Weekend Update

Happy Fourth of July Weekend! Both the House and the Senate will be in session this week following the holiday.

On Friday, the Centers for Medicare and Medicaid Services issued three proposed rules concerning updates to Medicare payment policies for physicians, hospital outpatient departments and ambulatory surgical centers and dialysis centers for 2012. CMS projects the Medicare Part B payments to doctors will drop by 29.5% under the current statutory formula unless Congress acts before the end of the year. Interestingly, as it is the subject of litigation out in California,

CMS is also proposing some changes in how it adjusts payment for geographic variation in the cost of practice.   The Affordable Care Act made some temporary adjustments that would be in place for two years while CMS and the Institute of Medicine study these issues.  As part of this initiative, CMS is replacing some of the data sources—such as using data from the American Community Survey (ACS) in place of HUD rental data and also using ACS data in place of the data currently used for non-physician employee compensation—as well as making other adjustments called for in prior year public comments.  Although these proposals result in very little change to the indices, they show that the data Medicare has used in the past and is proposing to use in the future produce consistent results—suggesting past year adjustments have accurately reflected geographic variations in the cost of practice. 

The California litigation alleges that the geographic variation is unfair to rural providers. On average, CMS will increase hospital outpatient departments payment rates by 1.5%, ambulatory surgical center payment rates by 0.9%, and dialysis center payment rates by 1.8%.

The Washington Post and Kaiser Health News reports today on the trend that the FEHBlog has been following -- health insurer acquisition of medical providers. While the FEHBlog thinks that this trend is driven by the Affordable Care Act which encourages integration and caps insurer profits and could bend the cost curve down which is an expressed objective of the ACA, the article's reporters seem to consider this trend to be the end of the world.

The Las Vegas Sun reports that

A Las Vegas physician has agreed to pay $5.7 million plus interest to settle allegations that he submitted false claims to federal health care programs for various radiation oncology services, the Justice Department announced Thursday.

The government accused Rakesh Nathu of submitting improper claims to Medicare, TRICARE and the Federal Employees Health Benefits Plan from 2007 through 2009.