September 1, 2011 Legislation






For those physicians on the listserv, the Congressional Budget Office has in their budgets for the next year cut out "doc fixes".  This means that they believe that as of this time there will be a 30% decrease in pay from Medicare to physicians starting January 1, 2012.  Physicians should begin to figure out how to drop Medicare patients and how to pare their staffs accordingly.  Of course those physicians who on on contract or salary will continue to see the elderly.  Other physicians and specialists in the community will need to look to send all their Medicare patients to the employed physicians freeing up more time for the non Medicare patient.

To physicians: Remember you must revalidate your Medicare licensure when the feds send a letter to you.  If you do not receive one by January 1, 2013 notify the feds.  If you have signed up for Medicare since March 25, 2011 you will not need to re-enroll.  Of course if the SGR goes into effect don't bother to enroll.

Medicare physician demonstration projects results were just released.  They show that performance was steady across the five years of the project.  More than 50% failed to earn incentive bonuses.  Only two of the 10 medical groups earned bonuses every year and no more than 5 got bonuses each year.

Kentucky has decided on the rules that will allow optometrists to do surgery.  They will be allowed to do post cataract laser and some glaucoma surgery.  To do the surgeries the unqualified must finish a course designed by the same board that is supervising these unqualified people to be able to do the surgeries.  The course length is not specified nor is the ability to do the surgery to be tested prior to working on patients without supervision.        Top


Sebelius has announced some rules for states setting up their own exchanges.  They will need to set up a central site where people can go to do one stop shopping.  This site will be for all, whether insured, Medicaid  or no-Caid.  The site will need to be set up and certified by January 2013 and in business by January 2014.  If they are not ready then the feds will run the state exchange until the state is ready.  The feds still have not released all the final rules. 

CMS continues to give out waivers for insurers to not have caps on insurance.  Another 105 waivers were given out in July.  This makes almost 1500 waivers given out since the insurers woke up.  

The US Post Office is planning on dropping the Federal Health System which will put pressure on the remainder of the system.  They plan to self insure and meet the private healthcare standards which are less rich than the federal system.  This may require other agencies to reexamine their health care benefits.

Medicare wants to start the bundled payment program in 2012.  They feel that they will get hundreds of applications for the program.  They will get applications from hospitals with captive physicians.  Those with independent physicians will be harder to get to come on board.  This is basically the same as HMO capitation in the 90s with some twists.   

Ex-Senator Frist of Tennessee, a heart surgeon, states that he believes that Obamacare will not be overturned by the courts, even if the individual mandate is.

The Washington Post writes that about 10% of midsize and big employers will stop offering healthcare after Obamacare goes into effect in 2014.  Also 20% are unsure what they will do when Obamacare hits.  HHS believes that more businesses will give healthcare coverage since that is what happened in the People's republic of Massachusetts.  The problem is that in the Republic the businesses insuring people were the same before and after not greater.  I guess HHS looks at numbers differently that the rest of the world.

It appears the Republic's towns have already caught on as many have either quit or in the process of negotiating a cessation of giving health insurance and put their employees on the state health plan.   

The Joint Commission has put out it's 47th Sentinel alert.  This one warns about radiation risks and lists "recommendations" for preventing accidental radiation overexposure.

Starting today HHS will start reviewing health insurance premium increases for appropriateness.  They can do nothing about changing any increases.

On November 1, 2011, CMS will start accepting only the new ABN that changes forma but not substance.  The document must be given to Medicare beneficiaries when the provider believes services do not meet Medicare medical necessary guidelines for the patient conditions, when the service are screening and more prevalent than authorized by CMS or the services or custodial. 

Today the fed help for almost all people receiving COBRA is going away.  This is part of the decrease in federal spending that was passed with Obamacare.       Top


Illinois is after three more hospitals for not doing enough to demand their non profit status.  They already won in court against one hospital chain and are now going after other hospitals.  Northwestern's Prentice Women's Hospital, Edward Hospital in Naperville and Decatur Memorial Hospital are all on the block.  If they lose their cases they will have to pay taxes to the respective counties.  The hospitals will appeal the ruling of the state to the courts.  

Eisenhower Hospital in Rancho Mirage, California, has been put on a watch list to have its credit be downgraded.  It lost almost $31 million in fiscal 2011.  It also charges huge fees for patients to see physicians in their own offices if the hospital owns the physician practice, even if the hospital does not own the building.  They deserve what they get.       Top


Arizona has filed complaints against eight physicians who have written over 50% of the state's marijuana prescriptions.  Of course, it is completely legal in the state to write the prescriptions providing a good faith history and physical are performed.  The state contend that the eight doctors have failed to check the prescription use of the patients as required by the state.  Arizona has a database and the physicians are supposed to check it prior to writing prescriptions for marijuana.  It is easy to check the numbers of times a physician has checked the database versus how many prescriptions they have written.  

Eleven providers have lost their licenses in Illinois since they had sometime in the past been convicted of a sex crime, a felony sexual assault or a misdemeanor battery against a patient.  See Recent Legal for law suits against the state medical board for making the rule retroactive when the law does not state retroactive.  

A New Jersey physician, Dr. Sylvia Lee of Emerson, lost her medical license for jabbing a teenager, her adopted daughter, with a screwdriver over 100 times.  Dr. Lee was an allergist and punished her daughter for not washing her dog's clothes properly.  The police report was forwarded to the Medical Board who convened an emergency meeting to suspend her medical license as a threat to the public.      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.