April 15, 2011 Legislation



The ACO regs have been published for comment.  The administration claims that they will save fed med between $510 million to $960 million in the first three years of operation.  It will probably cost much more than that to put the ACOs and their rules into effect.  In the demo projects it cost over a million dollars per ACO for start up costs. Patients will not sign up for the ACO.  They will be assigned an ACO if the physician they see the most during the year is a member of the ACO.  Physicians who participate in an ACO must post signs stating that they are participating.  However, a patient does not have to obtain any or all their care in the ACO but the ACO is still responsible for their care and outcomes.  This is a major flaw.  An ACO must prove that they can provide primary care not including hospitalization for at least 5000 members.  The physicians will be paid at first on a fee for service basis and that fee will be dependant on how much money they spend the prior year versus traditional fee for service Medicare rates.  The government also added 65 quality standards and the physician members must meet enough of them plus the money aspect to qualify for payments.

The IRS has put out guides for non profit hospitals to keep from getting into trouble for inurement.   I wish them luck as their funding will not be increased.

The IT needs will be more than the meaningful use requirements.  Not only that, but the ACO requirements start during the first year of the meaningful use requirements.  I also wish the ACOs luck in getting this together without spending an arm and a leg.  It seems that even though hospitals are not required to be a part of this scheme, they or an insurance company will be necessary to fund the operation.  Physicians will not be able to fund it on their own.     

The administration continues to grant waivers to almost all who want to defer one year a provision in Obamacare requiring at least $750,000 in annual benefits.  This last 125 waivers brings the total to 1,168.  There are now almost 3 million people covered by the waivers. 

I am sure no one is surprised that the AHA has written a letter regarding the potential to drop the terrible provision in Obamacare getting rid of physician owned hospitals.  The interesting part is that they sent it to the new Republican Congress.  The letter accuses physician owned hospitals of taking the wealthy, as if that made any difference with insurance.  The letter states that there is conclusive evidence that physicians send high margin patients to their hospitals but they do not state the impartial source of that statement.  They rightly state that physician owned hospitals take less Medicaid patients.  This is because less physicians take Medicaid patients.  They then go on to the old saw that the poor community hospitals are left with nothing.  Nothing could be further from the truth.  Community hospitals are doing very well.  They are making money although they could be making more without competition.  The AHA then blasts Medicare for not policing physician owned hospitals who the AHA states are using 911 to obtain medical assistance.  They state that this may, not does, violate Medicare standards.  Obviously Medicare does not agree with the AHA.  In reality, they just can't stand the competition.

MedPAC has released two recommendations.  The first is that the $300 Billion owed for the SGR be just written off and not compensated for.  The second is to cut reimbursements for MRI and CT exams.  They want a Medicare prior authorization put into place for physicians who utilize the exams substantially more than their peers.  They say that this will save $50 million in the first year and $1 Billion over five years.

Finally, the House and Senate have agreed on the removal of the onerous 1099 requirement in Obamacare.  They have agreed to pay for it via the Republican method of clawback on patients who get more tax credits for purchasing health insurance than they are entitled to. 

Obama wants to save money by targeting medical errors.  Under Obamacare errors are to reduce 40% over the next three years.  This was funded in the Obamacare bill.  They also want to cut readmissions by 20%.  They are trying to do this by giving more money to hospitals that meet the high standards.

The House, with all the Republicans and four Democrats voted to defund the preventive measures in Obamacare.  This will now go the Senate where it will die or if passed will be vetoed by Obama.

While all this nonsense is going on in Washington, the states are taking matters into their own hands.  Georgia's Senate has passed a bill to allow insurance from other states to be sold in Georgia.  This will now go back to the House and then for signature.

Arizona lawmakers have passed a bill to allow insurance companies outside the state sell policies within Arizona.  This would get rid of the state insurance mandates and allow people to buy what coverage they want or need.

Virginia has passed a law making it a criminal offense to attack any emergency room physician or nurse.   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.