By PETER LEVINE, MPH
Recently, it was reported on CNN that a county in Great Britain has announced a controversial policy to “support patients whose health is at risk from smoking or being very overweight.” The plan for the local clinical commissioning group is to “delay access to routine or non-urgent surgery under the National Health Service until patients improve their health.” Criteria have been established for the time limits and percentage of weight loss required for those with a BMI of over 30 and over 40. For smokers to have elective surgeries would require a patient to go eight weeks or more without a cigarette. They would have to take a breath test to prove their claim of abstinence. The Royal College of Surgeons in the UK opposes this policy. These patients will eventually get surgery, even if they are unable to lose weight or stop smoking, but they will have to wait.
The CCG states that financial savings are not expected. These proposals were developed “with the best interest of the whole patient population of our area in mind!” Interestingly enough, surveys are reporting 85 percent public agreement with these policies. A 2016 report by the Royal College of Surgeons shows that one in three […]
By ALLAN DOBZYNIAK, MD
The practice of medicine was not a political exercise for centuries. Now it seems more political and proscribed than thoughtful, deliberative or even analytical. The educated experienced physician exercising judgment and guidance for a unique individual, his or her patient, has been increasingly replaced by rules, regulations, mandates, laws, schemes and perverse incentives. These have been mostly at the hands of non-professional administrators and bureaucrats. That medical professionals have been cajoled into participating in this evolution acknowledges physicians acceptance of such questionable transitions in rendering care.
Politics, laws, and the burgeoning onerous administrative state are not intrinsic to the medical profession. How this occurred, has been allowed to occur and continues to occur are questions one would think a profession populated by educated, talented individuals exercising critical insights and analysis might ponder.
At its very basis, it is hard to escape the evolution of a fundamental “misconception” that has become the accepted fallacy permitting government’s intrusion into the sanctity of the relationship between a physician and her patient: the political fallacy that medical care is a right. If medical care, which must include physicians’ services, is considered the “right” of the patient, the “right” should be properly protected by law. Here then is the […]
By PETER DOMAS
Over the past decade, the health care industry has been accustomed to being center stage in political debates, but while medical providers and facilities did not have a prominent role in the latest political drama, the far-reaching effects of the Tax Cuts and Jobs Act of 2017, will impact almost everyone delivering health care goods and services. In addition to the reduction of personal tax rates, the following provisions will likely be most applicable to health care providers:
1. Reduced Business Tax Rates
The tax rate for businesses taxed as corporations was reduced from 35 percent to 21 percent, and entities taxed as a partnership, S corporation, or sole proprietorship may now be entitled to a Pass-Through Entities Deduction of 20 percent of domestic “qualified business income.” The Pass-Through Entity Deduction, however, is complicated and has significant limitations. For example, select services entities, such as physician practices, have low upper limits for the availability of the deduction ($415,000 for married taxpayers and $207,500 for single taxpayers). As a result, this deduction may benefit only a limited number of health care providers.
There has been significant speculation as to whether there will be (or should be) a rush for S-Corps to revoke their designation, or […]
The Department of Health and Human Services recently unveiled the next two steps in its ongoing efforts to reduce the significant volume of claims pending at the Administrative Law Judge (ALJ) level of the Medicare appeals process, each of which involve additional settlement options for providers to resolve their pending claim appeals.
The first new settlement option was announced by the Centers for Medicare & Medicaid Services (CMS), which CMS refers to as the “low volume appeals settlement option (LVA).” As the name suggests, the LVA will be limited to provider appellants with a low volume of claims pending at the ALJ and Medicare Appeals Council (MAC) levels of appeal. While CMS has only released limited details with respect to the LVA’s eligibility requirements at this time, CMS defined “low volume” as fewer than 500 Medicare Part A or Part B claim appeals pending at the ALJ and the MAC, combined, as of Nov. 3, 2017. Additionally, the billed value of each appeal must be $9,000 or less. According to CMS, for those eligible providers whose pending appeals meet these thresholds, and who also meet “certain other conditions,” CMS will offer to settle eligible appeals at 62 […]
It is not uncommon for a physician organization to act as an intermediary between its physician participants and third-party payers to facilitate the negotiation and acceptance of reimbursement rates and other payer contract terms.
