HR3200 : Division B : Day Five : Part One

Division B, Title IV, Subtitle E, “Reporting on Health Care Associated Infections” begins with a new requirement for public reporting by hospitals on health care associated infections. While the whole “reporting infections” thing is awesome, the intentions of the section may actually be a little deceptive.

The Secretary shall provide that a hospital (as defined in subsection (g)) or ambulatory surgical center meeting the requirements of titles XVIII or XIX may participate in the programs established under such titles (pursuant to the applicable provisions of law, including sections 1866(a)(1) and 1832(a)(1)(F)(i)) only if, in accordance with this section, the hospital or center reports such information on health care-associated infections that develop in the hospital or center (and such demographic information associated with such infections) as the Secretary specifies.

Hospitals and ambulatory surgical centers can only be part of the overall health plan if they agree to report “on health care-associated infections that develop in the hospital or center (and such demographic information associated with such infections) as the Secretary specifies.

While seemingly innocuous to most readers, I question the additional information that will be required simply on the Secretary of Health and Human Services’ decision. I understand that infections should be reported, and I agree that the information about which types of infections are important, but what other information would the Secretary require? Will they be collecting data on the race of patients? Maybe the age and overall health of patients? Some of that data may be legitimate and needed when analyzing infection data, but the section doesn’t stop there. It gives the Secretary the discretion to include any data he/she sees fit, which could be anything.

Section 1461 goes on to state that the CDC will be the collector of the above mentioned data, so it seems my brother-in-law may have some long term job security if the bill passes.

Such information shall be reported in accordance with reporting protocols established by the Secretary through the Director of the Centers for Disease Control and Prevention (in this section referred to as the ‘CDC’) and to the National Healthcare Safety Network of the CDC or under such another reporting system of such Centers as determined appropriate by the Secretary in consultation with such Director.

Another problem I have with this section is the fact that all of the information will be posted publicly. Remember, the Secretary will have the discretion to collect any information he/she sees fit, and we already know that privacy laws do not affect the government throughout most of this piece of legislation. Exactly what information will be collected and posted on the Internet?

The Secretary shall promptly post, on the official public Internet site of the Department of Health and Human Services, the information reported under subsection (a). Such information shall be set forth in a manner that allows for the comparison of information on health care-associated infections—

“(1) among hospitals and ambulatory surgical centers; and

“(2) by demographic information.

Think about it. If they collect data on staph infections and post that information, will they be including names of patients, age of patients, underlying medical conditions of patients, and prognosis following the infection? What about a patient’s right to privacy? Oh yeah, that’s right it doesn’t apply here. So, if you are someone with an illness that you would rather not be known to your friends, family, co-workers, priests, pastors, and everyone else, you better pray to God that you don’t pick up a health care associated infection while you are in the hospital.

Am I fearmongering? Some might say so, but this section (like many others in the bill) leaves the gate open for a lot of possibilities. Everyone knows that dog is going to run once you leave the gate open.

Starting with Title V, Section 1501 we learn that the government will now “redistribute unused residency positions” at hospitals.

If a hospital’s reference resident level (specified in clause (ii)) is less than the otherwise applicable resident limit (as defined in subparagraph (C)(ii)), effective for portions of cost reporting periods occurring on or after July 1, 2011, the otherwise applicable resident limit shall be reduced by 90 percent of the difference between such otherwise applicable resident limit and such reference resident level.

Does this mean there will be the same number of doctors at each hospital, no matter which hospital you choose? What happens if all the residency programs are filled up in your home state? Does this mean young doctors will be forced to move out of state to pursue their chosen profession? Who will decide which hospitals will be allowed more residency positions? Oh yes, the great and powerful Secretary, apparently.

In determining for which qualifying hospitals the increase in the otherwise applicable resident limit is provided under this subparagraph, the Secretary shall distribute the increase to qualifying hospitals based on the following criteria:

“(I) The Secretary shall give preference to hospitals that had a reduction in resident training positions under subparagraph (A).

“(II) The Secretary shall give preference to hospitals with 3-year primary care residency training programs, such as family practice and general internal medicine.

“(III) The Secretary shall give preference to hospitals insofar as they have in effect formal arrangements (as determined by the Secretary) that place greater emphasis upon training in Federally qualified health centers, rural health clinics, and other nonprovider settings, and to hospitals that receive additional payments under subsection (d)(5)(F) and emphasize training in an outpatient department.

“(IV) The Secretary shall give preference to hospitals with a number of positions (as of July 1, 2009) in excess of the otherwise applicable resident limit for such period.

“(V) The Secretary shall give preference to hospitals that place greater emphasis upon training in a health professional shortage area (designated under section 332 of the Public Health Service Act) or a health professional needs area (designated under section 2211 of such Act).

“(VI) The Secretary shall give preference to hospitals in States that have low resident-to-population ratios (including a greater preference for those States with lower resident-to-population ratios).

