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Compensation Committee from Hell? Print E-mail
Written by Jeffrey Herschler   
Thursday, 20 October 2011 07:12

The Joint Committee on Deficit Reduction plans to closely examine entitlement programs like Medicare and Medicaid as it attempts to resolve the nation's long term budget gap.  Reimbursements paid by these programs will be under the microscope.  Click on the link below to view pics of your favorite legislators:

 National Debt Super Committee - Money.CNN.com

Senate Dem's include ,  Patty Murray, Washington, Co-Chair, Max Baucus, Montana and  John Kerry, Massachusetts.  Senate Pub's are Jon Kyl, Arizona, Rob Portman, Ohio and Pat Toomey, Pennsylvania. House leaders serving on the committee are Dem's Xavier Becerra, California,  Jim Clyburn, South Carolina and Chris Van Hollen, Maryland and Pub's Jeb Hensarling, Texas, Co-Chair, Fred Upton, Michigan and Dave Camp, Michigan.

Don't expect the healthcare community to go down without a fight.  For example, see below for latest posting on the MGMA website:

Joint Committee announces first public hearing, contact lawmakers now to repeal SGR!
The new Joint Committee on Deficit Reduction held its first operational meeting Thursday, Sep. 8, followed by its first public hearing Tuesday, Sep. 13. The 12-member bipartisan committee is tasked with proposing at least $1.2 trillion in debt reduction by Nov. 23, which Congress must vote on by Dec. 23.  MGMA urges members to call on the Joint Committee and Congress to address the flawed sustainable growth rate (SGR) and avert the 29.5 percent Medicare physician payment cut scheduled for Jan. 1, 2012. The Joint Committee process may be the best upcoming opportunity to repeal the SGR, as budget offsets for SGR repeal will be in short supply after the Joint Committee completes its work. Visit the MGMA Advocacy Center to get involved and voice your concerns. 


Meanwhile, according to Modern Healthcare, the U.S. House of Representatives has recently reignited its SGR Repeal rally and is also promoting the concept of the Joint Committee as a conduit for change: 

"A 'dear colleagues' letter that was circulated in the U.S. House of Representatives urging repeal of the sustainable growth-rate formula for Medicare payments to physicians garnered 114 signatures before being sent on to the Joint Select Committee on Deficit Reduction." 

Learn More 

View Video:  Deb committee's job:  Fix everything

Last Updated on Wednesday, 26 October 2011 16:36
 
Pill Mill Busts Around the State Print E-mail
Written by Various Sources   
Saturday, 15 October 2011 14:32
Last Updated on Saturday, 15 October 2011 14:47
 
New Law Now Enforceable Print E-mail
Written by Jeffrey Herschler   
Thursday, 13 October 2011 09:36

NEWS YOU CAN USE

As of Oct 1, physicians from outside Florida are required to get a state certificate before providing expert witness testimony in medical malpractice litigation.  They then could face sanctions if it is determined that they gave "deceptive or fraudulent testimony."  The new law also offers safe harbor from lawsuits for doctors who donate health services to high school and college sports teams.  

Presented by MF Healthcare Solutions

Last Updated on Thursday, 13 October 2011 09:56
 
Healthcare Leaders Discuss Medicaid Reform Print E-mail
Written by Jeffrey Herschler   
Thursday, 13 October 2011 09:31

The Greater Miami Chamber of Commerce recently hosted a Panel Discussion entitled :

The Epicenter:  How Medicaid Reform Will Shake Up Healthcare in Florida

Serving on the panel :
-Melanie Brown-Woofter, AHCA, Acting Assistant Deputy Secretary for Medicaid Operations
-Jorge D. Luna, DO, Continucare (Broward County), Chief Medical Officer
-Jorge Rico, MBF Healthcare Partners, L.P., Co-Founding Partner
-Joseph Rogers, Broward Health, COO 

Ms. Brown-Woofter opened the discussion with a review of the current state of affairs, a few references to the past and some sobering statistics.  She reminded us that the state has a $20B budget with 56% federal and 44% state via the matching program.  (see Studies: Medicaid).  She went on to describe an explosion in utilization of Medicaid services due to a bad economy.  "This is what is driving the interest in managed care," she stated.

Dr. Luna stated that "This is Medicaid managed care 2.0" since it's already been attempted in the past.  He was optimistic about the potential to be "ahead of the curve" in Florida.   He went to suggest that the Medicaid managed care model works better in densely populated areas as a more robust network can be created.
Mr. Rico was also upbeat.  He predicted that managed care would create disciplines that are financially sustainable.  He pointed out that there are 3 million Medicaid recipients currently.  That number is expected to swell to 4 million by 2014.

Providing proof that panel discussions should always include a fourth, Mr. Rogers weighed in with a few zingers.  For example, he stated "Medicaid recipients know how to work the system."  He suggested that a program created as temporary assistance to those in an episodic crisis has evolved into a permanent health plan for many citizens.  He was decidedly skeptical about the merits of Medicaid managed care stating "You are dealing with a population not receptive to managed care".  He went on to impersonate a typical Medicaid patient:  "I call the ambulance.  They take me to the hospital.  That's my health plan."

At the end there was a Q & A.  One advocate expressed concern with the potential bad behavior of contracted third parties.  Ms. Brown-Woofter assured her that "intense monitoring of managed care" is part of the plan going forward. 

