Ebola is snagging the big headlines, but physicians have many other things to think about, not least of which is their ability to dispute the accuracy of data on payments made to them by device manufacturers and drug makers.
Most of the news of late about physicians has centered on the ebola outbreak that has doctors from across the world both riveted and worried, and rightly so. When a big health story dominates the landscape, it easy to overlook other important notable events such as the pressure CMS is under because of technical glitches plaguing yet another federal website—Open Payments. That's just one of three items that caught my attention this week.
Open Payments Website Has Healthcare.gov-like Problems
The American Medical Association is ratcheting up the pressure it is putting on the Centers for Medicare & Medicaid Services to delay the release of financial relationships between physicians and medical device and pharmaceutical manufacturers as part of the Physician Payments Sunshine Act, also known as the Open Payments Act.
Like the rollout of the federal health insurance exchange website, the Open Payments system has been plagued with technical difficulties and complaints that the registration process is too long, cumbersome, and difficult to navigate.
Among the chief concerns of physician groups is the ability to dispute the accuracy of data on payments made by manufacturers to physicians. According to the language governing disputes, if a manufacturer or GPO determines a physician's or teaching hospital's request to change data reported isn't needed, then the dispute can be dismissed.
In early August, the AMA and more than 100 medical specialty societies asked for delay of six months in three-page letter to CMS Administrator Marilyn Tavenner.
This week the AMA began surveying physicians online to gauge their experience registering with CMS to review what manufacturers and applicable group purchasing organizations were disclosing about the financial interactions they had with physicians.
Despite much consternation and speculation among physicians, and at least one erroneous media report, there is no definitive word from CMS on whether the Aug. 27 deadline will be enforced or delayed.
Federal Appeals Court Upholds Lame Duck IPAB, Sort Of
A lawsuit challenging the constitutionality of the controversial Independent Payment Advisory Board created by the Patient Protection and Affordable Care Act has been dismissed by U.S. Court of Appeals for the Ninth Circuit.
IPAB has been roundly criticized by Republicans and health industry groups as a body with the intent to ration care. The actual intent of the board, according to President Barack Obama and health policy supporters, is to be a nonpartisan entity that can control Medicare costs.
Although the IPAB's 15 members were supposed to have been appointed by now, there's not been a need to form the group because Medicare spending growth has slowed and been on target. IPAB recommendations for curbing spending are only triggered with spending is projected to outpace targets.
The court's decision to dismiss the lawsuit regarding IPAB came about in part because there is no group to file suit against. There is some speculation that IPAB will not exist in the near future. In her Senate confirmation hearing, Health and Human Services Secretary Sylvia Burwell testified that cuts to Medicare recommended by IPAB weren't likely to happen during her term.
AL Hospital System Settles Alleged Kickback Scheme
Mobile-based Infirmary Health System, one of Alabama's largest health systems, will pay millions of dollars for allegedly participating in a scheme that overbilled Medicare and rewarded physicians for referrals and unnecessary tests.
The total fraud settlement amount is $24.5 million and shared among IHS, along with two of IHS clinics, and Diagnostic Physicians Group P.C. (DPG).
The suit was brought by whistleblower, Christian Heesch, MD, a cardiologist who practiced with DPG. Heesch complained to the Alabama Department of Public Health in 2009 regarding unnecessary nuclear imaging tests ordered for patients. In court documents detailing the complaints, physicians were paid bonuses for ordering medical tests on equipment that was owned by IHS.
Physicians at DPG also received a share of Medicare revenues collected by the clinics. It's illegal for physicians to receive any kind of renumeration that induces referrals of items or services that are covered by federal healthcare programs, such as Medicare and Medicaid. The total amount of Medicare claims paid was $521.6 million; the amount of bonuses paid was more than $18 million.
The Justice Department claims that a DPG attorney warned clinic employees and DPG physicians that the financial referral system was illegal. The practice did not stop until 18 months later. In the meantime, Heesch was fired a month after asking to review DPG financial records. He is suing for punitive damages, lost wages, and other expenses.
He'll receive $4.41 million of the double-digit settlement.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.