July 15, 2010 Legislation


Meaningful Use


Is contraception a preventable service that should be paid by federal monies or is it something that should be paid by the individual?  No decision has been made but if it is paid by Obamacare, it should add a significant amount to the cost of the program.  It would also draw the wrath of those in the Congress and Senate who are against abortion as part of the program.  Twenty seven states now legislate that contraception is to be a covered service by the insurers.  Business is also in favor of contraception since it is cheaper than paying for child birth and the time off.  However, they only want to pay for generic and not brand name drugs.  Obamacare will mandate brand name drugs.  The cost to plans that pay for contraception is now at about $40 per member per year.  The typical family healthcare policy is now about $13,000 per year.

The White House has listed preventable services under Obamacare.  They include mammography and colonoscopy along with smoking cessation. Vaccines for children would also be covered.   Contraception is not among the preventable services and Planned Parenthood is attempting to get it covered separately. Preventative services would be at no charge to the patient.          

Obama has done some really good things in the last few days.  The most important is to loosen the restrictions on the vets with PTSD so they can get treatment.  The other was to put a focus on HIV/AIDS.  The problem here was the lack of focus on circumcision as a preventative.

CMS has proposed that the out of pocket costs for preventative services in hospital EDs and ambulatory surgical centers should be less that it is now.  I wonder what preventative procedures are done in those places.

USA Today states that small business and charities will face more reporting duties under Obamacare.  They must file 1099 forms for all vendors from which they purchase over $600 in goods during a year.  If they use more than 250 vendors they must file the 1099 forms electronically.  This is due to the need for more money to pay for Obamacare.

The Republic of Massachusetts has seen the light and not the money.  They passed a ridiculous law having drug companies report to the Republic all gifts to physicians over $50.  The companies retaliated by pulling conventions out of the Republic.  The Republic feels that the loss of money to them is worse than the law they passed two years ago.  

The People's Republic of Massachusetts has now capped the premium rates on 137 companies to 2009 levels.  This comes after a court ruled against the Republic last week.  Carriers must provide enough evidence to justify the requested increases.  This is to keep the rates low enough that the people can get re-elected in November.   

The Republic has now shelved a plan of using bundling of payments since it is too divisive.  This is what Obama is suggesting for their Accountable Care Organizations.  If a small state that is so regulated at Massachusetts can not do it, I wonder how it will go over in the nation.  The Republic is seeing its healthcare costs increase at about 8% per annum.  This is true even with the illegal caps on insurance companies premiums.  The Governor is up for re-election this year and continues to push patient care costs down so he may be re-elected and then will relent.

Rhode Island, whose health care is much cheaper than the Republics, gave their insurers the OK to increase their rates.  The rate increases varied between 8% and 12%.  These increases are just several percent below what insurers asked for.

Connecticut may change its mind and not do the high risk pool and defer to the feds.  It actually did some math and found that those with pre-existing conditions will cost more.  It is a shame that more states do not do actual projections but only go on politics.

Maine is requesting an exception to Obamacare's rule that insurers must spend at least 80% of premium for healthcare.  The state has only two insurers and one only spends 65%.  That insurer states they will pull out of the state if Obamacare rules go through as is.  

California has a bill in the hopper that will raise insurance costs again.  They plan to legislate that insurers must cover smoking cessation, a noble venture.  The legislature states that the insurer should cover any FDA drug approved for this.  This includes the state as the insurer for Medicaid.  The bill would increase premiums by about $84 million per year across the state.  The feds have stated that cessation programs will be part of their program.  It should be noted that none of the bills require cessation classes.  

Louisiana is planning a 4.6% decrease in Medicaid payments to providers and wonders what this will do to access.  It is easy to see why the state is low in the education loop. 

Illinois has enacted a law to bring consumer protection to all with insurance and not just those with HMOs.  Now all have a right to an external independent review of health care claims.

The individual states are resisting Senator Feinstein's bill to centralize with the feds the authority to review health insurance premiums.  This resistance includes the Senator's state of California.  There are now 23 states where the Insurance Commissioner does not have the power to review health insurance rates.

Obama has bypassed the Senate where he realized his choice for CMS head would be hard pressed to be confirmed.  He used the gimmick of a recess appointment to name Berwick as the head of CMS.  Obama did not want healthcare reform in the spotlight again as elections are coming up.  Berwick will serve until the end of the current Senate session.  

HHS has come out with a rule on HIPAA.  It extends the penalties to business associates and their sub contractors.  It would also allow patients more rights to their own health information and more availability on withholding what information goes to insurance companies.

Socialist Germany is preceding Obama's socialistic medical agenda. The Germans are having financial difficulty and are trying to cut back spending as the way out.  This means less money for many programs including medicine.  The Chancellor has given less money to all aspects of the medical field.  The main difference is that Obama believes the opposite and says that spending creating more deficit is way out of our financial problems.  The world leaders do not agree with Obama.          Top

Meaningful Use

The Feds have finally determined what they will pay for as meaningful use in the EHR arena.  This is $27 Billion over five years and includes both hospitals and physicians.  The final rule is much more lenient than the proposed rule that was released in January.  The number of core objectives dropped by 10 and the elective objectives were set at five for both.  One of the main changes was in electronic prescriptions.  The old rule stated that 75% had to be electronic whereas the new rule is down to 40%.  CPOE is also decreased to 30% from 80%.  The bottom line is the EHR is here and will not go away no matter how few want it.       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.