Medicare Premium Fairness Act seems very Fair

House Energy and Commerce Committee Chair Henry Waxman from California and Dina Titus from Nevada had shown once again their commitment to seniors when they introduced the Medicare Premium Fairness Act.  This proposal would bar Medicare Part B rates from rising the 20%, which is allowed under the current law.

The House passed this proposal by a majority on September 24th.  Unfortunately, it is meeting up with opposition in Congress by Republicans, the most notable being Senator Tom Coburn of Oklahoma.  He objects to the passage of this legislation without further debate and discussion.

According to the Medicare law as it is currently, more than 10.5 million people enrolled in Part B will see a hike of anywhere between $110 to $120 per cialis month.  Cost-of-living increases would compensate for the increases.  Unfortunately, there will be no adjustment next year and the new enrollees are not protected against the raise at any rate.

Senator Baucus, the Finance Committee Chair stated, “this legislation is a common-sense solution to protect seniors from paying dramatically higher Medicare premiums” in his statement on October 7th.  Rates would remain at $96.40 per cialis month.

Hopefully the debate will give way to common sense and our seniors will be protected.    

New Stark Law Effective 10/1/09–CMS is Looking for You

According to healthcare supporters, Stark Laws intruded into medical practice and caused obstacles in managed care networks.  President Clinton agreed and vetoed the regulations in 1995.

Now we can fast-forward to the present.  Starting October 1 of this year, The Centers for Medicare and Medicaid Services (CMS), ban fee payments in space and equipment leases when reimbursement is for healthcare services given to patients from referral between the parties.

Thus, equipment owned through a leasing company by a physician may not be leased to a facility that the physician uses or refers to.  Because the practice is vulnerable to abuse, it is illegal according to the Federal Medicare and Medicaid Anti-kickback Statute (AKS). Physicians can get an exemption if they are working only in a consulting capacity.

As of October 1,2009, both the healthcare facility that bills for rendered services and the provider that gives those services fall under the Stark umbrella. This prohibits the referring doctor from having an owner interest in equipment of the health site.

Separate components of hardware and supplies may or may not fall into the Stark regulations.  However CMS is being very vigilant about possible violations.

Hence, owning the hardware or software for your upcoming electronic medical systems and leasing it to your practice or to the healthcare facility may set off alarms.  Better to have the facility purchase it in its name directly and not have to look over your shoulder.  

Stark Laws to be Enforced as of 10/1/09

As of October 1,2009, the Stark Laws have been modified and noncompliance can lead to hefty fines and penalties.  To fully understand what the Stark laws are, one must digress for a moment to the initial phase.

The Stark law, named after Congressman Pete Stark who sponsored the bill, deals with physician self-referral of Medicare and Medicaid patients to healthcare facilities or labs for which the physician has a financial interest.  The interest can take the form of investment, compensation or ownership, whole or partial.  The custom is viewed as conflict of interest since the healthcare provider would derive financial benefit from the referral.  It is feared that by allowing this policy, services would be over-used, thus escalating healthcare costs as well as limiting usage of other physicians.

Effective January 1, 1992, physician self-referrals to laboratories was illegal (in comlpliance with the Omnibus Budget Refonciliation Act of 1989.  Adjustments were made in the Social Security Amendments of 1994.

What does this have to do with present day regulations?  Plenty!  Stay tuned to tomorrow when we delve into this further.

Medicare reform

The following blog comes from the AMA (American Medical Association).

I felt that it was important enough that everyone sees this, so I am helping to spread the word.

Permanent Medicare Reform Needed

An AMA survey shows that drastic cuts in Medicare payments will make it harder for patients to see their doctor.

Consider some of these alarming survey results:

  • 60% of all doctors say a Medicare cut will force them to decrease or stop seeing new patients and to discontinue nursing home visits.
  • A majority of doctors in rural communities say they will no longer be able to conduct important outreach services due to nine years of projected cuts.
  • Nearly 3 out of 4 doctors say the Medicare cuts will force them to delay purchasing critical new medical equipment.
  • 65% of doctors say the Medicare cuts will force them to delay purchase of new health care technology.

Many doctors also reported that more Medicare patients are now being treated in emergency rooms for conditions that could have been treated in a physician’s office, that it’s gotten harder to refer patients to certain medical and surgical specialists, and that many seniors now have to travel further for needed medical care.

S. 1776 eliminates the flawed Medicare payment system and preserves seniors access to care. Use (888) 434-6200 to call your senators and tell them to support S. 1776. 

As you see from above, by trying to help a sector get medical care and out of the emergency rooms, legislation would effectively put another sector (which is larger) in the same boat.

We must not sacrifice our seniors for the sake of another sector.  It is crucial that we find another alternative that doesn’t make any one group the scape goat.

 

Medicare Benefits Won’t Change

The Mantra that legislators recite is “Medicare benefits won’t change”.

Let’s take $500 million out of the system. “No problem” was the legislative cry, the money will be recouped from fraud prevention of the current system.

