By ALLAN DOBZYNIAK, MD
The collective “wisdom” promoted by the MBAs, nouveau healthcare experts, politicians and bureaucrats can be condensed into a singular thought: Doctors were part of an anachronistic model which was condescendingly labeled a “cottage Industry.” According to this expanding array of mutually anointed experts, this was a stupid residual from a previous era. The truly operative word here is industry. Then, as an industry, it needed to be aggressively nudged into modernity as these wizards envisioned it. Included in this group-think vision was the caveat that turning the physicians’ practice of medicine, a profession, into an industrial model laden with regulations, mandates, rules, care models and protocols was mandatory. But could it have been the dollar signs in the eyes of the industrialists when gazing at 16 percent of the U.S. economy attributed to healthcare that was originally and continues at present to be the salient motivator? Add to this the enormous transfer of power to the federal government.

Those fortunate enough to get in on this potential bonanza certainly have prospered. The exponential increase in government healthcare bureaucrats with their lavish salaries and benefits, the hospital management aristocracy, the health insurance companies, the IT companies selling their ludicrous fantasies, the pharmaceutical enterprise with [Read More]

(FLINT)—an 80 percent majority of the 87 Legionnaires’ diseases cases that came out of the city of Flint from 2014 to 2017 can be connected to the city’s water supply, according to a hotly disputed study released in early February.

A research team made up of experts from the University of Michigan, Wayne State University and Colorado State University also found the less chlorine used to treat Flint River water, the more likely those who drank the water contracted Legionnaires’ disease.

Temperature of the water was not tested, a key point because the warmer the water, the easier it is for Legionella to grow. However, the researches from the “Flint Area Community Health and Environment Partnership (FACHEP) research team” did suggest using polyvinyl chloride pipes, which don’t release iron when exposed to corrosive water.

The Department of Health and Human Services (DHHS) quickly disputed the report’s findings, writing that it reviewed the final draft articles, as did an independent third party, KWR Watercycle Research Institute and found numerous flaws that were brought to the research team’s attention, but to no avail.

“By publishing these inaccurate, incomplete studies at this point, FAHCEP has done nothing to help the citizens of Flint and has only added to public confusion on this [Read More]

Three huge and influential employers, Amazon, Berkshire Hathaway and JP Morgan Chase, announced Jan. 30 they were partnering to create an independent company aimed at reining in health-care costs for their U.S. employees.

There were almost no details available about what the company would do or how it would use technology to disrupt and simplify the complicated fabric of American health care. But there’s no doubt that the companies, which collectively employ more than 1 million workers worldwide, have a real interest in ratcheting down their spending on health care. Health-care premiums are split between employers and employees and have been growing much faster than wages.

Major health company stock prices tumbled on the news, and the announcement stirred excitement — and questions — about how the three companies could bring their clout to containing costs in the massive employer-sponsored health insurance market, which provides coverage to approximately 160 million Americans.

According to a survey of employer health benefits, health insurance premiums have been rising faster than wages. Between 2012 and 2017, workers’ earnings grew by 12 percent, while premiums went up by 19 percent. Between 2007 and 2012, premiums increased twice as fast as workers’ earnings.

The announcement comes amid rampant rumors and anticipation that Amazon could disrupt [Read More]

By EWA MATUSZEWSKI
According to the CDC website, many health plans and employer groups offer diabetes prevention programs (DPP) because scientific research shows that they work. The federal government must read its own webpages (eventually) because effective April 1, 2018, Medicare and Medicare Advantage programs will begin reimbursing for DPP services as well. It’s long overdue, but now that it’s on the horizon, we need to take action as a healthcare community and encourage the full use of these programs to raise awareness of the high incidence of Type 2 diabetes and halt its devastating impact on overall health and quality of life. Some quick facts:

Eighty-six million adults in the United States have prediabetes, with nine out of ten people not knowing they have it. The risk for prediabetes and diabetes is higher if the person is:

