News from Tallahassee for 4/24/14

Medicare Pays FL Doctor $21M posted on 4/9/14

by RICARDO ALONSO-ZALDIVAR | AP

Medicare paid a tiny group of doctors $3 million or more apiece in 2012. One West Palm Beach ophthalmologist got nearly $21 million.

Those are among the findings of an Associated Press analysis of physician data released Wednesday by the Obama administration, part of a move to open the books on health care financing.

Topping Medicare's list was Florida ophthalmologist Salomon Melgen, whose relationship with Sen. Robert Menendez, D-N.J., made headlines last year after news broke that the lawmaker used the doctor's personal jet for trips to the Dominican Republic. Medicare paid Melgen $20.8 million.

AP's analysis found that a small sliver of the more than 825,000 individual physicians in Medicare's claims data base — just 344 physicians — took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion.

About 1 in 4 of the top-paid doctors — 87 of them — practice in Florida, a state known both for high Medicare spending and widespread fraud. Rounding out the top five states were California with 38 doctors in the top group, New Jersey with 27, Texas with 23, and New York with 18.

Melgen, the top-paid physician in 2012, has already come under scrutiny. In addition to allowing the use of his jet, the eye specialist was the top political donor for Menendez as the New Jersey Democrat sought re-election to the Senate that year.

Menendez's relationship with Melgen prompted Senate Ethics and Justice Department investigations. Menendez reimbursed Melgen more than $70,000 for plane trips.

The issue exploded in late January 2013, after the FBI conducted a search of Melgen's West Palm Beach offices. Agents carted away evidence, but law enforcement officials have refused to say why. Authorities declined to comment on the open investigation.

AP picked the $3 million threshold because that was the figure used by the Health and Human Services inspector general in an audit last year that recommended Medicare automatically scrutinize total billings above a set level. Medicare says it's working on that recommendation.

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Telemedicine Bill Still in Play posted on 4/9/14

by AP

caduceusA Senate bill that would increase the use of telemedicine and establish requirements for health providers who treat patients remotely remains in play in Florida’s Legislature.

A companion bill is also making its way through the House, but that bill doesn't require doctors to have a Florida license — only that they be licensed in their home state and registered in Florida.

"If we didn't have an access problem we wouldn't be here today ... everyone would rather see the doctor face to face, but when your mother is having a stroke in rural Florida and the choice is having a doctor via telehealth versus having no doctor," said Rep. Cary Pigman, an emergency room physician who supports the bill.

Today, the Senate Appropriations Subcommittee on Health and Human Services will vote on the bill, which requires doctors providing telemedicine services to patients within the state to be licensed in Florida or meet an alternative requirement. Just one more committee will consider the bill before a Senate floor vote.

For example, an insurer using a doctor that's in-network in another state would also be allowed to treat a Florida patient.

The Senate bill also would require Medicaid to reimburse for telemedicine services and allow doctors to negotiate payment rates with insurers. The House bill doesn't address payments.

» Read more

Obama Administration Retreats On Private Medicare Rate Cuts posted on 4/8/14

by Jay Hancock | Kaiser Health News

Under intense, bipartisan political pressure, the Obama administration backed down for the second year in a row on proposed payment cuts for insurance companies that offer private plans to Medicare members.

After estimating in February that the cuts required by the Affordable Care Act as well as other adjustments would reduce would reduce what it pays insurers next year by 1.9 percent per beneficiary, the Department of Health and Human Services said Monday it would instead give Medicare Advantage plans a raise of 0.4 percent.

America's Health Insurance Plans, the main industry lobby, said it was still studying the announcement. While it acknowledged that Monday's action leaves payments higher than what HHS had originally proposed, it disputed the agency's statement that 2015 rates would rise. AHIP had calculated the originally proposed cuts to be nearly 6 percent, not 1.9 percent.

Adjustments to the February proposals "will help mitigate the impact on seniors," AHIP CEO Karen Ignagni said in a statement. "But the Medicare Advantage program is still facing a reduction in payment rates next year..."