However, when facilitation becomes negotiation and a PO accepts contracts with third-party payers on behalf of physician participants, also known as “single-signature contracting,” a PO may be unintentionally engaging in illegal “price-fixing” in violation of antitrust law.
Under Section 1 of the Sherman Act, it is illegal to engage in horizontal price fixing arrangements. This includes circumstances where PO physician participants, who are otherwise competitors in the market, collectively agree or disagree to a third-party payer’s terms. As a result, if a PO negotiates and unilaterally accepts or rejects rates on behalf of all its physician participants, it must proceed with caution and comply with Section 8 of the Department of Justice and Federal Trade Commission in their Statements of Antitrust Enforcement Policy in Health Care.
Single-signature contracting is not always a violation of antitrust law. The DOJ and FTC (the “Agencies”) specifically outline “safety zones” by which such conduct is permitted, provided that there are no extraordinary or unusual circumstances involved with respect to the […]
The Department of Health and Human Services would be barred from crafting future immunization-related rules, meaning any age- or dose-related updates would need legislative approval, under a pair of bills debated in committee Nov. 30.
HB 5162 and HB 5163 comes as parents with objections to child immunization told the House Oversight Committee how state and local health officials have been “overly zealous” in pursuing a pro-vaccination agenda by belittling those seeking a state exemption.
Joel Dorfman, of Michigan for Vaccine Choice, said DHHS has used the administrative rules process to “eviscerate” a state law that is neutral on child immunizations by treating citizens who don’t want to give their kids shots as “deviants who need coercion to mend their way.”
“(The bills) would send a message to DHHS that they can’t use the rules process to eviscerate the law,” Dorfman said.
Rep. Steve Johnson (R-Wayland Twp.) said HB 5162 and HB 5163 don’t change any current requirements. It only makes it clear that moving forward, DHHS can’t make any administrative rules regarding immunization. That includes alterations to vaccination schedules.
“This issue is so deeply personal that it should be made by a body that follows a Democratic process,” Johnson said.
Bob Swanson, DHHS’ program director of immunizations, walked the committee […]
The American Hospital Association and the Federation of American Hospitals Dec. 6 released a report that details the impact a repeal of the Affordable Care Act would have on hospitals and health systems and the patients and communities they care for.
The report finds that, under the most recent repeal-without-replacement bill, H.R. 3762, hospitals across the nation would suffer losses amounting to hundreds of billions of dollars.
Rick Pollack, AHA present and CEO, and Chip Kahn, FAH president and CEO, observed that, “Losses of this magnitude cannot be sustained and will adversely impact patients’ access to care, decimate hospitals and health systems’ ability to provide services, weaken local economies that hospitals help sustain and grow, and result in massive job losses. As you know, hospitals are often the largest employer in many communities, and more than half of a hospital’s budget is devoted to supporting the salaries and benefits of caregivers who provide 24/7 coverage, which cannot be replaced.”
In letters sent Dec. 6 to President-elect Trump and congressional leaders, Pollack and Kahn outlined the findings of the report and their concerns about the potential impact on patients and communities. They also expressed their commitment to working with the Trump administration and Congress as they begin reconsideration of the ACA and reiterated […]
A sprawling health bill that passed the Senate Wednesday and is expected to become law before the end of the year is a grab bag for industries that spent plenty of money lobbying to make sure it happened that way.
Here are some of the winners and losers in the 21st Century Cures Act:
Pharmaceutical and Medical Device Companies. The bill will likely save drug and device companies billions of dollars bringing products to market by giving the Food and Drug Administration new authority and tools to demand fewer studies from those companies and speed up approvals.
The changes represent a massive lobbying effort by 58 pharmaceutical companies, 24 device companies and 26 “biotech products and research” companies, according to a Kaiser Health News analysis of lobbying data compiled by the Center for Responsive Politics. The groups reported more than $192 million in lobbying expenses on the Cures Act and other legislative priorities, the analysis shows.
Medical schools, hospitals and physicians. The bill provides $4.8 billion over 10 years in additional funding to National Institutes of Health, the federal government’s main biomedical research organization. (The funds are not guaranteed, however, and will be subject to annual appropriations.)
