January 15, 2013 Legislation





Well, the Washington idiots of both parties finally did something. Of course, they and the do nothing President had to wait until the last moment.  They not only passed a major bill that delays our fiscal worries for two months but also again kicked the can on the SGR for another year.  They just do not want to pass an unfunded law which grows in how much will be needed daily.  They will fund one half of the one year delay by taking money from the hospitals.  The other half will come from some bundling and removal of money from Medicare Advantage and DSH as well as no increase in Medicare payments for physicians this year.  The Washingtonites also delayed for several months the 2% sequestration. Now they can wait for the two months and do a crisis scenario again.  Several pieces of Obamacare were also cut to pay for the bargain.  The CLASS (long term care portion) was cut as was financing of the non profit health care cooperatives.  Next on the list is the removal of the Board.

One of the things that took a beating in the fiscal cliff negotiations was the payments to physicians who do CT and MRI scans.  They took $800 million over 10 years from the payments if one does the scans in out of hospital settings.  This goes into effect in January 2014 and will cost the government more money as the hospitals charge much more for scans and all tests than the outpatient physicians.  The reduction is only in the technical component and is based on erroneous assumptions. 

The Hill writes that younger individuals will be charged more under Obamacare due to the 3:1 ratio that is in place.  The higher price for the younger people will allow insurers to charge more for the older ones since they can charge no more than three times the premium of younger payers.

To the detriment of Obama, Sebelius is staying on as the head of HHS.

CMS paid out $1.2 Billion in December for EHR bonuses.  Of course, they are getting nothing in return as all know EHR is only for billing and not information that is meaningful.  

There are now 106 more ACOs which will lose money in the next few years.  That is the number of new organizations approved by the feds.  About half a physician centered and not centered around hospitals or insurance companies.

MedPAC has recommended against any increased payments to ASCs.  They want value based payments starting in 2016.  They do want a 1% increase in payments to hospitals in 2014.  They also agree with Congress that Obama's Medicare Advantage Demo project is a waste of money and illegal.

By having more cost effective care which would include changing the fee for service Medicare program to a value based system we could save about $2 TRILLION.  Let's see that get through either House of Congress.

HHS has released a report stating that healthcare costs can not be controlled due to the aging of the population.

Yale university states that we are spending as much on screening mammography as we spend on treatment of breast cancer.  Think about how much we could save if we never screened nor treated.  Death is cheap.

The People's Republic of Massachusetts may be becoming the fiscal leader of the country.  The governor wants to actually get the Republic fiscally responsible by requiring public employees work 20 years instead of 10 to get health insurance.  He also wants them to pay more.  This could save $20 Billion in the next 30 years.  Of course, it will have to get through the Democratic legislature so the legislation is doubtful.        Top


California has a tool for identifying over prescribing physicians and pharmacies.  The problem is that it is not being used by the Attorney General of the State.  The program CURES is just sitting in her control and she refused to talk about the program or to use the program.  This is probably due to her negligence and non caring attitude.  She also refused to while San Francisco's attorney general to prosecute death penalty cases.  The chief of staff said it is not being used since if they found something they do not have the resources to go after the physician or pharmacy.  This is a poor excuse by an office led by a poor excuse.

New York City is going to tie physician pay in their public hospitals to quality of care which includes what nice things the patients say about them.  This needs to be negotiated with the physician's union.  The terms of the contract for pay will be interesting as to how much is there with regard to those aspects of care that physicians have no control over.  This would be a basic salary plus a bonus to all the physicians at a particular hospital so all physicians would get something but that something may not be equal.        Top


California is investigating Kaiser for sending paper medical records to a couple in Indio, California, for storage.  They did this without any contract with the Deans who kept the records in a warehouse shared with a party supply business.  After Kaiser found out that they screwed up they negotiated a settlement with the couple paying them $100,000.  However, the Deans never gave Kaiser back all the information on their computer, just the paper records.  Now Dean states he has deleted the information off his computer but Kaiser wants to check the computer.  Dean wants more money for his inconvenience and Kaiser says they have paid the Deans enough.  The stalemate continues between the parties but in the meantime Kaiser is being investigated by both the feds and the state and will have to pay a fine possibly to both for their negligence.  A court ruled that Kaiser may not access the Dean's information but issued an injunction against the Deans to forbid them from retaining or disclosing any patient information.        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.