May 1, 2011 Legislation






HHS has announced that they realize their mandates have been wrong headed and are now willing to give states flexibility in how to run their Medicaid programs.  They will give a whole potential $1 million to all of 15 states to help coordinate care for dual eligibles.  They will also give greater latitude to the states to arrange for home care.  The feds will also increase to 90% the money needed by the states to to revamp their IT systems to help people enroll in the Medicaid program so the states can spend more money on them.

A little noticed but legal signing statement by Obama when he signed the budget for the remainder of this year stated that there may be czars appointed by the President who do not have to be confirmed by the Congress.  This was against the law that prohibited funding for four czars, including healthcare.

On the day your income tax was due, April 18, you could have begun reporting your meaningful use IT.  This is so you can receive $44,000 over three years or $64,000 over five years by only spending much more than that for useless IT programs.

Obama has again reversed his course due to politics.  Medicare Advantage was supposed to have its payments reduced but since that would mean seniors who are the largest voting segment would have some of its benefits removed the MA program got a small increase.  If kept in place many seniors may have voted against the Dems who put in Obamacare and Obama in 2012.  The administration's Medicare Payment Advisory Committee even said the increase in payment was wrong.

Both political parties are now against the Obamacare Independent Payment Advisory Group (IPAG) that will set policy without Congress.  There is a bilateral law being proposed to do away with the Board.  Obama not only wants the Board but he wants it to have more authority so he won't have to deal with Congress.

MedPAC has recommended to CMS to begin rationing money for CT and MRI scans to those who use them the most.  The way they propose is to require pre-authorization for the scans.  This will hurt people but is easier than trying to look retrospectively and get back money like they do in all other phases of CMS payments. 

The House Republicans have asked Obama to give specifics of his statement of saving $480 Billion in healthcare over the next 12 years.  They particularly want to know about Obama's plan for the new IPAG, the new public private partnership to reduce hospital readmissions and the leveraging of Medicare's purchasing power for drugs. The answers should be interesting but probably not illuminating.

Ev Dirkson, the former Senator from Illinois, would turn over in his grave at the stupidity of the CMS.  They could save over $4 Billion per year by following the recommendations of the OIG.  They will not since it is too hard to do and not worth the effort.

The CBO has issued a report that if Congress repealed a law that the feds would help the states with planning grants to set up exchanges, approximately $14 billion could be saved over ten years.

CMS has decided that patient satisfaction ratings of hospitals will determine 1/3 of the bonus payment to the hospital.  This subjective measurement from Press Ganey or some other outfit will determine how the 1% withhold will be given to the hospital. 

Idaho's Governor has issued an edict to forbid any executive worker from doing anything to help Obamacare come into the state.  This includes accepting any money that would go towards implementing the law.

The Democrats of the People's Republic of Massachusetts are beginning to eat their own young.  They want the municipalities to be able to unilaterally change the benefits and cost of insurance to their union workers.  They say the union may still bargain for how much the union member will individually pay for the insurance.  The Republic has a projected debt of $1.9 Billion due to their expenditures on the health reform, the loss of federal money and lowered state revenues.  They will get rid of state jobs, and cut expenditures.  They want to balance their budget and are willing to cut without raising taxes to do this. 

The People's Republic finally ha done something right.  The House has voted to reverse their stance on drug gift bans.  The Republic's stance has cost the restaurant industry money and has not reined in any healthcare costs.  Several conventions also dropped their plans to go to the Republic due to the law. The Democratic Senate has nixed the plan in the past.

These people really are schizophrenic.  First they decided that all people in the Republic would be medically covered.  Then they found out how much that would cost and determined that legal aliens would not be covered.  The Republic's House Ways and Means Committee decided that the $50 million for the program could be used better elsewhere.  The full House decided the like the legal immigrants and restore $25 million to the program.  I wonder which half will be covered.

Arizona's Governor has vetoed a bill that would allow out of state insurers to sell in Arizona.  The rationale for the veto was that the Arizona healthcare mandates would not be necessarily adhered to and the possible recourse against outside state insurers if the consumer is mistreated by the company.

England's NIH has again said a drug that may help patients with cancer is too expensive.  They will not allow Afinitor, a drug for advanced renal cancer to be put on the formulary due to the cost.  The cost is $56,000 a year per patient.  Contrast that with CMS allowing Provenge, a anti prostate cancer drug that costs $96,000 per year and only gives an extra four months of life.      Top


The feds were going to pull the certification of the University of Chicago Hospitals for multiple patient problems.  These problems were brought into the sun by the death of the Chicago Sun-Times Chair. However, a follow-up investigation showed a correction of the problems.  Nobody would state what the deficiencies were but it appears that the death was caused by an air embolism upon removal of a dialysis catheter. 

In October, hospitals will see a 0.5% cut in its Medicare payments due to an increase in payments in the past. 

CMS has mandated that hospitals educate all patients about the flu vaccine and all patients are to be offered the vaccine after being given informed consent.  This is to go from September 1 until the end of February.

An audit at the University of Iowa has found problems with their physicians using the Epic EMR system.  There were problems with billing by the physicians and the hospital as well as multiple complaints about the system.  The CFO likes the system because the hospital makes more money, which is the real reason for EMR.       Top 


New Mexico's Governor has vetoed a bill that would have raised the amount allowable in a med mal case non-economic damages to $1 million and would have raised that cap by 3% annually.  The reason for the veto was that she realized the increase would cause physicians to leave or not want to come to the state.  

Michigan has a signed law that lets physicians apologize to harmed patients without the apology being used in court against the physician.  There are now 35 other states that have the same law.   

The North Carolina House has passed a Med Mal law that limits non economic damages to $500,000 in cases not involving death, disfigurement, permanent injury and loss of a body part.  This now goes back to the Senate for their consideration.  The bill also states that ED physicians must have violated the standard of care by "clear and convincing evidence".    Top


Dr. Alexandra Than of Massachusetts was fired from her position as a ED physician at a hospital and then was reprimanded by the Medical Board and fined $500 for talking about a patient on Facebook.  Although she did not identify the patient there were enough facts that people could recognize who she was talking about.        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.