The money could help researchers at universities and medical centers get hundreds of millions more dollars in […]
As it works to integrate its national health system, Ascension facilities in Michigan and Wisconsin will be first to adopt the unified name of Ascension. The hospitals and other sites of care that are part of the current systems of Ascension Michigan – Borgess in the Kalamazoo region; Crittenton in suburban Detroit; Genesys serving the Flint/Grand Blanc area; St. John Providence in metro Detroit; St. Joseph in Tawas City; and St. Mary’s with services in Saginaw and Standish – will adopt the Ascension identity. Similarly, the hospitals and other care sites of the current systems of Ascension Wisconsin – Ministry Health Care, Columbia St. Mary’s and Wheaton Franciscan Healthcare, serving residents across the state – will now use the Ascension name.
The moves are intended to make it clearer and easier for patients to access care and to navigate their health through the Ascension system.
“We have an obligation to provide high-quality, affordable care, and quality outcomes, with an enhanced experience for our patients and our providers,” said Anthony R. Tersigni, EdD, President and Chief Executive Officer of Ascension. Adopting a unified Mission statement and creating a clear and consistent identity reflect our collaborative national system and move us in this direction.”
Collaboration among Ascension’s hospitals across the […]
The House Health Policy Committee Sept. 20 reported a bill to license and regulate nurses with a masters, post-masters or doctoral degree in a nursing specialty, called advance practice registered nurses (APRNs).
APRNs may be nurse-midwives, nurse practitioners or clinical nurse specialists. Currently, the Michigan Board of Nursing may grant specialty certification to a registered professional nurse who has training beyond the requirements of initial licensure.
The bill, HB 5400, would add a list of protected terms, restricted to be used only by individuals authorized to use them: “certified nurse midwife,” “CNM,” “advanced practice registered nurse,” “APRN,” “NP” “certified nurse practitioner,” “CNP,” “clinical nurse specialist,” “CNS,” “clinical nurse specialist-certified,” and “CNS-C.”
These nurses would have the ability to prescribe drugs and controlled substances, dispense complimentary starter doses of controlled substances and would allow APRNs to make house calls or go on rounds whose timing and frequency is unrestricted by a physician.
Bill sponsor Rep. Ken YONKER (R-Caledonia) has been working on this bill since his first term and this year worked with a variety of health care stakeholders to forge the draft reported last week. “It’s a very simple bill, but it’s been a very complex bill,” Yonker said.
The intent of the bill, Yonker said is to improve patient […]
A number of Congressional Democrats—including every Democrat in the Michigan Congressional Delegation—announced they’re going to battle after emergency funding for Flint was removed from a government-funding bill.
The issue is swiftly becoming the pivotal matter on which a government shutdown may rest. If the impasse lingers, it will likely invite more national scrutiny to Flint’s water crisis, and with that, further squabbling over the allocation of blame.
Minority leadership in the U.S. Senate coalesced to block a vote on the bill that would keep the government funded for the next 10 weeks, due to the exclusion of funding for Flint as it still grapples with the water crisis. Republicans have accused the Democrats of political motivations underscoring the action.
The provision looks to provide $220 million in aid to the city and is fully funded.
Despite broad bipartisan support in the Senate, it has been stonewalled in the House, where leadership asserts the funding would be better placed in the Water Resources Development Act (WRDA).
When U.S. Rep. Dan KILDEE (D-Flint) reportedly attempted to introduce the funding to that legislation as an amendment in committee, it was rejected when Republicans split over whether it had proper jurisdiction there.
Party leadership has since become the point people for the showdown, but all […]
For the first time since voters said “yes” to medical marijuana in 2008, the state will be legalized freestanding shops where the product can be sold, under legislation Gov. Rick SNYDER signed into law Sept. 21.
A five-tier regulatory structure will now co-exist with the current distribution model, in which a caregiver can grow plants for him or herself and five others.
The bills, HB 4209, HB 4210 and HB 4827, create a license structure for the growing, testing, processing and transporting of medical marijuana, as well as legalize medical marijuana in non-smokable forms.
Those with any of the five state licenses, however, will not be allowed to a license for any of the other four tiers. A grower can’t sell the marijuana to a customer, just as a transporter can’t test or process the product.
“This new law will help Michiganders of all ages and with varying medical conditions access safe products to relieve their suffering,” Snyder said in a statement. “We can finally implement a solid framework that gives patients a safe source from which to purchase and utilize medical marijuana.”