Last Updated on Thursday, 20 October 2011 07:24
 
Alt Weeklies: Pill Mill Enablers? Print E-mail
Written by Tara Pihn   
Friday, 30 September 2011 00:00

I Read the News Today Oh, Boy!


Earlier this month I read Bernd Wollschlaeger's post:   Pill Mills Under Pressure.  It's an upbeat article highlighting recent achievements in shuttering pill mills and "choking off" the supply of prescription drugs being sold illegally in Florida.   So feeling cheery, I decided to break for lunch.  I grabbed a copy of the Broward/Palm Beach New Times as my meal companion.   I enjoy the feature articles exposing local government corruption, the events calendar and the restaurant reviews.   And I must admit I sort of like the Savage Love column.

So there I was eating a sandwich and a bag of chip and I couldn't help noticing that there are a lot of ads for pain management clinics.  For example in the September 8 edition of Broward/Palm Beach New Times, there are 36 ads for clinics and physician offices offering pain management services.  Sadly and perhaps ironically, there are also several ads offering to treat opiate addiction.  I also see ads for very inexpensive MRI's, less than $200 (more on this later). The other alternative weeklies in the area, Miami New Times and City Link, also run these ads.  And these ads look very sleazy.  Click HERE to watch a video.  One clinic offers pain management services with "NO LIMIT".  Another beckons new patients with this message:  "Has Your Doctor Closed?".  Others will "Meet any Competitors Offer" or deliver "Full Service Pain Management".

These papers have wide circulation in the 25-45, single, urban lifestyle demographic. According to my sources these ads cost $200-$850 per week. Trying to keep an open mind, I thought, perhaps, these operators are legitimate and providing some benefit to the community. But would a legitimate operator get value from this type of marketing expenditure?   To this type of audience?  And if they are not legitimate, could they operate openly by running ads in the alternative weeklies?   

I needed feedback from some experts. So I asked my pal, Jeff Herschler, Publisher of FHIweekly and FloridaHealthIndustry.com, if he could survey his audience.   The survey response was remarkable. Some evaluated the situation from a completely economic view point by calculating a hypothetical ROI.  "Assume a $70 gross rev per visit with 40% margin. Do the math for the cognitive component excluding the technical component and other mark ups..." one Healthcare Consultant wrote. Others were pragmatic, suggesting clinics could meet the letter if not the spirit of the law.  "There is so much scrutiny on these clinics now I have to assume they are doing everything possible to make money and avoid the authorities" a Healthcare IT Executive stated.  But most of the respondents felt the clinics were at best barely legal with serious moral and ethical issues:


"Some of the same clinics are advertising pain management and addiction treatment.  So the suppliers are meeting the demand and in that process creating demand for a new service."   Advertising Executive

"The ease of getting these drugs eventually brought in real druggies who gamed the system in order to get pills to consume or sell. Come here and see a few different pain clinics and a drug dealer can get lots of oxy codone to sell."   IDTF Owner

"The readers of New Times who pay attention to (respond to) pain clinic ads are generally interested in pain meds and other controlled substances for non-medical (abuse, profit) purposes."   M.D. Broward
 
"I have called and will call those doctors drug dealers in white coats. They should not be confused with legitimate pain management specialists who apply multiple treatment modalities to treat pain. We must undertake  all efforts to stop those pain mills."  M.D. Miami Dade

"Any real pain physician would not advertise in those papers."   Practice Management Consultant, Miami Dade

"I remember....,  the truly scary scene where a motley crew of tattooed low lifes and dazed & pierced  hipsters were about to riot because the Doc's office was locked up with a note saying the good doctor was on vacation (probably in the Caymans depositing some cash)."     Healthcare Professional, South FL 

Submit a READER RESPONSE for possible publication.

In sum not a single respondent believes legitimate Pain Management Clinics would or should advertise in an alternative weekly.  Oh, and what about those $199 MRI's?  According to a healthcare professional familiar with the economics of imaging in Florida, "It is hard to imagine earning a profit on an MRI at $200 after subtracting the cost of capital, rent, materials, the tech and the read." Legitimate IDTF operators have long believed these rock bottom priced MRIs are shoddy or even counterfeit studies. To get a scrip the patient needs a study in his chart.  But that film might not be his or her body part.  Thus the pill mills have apparently spawned a cottage industry of questionable MRI providers. 
 
This survey is hardly scientific.   However it does include a broad cross-section of the healthcare community in S. Florida:  men and women with the education, experience and geographic proximity to evaluate what's going on. Please follow this LINK to view the complete Reader Response. 

It seems reasonable to suggest that New Times, part of Village Voice Media, and City Link (Tribune Company) need to rethink who they are doing business with.  One could make the "Freedom of Speech" and "Victimless Crime" argument with regard to the Adult ads.  It's hard to defend the Pain Clinic ads.
 
In addition, it is apparent to me that if you are a law enforcement official charged with Pill Mill crackdown, finding suspects must be like shooting fish in a barrel.
 
Please Read this Report:

Prescription Drug Abuse in Miami-Dade, Broward, and Palm Beach Counties            (Thanks to the BCMA for providing)  
Please contact your Florida State Representative. 
The above link will take you to a web page that (after typing in your home address) will lead you to another web page where you can draft e mails to your State Representative.
 
Please write a Letter to the Editor:
 
Last Updated on Thursday, 13 October 2011 09:36
 
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