• Overweight or obese
• Has a family history of the disease
• Aged 45 or older
• Not physically active
• Had diabetes while pregnant
• Is African American, American Indian, Hispanic, Asian American or Pacific Islander

Full disclosure – my organization was the first independent physician organization in Michigan to be fully accredited by the CDC for our DPP. The Medicare reimbursement won’t incentivize us though; we were incentivized years ago when we saw [Read More]

By DUSTIN WACHLER-WACHLER & ASSOCIATES, P.C.
Physicians increasingly seek to provide comprehensive care and increase revenue by offering clinical laboratory services to their existing patients. While many laboratory arrangements are permissible, Michigan healthcare providers must be aware of federal and state authorities governing their ability to derive revenue from orders for clinical laboratory services.

Physician practices may provide testing for their own patients through a physician-office laboratory, or refer laboratory tests to an independent clinical laboratory. The federal Stark law prohibits a physician from referring Medicare or Medicaid patients for clinical laboratory services to an entity with which the physician or an immediate family member has a financial relationship. Michigan licensure laws applicable to physicians and other healthcare professionals incorporate the Stark law, and thus the Stark law’s prohibitions and exceptions apply to referrals of laboratory tests for all patients in Michigan.

Michigan healthcare providers structure physician-office laboratories to comply with the Stark law’s exception for in-office ancillary services. This exception permits a physician group practice to provide clinical laboratory services to the practice’s patients if the arrangement satisfies certain requirements related to the performance and supervision, location, and billing of the laboratory services. However, due to these requirements, physician groups generally cannot own and refer to [Read More]

By ROSE WILLIS-DICKINSON WRIGHT
The phrase “healthcare compliance program” is commonly used to describe those processes and procedures implemented by a healthcare provider to prevent submission of erroneous claims and combat fraudulent conduct. The expectation is that providers using internal controls will more efficiently monitor adherence to legal and regulatory requirements than providers without such controls in place. However, confusion remains over whether a healthcare compliance program is legally required for many healthcare providers, particularly those in clinical practice.

Some healthcare providers may believe a formal compliance program is not necessary until a clear, legal requirement is established involving detailed parameters and penalties. This perspective primarily comes from those who don’t have the time, energy or resources to implement a program unless they understand it as an enforced legal mandate tied to penalties. Understandably, the same perspective surrounded compliance with HIPAA until the 2009 HITECH Act issued a clear enforcement rule with sizeable penalties for noncompliance.

Unlike HIPAA, currently there exists no clear enforcement rule setting forth explicit penalties against all types of providers for failure to implement a formal healthcare compliance program. While Section 6401 of the Patient Protection and Affordable Care Act requires as a condition of participation, all healthcare providers participating in a federal [Read More]

By GERALD NATZKE, JR. DO
President
Genesee County Medical Society

As we enter the holiday season and ponder how 2017 has quickly flown past, many of us wonder if there is anything more we could medically do to assist the Flint residents who drank leaded water. We could easily argue that more should have been done to prevent this disaster by those responsible for monitoring the quality of the city’s water. Fortunately, a lot of good, caring people in this world have stepped up to provide aid. Several foundations, as well as the state and the federal government have granted monies for services to improve education, research, epidemiological needs and water line repair. On the periphery, it would seem everything is being taken care of as much as it can be. The true situation is…not really. There is still more, possibly a lot more. The GCMS Community and Environmental Health Committee have been researching this subject since the end of 2015. As a result, it has thoroughly evaluated several potential treatments and may have some answers. It seems there is very little information in the literature on the effects of low-level chronic lead ingestion and accumulation within a population. The FDA had long approved both oral DMSA and [Read More]

By ALLAN DOBZYNIAK, MD
Blaming physicians for the “opioid crisis” is so far off the mark as to be potentially harmful. Then throw in pharmaceutical companies, and politics has definitely been substituted for truth. On “Face the Nation” former New Jersey Gov. Chris Christi, chair of the president’s opioid commission, blamed overprescribing doctors. He said, “This crisis started not on a street corner somewhere. This crisis started in the doctors’ offices and hospitals of America.” In the following discussion I will not even mention the significant contribution to the crisis related to the obsession with pain management by JCAHO, Medicare, Medicaid and finally by private insurance companies. But remember it was these bodies that forced the definition of pain as the fourth vital sign.