The bills, sponsored by Rep. Mike CALLTON (R-Nashville), Rep. Lisa LYONS (R-Alto) and Rep. Klint KESTO (R-Commerce Twp.), also allow “medibles,” oils, chocolates and other products that […]
The University of Michigan Health System has established a new partnership with Meijer pharmacies to provide hypertension management services for adult patients.
U-M patients will be able to visit participating Meijer pharmacy locations to receive a blood pressure check and assessment. If the patient’s blood pressure is elevated, the clinically trained Meijer pharmacist will communicate directly with the patient’s U-M Health System provider. The patient will also receive appropriate follow-up and education about disease, clinical goals, medications and lifestyle.
In addition, documentation of the patient’s visit to their Meijer pharmacy will be recorded in their electronic medical record so the patient can easily discuss the reading and assessment with their U-M Health System provider at their next medical visit.
“This partnership is allowing us to provide our patients with clinical pharmacist services in the community,” says Hae Mi Choe, director and associate dean of pharmacy innovations and partnerships at U-M. “Our patients will have more access to an effective and safe hypertension treatment and monitoring program right in their neighborhood.”
The partnership is available at two participating Meijer locations in Ann Arbor: Meijer at 3825 Carpenter Road and Meijer at 3145 Ann Arbor-Saline Road.
Nearly 90 percent of Americans live within five miles of a pharmacy and a community pharmacist […]
ICD-10, which contains more than 70,000 diagnostic codes, replaced the ICD-9 code set, which relied on just 11,000 codes.
The grace period had only applied to claims submitted to Medicare and Medicaid, and while many commercial insurers offered similar flexibility, the majority did not, according to a report in Healthcare IT News.
The lead-up to the ICD-10 had many healthcare providers worried that the exponential increase in diagnostic codes would lead to more errors in medical claims, and ultimately denials, due to the new specificity required. But the years of lead-up to the launch due to a handful Congressional delays gave healthcare providers more time to prepare. The years of training, and the extra time to staff-up coding departments paid off. Most studies show the rate of denials had gone practically unchanged since the roll-out.
Though the grace period will end on Oct. 1, CMS said providers will still be allowed to use unspecified codes when they are warranted.
“While you should report specific diagnosis codes when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, in some instances signs/symptoms or unspecified codes are the best choice to accurately reflect the health care encounter. You should code each healthcare encounter to […]
Researchers in the Wayne State University School of Medicine’s Department of Psychiatry and Behavioral Neurosciences will use a new five-year, $3.2 million grant from the National Institute of Mental Health to explore the underlying mechanisms of impaired learning and memory in schizophrenia from the perspective of brain plasticity, function and network dynamics.
The NIMH defines schizophrenia as a chronic and disabling mental disorder that affects how a person thinks, feels and behaves, including loss of reality due to hallucinations, delusions, unusual or dysfunctional ways of thinking, and agitated body movements. People with the condition also have difficulty beginning or sustaining activities, focusing or paying attention, or remembering information immediately after learning it. About 1 percent of the United States population, or 2.2 million people, have schizophrenia, but the neurobiology of the illness remains poorly understood.
Principal Investigator and Associate Professor Jeffrey Stanley, PhD, and Co-Principal Investigator and Professor Vaibhav Diwadkar, PhD, lead the study “Advancing innovative brain imaging to detect altered glutamate modulation and network dynamics in schizophrenia,” which was funded on its first submission. The study is the first to combine functional MRI, or fMRI and complex analyses of brain imaging data with innovative measurement of the brain’s functional neurochemistry using functional magnetic resonance spectroscopy, or […]
If technology and data was the last $1 trillion industry, data-driven advancement in biotechnology will be the next and West Michigan is positioned to take advantage, said former Hillary CLINTON innovation aide Alex ROSS.
Ross was a keynote speaker at the Grand Rapids Economic Club luncheon and drew on his experience as former senior innovation aide to Clinton while she was Secretary of State. Ross said the data collected mapping the human genome over the last 15 years will likely be used next to conduct “liquid biopsies”—an early cancer detection test–and pharmaceutical therapies tailored to a patient’s specific genetic needs.
