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Archive for the ‘Health Law Reform — General’ Category

CMS launches database of manufacturer and GPO payments to physicians

October 3, 2014 Leave a comment

The following post will also be published today on the Akerman Health Rx blog.

The Affordable Care Act contains a provision known as the Physician Payments Sunshine Act, which requires the Centers for Medicare and Medicaid Services (“CMS”) to establish a national databank containing information on the financial relationships between physicians (which includes dentists, chiropractors, and other physician specialties) and teaching hospitals, applicable manufacturers, and group purchasing organizations (“GPOs”).  CMS launched its Open Payments website on September 30, 2014 , making its database available to the public.

The database is populated by information reported to CMS by applicable manufacturers and GPOs regarding their payments or other transfers of value to physicians and teaching hospitals.  It is important to note that this reported information specifically includes any ownership or investment interest that physicians (and their immediate family members) have in the manufacturers and GPOs.

CMS encourages physicians and teaching hospitals to register with the Open Payments website.  While registration is voluntary, the reported information is made available to registrants before being made public, and registrants are given an opportunity to dispute any reported information.  In fact, there is a mobile app (and other resources) that allows physicians, teaching hospitals, manufacturers, and GPOs to track provider and industry contact details, share information, and track payments and other transfers of value.

According to CMS and as reported, 4.4 Million payments valued at nearly $3.5 billion were made to 546,000 individual physicians and 1,360 teaching hospitals in the last five months of 2013.  The website will provide future reports on an annual basis.  Beginning in June 2015, it is expected to report twelve full months of data.

We know that the public, and in particular the press, will access the Open Payments database, and there will likely be a high level of misunderstanding and misinformation.  One cannot forget the feeding frenzy that arose when CMS released physician Medicare billing data  earlier this year.  Any physician who receives payments from a manufacturer or GPO would presumably want advance notice of any disclosure regarding payments to that physician.   Accordingly, any physician who does receive such payments should register on the Open Payments website and check the accuracy of all information reported about them, and be prepared to answer questions they may be asked.

Harvard’s Bill of Health Blog: Contraceptive Mandates and Conscience – All Objections Are Not Equal

August 30, 2014 Leave a comment

The Harvard Law School Blog, Bill of Health, recently posted an article entitled “Contraceptive Mandates and Conscience – All Objections Are Not Equal.”

… studies show that medical professionals may object to services based on clinically false information. …  If medical professionals make decisions based on ignorance, one can suspect that lay employers and patients do as well.

This suggests that individuals often lack the information necessary to truly assess their stance on morally controversial services.  While the law does (and should) play a role in protecting conscience, it seems unsatisfying when such protection is granted to those holding underdeveloped views, and at the expense of (and detriment to) those seeking legal medical services.

This seems so simple and logical.  We do not let employers make other health-related decisions for their employees, why do we let some employers make reproductive decisions for their employees based on a religious view not shared by their employees?

Charlotte’s Tangled Web — Florida’s New Law on Medical Marijuana

August 24, 2014 Leave a comment

 

Stetson

USF Health

I invite you to register for this timely and lively program, “Charlotte’s Tangled Web – Considerations for How Doctors and Lawyers Might Avoid the Legal Entanglements of Medical Marijuana in Florida.”

It is being sponsored by Stetson University College of Law and USF Health.  I will be one of the speakers.

Legal and medical continuing education credit has been applied for.

Ohio Cardiologist Indicted for Performing Unnecessay Medical Procedures

August 24, 2014 Leave a comment

“The charges in this case are deeply troubling,” U.S. Attorney Dettelbach said. “Inflating Medicare billings alone would be bad enough. Falsifying cardiac care records, making an unnecessary referral for open heart surgery and performing needless and sometimes invasive heart tests and procedures is inconsistent with not only federal law but a doctor’s basic duty to his patients.”

“This doctor violated the sacred trust between doctor and patient by ordering unnecessary tests, procedures and surgeries to line his pockets,” Special Agent Anthony said. “He ripped off taxpayers and put patients’ lives at risk.”

Just another case where greed coupled with disregard for his patients’ welfare led a physician to commit fraud on the government and commercial insurers and to forsake his Hippocratic oath to do no harm.  Here, the physician not only ordered unnecessary and more invasive procedures than the patient needed but also falsified nuclear test results to justify the unnecessary procedures.

While there is no way to prevent greed like this (other than locking the bastards up), I have predicted in other posts that the migration of medical reimbursement from procedure based to quality of care of the patient will reduce the incentive to perform unnecessary tests and hopefully reduce this kind of fraudulent activity.

State Health Insurance Exchanges vs. the Immorality of Politics

August 17, 2014 Leave a comment

So, we have two decisions from two different U.S. Circuit Courts of Appeal, Halbig v. Burwell and King v. Burwell, and  coming to two different conclusions as to whether it is permissible to provide financial subsidies to residents of states which refused to establish their own health insurance exchanges.