Correlation does not mean causation, but there are some correlations that seem not only interesting, but important relative to opioid abuse. If you have a job, are married, older than age 50, female and black the scourge of opioid abuse is less, much less. Recent studies though have shown cocaine related deaths to be greater in the African-American community. Being unmarried, divorced, unemployed or a young adult correlates with greater risk. One can wonder if the increased geographic risk in West Virginia, New [Read More]

The state is asking a judge to dismiss a lawsuit claiming the Department of Technology, Management and Budget showed “blatant favoritism” in awarding a $657 million contract for the Healthy Kids Dental Program.

The state says MCNA Insurance Company’s suit filed in Ingham County should be dismissed “because disappointed bidders lack standing to challenge a public bid process,” according to court documents.

The state further alleges the court doesn’t have jurisdiction over MCNA’s appeal because DTMB’s award recommendation was not a final decision by a judicial agency.

“The state’s attempt to dismiss the case, on a technicality, sends a clear message: It believes DTMB’s procurement decisions are immune from judicial review and it can act with impunity no matter how flawed the process or how blatant a violation of the law has occurred,” said MCNA attorney Scott Eldridge, of Miller Canfield Paddock and Stone.

“Transparency and fiscal responsibility require judicial review of this flawed decision,” he added. “These tactics contradict Michigan’s stated commitment to fiscal responsibility and competitive bidding.”

MCNA Insurance Company asked an Ingham County judge to reverse the DTMB’s decision to award the Healthy Kids contract to Blue Cross Blue Shield. It filed a related suit in the Court of Claims in January regarding DTMB’s response to its [Read More]

The Genesee County Medical Society presents a Dinner Business Meeting and Medical Community Town Hall

Mindfulness: its Importance to the Medical Community and Patients
February 1, 2018
Flint Golf Club
3100 Lakewood Drive
Flint, MI 48507

Physicians, Practice Managers, and Health Care Professionals Welcome!
$40.00 – GCMS Members, Spouses, Practice Managers, & Staff
$40.00 – Genesee County Osteopathic Association Physician Members & Spouses
$25.00 – Residents & Students
$75.00 – All Non-Member Guests

Evening Schedule:
6 pm, Registration & Social Hour
6:30 pm, Dinner
7 pm, Meeting
7:15 pm, Presentations

Space is limited!
Please register by January 25, 2018
Please mail your reservation payment to:
Genesee County Medical Society
4438 Oak Bridge Drive, Suite B
Flint, MI 48532
Email Sherry at [email protected] to register your attendance or call 810-733-9923 for more information.

(FLINT) – A Wayne State University professor testified that Michigan’s chief medical executive consistently tried to blame Genesee County hospitals for the 2014 and 2015 Legionnaires’ disease outbreaks in Flint.

Shawn McElmurry, who led a team of researchers trying to identify the source of the outbreak that is attributed to 12 deaths, also testified Dec. 20 at the preliminary exam for Dr. Eden Wells that he told Gov. Rick Snyder that the team’s study “wasn’t going well” and he could use his help to carry out much-needed testing.

“It was made clear to me I don’t (report) directly to the governor,” McElmurry testified. ” . . . It was made clear to me I was to work with (Michigan Department of Health and Human Services Director) Nick Lyon.”

When Lyon wasn’t available, McElmurry said, he was to reach out to Rich Baird, a Snyder senior advisor.

Wells is charged with obstruction of justice and with lying to a peace officer by knowingly giving false statements to a water investigator.

