February 15, 2013 Legislation




Two faced Sebelius who originally said she would not change the Obamacare rules to accommodate religious groups has done her usual about face.  Since she is having to look at 50 suits against her by religious organizations, she and the administration all of a sudden got religion.  They changed the rules so those entities with religious objections to contraception will not have to pay to insure patients for abortions or contraception.  This change in the rules may but may not abate the lawsuits which were heading to the Supreme Court.  Obama does not want to give the high court another bite at the apple.

The best laid plan of mice and Obama goes astray.  He does not want the high court to get at Obamacare again but it will.  The Catholic Bishops have rejected the compromise offered by Obama's hack Sebelius.  The will continue with their suit against the government of the freedom of speech issue.  

The Obama administration is throwing Medicare recipients under the bus in favor of Medicaid.  The reason is the lack of states that are going to enlarge Medicaid under Obamacare.  The administration wants to show the states that the feds will shoulder the initial costs of the Medicaid expansion (ever try to take away an entitlement once it is in place).  Of course, this means less money available for Medicare and this will be seen in lower payments to hospitals and physicians.  This will lead to less access to care for Medicare recipients.  The White House says that this is part of their new liberal agenda.

CMS has announce four new types of payment bundling all involving hospitalizations.  They have "awarded" about 500 organizations including for profit, not for profit and physician owed facilities in the trial program.  The results should be interesting as to how the pie is sliced especially in those hospitals that do not have employed medical staffs.

The HHS has missed some very important deadlines for Obamacare to be operational especially in the Medicaid arena on time.  They have not paid out money to entice physicians for two years to see Medicaid patients by raising their now pitiful payment to Medicare rates (about a 74% increase).  They have not gotten their act together in paying states for getting rid of co-pays for preventative care such as vaccines.  They also missed the deadline for lower cost sharing for people who make too much for Medicaid.  Several states will end coverage at the end of this year since it was assumed that the feds would take over.  This leaves the people without the means to purchase insurance.

CMS has finally issued the Sunshine Rules.  These direct a database of how much physicians are paid by drug companies and device manufacturers.  This allows patients to go online and see if their physician gets paid for recommending a particular drug or device if the purchase is covered by government funding.  The collection of data begins on August 1.  The public website will start on September 30, 2014.  

HIPAA, as all know, has issued new regs.  The good news is that physician offices do not need to give the new required privacy practices to established patients, only new ones.  It does make a great time to review the practice's policies and how they are complying with the rules.

One of the provisions states that if a patient pays in cash, all information about that visit can remain confidential from any insurer.

Bipartisan support in Congress is again attempting to get rid of the Medical Device tax that fuels some of the money for Obamacare.  The Democrats realize that the tax will cost jobs and hamper innovation.  Obama last year threatened to veto the bill but his threats are usually empty.

CMS has lengthened out the time between it's announcements telling how great Obamacare is.  The latest one states that seniors have saved $5.7 billion in 2012.  This includes the gradual closing of the doughnut hole as well as preventative services which are paid for by tax dollars and not the individual.  The Cato Institute faults HHS for giving 50% reduction on brand name drugs.  This encourages seniors to use brand name over generic drugs.  The last year saw a savings of $2.5 billion for brand name drugs and only $105 million on generics.

CMS has issued regs to lessen the regulatory burdens on healthcare providers.  This is in response to a two year old executive order.  No one ever accused the feds of moving quickly, especially Sebelius unless she wants to tout Obamacare.  The new rules are designed to lessen the burdens on the physician with the overseeing of procedures and with red tape.  CMS has also put into the Federal Register new Condition of Participation regulations that state that every hospital even those in a major chain must have its own independent medical staff and that there must be one member of the medical staff on the Board.  This latter was delayed due to the AHA not liking physician in position of power.  This will probably be changed to reflect that the Board on a regular basis consult with a medical staff member responsible for the medical staff.  This may be the hospital appointed VPMA or other such lackey.  The person would need to be in each hospital in a multi-hospital system.  The new reg would allow outside practitioners to order tests at the hospital even if not on the staff when authorized by the medical staff and state laws.

California and Oregon are both attempting to lower the standard for practicing medicine to comply with Obamacare.  Oregon wants to give all nurse practitioners the right to prescribe.  California is attempting to go even further down the rabbit hole and allow both nurse practitioners and physician assistants to set up independent practices with no physician supervision.  Thank God I will not be part of Obamacare. 

The People's Republic of Massachusetts has got something right.  They passed a rule allowing hospitals to trade drugs with other hospitals in the case of drug shortages.        Top


Michigan has a new tort reform law.  It keeps most of the old law but makes sure that loss of consortium, companionship and household are all non economic damages and come under the $280,000 cap.  It also changed the formula for future damages.  The physicians are happy and the Trial Lawyers are not.  That is a good sign.         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.