By EWA MATUSZEWSKI
While my recent columns have put me on the defensive regarding primary care trends, I’m thrilled to see CMS not only acknowledge but reinforce the important role of primary care in achieving optimal overall health and well-being through the recent introduction of its Primary Care Initiative Medicare payment models. At the heart of the introduction is a threefold goal: reduce administrative burdens, empower PCPs to spend more quality time with patients, and reduce overall healthcare costs. I’m not the only one applauding. The Patient Centered Primary Care Collaborative (PCPCC) cites the CMS move as reinforcement of the role primary care plays not only in health, but healthcare value.

There [Read More]

By JESSE ADAM MARKOS, ESQ.
Wachler & Associates, P.C

The National Practitioner Data Bank (Data Bank) published an article in the May 2019 issue of NPDB Insights that provides significant guidance regarding when proctoring is reportable. Proctoring can come in many different forms and has several different names depending on the hospital, such as monitoring, mentoring, or preceptoring. Regardless of the name, hospital-assigned proctorship agreements can be a useful tool to help evaluate a practitioner when a hospital has concerns about clinical competence. This is especially true because certain proctorships can be structured to avoid a report to the Data Bank. When that is accomplished, hospitals are able strike a [Read More]

By FEDERICO MARIONA, MD
Last Nov. 6, in lieu of a legislative decision that never took place, the Michigan voters approved the legalization of marijuana for recreational use by adults. That made our state the first in the Midwest to have such policy, complementing the previous implementation of the medical marijuana use. The statute included the proviso that recreational marijuana was to be allowed on persons of 21 years old and above, and that certain rules and regulations were to be developed via legislation to organize the cultivation, process, distribution and sales of the approved substance by a state certified system.

As of May 6, six months after the approval, a rather [Read More]

State Medicaid Official Placed On Leave Following Negligence Accusation

Michigan’s chief medical director for Medicaid was placed on administrative leave May 9 after accusations of negligence and deficiencies in patient care.

Dr. David Neff, who had been recognized for helping combat the state’s opioid crisis, is accused of failing to meet minimal standards and violating his general duty as a health care provider, according to an administrative complaint filed by the Michigan Department of Licensing and Regulatory Affairs (LARA) that MIRS received via a Freedom of Information Act request May 31.

LARA spokesperson David Harns said the department is not commenting outside the administrative complaint.

Lynn Suftin, spokesperson with the Michigan Department of Health [Read More]

House Republicans stuck together and, with the support of three Democrats, pushed through sweeping reforms to the state’s 40-year-old auto insurance.
Michigan’s auto insurance customers would see guaranteed rate rollbacks, choice in personal injury coverage and a fee schedule for medical providers under a plan that moved 61-49 at 2 a.m. Thursday morning, 18 hours after the Senate passed similar changes.

Unlike the Senate version, HB 4397 will give the Department of Insurance and Financial Services (DIFS) the power to prevent non-driving factors from affecting rates. It also mandates that between 10 and 100 percent of previous personal injury protection (PIP) costs, meaning some ratepayers can opt out of the Michigan Catastrophic [Read More]

By JUDITH GRAHAM
Dr. Hasan Shanawani was overcome by frustration. So, he picked up his cellphone and began sharing on Twitter his family’s enraging experiences with the U.S. health care system.
It was an act of defiance — and desperation. Like millions of people who are sick or old and the families who care for them, this physician was disheartened by the health care system’s complexity and its all-too-frequent absence of caring and compassion.

Shanawani, a high-ranking physician at the Department of Veterans Affairs, had learned the day before that his 83-year-old father, also a physician, was hospitalized in New Jersey with a spinal fracture. But instead of being admitted as an inpatient, [Read More]

By EWA MATUSZEWSKI
As any regular reader of this column knows, I’m a big booster of the pharmacy profession and have been committed to maximizing the skill level and reach of pharmacists when it comes to primary care. That’s why our organization was among the first Patient Care Organizations (formerly PO’s) in Michigan to actively recruit pharmacists into care management training programs and to seek out pharmacists to serve as care managers at large primary care practices within our network. It’s been gratifying to see other Patient Care Organizations follow suit.

Still, I was taken aback when I read a recent Detroit Free Press article with the headline, “Flocking to pharmacies instead [Read More]

By ALLAN DOBZYNIAK, MD
Doctor, if you have recently visited with upper hospital management in the plush executive suite, it was most surely you who stood out conspicuously. Being greeted by one of the administrative secretaries, you were asked to be seated and wait along with others, consultants, lower level management, salesmen, business associates, insurance executives and maybe even golf buddies. You were notable as the only one not appearing in sartorial splendor, groomed to the hilt, well rested and adorned in a three-piece suit. You were the person bleary-eyed from the night shift or up all night with an emergency, dressed in a white coat with pockets full of papers [Read More]

By ANDREW B. WACHLER, ESQ.
On Nov. 1, 2018, U.S. District Court Judge Boasberg ruled that the U.S. Dept. of Health and Human Services (HHS) must eliminate the Medicare appeals backlog by the end of fiscal year 2022.

As of the end of 2018, there was a backlog of 426,594 appeals. Judge Boasberg’s ruling imposes a timetable for reducing the backlog of appeals. Specifically, HHS must clear 19 percent of the appeals by the end of fiscal year 2019; 49 percent of the appeals by the end of fiscal year 2020; 75 percent by the end of fiscal year 2021; and eliminate the backlog entirely by the end of 2022. Beginning [Read More]

By JULIE ROVNER
“The Mueller Report” is so last week’s news. Health care has returned in force as the dominant political issue in Washington, reflecting what voters have been telling pollsters for the past year.

The Trump administration moved night to get more in line with President Donald Trump’s voter base by endorsing a Texas federal judge’s December opinion that the entire Affordable Care Act should be struck down as unconstitutional.

After he arrived at the Capitol for lunch with Republican senators Tuesday, Trump endorsed the change, suggesting it will usher in Republican priorities instead. “The Republican Party will soon be known as the ‘party of health care!’” he told reporters.

Less than two [Read More]