April 2010 Archives

Analysis of the health care reform package signed into law by President Obama earlier this month reveals that more people will be covered than anticipated but also that the hoped for cost  savings may not materialize: 

Economic experts at the Health and Human Services Department concluded in a report issued Thursday that the health care remake will achieve Obama's aim of expanding health insurance -- adding 34 million to the coverage rolls.

But the analysis also found that the law falls short of the president's twin goal of controlling runaway costs, raising projected spending by about 1 percent over 10 years. That increase could get bigger, since Medicare cuts in the law may be unrealistic and unsustainable, the report warned.

The newly passed health reform legislation includes an expansion of the False Claims Act, and could expose physicians to greater liability in fraud investigation cases.

The new health system overhaul law includes significant expansions of the government's reach under the federal False Claims Act, and experts warn that doctors need to be ready.

Although the changes largely enhance prosecutors' fraud-fighting tools, often with the help of whistle-blowers, they also put physicians in line for additional liability exposure, experts say.

"This is another link in the chain of events that has expanded the scope of liability under the False Claims Act, and physicians have got to be aware of these changes and ensure they have effective compliance measures in place," said Roderick L. Thomas, a partner and false claims expert with the law firm Wiley Rein LLP in Washington, D.C.

In one of its more significant false claims provisions, the health reform law imposes an explicit duty on physicians to return known overpayments to the government within 60 days of discovering an error, according to health care fraud defense lawyer Gadi Weinreich. Retaining an overpayment beyond that deadline could constitute a false claim.  "Now we have a law that says, if you've been paid in error, don't write us a letter. Write us a letter and include your check," said Weinreich.

For the full story, click here:  Health Reform Law Expands False Claims Act; American Medical News - April 26, 2010.

The first Kaiser Health Tracking Poll fielded since the passage of health reform last month finds that 8 in 10 Americans know that President Obama signed the legislation into law. But 55 percent say they are confused about the law and more than half (56%) say they don't yet have enough information to understand how it will affect them personally.   

The poll finds that the public supports many of the provisions of health reform that are set to be implemented in the short term.  When asked about 11 specific provisions scheduled to take effect this year, in each case a majority of Americans viewed them favorably, often with bipartisan support.

Still, the public remains divided on the law overall, with 46 percent viewing it favorably, 40 percent unfavorably and 14 percent undecided. Similarly, 31 percent of Americans say they expect personally to be better off because of the law, while 32 percent say they will be worse off and 30 percent say they don't expect to be affected.

For the full story, click here: Kaiser Health Tracking Poll -- April 2010; Kaiser Family Foundation - April 21, 2010.  For the complete poll results, click here. 

NPR news reports that the new health reform legislation boosts Medicad reimbursement rates for physicians but the increase may be temporary:

To ease the worries of already strained primary care doctors, the new health law includes an increase in Medicaid payment rates, bringing them up to the same level as those from Medicare. That bump is expected to be pretty helpful when a huge chunk of the increase in insurance coverage under the law comes from expanding Medicaid, the federal-state program for low-income Americans, to cover 16 million more people.

The problem? Under the new law, the Medicaid raise may only last two years.... The higher Medicaid payments would take effect in 2013 and would be funded entirely by the federal government. But the bill doesn't mention what happens after 2014.

For the full story, click here:  More Medicaid Pay For Some Doctors, But Will It Last?; NPR - April 6, 2010

An article in the New England Journal of Medicine discusses the emerging "disclosure-and-offer" approach to medical malpractice reform in light of some constitutional challenges that tort reform efforts have faced.  The authors argue that private, non legislative methods can have some significant advantages and goes on to discuss several models of the disclosure and offer approach.

In general, private, institution-led reforms have many advantages. First, most of the reforms can be pursued without legislation. In some states, it is nearly impossible to effect liability reform because of political divisions fostered by powerful interest groups. In others, the legislature is dysfunctional and unable to accomplish major reform or is hamstrung by budgetary problems. Initial optimism that federal health care reform legislation would include major liability reform eventually faded, though the Obama administration has made a substantial commitment to supporting demonstration projects in which health care systems or states implement innovative reforms.

The Physician Payments Sunshine provision of the new health care reform law is that pharmaceutical companies and medical device manufacturers reveal payments made to physicians and some hospitals.  While compliance with this part of the law isn't required until 2012, the University of Miami has a head start:

The University of Miami medical school has become one of the first in the country to offer an online, searchable database revealing its doctors' relationships with outside businesses.

``This is a growing trend,'' says Alan Coukell, director of the nonprofit Pew Prescription Project. ``I know of four other schools that are doing this. With the passage of the Sunshine Act, there's going to be a lot, lot more.''

A provision of the new healthcare reform law, the Physician Payments Sunshine section, requires all manufacturers of prescription drugs, medical devices, and supplies must reveal any payment of more than $10 to physicians and teaching hospitals.

Such requirements were pushed by lawmakers after Pew and others exposed relationships between doctors' prescribing patterns and their oft-hidden relationships with the drug makers.

The sunshine provision starts in 2012, with the federal government required to have a searchable database by Sept. 30, 2013.

For the rest of the story, click here: University of Miami Database to Reveal Payments to Doctors; Miami Herald - April 1, 2010

Related story in the New York Times about drug maker Pfizer's efforts to comply with the new health care reform law:  Pfizer Gives Details on Payments to Doctors; The New York Times - April 1, 2010

In honor of April Fool's Day, check out Timothy Noah's article in slate that discusses some of the most entertaining myths about health care reform that are circulating on the internet, including the fear that the health care reform bill that was passed into law last week will require Americans to get microchips implanted in their brains.

Enjoy:  Health-Reform Bubbemeises - Slate, March 31, 2010