CMS has become busy. They are proposing a increase of payments to hospitals for 2009 while the payments for physicians tank. We know who has the most money to pay off people, lobbying. The hospitals may get a raise of 4.1% which includes the offset for the known and expected false billing (upcoding) the hospitals do.
The CMS also has added to the never events that it will not pay for if acquired in the hospital. These include vent acquired pneumonia, deep vein thrombosis and Staph bacteremia.
CMS is wanting comments on its "stand in the shoes" and gain sharing Stark and anti kickback statutes. One of the two new thoughts is that a physician does not stand in the shoes of an entity that already meets an existing exception. The other is a proposal that mission support payments to physicians components of integrated delivery systems would be protected as are the teaching hospitals.
CMS has stated it will send information collection tool to 500 acute care hospitals on reporting requirements and physician self referral provisions. Top
South Carolina has sent to the Governor a bill which would force a woman wanting an abortion to pay for and see an ultrasound of the fetus prior to having the procedure. The Oklahoma, the legislature voted to override the Governor's veto of a similar bill. These states must have alot of money for the law suits these laws will engender. Top
At least Kansas has a governor that understands the law. She vetoed a bill sent her that would have forced a physician to tell the patient at least 30 minutes prior to the abortion if there is a fetal heart tone and if not, why not. It would also allow law suits by the family or any local prosecutor if they felt the abortion was improperly terminated. The governor felt that this could hinder the life of the woman. This is really a bill against one physician in the state who performs late term abortions.
The People's Republic of Massachusetts continues to be short sighted and short of money. The rat hole they call Universal Care continues to draw all the resources from the rest of the state. In the first year the tab was over $154 million over budget. The budget was $472 million. They have covered just over half of the state's uninsured. The shortfall will be paid out of the general fund. The next years budget will be $869 million and it is not thought to be enough. Remember this is a small state with very liberal views on mandates.
Never fear. The People's Republic has come up with yet another plan to attempt to save money. It will mandate EMR in the state and set up uniform billing. They also added a fine of $5000 for physicians that take gifts from pharmaceutical companies. That's a lot of money for a pen.
In another liberal state, Minnesota, the legislature is proposing a set fee for physicians and other providers to treat patients on the state payroll with chronic illnesses. At the same time the Governor wants to raid the Health Care Access Fund by half, taking $250 million to offset a general fund deficit.
In a third Blue State, Maine, they have not learned from their brethren to the south. The state has passed and the governor has signed the Dirigo Bill for Universal Care. This law will be funded by more taxes on soft drinks, beer and wine. There will also be a 1.8% tax on paid health insurance premiums. The state will also raid its general fund for an additional $3.6 million and take $5 million from its tobacco settlement fund.
California is again a leader in states mandating health insurance coverage without payments. The Democratic legislators want the insurance companies to insure more screening and diagnostic testing. The insurance companies say this will raise rates significantly as the total cost would be about $2.7 Billion. The legislators just want their names on bills so they can be re-elected until turned out on term limits. If it passes, which is doubtful, it would mean much higher prices and more uninsured in the state.
The IRS has announced rules on employer contributions to HSAs. They must contribute and notice the employees. It does not state how much the employer must contribute. It depends on how much the employee contributes. This comes out at the same time a Kaiser Foundation article states that many uninsured families lack assets to contribute to the HSA cost sharing. Of course, since some can not contribute the entire program is no good and should be tossed for universal healthcare.
The Wall Street Journal had a editorial blasting the Congressional Democrats for their stand on HSAs that they don't like since it gives people choice. The Congress passed and sent to the Senate a bill for a strict oversight of the HSA expenses of each individual. Who pushed for this bill, Evolution Benefits. This is the company that has a computer program to do what the Dems such as pure Pete Stark and Clinbama want. It should never pass the Senate since it can not get the required 60 votes.
Florida is not known for its brains only its chads. The House has passed a bill that gives matching funds and no interest loans to help develop a statewide health information exchange. The bill provided no money. It is form without substance.
