The state’s health department is requesting a one-time $386.1 million cash pump into behavioral and public health services, with more than 84% of the deposit going into a new state-operated psychiatric complex.

The Senate Health and Human Services Appropriations Subcommittee hosted its first hearing for the Fiscal Year 2023 budget this month.

In the governor’s $74.1 billion proposed budget for the new fiscal year, $325 million would be infused into a new state psychiatric facility complex, which would replace the 66-year-old Hawthorn Center and the 43-year-old Walter P. Reuther Psychiatric Hospital as a single campus.

“This new facility will be used to provide treatment, care and services to children and adults with severe mental illness,” said Elizabeth Hertel, the director of the Michigan Department of Health and Human Services (DHHS). “We would expect the build of this facility to take around four or five years at a minimum.”

Currently, the Hawthorn Center in Northville is the sole state-run psychiatric hospital for pediatric patients – and with 55 beds authorized by the state for treating youths, admittance is often weighed down by a waitlist.

The governor also proposed spending an extra $15.2 million of FY 2022 dollars and $10.5 million in FY 2023 to open up new units at the Hawthorn [Read More]

By EWA MATUSZEWSKI
I was recently asked to comment on best practices for physicians and Advance Practice Providers (APP) considering the purchase of new technology for their independent practice. With 2022 still largely ahead of us, it’s good timing for a topic that may be on your business to-do list this year. Let me first start with an admitted bias. I love technology and have always been an early adopter, whether it was a Palm Pilot, BlackBerry, smartphone, Kindle, iPads or videoconferencing (long before the pandemic). Yet, I know that purchasing tech on a broader scale, namely software for healthcare practices, can be difficult and user non-friendly. (Well, perhaps that last comment is a veiled reference to my ongoing frustration at the lack of interoperability of various healthcare software platforms and reporting systems.)

The evolution of technology demands its ongoing consideration, and it’s important to note that, in large part, patients-consumers are driving the need for new healthcare IT. While telehealth comes to mind, several of our own members’ practices (non-ophthalmologists) have been doing retinal eye exams using digital retinal cameras for several years now. In general, there is an ever-growing area of patient-facing products, including those for continuous glucose, weight, blood pressure and EKG remote monitoring, [Read More]

By ROLF LOWE
In the past few months there have been two Federal District Court rulings addressing lawsuits brought in part on an alleged disclosure of Personally Identifiable Information (PII) and/or Protected Health Information (PHI) protected under the Health Insurance Portability and Accountability Act (HIPAA). In the rulings, the Courts have relied on a recent Supreme Court ruling on a case involving a class action lawsuit alleging violations of the Fair Credit Reporting Act (FCRA) issued in the spring of 2021.

The Supreme Court case, titled Ramirez v. TransUnion, arose out the named plaintiff, Sergio Ramirez, being placed on a list maintained by the Treasury’s Department’s Office of Foreign Assets Control (OFAC) of people with whom United States companies cannot do business because they have been flagged as being either terrorists, drug traffickers or serious criminals. Ramirez’s credit report with TransUnion contained inaccurate information and TransUnion eventually removed the OFAC alert from any future credit reports that might be requested by, or on behalf of, Ramirez. The class action lawsuit brought by Ramirez and others similarly situated against TransUnion was premised on the fact that the class members’ credit reports contained misleading information and the information was disseminated to the third parties. The Supreme Court dismissed a [Read More]

By JEREMY BELANGER
On Oct. 24, 2018, the Eliminating Kickbacks in Recovery Act (EKRA) was enacted. Broadly speaking, EKRA prohibits soliciting, receiving, paying, or offering “any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind,” for referring or to induce a referral to a recovery home, clinical treatment facility, or laboratory, as those terms are defined in EKRA. While modeled after the federal Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b), EKRA applies more broadly to any public or private plan or contract providing medical benefits, items, or services. EKRA is a criminal statute enforced by the U.S. Attorney General. A violation of EKRA may result in a fine of $200,000, up to 10 years imprisonment, or both for each violation.

EKRA contains several statutory exceptions. Among them are:

[A] payment made by an employer to an employee or independent contractor (who has a bona fide employment or contractual relationship with such employer) for employment, if the employee’s payment is not determined by or does not vary by–
(A) the number of individuals referred to a particular recovery home, clinical treatment facility, or laboratory;
(B) the number of tests or procedures performed; or
(C) the amount billed to or received from, in part or [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

MDHHS: Masks No Longer Needed At Schools, Indoors

Department of Health and Human Services officials announced that it is dropping the suggestion that masks be worn in schools or indoors as COVID-19 cases continue to fall.

The health department reported 4,271 new cases and 312 new deaths of COVID-19 over a two-day period this month. The two-day average of cases was 2,136, marking a decline in new cases across the state.

