August 15, 2013 Legislation




Congress takes care of its own.  The government, or as it is known taxpayers, will pay most of Congress' healthcare premiums.  However, Congress and many of their aides will need to get their insurance via an exchange.  The taxpayers will pay up to $5000 per individual or $11,000 per families for elected individuals and their aides .  The aides will not be eligible for any assistance to purchase health insurance outside of the amount given.  This is a compromise solution between Congress and the White House to keep the Congressional staff from leaving to get healthcare.  This is also illegal as only Congress has the right to change the law but it was done with presidential fiat.

On August 1, the Sunshine Act took effect.  This is the law that requires any remuneration of more than $10 cash or in kind to any physician or teaching hospital by any drug manufacturer or supplier or GPO to report it to CMS.

Illinois may be corrupt and bankrupt but it is now the 20th state to authorize medical marijuana.  The users must have a relationship with a physician who prescribes the weed but the users can not grow it themselves.  They must buy it from one of 60 authorized dealers in the state.

The GAO has recommended to CMS to keep track of self referrals for prostate cancer self-referrals for IMRT radiation.  The amount of patients to use this modality in the self referred group has risen from 80,000 to 360,000.  In the same time span non self referring physicians saw a decrease in IMRT.  Self referrers sent 52% of newly diagnosed prostate cancer patients for IRMT but non self referrers sent 37%.  This rose to 54% when the physicians switched to becoming self referrers.  The GAO wants CMS to require self referrers to disclose their interest in the IMRT therapy.  They also wanted the CMS to insert a flag in the billing form to state this is self referred.  The HHS said this was too much work and refused.

California's Medicaid program will reduce payments by 10% starting next month with medical transporters and will add others monthly until all are covered by January 1, 2014.  To make matters worse since this was supposed to go into effect two years ago but did not because of law suits it is retroactive.  This means some return of money to the state by those who provided care.  Any person or entity that stays in the program is either using it illegally or as a loss leader.  Hospitals and physicians should hopefully leave the program in droves.

California is going to pay more than necessary for the exchanges.  They will have only one deductible starting in January 2014 for $6300 instead of one for pharmacy and one for medical as the feds will do.        Top


California has just fined ten more hospitals for patient safety issues.  They are Alta Bates for unsafe parenteral nutrition $50,000; Barlow Respiratory Hospital poor telemetry monitoring $50,000; Desert Valley Hospital for problem with cardiac catheterization $50,000; Hollywood Presbyterian for lack of patient safety $50,000; Marin General for problems with respiratory care $100,000 (4th penalty); Memorial Medical Center in Modesto for problems with patient care $100,000 (3rd offense); UCLA  for retained foreign body $50,000; Sharp Memorial $75,000 (wrong side surgery and 3rd offense); St. Jude in Fullerton for not following surgical procedure and 5th penalty $100,000; UC Davis problem with patient care $50,000.

Look at the difference.  Florida's Halifax Hospital in Daytona Beach did a wrong site surgery and internally terminated one employee, reprimanded others and the surgeon that did the wrong site surgery is no longer on the staff.  The state, when told about the incident, recommended to CMS that funds be withheld.  Of course that would never happen and the hospital changed it flawed rules to comply.

Rawson-Neal Psychiatric Hospital in Las Vegas has been given a preliminary loss of accreditation for their shipping patients out of state without anyone to care for them.

The Wisconsin Attorney  General has issued a ruling that states that Catholic hospitals can not deny admitting privileges to physicians just for the reason that they do abortions.  If the physician can prove they are being kept off the staff for that reason the hospital may lose its federal funding.  The AG quoted federal law for his opinion.  The state passed a law now under legal attack that requires physicians that do abortions have a hospital affiliation within 30 miles of the place of abortions.        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.