The Finance Committee proposes to cut payments to private Medicare Advantage plans by $17 billion over a ten year span and decrease reimbursements to healthcare providers by $162 billion.

Hospital lobbyists have agreed with the White House to a $155 billion  reductions in Medicare reimbursements over ten years with the caveat that “97 percent of all legal residents were insured.”

Charles N. Kahn III, President of the Federation of American Hospitals, confirms that Mr. Baucus and his proposals have not met the tenet of the agreement.

With constant cutting, it is perfectly obvious that hospitals will have to cinch in their belts in order to survive fiscally.

Further, a Medicare Commission would be formed which for the sake of saving $22 billion, would make cutbacks to the Medicare program.

Democrats naively recite their Mantra– “No change to Medicare benefits”.  Let’s not join in the chant blindly and call it like it is.

With all these cuts, seniors and Medicare beneficiaries will be made to suffer.

Public Health Option is Nothing New

A new bill is arising from the House of Representatives to require additional tax payments from insurance companies who offer “Cadillac” insurance plans.  The additional tax is supposedly going to help defray the cost of any new public health options being offered.

Since February 2009, there has been a whole hullabaloo regarding the establishment of a public health option with the purpose of “competing with existing private plans”.

However, we already have a public health option which has been in place for over three decades…It’s called Medicaid.  The problem is that with the economy in shambles, more people are finding themselves just missing the financial cut off to qualify for Medicaid and not having enough to afford private insurance.

Instead of having propositions to change health insurance as we currently know it for the masses, perhaps we should be directing our attention to merely changing the level of the bar to let a more realistic number of people qualify for this public program.

Healthcare Numbers Don’t Add Up

Democrats are rejoicing that they have pared down the healthcare bill to “meet President Obama’s demand that legislation not add one dime to the deficit.”

Mr. Baucus who authored the bill prides himself and touts the bill as one that will revolutionize the healthcare system for this century.

Analysis issued by the Congressional Budget Office states that legislation from the Senate Finance Committee would provide healthcare to 29 million people at a cost of only $829 billion over the next ten years.

This is a prime example of the old “bait and switch” tactics.

A heated debate ensued when $1 trillion was bandied about to cover 47 million uninsured but because the cost is now less than $1 trillion, the bill shows promise.

Keep in mind that now the cost is to cover only 29 million people, not the 47 million that were discussed in prior proposals.

The thing is, new proposals are nothing different.  The numbers just don’t add up!

Medical Humor is really Legal Humor…Or No humor at all!

The following was listed as a joke on a popular website for humor.  It was also listed with a tag for health insurance:

Health Care Blues…

Thought I’d let my doctor check me,
‘Cause I didn’t feel quite right. 

All those aches and pains annoyed me. 
And I couldn’t sleep at night. 

He could find no real disorder
But he wouldn’t let it rest. 

What with Medicare and Blue Cross,
We would do a couple tests. 

To the hospital he sent me
Though I didn’t feel that bad. 

He arranged for them to give me
Every test that could be had. 

I was fluoroscoped and cystoscoped,
My aging frame displayed. 

Stripped, on an ice cold table,
While my gizzards were x-rayed. 

I was checked for worms and parasites,
For fungus and the crud, 

While they pierced me with long needles
Taking samples of my blood. 

Doctors came to check me over,
Probed and pushed and poked around, 

And to make sure I was living
They then wired me for sound. 

They have finally concluded,
Their results have filled a page. 

What I have will someday kill me;
My affliction is OLD AGE!!!

Lawyers, Lawyers Everywhere!
Earn Your Paralegal Certificate
And Find Work Near You…

Please take note of the advertisement following this “joke”.  The content is not a laughing matter for most people.  It is a joke at the public expense and fodder for the legal profession.

The fact is, the physician could have told the patient initially that there is nothing wrong.  All the tests are to prove to all the lawyers what the physician knew to be true in the first place.

That is why there can not be any true decrease in healthcare costs until there is a concurrent tort reform.

Insurance Fraud to be Addressed

It is difficult to comprehend how quality will not change to medicare when $500 million dollars are taken out of the system- this when 30% more of the population is entering.  I posed this question to the White House.

The response that they gave was that there is over $1 billion in fraud that will be investigated and recouped in order to keep any changes from being a burden.

If fraud is rampant and the administration is aware of it, why is it associated with reform?  Why not eliminate the fraud now?  Medicare has been estimated to go bankrupt by 2017.  Let’s eliminate waste and secure funds without foolhardy investments to keep it going.  Too many seniors, who have put their savings into the system, depend on it.

Health Care in Switzerland Can Be Beneficially Transported

Switzerland provides universal health care for its citizens without a public option.  A very attractive facet of this care that allows the program feasibility is that the insurance companies do not make obscene profits and pharmaceuticals are regulated.

It is time to divert the burden from the taxpayers of the United States to insurance companies where executives make an incredible salary at the expense of the public.

Perhaps it is time to require insurance companies to accept all people interested in enrolling while eliminating pre-existing condition restrictions and not raising premiums to outrageous rates.