Medicare for overseeing the fee for service Medicare, Medicare Advantage and Medicare Part D and the CMS Center for Strategic Planning to oversee the Office of Research, Development and Information (ORDI).  ORDI is responsible for CMS demonstration projects which includes the medical home and bundling of payments.  All these will have many people working in each one and their salaries will not count toward the cost of the reform program.  What a joke!

The first Democrat has sided with the Republicans to act to repeal Obamacare.  Mississippi House member Gene Taylor has pledged to vote to repeal the law.

The first part of Obamacare is now in place.  On September 23, 2010, the provisions that allow young adults to remain on the parent's insurance until age 26, guaranteed coverage for those under 19 years old with pre-existing conditions, preventative care, no lifetime benefit limits, no rescission, appeal rights and the making of pediatricians and OBs into primary care physicians.  This will raise premiums for all.

McDonalds has threatened to drop its health insurance for employees (30,000) unless there are changes in the amount of payments for medical care that an insurance company makes.  The Secretary has the power to make modifications but will not make any announcement until at least the end of the year.  This is for the company's "mini-med" coverage.  Many in the country have this same type coverage and many companies have so far been exempted from the $750,000 minimum cap on medical payouts.

CMS has told Medicaid that with respect to children with cancer who have elected hospice care the medical treatment must continue to be paid for if the parents so desire a blended care. CMS state that this new regulation is part of Obamacare.

The House has passed a bill worth $7.4 Billion to help with medical expenses of those who were injured in the September 9, 2001 attack.  This may die in the Senate.

The House also passed a bill to ban executives of companies from doing business with Medicare if their businesses are found guilty of committing fraud.  This includes parent companies of shell fraudulent companies.

The People's Republic of Massachusetts has the nation's only "health care reform."  As all know, it is failing badly financially.  The state is now planning to abandon fee for service completely and go to only funding ACOs and global payments.  They intend to have the plan worked out by the first of the year probably starting with the state's Medicaid program.   

California has passed a bill allowing out of state volunteers to work at no-cost health care clinics. Another bill signed by the Governor was the forcing of physician who provide service in hospital emergency rooms to provide discounts to those without insurance.  He vetoed bills requiring insurers to provide mammograms, diagnosis and treatment of mental illness and limiting insurance premium raises to one time per year.         Top


United Health is in deep trouble in California.  California originally wanted to fine United for problems of PacifiCare which it purchased.  United appealed and the case went to a ALJ.  During the hearing many more problems have been discovered and the original $3.5 million could balloon to over $9 Billion.  That is more than United paid for PacifiCare and is unlikely to take place.        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.