May 1, 2012 Legislation




Physicians in Kansas, Iowa, Missouri and Nebraska have received information of how they fared against their peers in cost and quality according to the CMS. This is called resource use reports.  This is a forerunner of the new CMS payment system.  The reports tell of how many physicians saw the patient and the cost of each physician's care to the patient. Physicians are now directly accountable for patient costs to Medicare and the costs in 2013 will determine the payments in 2015.  It is hoped by the feds that this will then come into the commercial market.  It is becoming more evident that it will be impossible to look at individual physicians but only as they relate to groups or to total per patient spending.  There is no mention of quality anywhere as this has never been defined.

New Hampshire is quietly passing a law that prohibits physicians from prescribing any implantable device if they would gain profit directly or indirectly from the sale of the device.  There are no exceptions except for shares held in publicly traded companies.  This will take away any small business in medical devices from the state or any testing of devices by any university.  If a physician in the state develops a better widget, he/she would have to move the medical practice out of state to use the widget.  Another example of law makers not thinking things through and drafting bills with ambiguous definitions.   

The AMA and 13 other medical organizations are fighting CMS's regs regarding the 10 year look back for overpayments as well as the terrible writing of conflicting rules and regs that one would expect from CMS.     Top


The Treasury Department states that Obamacare offers an opt out of individuals getting employer insurance and being eligible for the exchanges if the employer premium to the person is greater than 9.5% of the total household income.  Consumers are against the rule since it looks at affordability on how much it would cost to cover the individual and not the family.  They say the way it is being interpreted will leave out families from getting insurance.  The law states it is for self coverage only.  The consumer want Congress to better state what they intended for the law.  Good chance of that.  

The feds (CMS) has started to put the screws on the hospitals and nursing homes as to what drugs they may or may not use on their Medicare population.  They are stating that if the institutions give drugs not approved for dementia they are running the risk of reduced payments if an adverse reaction happens.  They are not saying one can not use the drugs but if you do be prepared for a potential reduction in income.  It is the Golden Rule.  He who controls the gold, rules.

Medicare is enlarging the bidding process on durable medical equipment.  The bidding process has saved Medicare $202 million in the first year.  This will hopefully go to $25 Billion in a decade.

The GAO states that the administration is wasting over $8 Billion in money given to Medicare Advantage plans that do not have good quality measures.  The law states the money is only to go to the upper tier plans for a reward.  The administration states that the extra money should go to the lower tier plans to bring them up to snuff.  This is against the law but as usual that means nothing to the administration.  The GAO intimated the money was a boondoggle since it could not be determined if the extra money would help on not.

In two sides of the same coin, the administration states that Obamacare will save $208 Billion over ten years and a Medicare trustee says it will add between $340 and $350 Billion to the federal deficit over the same period.  It should be noted that prior to Obamacare it was estimated that Medicare would be solvent until 2029.  The year after Obamacare came into law the solvency only went to 2024.  The administration believe the timeline but also believes Medicare is unsustainable.  This is with the soon to go into effect 3.8% Medicare surtax on incomes over $200,000, not indexed for inflation.  This goes along with the rapid demise of the Social Security System under this administration.  The new end date for Social Security is three years sooner than previously estimated.  It is now 2033.  The Social Security Disability Trust Fund will be gone in 2016.  After this announcement from the Social Security folk, Sebilius stated in a prepared statement that Medicare is stronger than ever since Obamacare passed.  Who do you believe?  

To make matters worse the dire Medicare predictions assumes that the physicians will take the 30% hit under the SGR.   All know this will not happen as there will be very few physicians available to take care of patients.  The Medicare Trustee report states this but Sebelius seems to forget to mention it when she gives the Obama line.  Even if the dreaded IPAB goes into effect, that does not happen until 2019 and they can only reduce expenses by 0.1%.  Medicare as we know it is on the way out!

CMS has made final a rule that states all providers and suppliers that qualify for an NPI include the NPI on all enrollment applications and claims for payments.  Also all physicians and other suppliers that order DME or other supplies as well as imaging, lab home health or supplies keep the documentation of the orders for seven years from the date of service.

Dear Representative Pete Stark, who made the health attorney's forever work laws, now is after Accretive Health, a collection system.  He thinks that they are violating federal law because of a newspaper story that insinuated such.  The story said that the hospitals had Accretive employees embedded in their EDs and they required patients pay old bills before they are seen in the ED and that would be, according to Dear Pete, a EMTALA violation.  This is actually good.  I didn't know Stark could read.    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.