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The Pennsylvania Department of Health is considering changes in the way medical care in the state is regulated. This would include the dreaded nurse patient ratios that have caused chaos in California, the reporting by hospitals of serious events and infections and would allow public traded hospitals to state how they would run hospitals in the state.
Humana will be investigated if that paragon of virtue Representative Pete Stark has any say. It seems that Humana is illegally marketing their Medicare Part D products. The company is paying commissions that are double if the agent sells both the HMO and the drug plan than if they sell the drug plan alone. Paragon Stark wants Humana thrown out of the program immediately.
Medicare Part D will not allow enrollment without penalty after May 15. An attempt to extend the deadline failed in the Senate on a 52-45 vote. It needed a 60 votes to pass. Another paragon H. Clinton stated the whole program should be scrapped. As usual, she did not have anything to replace it. The program seems to be getting the kinks out and will be running smoother. The average monthly premium is at $25 and not the originally thought $37. The new estimate is that the program will cost "only" 678 billion over ten years rather than the original thought of $730 billion.
In a surprise there is a cap on Medicare spending for physical therapy performed outside a hospital setting. The cap is $1740. There is no cap if the therapy is provided by a hospital. This makes no sense. Why should people travel longer distances to get their therapy. Could the hospital industry have anything to do with this inane rule? There are no plans to change the law but there may be some modification for injuries. What this bill means is that people will either get the original $1740 in rehab services from their choice of provider and then go to the hospital for the remainder or pay for it themselves. If the estimated 4 million Medicare beneficiaries get their rehab at the hospitals, there will be longer waits and less time to do the rehab. The private centers will not go away since the majority of physical therapy is done on non-Medicare patients. The caps include those with strokes and the use of speech pathology as well as other occupational therapy. This law has been on the books since 1997 but has not been activated until this year. All Medicare people who go to any rehab facility are required to be told about this on their first visit.
Hidden in the recent deficit reduction bill recently signed by President Bush was a small item that mandated CMS to put an additional six month moratorium on physician hospitals until CMS reports to Congress. This shows the value of lobbyists for the big Hospital Association. Top
Cigna has been fined $150,000 by New York. The reason is the arrogance of the company for not responding to consumer complaints. Cigna agreed with the charges and agreed to change their operations, right. Top
Congress finally passed the bill to reverse the 4.4% physician deduction for treating Medicare patients retroactive on January 1. This must happen six more times until the law sunsets. Congress does not have the guts to just repeal the law that has never taken hold. They just repeal each year as it comes. Top
The Joint continues to delay any ruling on MS 1.20 since it may not be a clear statement and it may require many hospital medical staffs to revise their bylaws. This means there will be an additional delay in implementation beyond the January 1, 2007 effective date. The main aspect of the proposed is that the medical staff and the hospital are on equal footing. There can be no conflicts between the two organizational entities. The medical staff only has to comply with the medical staff bylaws. All actions against practitioners are included in the bylaws and can not be hidden and easily changed in another policy. The same would be true for the credentialing process and the roles and actions of the Department chairs. All members of the medical staff who are eligible can have the opportunity to vote on any bylaws changes. 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.