“In five years, 95 percent of the hands in this room will go up,” Ross said about liquid biopsies. Right now the procedure is too cost-prohibitive, but that cost is likely to plummet Ross said. Today, the procedure costs $3,000, but 13 months ago it cost $14,000 Ross said.
The way the pharmaceuticals will also change. Ross said he believes that doctors will begin to “develop therapies and treatments not generically designed to treat an illness, but designed around an individuals genetics.”
Ross said the barriers to new bio-science therapies is “principally regulatory” as it takes “billions in FDA [Food and Drug Administrations] drug trials” to get a new […]
The nation’s No. 3 insurer said this week it will reduce the number of states in which it sells policies on government exchanges from 15 to three or four.
Aetna, Inc, decided to pull out of the 11 states amid sizable losses on it’s individual policy business. The states remaining are Delaware, Iowa, Nebraska and Virginia.
“Following a thorough business review and in light of a second-quarter pretax loss of $200 million and total pretax losses of more than $430 million since January 2014 in our individual products, we have decided to reduce our individual public exchange presence in 2017, which will limit our financial exposure moving forward,”said Aetna Chairman and CEO Mark Bertolini Aug. 15. “More than 40 payers of various sizes have similarly chosen to stop selling plans in one or more rating areas in the individual public exchanges over the 2015 and 2016 plan years, collectively exiting hundreds of rating areas in more than 30 states. As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision.”
Aetna’s action follows on the heels of similar moves by major insurers UnitedHealth Group and Humana, which have also cited financial losses on the government […]
The Flint water flowing from her showerhead caused her hair to fall out, read a Jan. 29, 2015, complaint from one Flint resident to Attorney General Bill Schuette’s office.
A year later, the Attorney General opened his investigation into the city’s municipal water supply.
“My skin is disgusting and my dog was sick until we switched her to bottled water . . . We need help in Flint PLEASE,” the Tiffin Street resident wrote.
Today, Schuette is a central figure in the prosecution of nine government employees allegedly connected to the contamination of Flint’s municipal water.
He’s also spearheading civil action against a pair of engineering firms potentially responsible for mistreating Flint River water.
But before taking action this past January, Schuette received 14 complaints from Flint residents about the city’s poor water quality, according to documents MIRS received through the Freedom of Information Act from April 1, 2014—the same month Flint switched its supply to Flint River water—to Dec. 31, 2015.
Schuette started his investigation into the Flint water situation Jan. 15, 2016.
“I don’t know why he didn’t get in front of this quicker than he did,” said Laurie Barr, one of the 14 to write Schuette a letter. Her correspondence came in early November. “When the shit hit the […]
Mercy Health has opened a $3.9 million medical center in Ludington in northwest Michigan.
Mercy Health Ludington offers urgent care, primary care services, lab, imaging and specialty clinics, and continues services at neurosurgery and cardiology clinics. An occupational medicine clinic was slated to open Aug. 15 and behavioral health services are penciled in for the fall.
The 15,000-square-foot facility is less than a mile away from the Spectrum Health Ludington Hospital.
Mercy Health announced plans to build the center last May and broke ground in September.
A West Michigan multi-campus health care system, Mercy Health features five hospital campuses, more than 60 physician offices and more than 1,300 medical staff physicians.
Omar Khan, MD, chair of the Wayne State University Department of Neurology, died Aug. 13.
Dr. Khan joined the Department of Neurology in 1998, and was appointed chair in 2012.
“He was a strong leader of his department,” School of Medicine Dean Jack D. Sobel, MD, said. “This is a substantial loss to our School of Medicine and a tremendous loss for multiple sclerosis patients, for whom Dr. Khan was a staunch advocate.”
Dr. Khan also served as director of the Wayne State University Multiple Sclerosis Center and Magnetic Resonance Image Analysis Laboratory, neurologist-in-chief for the Detroit Medical Center and formerly as associate chief medical officer for the Wayne State University Physician Group.
He received his medical degree in 1987 from the Allama Iqbal Medical College, University of the Punjab in Lahore, Pakistan. He served on the University of Maryland faculty from 1996 to 1998, when he joined Wayne State University.
Dr. Khan secured more than $8 million in research funding. He served as principal investigator in more than 55 studies and at the time of his death was the principal investigator in more than 15 clinical trials and investigator-initiated studies.
