November 15, 2012 Legislation




The GAO has determined that those with MRI and CT scans in their office self refer for exams more than those without the scans refer.  This, they say, boosts costs.  What they don't state is the need and ease of getting the scans and if the scans saved any time, anxiety or health.  They were only interested in money. The amount of money is $100 million, not small potatoes but not a lot either.

It looks like Medicare will see budget cuts and possibly more money from constituents as the fiscal cliff is eroded.  This is the thoughts of Daschle and Frist.

The CBO stated that maintaining the present Medicare physician fees and eliminating the automatic cuts to non-defense spending would increase federal spending by about $40 Billion next year and $61 Billion in 2014.  The physician portion would be $10 Billion and $16 Billion respectively.  

The CBO stated that the Republican bill to amend the 80% mandate on health insurer companies to exclude brokerage fees would cost the deficit about $1 Billion over ten years.  What is happening now is that brokers are no longer being paid to help consumers manage the healthcare minefield.

The CBO says that something must give, either Medicare gets less or Obamacare needs to get changed or the healthcare of the nation will eventually cut into all other spending dramatically.  With the election of Obama it is very doubtful that less people will be covered under Obamacare and yet the Dems also do not want to mess with Medicare.  

The Obamacare exchanges have not been popular with the states as only 15 have filed blueprints for the exchange.  It is expected that about 1/3 of the states will not have anything to do with the exchanges and will let the Feddies do it.  Sebelius has issued an extension to December 14 for the states to send in a blue print but they still must meet the November 16 deadline for notifying the feds if they will run an exchange.

The feds have released the final 2013 physician fee schedule.  It includes the SGR decrease of 26.5%, the increase to primary care who take care of patients when they are released from an institution, a reduction for performing multiple nuclear med procedures at the same time, reduction to physicians who furnish serviced to the individual who has an advanced imaging procedure in the same session (session is not identified), there will be a reduction in payments to ophthalmology and cardiac services of 20% and 25% respectively.  For DME the practitioner must have a face to face meeting with the recipient when multiple things are ordered.  I am so glad I am out of the medicine business.

AHRQ wants to hear from patients regarding how badly their physicians are treating them.  They are passing out fliers in pharmacies and hospitals so they can make complaints directly to the feds.  Physicians would be told of the complaint.  The Institute of Healthcare Improvement believes physicians are arrogant.

Congratulations to Colorado and Washington states for passing bills that allow medical marijuana.        Top


CMS has issued the final rule increasing pay for primary care who see Medicaid patients up to the amount one gets for seeing Medicare patients in 2009 not today.  This increase is only temporary and one wonders what the physicians will do when the increase expires in two years.  One also wonders who the primary will refer their patients to since the specialists are left out.

California is finally going to more actively investigate who the non-physicians in the state who are illegally calling themselves physicians are. Last year the amount of people caught doubled from the year before.  It's about time they did something useful.      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.