April 1, 2012 Legislation




MedPAC continues to urge as does all of medicine, the repeal of the stupid SGR.  In it's annual report to Congress the organization requests Congress replace the law which has never taken effect with a 10 year statutory changes.  They recommend keeping primary care as is and reducing all others by5.9% for three years.  This would be followed by a freeze on all payments.  They also see no reason to pay physicians more who see patients in the hospital than their offices. 

Obama and Sebelius are tying the Gordian Knot with their rules on contraception in religious groups.  They have published new rules that say women in religious groups that do not believe in abortion or contraception will be funded by someone yet to be named.  Student health groups underwritten by insurers such as United will have to provide contraception but they get a year delay.  Those groups who self insure do not need to comply with the law.

The latest CBO report shows an expected jump of 100%  in Medicare and Medicaid costs in the next decade.  Medicare spending will increase due to the aging of the population.  Medicaid will increase even more than Medicare due to Obamacare's increased allowed people into the program.  A plus is the going generic of many high cost drugs which is saving money for Part D Medicare.

CMS finally got something right.  They have not set a date to have the dreaded ICD-10 go into place.  This is good since less than half of providers are ready for compliance.

It continues go get more expensive to practice medicine.  The DEA has upped the cost of a license by 1/3 to $731.  Of course, government workers are exempt.

Congress has passed the repeal of the dreaded IPAB along with tort reform.  It may pass the Senate depending on how much arm twisting Obama and Reid can do to get it quashed or not even taken to a vote.  The White House has threatened a veto but of course that could change.

The feds released some of the regs for the state exchanges.  They do not discuss out of network treatments except that if one is out of the area their emergent bill would be covered.  Some are worried that patients will use their free will and see physicians who they want to see and not who is in their network.  The feds state that this is up to the states to decide how to handle.

The Obama administration has shown us why EHR is important.  It has nothing to do with patient care at the local level and everything to do with the government getting data for whatever reason.  The administration just authorized $200 million to find the best ways to sift and analyze the data that will come in via the EHR.

Georgia has passed a bill that guarantees the professional autonomy of Georgia physicians making it illegal to to force participation in any insurance plan, public or private.  The Governor still needs to sign the bill of let it be for six days.

In California, a rare bird has occurred.  The Department of Managed Health Care has taken action against a physician instead of a health plan.   The physician, plastic surgeon Jeanette Martello of South Pasadena has been accused of the big nasty.  She balance bills patients she sees in the ED while on call who have poor insurance, e.g. HMO coverage.  California law requires physicians to balance bill the insurer and not the patient, which she did.  She is also in trouble with the state medical board for implanting too large a breast implant and when it impinged on blood supply, removed only one implant.        Top


Rush Surgicenter in Chicago along with two nurses were fined by Illinois for violations of radiological regs.   They allowed untrained nurses to operate x-ray machines (C-arms).  The center was fined $2000 and the nurses $500 each.  Several patients received too much radiation due to the problem.  As is typical of university programs after the first problem was reported they did nothing and then fired the nurse that told the state of the hospital's lax practices.  The lawsuit will come later.   

Sutter Health in California has made a significant enemy of the unions that represent hospital workers.  In San Francisco, a union stronghold, Sutter wanted to comply with the state law for earthquake safety.  They were going to do this by retrofitting one hospital and rebuild another.  The union city supervisors would not allow this until Sutter would agree to their demands.  Sutter finally gave in and agreed to keep the money losing St. Luke's Hospital a retrofit and keep it open with an emergency for the next twenty years.  Sutter also agreed to treat the money losing Medicaid patients that are supposed to materialize under Obamacare.  They also have to donate $86 million per year for ten years for health care to the City.  They also would have to pay $20 million to fund a new community center and also an additional $63 million for affordable housing.  There would be a cap on how much the hospital could charge city employees that use the hospital.  The City robbed the organization who had no choice to accede to the unfair demands or to close.           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.