The report prompted the health department to revise guidance for wearing masks indoors to prevent the spread of the virus.

“This is good news for Michigan,” Gov. Gretchen Whitmer said. “While Michigan hasn’t had statewide mask policies since last June, this updated guidance will underscore that we are getting back to normal. Let’s keep working together to build on our momentum so we can keep our kids learning in person.”

The guidance would not be dropped for nursing homes, homeless shelters, jails, prisons and other health care facilities. Officials also still recommended masks for people in isolation or quarantine after exposure to COVID-19.

Health department officials stated that school administrators and other organizations should continue working with county health departments to determine local risk for school.

Michigan [Read More]

This story courtesy of MIRS, a Lansing-based news and information service.

The U.S. Supreme Court stopped the President Joe Biden administration’s vaccination-or-testing requirement on the nation’s largest employers.

The court allowed, however, the administration’s mandate for most health care workers at federally funded health care facilities to continue.

Chief Justice John G. Roberts Jr. and Justice Brett M. Kavanaugh were the only two justices in the majority on both orders while liberal Justices Stephen G. Breyer, Sonia Sotomayor and Elena Kagan would have allowed the workplace requirements to continue.

In the blistering dissent, the justices said, “When we are wise, we know not to displace the judgments of experts, acting within the sphere Congress marked out and under Presidential control, to deal with emergency conditions.

“Today we are not wise,” they wrote. “In the face of a still-raging pandemic, this Court tells the agency charged with protecting worker safety that it may not do so in all the workplaces needed. As disease and death continue to mount, this Court tells the agency that it cannot respond in the most effective way possible.”

In September, Biden signed an executive order mandating that federal employees would need to be vaccinated as a way to control COVID-19 spread, and that companies with 100 or more employees would be required to ensure their employees are vaccinated or test [Read More]

By LAUREN WEBER & PHIL GALEWITZ
The surge driven by the extremely infectious omicron variant helped push the South Florida hospital with 206 licensed beds to 250 patients. The rise in cases came as the hospital struggled with severe staff shortages while nurses and other caregivers were out with COVID.

The challenge is finding room to safely treat all the COVID patients while keeping staffers and the rest of patients safe, said Dr. Scott Ross, chief medical officer.

“It’s not a PPE issue,” he said, referring to personal protective equipment like masks, “nor an oxygen issue, nor a ventilator issue. It’s a volume issue and making sure we have enough beds and caregivers for patients.”

Nationally, COVID cases and hospitalizations are at their highest levels since the pandemic began. Yet, unlike previous COVID surges, large portions of the patients with COVID are coming to the hospital for other reasons. The infections are exacerbating some medical conditions and making it harder to reduce COVID’s spread within hospital walls, especially as patients show up at earlier, more infectious stages of the disease.

Although the omicron variant generally produces milder cases, adding the sheer number of these “incidental” hospitalizations to COVID-caused hospitalizations could be a tipping point for a health care system that is [Read More]

By PAUL NATINSKY
Many recent articles appearing in mainstream conservative newspapers and magazines have bemoaned the unfair persecution of people who choose not to be vaccinated. Many authors find vindication in the shifting nature of virus variants, COVID’s growing footprint as an endemic virus and the highly contagious but less severe omicron variant currently dominating headlines.

What has been left out of many such reports are a few salient facts and included have been some curious policy rationales.

Case in point—The nation’s 17 million healthcare workers must be vaccinated, but not its 80 million workers as the Supreme Court split the baby of the latest federal bill on the subject. As increasing numbers of providers miss work for illness, they are not afforded the very same protections shielding their patients.

Its also been widely reported that two-thirds of COVID hospitalization cases are comprised of the unvaxxed as Michigan hospitals make public appeals for judicious emergency room use and increased vaccinations—the same hospitals that have had to call in federal manpower help as cases surge and caregivers increasingly sicken.

It’s one thing for opinion mills—on the right and left—to take a righteous, one-sided view of almost every news story. It’s quite another for heretofore responsible newspapers and magazines—yes, there still [Read More]

By EWA MATUSZEWSKI

A recent Wall Street Journal article was entitled “The New Trend in Healthcare – Do it Yourself.” My immediate reaction was, “Is this what we’ve come to as community of healthcare professionals – encouraging a DIY approach to primary care?” But reading the article, which had an excellent balance of what patients should and should not be doing on their own, made me realize we’ve been leading up to this point for years. After all, isn’t the patient-centered medical home a partnership model between patient and physician where we’ve encouraged patients to take control of their health? Now, through remote medical monitoring devices, over the counter tests, and mobile apps we are much better positioned to do so. I think we have to look at this development as tremendous progress on the healthcare continuum and that care coordination may finally become reality.