The Wayne State University Multiple Sclerosis Center, which he directed, is one of the top five MS centers in the […]
A combined concern based on professional image and safety drives the American College of
Surgeons new communique on clothing. No dangling surgical masks, loose jewelry, grungy scrubs or uncovered ponytails or mutton-chop sideburns allowed. And, much like pro athletes, ditch the uniform (scrubs) for a jacket and tie for “encounters outside the OR.”
“The whole idea is to support professionalism on behalf of patients,” ACS Executive Director David Hoyt, MD, said in a news story.
The guidelines, which the ACS says were developed based on “based on professionalism, common sense, decorum, and the available evidence,” were designed standardize dress codes, which vary in different organizations.
“There’s a lot of confusion as to what is out there and what is being assessed. We felt it was very important to create a document that tries to evaluate everything and put it into perspective,” Hoyt said in the story. “This is what the surgical community feels is appropriate and best practice.”
Such dress codes aim to ensure that physicians look professional, which research shows is important to patients: Data aggregated from 30 studies found that most patients prefer physicians in professional attire.
As defined within the study, professional attire is “a collared shirt, tie and slacks for male physicians and blouse (with or without […]
Hospitals and health systems across the country are partnering with Uber to help patients make it to appointments on time, according to a recent article in the Atlantic magazine.
Columbia, Md.-based MedStar Health is one such system. The nonprofit health care system began a partnership with Uber in January. Through the partnership, patients can use Uber can book trips via the MedStar website. Medicaid patients or those without the Uber app can set up rides by calling MedStar’s patient advocates directly.
The arrangement has been wildly popular. “We probably had 50 different systems across the country reach out to us and ask us, ‘How did you do it?’ I would say that it has been a seismic shift for people who have used the service and the places we’ve provided it,” said Michael Ruiz, MedStar’s chief digital officer, according to the report.
The trend is occurring in a variety of systems. Hackensack (N.J.) University Medical Center and Sarasota (Fla.) Memorial Hospital both recently decided to work with Uber. Other organizations — such as Relatient, a healthcare communications company, and National MedTrans Network, a transportation company — have done likewise, having partnered with Uber and Lyft, respectively. Medicaid patients in Idaho have a new way to get to the […]
The American Medical Association and the Centers for Disease Control and Prevention issued the following statements this week regarding the Zika virus as they hosted a webinar for American’s physicians and clinicians on the current status of the outbreak.
“As the Zika virus outbreak continues to evolve and more Americans become impacted by the virus, we must ensure that our nation’s physicians, and all clinicians, are prepared to handle possible cases of the virus and are equipped with the most up-to-date information to answer patients’ questions. The AMA and CDC will be holding a live webinar tonight to provide physicians and other clinicians with an update on the current status of the outbreak and the latest clinical guidance to help them diagnose and manage patients and prevent further transmission of the Zika virus,” said AMA President Andrew W. Gurman, MD.
The AMA will continue to update its online Zika Virus Resource Center with the latest Zika-related information from the CDC and other trusted healthcare organizations to support health care professionals in combatting and preventing complications from the virus to help keep their patients safe and healthy.
With an increasing number of Zika cases confirmed in the US, including this week’s news of the death of a newborn baby […]
Wayne State University School of Medicine could be down 37 faculty members because of retirement and termination, according to The Detroit News.
The news was revealed via a letter to faculty members from Dean Jack Sobel, MD.
Eighteen faculty members have “agreed to retire, accept phased retirement or received notice of nonrenewal of their contract,” according to Dr. Sobel’s letter. Eleven others will be recommended for dismissal from their positions, and eight more chose to take part in separation agreements. Most of these eight will stay on staff at Wayne State until after Sept. 1.
These 37 members are part of the 700 researchers in the medical school’s basic sciences and clinical departments, according to Charles Parrish, PhD, president of the American Association of University Professors-AFT Michigan Local 6075.
Dr. Sobel’s letter comes after Wayne State warned faculty members of the consequences of their unproductive habits in March. “Too many of our faculty [members] have been unproductive for many years,” Dr. Sobel and David Hefner, Wayne State’s vice president for health affairs, wrote in a letter to 527 faculty members. “They have been allowed to consume needed resources totaling many millions of dollars.” Mr. Hefner claimed between 60 and 80 faculty members were categorized as unproductive, and he and […]