October 1, 2011 Legislation





The Healthcare Leadership Council representing healthcare executives have placed before Congress a suggestion that Medicare age be raised to 67.  This is the same idea that Obama and Boehner raised and agreed upon during the debt debate.  The AHA has also backed the idea.

Obama has come up with a plan that has no chance of passing.  He wants to tax health benefits of those earning over $250,000 per year. This was turned down by both parties earlier.  During the Obamacare debate it was decided to tax "Cadillac Plans" defined as plans worth more that $10,200 for individuals and $27,500 for families.  Originally Cadillac cars were cheaper but the unions wanted more expensive cars.  Insurance companies are supposed to pay the 40% tax but they will pass the cost on to those insured. 

Other ideas from Obama (MedPAC) to the debt reduction team are to get rid of the SGR by having no primary care physician raises for ten years along with 6% per year decreases in specialty payments for three consecutive years followed by 7 years of no change. I am so happy I am out of the business.  He would also get rid of the idea of having Social Security not count for Medicaid income.  He also asked for $320 Billion in reductions to Medicare and Medicaid.  He would do this my reducing Medicare payments for bad debt, cut indirect graduate medical education by 10%, and reducing payments to post acute providers.  He would also decrease payments to rural providers by ending add on payments for all in frontier states, reduce payments to CAH by 1% and getting rid of CAH that are within 10 miles of the nearest hospital.  The AHA immediately blasted the proposals as making it harder to patients to get care.

The new IPAB, according to Obama, is to start operation early.  The 15 member team must be appointed by the President and confirmed by the Senate. He has to do it soon so the Senate is still Democratic when the appointments come to it.  The groups authority will kick in at a lower threshold that prior and they will be given greater powers, much more than the current MedPAC.  Of course the largest driver to high medical costs hospitals can not be touched until 2019.  It is hoped by both parties that IPAB will never be launched and be repealed by Congress.

The administration is being pressed to release information in the National Practitioner Data Bank.  Although the information is confidential as to the practitioner the identity could be ascertained by nosy reporters.  This happened in Kansas City and it meant the taking away of all access to any part of the data bank at least for now.  Of course the journalism groups told Obama where to go and published the banned list on their own.

The Washington Examiner has an oped about Sebilius instructing hospitals to give HHS detailed health records on all their patients.  Her authority comes out of Obamacare which again no one read prior to its passing. The Government will then either distill the information and either lose it or give it to researchers.  This means that insurers will lose proprietary information.

HHS has stated they will trim staff from the long term care CLASS law which means it may never take effect.  The law does not state when this unsustainable program is to begin so it may begin never.

HHS continues to launch new pilot programs.  The latest is to provide bonuses to primary care physicians who coordinate care.  They will work with the private insurers to pay bonuses who deliver "better care and use the money wisely".  It does not state what better care than what or that using money wisely is a metaphor for cheap.  they will register physicians in five test markets starting in November.  They expect the physicians to help patients with chronic illnesses follow personalized treatments, have patients be able to access their records or care 24/7, deliver preventative care, engage people in their own care and work with other physicians to provide better coordinated care (better than what).  CMS will pay physicians a monthly fee on top of their Medicare fees if they do these things. 

The Medical Home is the pilot project of CMS.  The trial is a four year trial but CMS will pay an average rate of $20 per patient per month in the trial for the first two years. The actual rate will depend on severity of illness.  The last two years the pay will be reduced to $15 since the physician will be more used to the system. 

The GOP is planning to follow the agreement reached for the debt reduction and reduce spending in health care, education and the National Labor Relations Board.  The monies in total will be to the Democrat's liking but not the way the money is structured. The Head Start program will get what Obama requested but this will cut into the Race to the Top program. The NLRB will be cut by $50 million (50%). Health Care will get $8.6 billion less that the appropriations authorized under Obamacare. 

Illinois continues to go after hospitals that it believes are not doing the amount of charity care that allows them a non-profit status.  It is now investigating 15 health systems.  Three systems were denied property tax exemptions last month.  They were Northwestern Women's Hospital, Decatur Memorial Hospital and Edward Hospital.   

After the Revenue board came out with the above, the governor ordered a stop to the making of non profit hospitals actually do non profit work. He gets a fair amount of financial backing from the Illinois Hospital Assn.  

Washington State has a new rule that Medicaid patients may only visit a hospital ED three times a year for non emergency conditions.  They hope to save $70 million over two years with this maneuver.  Medicaid will not pay the hospitals or the physicians for any more than the three visits.  This will lead to hospitals and physicians either losing money since the patient may not be turned away under EMTALA or making sure that they code the problem as an emergency.  It is probable that the state will be sued since there is a law that the prudent layperson standard is applicable not the final diagnosis.

The Joint Commission was again given deeming authority for CMS.  This runs out in 2017.

The British NHS has approved Abiaterone acetate for prostate cancer depending upon the price.  This is the medicine given to the Lockerbie terrorist to keep him alive upon his repatriation to Libya.  It is very expensive and does extend lives as well as improves quality of life.  NICE still has to approve the drug and it's large monetary outlay.  Soon we in this country will be doing the same as Britain. 

NICE in Great Britain has disallowed Jevtana, a drug that prolongs life in prostate cancer patients.  It does not meet the threshold of at least 12 weeks of live as the studies show only an extra 10 weeks of life.  It costs $34,000 per treatment course.  It is approved in both the EU and in the USA.     Top


The Obama filled National Labor Board has ruled that as of November 14 all employers including medical practices must put up a notice that the employees have a right to collective bargaining.  The rule applies to all employers with income or expenses of at least $250,000.  This is the Dems way to get more labor votes.   

A new Texas law bans anonymous complaints against physicians. The law also requires physicians be informed when pharmaceutical or insurers file against them.  The Board will keep the complainants confidential.  Only 4% of the complaints are filed anonymously.  

Virginia regulators have stated that a physician that has been suspended from medical practice may still own an ASC.  He just can not treat any patients in the state.   

A reminder to physicians- the attestation for EMR incentive program must be filed by October 3 for the year 2012 program.    

The FDA has warned eye care professionals that they have 90 days to get rid of and update misleading LASIK advertising.  There can be no errors of omission and all claims must be able to be verified.  Potential problems must also be explained to the patient such as possible larger pupils.        Top


The California Attorney General Kamela Harris, a democrat who got a lot of money in her close win for the position from the unions, has turned down the sale of Victorville Hospital to Prime Health.  Prime Health does not do unions.  This could be the death knell for the hospital and the city of Victorville but Harris has paid back the union.  

In another story that is so surprising Price Waterhouse has done a survey that shows that the health industry is not prepared to protect patient information.  Maybe it's surprising because only 11 million people have had their information taken in the past several years.         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.