The prosecution is expected to seek an involuntary manslaughter and misconduct charges at the conclusion of the preliminary exam, which continues Jan. 28 before Judge William Crawford III in downtown Flint. The manslaughter charge is in connection with the death of [Read More]

By JOHN DALEY
Colorado Public Radio

Seven years ago, Robert Kerley, who makes his living as a truck driver, was loading drywall when a gust of wind knocked him off the trailer. Kerley fell 14 feet and hurt his back.

For pain, a series of doctors prescribed him a variety of opioids: Vicodin, Percocet and OxyContin.

In less than a year, the 45-year-old from Federal Heights, Colo., said he was hooked. “I spent most of my time high, laying on the couch, not doing nothing, falling asleep everywhere,” he said.

Kerley lost weight. He lost his job. His relationships with his wife and kids suffered. He remembers when he hit rock bottom: One night hanging out in a friend’s basement, he drank three beers, and the alcohol reacted with an opioid.

“I was taking so much morphine that I [experienced] respiratory arrest,” Kerley said. “I stopped breathing.”

An ambulance arrived, and EMTs administered the overdose reversal drug naloxone. Kerley was later hospitalized. As the father of a 12-year-old boy, he knew he needed to turn things around. That’s when he signed up for Kaiser Permanente‘s integrated pain service. (Kaiser Health News is not affiliated with Kaiser Permanente.)

“After seven years of being on narcotics and in a spiral downhill, the only thing that [Read More]

By EWA MATUSZEWSKI
CEO MedNetOne Health Solutions

For years, there’s been a concerted effort by insurance companies to halt the number of unnecessary visits to the Emergency Department. (Note – it is no longer a room.) This was a wise move designed to contain overall health care costs and excessive—and often unmerited—testing. While numbers are still too high, there’s been a decrease in the number of visits over the past several years.

That’s good news, the education on not using the ED like a physician’s office is working! Yet the shift from the ED to urgent care clinics or primary care physicians, where patients’ nonemergent needs are best met, resulted in reduced fees to hospitals and health systems. Darn those unintended consequences! Coupled with the trends of decreasing hospital admissions and shortened hospital stays, something needed to be done, right? In response, the Agency for Healthcare Research and Quality (AHRQ) released a five-level emergency department triage algorithm that stratifies patients into five groups, from least to most urgent, based on patient acuity and resource needs; but left out of the reimbursement bonanza are PCPS rightfully doing the same work in their own office – which they pay for.

PCPs can’t charge an exorbitant facility fee, while hospitals and emergency [Read More]

By SARAH HILLEGONDS
Wachler & Associates, P.C.

In today’s mobile society, it is important that physicians are reminded of the requirement to maintain current, accurate mailing information with the appropriate state and federal agencies for licensing and Medicare and/or Medicaid billing purposes. There are significant potential consequences if a physician has an inaccurate address on file, fails to regularly check the mailbox connected to the address on file, or does not timely report a change in mailing address or practice location.

For state licensing, under the Michigan Public Health Code, Act 368 of 1978, physicians have a duty to notify the Michigan Department of Licensing and Regulatory Affairs (“LARA”) of a change in mailing address within 30 days after the change occurs(1). Failure to report a change of mailing address is, by itself, a sanctionable offense under the Public Health Code. The disciplinary subcommittee may impose a fine or reprimand a physician who fails to timely report a change of address(2).

In addition, if LARA files an administrative complaint against a physician alleging any sanctionable offense, it may notify the physician by sending a copy of the administrative complaint through regular mail and certified mail, return receipt requested, to the provider’s last known mailing address(3). A physician has 30 [Read More]

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 [Read More]

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 [Read More]

By PETER DOMAS
Dickinson Wright

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.

Action Steps

There has been significant speculation as to whether there will be (or should be) a rush for S-Corps to revoke their designation, or [Read More]

By KEVIN R. MISEREZ, ESQ.
Wachler & Associates, P.C.

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 [Read More]

By JESSICA RUSSELL & PAHL ZINN

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.

SAFETY ZONES

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 [Read More]

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 [Read More]

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 [Read More]