Pivoting from DIY healthcare to its polar opposite, I want to say a few words about vaccine pop-up clinics. After hosting more than 200 clinics and administering more than 5,000 vaccines with first and second dose, booster shoots, or all three, my belief in the value of community-based care has never been stronger. The connections made, the health education information shared, and [Read More]

By STEPHEN SHAVER & CHRISTIAN IERACI
Wachler & Associates P.C.

When a Medicare provider or supplier receives an overpayment demand that they believe is in error, the provider or supplier has a strategic and practical choice to make: let Medicare recoup the money while the appeal is pending or follow certain procedural steps to stop recoupment during the appeal. Either option may have unforeseen consequences and a new court case may offer some tools to providers and supplier caught in this situation.

A Medicare overpayment demand letter kickstarts the lengthy process of appeals and collection attempts, which can be costly and span several years. A demand letter will explain the reason for and the amount of the overpayment, the payment and interest accrual timeline (the provider generally has 30 days before accrual of interest begins), and the provider’s right to appeal the determination. The demand letter will also give the provider options for repayment, which include the immediate payment of the overpayment or recoupment. Recoupment is a process where the applicable Medicare Administrative Contractor (MAC) will recover the overpayment amount by withholding future Medicare payments until the full overpayment amount is recovered.

If the provider files their appeal within a certain timeframe, usually 30 days, it can generally [Read More]

By CHRISTOPHER J. RYAN & GREGORY W. MOORE
Since last year, certain providers (e.g., anesthesiologists, radiologists, surgeons, etc.) in Michigan have had to navigate Michigan’s Surprise Medical Billing Law (Michigan Act). Starting Jan. 1, 2022, those same providers have also had to comply with the Federal No Surprises Act (Federal Act). Generally, both statutes prevent nonparticipating providers from balance billing patients when the patient’s insurance company pays less than the nonparticipating provider’s usual and customary charge. The Federal Act defines “nonparticipating providers” as those who do not have a contractual relationship with a plan/insurance company.

Although the two statutes largely apply to the same providers, those providers need to pay attention to which law applies and take steps to carefully abide by the rate setting process unique to each. Generally speaking, both laws apply to situations where the patient is not able to control whether their treatment team consists of participating or nonparticipating providers.

Michigan’s Surprise Medical Billing Law

The Michigan Act typically applies to three types of treatment rendered by nonparticipating providers:

(1) Treatment of all emergency patients;
(2) Services to non-emergency patients in participating hospitals where the patient does not have the opportunity to choose a participating provider (or the patient has not been provided with prior disclosure); and
(3) [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

COVID-19 Surge Likely To Peak In Late Jan.-Early Feb.

The ongoing COVID-19 surge isn’t likely to reach its peak until the end of January or early February, according to coronavirus scenario hubs viewed by Michigan health officials.

Amongst the most cynical predictions for Michigan, COVID-19 hospitalizations could peak at 8,000 – more than a 90% increase from when the state broke the hospitalization record with 4,191 in late November of 2021.

Slide from the Michigan Department of Health and Human Services during Jan. 11 media briefing.

While an optimistic forecast shows hospitalizations not experiencing much of an increase – similar to where the state is now – Dr. Natasha Bagdasarian, the state’s chief medical executive, said, “We don’t think that is likely to be reflective of our next few weeks here in Michigan.”

“These are ensemble models utilizing information and scenarios put together from top academic institutions around the country, funded by the (Centers for Disease Control and Prevention (CDC) and very similar to CDC models…they’re showing that we will likely peak between the end of January to early February, and then after that things will start coming down,” Bagdasarian said.

At this morning’s media briefing, Bagdasarian [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

Schools Should Mandate Mask Wearing When Classes Resume, Doctor Says

Schools should make mask wearing mandatory for students when they return to the classroom next month, Dr. Matthew Sims, director of Infection Prevention Research for Beaumont Health, said Aug. 10 in an online press conference.
“It’s just a danger that there is no reason to take the risk of making this optional,” Sims said.

He was speaking during an online press conference hosted by Beaumont Health.

Dr. Sandy Patel, pediatrician at Beaumont, said the hospital system has been admitting two to three COVID-positive pediatric patients each week for the past few months. Likewise, the system is seeing one to two mothers each week who are testing positive for COVID while preparing to deliver a newborn.

Children under 12 currently are not eligible for COVID vaccinations, they noted. Sims was asked if schools should mandate mask wearing.

“I really believe they should. We have this entire population of people who cannot be protected by the vaccine and they are going to make masking optional in a place where they can’t keep social distancing? Kids, as you know, are much more likely to hug and touch, get together at [Read More]