February 15, 2012 Legislation





Seton Hospital in Daly City, California, has been hit with a $100,000 fine by the state.  A major error in the long term care unit caused the fine.  The staff changed a trach tube but forgot to remove the cap and the patient suffocated.  The hospital is appealing the fine but it had no policies in place as to how to change a tube.  They should admit their error and put in procedure policies as well as beef up the training.  That would be more useful than attempting to pay less.        Top


The House has voted to repeal a part of Obamacare that even Obama states is not sustainable.  The CLASS part of the bill has already been suspended by CMS but Obama wants it to remain so that no portion ob Obamacare could be said to be repealed prior to the election.  The repeal will not make it in the Senate.

One of the good parts of Obamacare is the change in the doughnut hole for those on Part D.  HHS states that the change has saved patients abut $2.1 Billion in drugs.  This is the first tangible benefit of Obamacare reported.

Obama has flip flopped again.  One day after he allowed the Super PACs to give him money he announced a change in the contraceptive provision of the Obamacare.  Prior, religious entities were not exempt from the rule that they must cover contraception for women, not men.  Now religious organizations are off the hook.    

AARP and the GOP in the House and Senate are at odds.  That is not uncommon.  AARP is protective of the status quo and does not focus on the longer term solvency of the Medicare program. They have been asked to provide concrete proposals on how to solve the problem of Medicare becoming financially insolvent in ten years.  

Getting rid of the SGR just got a lot more expensive. The CBO just reported that the permanent repeal of the SGR would cost about$316 Billion, an increase from $290 Billion the same organization found in November 2011.  The CBO went on to state that they expect Medicare gross spending to increase by 90% by 2022 due to the baby boomers.  This is if the SGR remains and is enforced or not.  They also expect Medicaid to double in the same period.  They do not say this is due to Obamacare but it can be inferred.  The only way to pay for the doc fix is probably to use the funds that were to be used by the Pentagon for the wars in Iraq and Afghanistan.  The GOP is against this. The GOP wants to reduce the money now paid to hospitals for E and M services to the same amount paid to physicians in their offices.  This would also pay for the SGR removal.  The hospitals are against this using the old saw that our patients are sicker.  That can't be true for the codes.  This may put a slow down to the purchase of physician practices.

The GOP was to split the employment, payroll and SGR into separate bills to make an up or down vote on each individually.  This means that it is possible that the SGR would not make it on time because the Washington idiots are going on vacation again.  Then the GOP compromised and the conference committee came out with a bill for all three prongs.  The prongs would last until the end of the year only.  The payroll reduction would not be offset by budget reductions elsewhere but would add to the deficit.  This is not bad since tax reductions may lead to higher spending and more taxes.  The unemployment bill will never be fully utilized.  The Medicare payments to physicians would be paid for by a reduction in parts of Obamacare.  Also the GOP Senate would want a new look at the onerous AHA provision against physician owned hospitals in order to vote for the compromise bill.

Another good piece of news is the potential for delay of the terrible ICD-10 provisions.

Obama has again shown he is no friend of the physicians.  His budget requests a $320 Billion reduction in Medicare and Medicaid and as part of this is a reduction in payments to post hospitalization providers.

More regulations are coming into effect.  At least this one is good for all concerned.  All health plans will need to make very clear their summaries of benefits.  This will need to be in standardized format.  It will need to say the costs of deductibles and co-pays as well as what they will pay for going out of network.  Each plan will include two items and tell what the out of pocket amounts will be.  The disclosure can be only six pages so it will be harder to hide information in the large contracts that are currently sent.  This will start in September.

Anthem Healthcare has continued to defy California in paying the provided it shortchanged several years ago.  It state the fine it paid the state settled all the claims.  The state said the fine was on top of the monies that need to be returned to the providers they cheated.  It will be interesting to see who blinks first.

The feds have said no to California wanting to put co-pays for physician visits, hospital visits and prescriptions.  This will cost the state an unbudgeted $575 million.  

California now has a law reinstating the Board of Nursing which was disbanded for gross negligence.  The new law does not give enhanced pensions to the Board members.  

Washington was beaten down when they wanted to limit Medicaid patients to four ED visits per year.  Now they have changed and want to pay for no ED visits that using the retrospectoscope were not true emergencies.  I doubt that that will fly either.  The physicians are to eat the costs of treating patients on Medicaid who do not have one of the 500 diagnosis allowed by the state.  Of course, it is against the law not to see and treat any patient that presents to the ED.  The physicians will probably have to sue the state to stop the insane program.

NICE in England has stopped the use of Zytiga, a chemo drug for prostate cancer because it is too expensive.  It does extend lives.  More interesting is that the drug was developed in England and Cancer Research UK would have gotten royalties for the use of the drug.        Top


CMS has stated that starting in 2013 physicians who do not report enough quality data will be paid less.  They will forfeit any bonus and by paid 1.5% less in 2015 and 2% less each year thereafter.  So far quality measures sent to Medicare have been well under 20%.  The problem is CMS has their head up somewhere it does not belong unless one is a gastroenterologist.  They will retrospectively determine whether or not a physician has reported enough on 80% of eligible patients, whoever they are.  There are some bonuses at present if you do what you are supposed to but after 2014 Obamacare forbids more bonuses and only allows penalties.  Physician can use for about $200 per physician certain registries to report to CMS.  More money out the window for red tape.

HHS has warned physicians that if they allow any healthcare firms to use their Medicare number for billing, they may be liable for any fraudulent bills by the firms.  Physicians can legally reassign collections to a firm by filling out a form CMS-855R.  Under the law physicians have unrestricted access to claims filed using their number by any firm.  That includes hospitals.

Since HIPAA 5010 went into effect on January 1, a strange thing is happening, physicians are not being paid and taking out  loans to cover expenses.  Almost all the problems are due to problems with the carriers.  CMS in order to help the problem has delayed the implementation to March 1 and maybe even longer. Many offices are going back to paper claims in order to be paid.  If physicians think this is bad wait until ICD 10 goes into effect. 

Oregon has started requiring physicians with concierge practices to register with the state insurance department.  There is no deadline of fee for enrollment.  This is to make sure concierge or retainer practices do not have to conform to insurers requirements.  The questions asked on the form for the state are intrusive at best.        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.