There have been companion bills entered in the Congress and Senate on the lack of care and knowledge of the VA system regarding suicides. This comes at the same time as a trial is occurring in San Francisco against the VA on the same matter. In that trial the plaintiffs have introduced emails that show the VA head of Mental Health knew that about 1000 vets a month were attempting suicide. This after saying there was no epidemic of suicide in the vet population. This continues to show the need to get rid of the entire VA system and allow the vets to enter mainstream medicine but paid for by the Medicare system. No duplications of service. Able to get care near home. Oversight by Medicare. No downside.
The Missouri Senate has passed a bill based on the Federal bill to prohibit physicians from marking up lab tests not done in their offices and making the lab that does do the test bill the patient directly.
California continues to put pressure on the HMOs that have dropped patients after they have made a claim. The Department of Managed Care has launched a review of all rescissions over the past four years and will order the organizations to pay all their claims plus reinstate the member. The State made this pronouncement a week after the LA District Attorney sued for the same thing since the Department would not act.
Florida has decided that the uninsured need to know from physicians and hospitals approximately what each service would cost prior to doing it. This would be a nightmare in a hospital after a patient was admitted and needed more tests than originally thought. The new law which is before the governor to sign also requires the state to publish hospital charges for the 150 most common medical procedures. Removed from the bill was a provision that would have mandated a look to see if non profit hospitals are creating community benefit. Good hospital lobby with alot of money to bribe (lobby) the legislature. Top
The greedy AHA and their cohorts continue to try and buy Congress (lobby) in their quest to stifle competition that they are not able to compete against. They use studies that they fund to show that physician hospitals increase utilization and cost more. In fact other studies show just the opposite. Physician run hospitals and ASCs provide the stimulus for the community hospital to improve their care of the patient and their physicians. Without competition the community hospitals will continue to be one of the biggest impediments to change in the health care environment.
California has levied the largest fine it can under the law against a Palm Desert nursing home. The Springs at Calcutta was fined $100,000 for allowing the death of a woman from a perforated colon. She was there to recover from a fractured pelvis. The investigation took over a year due to the lack of a report from the Riverside County coroner's office. The nursing home may contest the citation or pay only 65% of the amount in lieu of an appeal.
It then levied the same fine against a Marysville, California, nursing home for a death of a patient by strangulation after the patient was found out of bed with her neck between the bed and the railing fracturing her larynx. There was no bed alarm in use. The state sanctioned the nursing home with 36 deficiencies last year on 17 complaints. These are over the state average.
In a moment of lucidity the Feds have removed the provision from a farm bill that would have prohibited physicians from owning their own hospitals. This is still in a bill in the House on mental health parity. AMA 1, AHA 0. Top
The president of the Massachusetts Medical Society is raising legal issues about the Medical Board's new rules. The Board wants to open its disciplinary hearings to the public, making patient information public. There is an old State Supreme Court decision that prohibits this unless the patient consents prior to the hearing. This is also comports with HIPAA as it is more stringent than the national rules.
In North Carolina the Medical Board wants to put med mal settlements for the past seven years on line. The settlements would remain on line for seven years. The problem is that settlements are often business decisions made by insurance companies based on finances for defending the suit versus settling the case. This will shine a false light on some physicians. It will also add to litigation since the physician, if he/she is to be publicized, wants to defend oneself to the fullest. The only way the Medical Board should publicize settlements is if the settlement was done due to substandard care as determined after an investigation by the Medical Board. This is not something the Board would want to do.
The North Carolina Medical Board also suspended for 60 days the medical licenses of three physicians for being "web physicians". The suspensions were stayed on the condition that the physicians, one from Minnesota, one from Georgia and one from South Carolina never again work with Virtual Medical Group. With these three physicians now gone the Medical Group no longer works out of North Carolina. Top
The Tennessee Governor has a bill passed by both houses requiring attorneys have experts agree there is med mal 90 days prior to filing the suit. Physicians must be notified 60 days prior to the suit being filed. Top
Even though the Feds allowed Evanston and Highland Park Hospitals to remain intact, they did violate antitrust laws. As a penalty the FTC has stated that they must negotiate separately for all managed care contracts. To make matters worse, at the managed care payor's discretion, binding arbitration by the payor and Evanston Hospital may be required. 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