Ana Gupte, an industry analyst for Leerink Partners, agreed, saying the rates disclosed Monday will cut Medicare Advantage payments by about 3 percent. Still, that's a smaller reduction than what she calculated to be 5.5 percent in HHS's first proposal, she said in a note to clients.

The administration, for its part, portrayed the rates disclosed Monday as even better than the flat, year-to-year change that insurance companies sought...

The administration, for its part, portrayed the rates disclosed Monday as even better than the flat, year-to-year change that insurance companies sought.

"The industry asked us to use whatever means we could to keep the rates close to parity, to where they are today," Jonathan Blum, principal deputy administrator at the Centers for Medicare & Medicaid Services, told reporters. The rates set Monday are "a little higher than what the industry had recommended," Blum said.

Among other alterations, HHS dropped a plan to abandon the use of home-visit diagnoses for assigning member risk scores that affect payments. That proposal alone would have shaved 2 percentage points off what Medicare Advantage plans get from the government, according to a study commissioned by AHIP.

"There's a little bit for everybody" in the final policy for 2015, said Anne Hance, a lawyer with McDermott Will & Emery who represents insurers. The administration "tried to work with Medicare Advantage organizations and recognize their concerns," she said.

Medicare Advantage costs taxpayers about 6 percent more per beneficiary than traditional Medicare, according to the Medicare Advisory Commission. Reducing or eliminating that gap could save the program billions of dollars, proponents say.

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Fla lawmakers look to expand, regulate telehealth posted on 4/8/14

by kelli kennedy | AP

MIAMI — The calls may come in the middle of the night and from hospitals more than an hour away. Someone is having a stroke and is en route an emergency room in the Florida Keys, but there aren't any neurologists on call.

Within 15 minutes, a University of Miami neurologist pops onto a computer screen and can order an IV drug that should be given within three hours. It's that sort of potentially life-saving technology that some lawmakers say will drive down health care costs, while also addressing serious doctor shortages around the state.

A Senate bill would increase the use of telemedicine in Florida and establish requirements for health providers who treat patients remotely. A companion bill is also making its way through the House, but that bill doesn't require doctors to have a Florida license — only that they be licensed in their home state and registered in Florida.

"If we didn't have an access problem we wouldn't be here today ... everyone would rather see the doctor face to face, but when your mother is having a stroke in rural Florida and the choice is having a doctor via telehealth versus having no doctor," said Rep. Cary Pigman, an emergency room physician who supports the bill.

The Senate bill requires doctors providing telemedicine services to patients within the state to be licensed in Florida or meet an alternative requirement. For example, an insurer using a doctor that's in-network in another state would also be allowed to treat a Florida patient. The bill recently passed a Senate committee, but has two more stops before it's heard on the floor. Dozens of other states have passed legislation supporting telemedicine.

The Senate bill also would require Medicaid to reimburse for telemedicine services and allow doctors to negotiate payment rates with insurers. The House bill doesn't address payments.

» Read more

As lawmakers pass session’s halfway point, here’s where big issues stand posted on 4/7/14

by News Service of Florida

FL Capitol BldgTHE CAPITAL, TALLAHASSEE -- Florida lawmakers have crossed the mid-point in their 60-day march to craft new laws, amend existing ones and agree on a roughly $75 billion budget for the next fiscal year.

And they've done so mostly without controversy.

A day at the Capitol was blown out to honor the Florida State University football team for winning the national championship, and another day was seemingly devoted to lawmakers taking "selfies" with retired British soccer star David Beckham, who wants to build a soccer stadium in Miami.

With the two chambers working in tandem on most issues, Gov. Rick Scott was able to sign a series of bills into law this week. They included a bill, dubbed the "Florida GI Bill," aimed at making the state more military friendly; a package of bills aimed at keeping sexually violent predators locked up; and a bill that will roll back motor-vehicle registration fees.

Meanwhile, the vast majority of the 1,826 bills, resolutions and memorials filed by members and committees as of Friday morning had already died with barely a murmur.

Here's a look at where a dozen major issues stand as lawmakers head toward the homestretch of the 2014 session:

» Read more

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