Here is some background of the two cases (from the Daily Kos, 7/27/14, “The Halbig Case: or, the banality of conservative evil“):

[T]he Affordable Care Act expands access to health care by allowing states to create insurances exchanges on which private companies can sell insurance plans that meet federal standards. To help ensure affordability, the ACA subsidizes a certain portion of the premium on a sliding scale based on income. If a state either cannot or will not set up an exchange, there are also plans available on a federal exchange.

So far so good, right? Wrong. Because of the fervent opposition to the law, most states with Republican-controlled statehouses opted not to participate by building their own exchanges, and instead watched passively as their citizens became eligible for plans subsidized under the federal exchange. Just one problem, though: the authors of the Affordable Care Act did not seem to anticipate that states would refuse to establish exchanges out of political spite. Consequently, the provision of the Affordable Care Act authorizing the payment of subsidies refers specifically to plans under state-based exchanges, but does not explicitly authorize subsidies to help cover plans sold by the federal exchanges. The IRS issued a regulation that federal exchanges were eligible for premium subsidies. But a group of anti-Obamacare plaintiffs, headed by an attorney from the Federalist Society, argued that because Congress had not expressly mentioned subsidies to plans under the federal exchange, those subsidies were unlawful. And that argument won the first round in the DC Circuit Court, whose panel ruled that regardless of whether Congress intended the subsidies to also be available to plans under the federal exchange, a strict reading of the legislation said otherwise.

Let’s be honest.  These cases are not about the stated Constitutional challenge that the President and the IRS have gone beyond the statutory authority of the Affordable Care Act.  They are about politics and the continuing attacks on the President through the rant against Obamacare.

There is no concern about law or justice — and the political maneuvering is more insidious because it hides behind black robes.

If we start with the assumption that politics and politicians should have the goal of helping their constituents, under what theory does one bring these cases when the desired result will deprive millions of Americans of the health insurance that they have purchased?  How have so many lost so much perspective and purpose?

The “class war” that the President is often accused of promoting is really being fueled by a conservative myopic minority. Their willingness to hurt innocent citizens of less means who are seeking health insurance and rely on the subsidies provided is just bullying aimed at achieving some political end and helping no one.  Isn’t it time this immorality stopped?

Another Hole in the Halbig Verdict | Bill of Health

August 16, 2014 Leave a comment

Another Hole in the Halbig Verdict | Bill of Health.

Here is my view — Of the contradicting decisions, one is clearly right, and the other wrong.  Getting to the right result, however, is really only politics hiding under black robes.

Concern mounting over Prime Healthcare pursuit of Bay Area hospitals – San Jose Mercury News

July 26, 2014 Leave a comment

 

A controversial Southern California-based hospital chain that buys financially struggling hospitals has surfaced as a bidder for the beleaguered Daughters of Charity Health System, which operates four Bay Area hospitals that serve the poor.

But the overture by Prime Healthcare Services isn’t playing well with local hospital employee unions, who say the chain’s checkered history shows it will turn its back on low-income patients and slash workers’ pay and benefits.

 

Source: www.mercurynews.com

So, we know this is the way that healthcare is going — consolidation into bigger and bigger organizations.   In the short run quality should go up and costs should go down. Hopefully.  In the long run, I’m not sure bigger is better for anything.

Americans Pay Way More For This Than People In Other Countries

April 26, 2014 Leave a comment

As anyone who’s ever paid a health insurance premium or a hospital bill knows, medical care is expensive. What Americans may not know is that residents of other countries don’t pay nearly as much for the same things.

The latest data from the International Federation of Health Plans, an industry group representing health insurers from 28 countries including the United States, once again illustrates that American patients pay the highest prices in the world for a variety of prescription drugs and common procedures like childbirth and hospital stays.

See on www.huffingtonpost.com

Everyone seems to know this except the Republicans in Congress.

 

Survey Estimates Net Gain of 9.3 Million American Adults with Health Insurance | RAND

April 12, 2014 Leave a comment

Early survey evidence indicates that the Affordable Care Act has already led to a substantial increase in insurance coverage. Consistent with the ACA’s design, this gain in insurance has come not only from new enrollment in the marketplaces, but also from new enrollment in employer coverage and Medicaid.

Despite all of the flaws in the Affordable Care Act , one has to marvel at the many positive improvements in healthcare since the ACA’s passage.  I have said many times that Barack Obama’s legacy will not be that he was the first African American President but that he raised the level of debate in this country on many issues, including healthcare.

See on www.rand.org

Health Care Nightmares

April 12, 2014 Leave a comment

Obamacare is doing just fine. But America is not, thanks to the ugliness brought out into the open by the debate on health reform.

I am a big fan of Paul Krugman.   He’s smart (a Nobel Prize winner in economics), and he’s not afraid to speak out.

The flatworlders will not stop until healthcare reform is dead.  It’s sad and it’s a horrible waste of money, not to mention the real harm being done to the uninsured, underinsured, and the poor in general. The flatworlders have elevated lies and fear to the level of facts and debate; they still rejoice at their momentary and fleeting victory of having made Galileo recant his view that the world revolves around the sun — their last real success.

See on www.nytimes.com

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