Read that last one again. Residents will no longer have the option to choose which location they will practice medicine. In fact, someone from Georgia, who is educated at Emory, could end up doing their residency in some small town in northern Idaho, simply because the Secretary of Health and Human Services decided that the hospital there had a low resident-to-population ratio and they were a Federally qualified health center.

The government makes all the rules. The government enforces all the rules. The people have no say. The government decides it all. If it’s not good for the collective, it is not allowed. If it serves the collective, then it is required.

Socialism — a theory or system of social organization that advocates the vesting of the ownership and control of the means of production and distribution, of capital, land, etc., in the community as a whole.

Once again, we are left with no doubt as to the direction this bill will take our country.

The remainder of Title V covers all of the different aspects of the resident programs. Feel free to read it if you wish.

Title VI, Subtitle A is an oxymoron as far as government is concerned. “Increased Funding to Fight Waste, Fraud, and Abuse” and Subtitle B describes the “Enhanced Penalties for Fraud & Abuse”. Subtitle C provides for “Enhanced Program and Provider Protections”.

All three of these Subtitles give the Secretary of Health and Human Services the authority to impose penalties and ultimately to decide if a provider is a “serious risk of fraud, waste, or abuse”. If so, the Secretary has the discretion to deny their application as a Medicare/Medicaid provider.

Section 1632 requires a face-to-face encounter with the patient in order to certify eligibility for home health services or durable medical equipment under Medicare. Section 1632 will modify Section 1814(a)(2)(C) of the Social Security Act.

by inserting after “care of a physician” the following: “, and, in the case of a certification or recertification made by a physician after January 1, 2010, prior to making such certification the physician must document that the physician has had a face-to-face encounter (including through use of telehealth and other than with respect to encounters that are incident to services involved) with the individual during the 6-month period preceding such certification, or other reasonable timeframe as determined by the Secretary”.

On the surface this does not seem so bad, does it? The doctor must meet with the patient before they are eligible for home health services or medical equipment under Medicare. The key is that they have to have had a face to face encounter with the patient in the six month period leading up to that certification. How long will certification last? Will patients be required to see the physician every six months to continue certification?

In the case of my sister-in-law, who is mentally handicapped, the government sends her notices every year insisting that she can “work” to offset some of the costs of her care. She has the mentality of a three-year old and cannot talk. She suffers from seizures and has injured herself numerous times during those seizures. Where exactly would she be qualified to work, and what job would she perform? Yet, the government insists on her seeing a physician every year to “guarantee” that she has not recovered from her 50 plus year diagnosis of brain damage. Yes, they’ve been requiring this every year for the past twenty years or so.

Can you imagine what will happen if seniors and disabled people all across the country are required to meet with their physician every six months simply to prove that they still require the treatment or equipment to keep them healthy (and/or alive)? How does this ensure lower cost health care? Won’t more frequent visits drive up the costs?

If you’re not disabled, requiring home health care or durable medical equipment, don’t worry about feeling like you have been left out.

The Secretary may apply the face-to-face encounter requirement described in the amendments made by subsections (a) and (b) to other items and services for which payment is provided under title XVIII of the Social Security Act based upon a finding that such an decision would reduce the risk of waste, fraud, or abuse.

Every person on Medicare/Medicaid could be required to visit their physician every six months whether or not they have a reason to be doing so, simply to help reduce the risk of waste, fraud, and abuse in the system. If this isn’t an abuse of the system, I don’t know what is.

Subtitle D, Section 1651 takes health care into the realm of criminal justice by allowing access to information by the Attorney General.

For purposes of law enforcement activity, and to the extent consistent with applicable disclosure, privacy, and security laws, including the Health Insurance Portability and Accountability Act of 1996 and the Privacy Act of 1974, and subject to any information systems security requirements enacted by law or otherwise required by the Secretary, the Attorney General shall have access, facilitation by the Inspector General of the Department of Health and Human Services, to claims and payment data relating to titles XVIII and XIX, in consultation with the Centers for Medicare & Medicaid Services or the owner of such data.”.

Once again, on the surface this sounds like something that should already be done. If someone is committing a crime that information should be turned over to law enforcement. The thing is, it already is. I served on the Grand Jury just a couple months ago and one of the cases before us was someone trying to defraud the Medicaid system. Why would the government need to add this to the books?

Of course this just ties up all of our information into one central database.

Financial information, medical information, and now criminal history. All of our information provided to anyone in the government who needs it, all in one nice nifty central database.

Once central place where all of your information is located. One central place where your existence is recorded. Once central place where that mere existence could be wiped from the record books, forever.

“People simply disappeared, always during the night. Your name was removed from the registers, every record of everything you had ever done was wiped out, your one-time existence was denied and then forgotten. You were abolished, annihilated: vaporized was the usual word.”

– George Orwell, 1984, Book 1, Chapter 1

Could this happen? Sure it could. Will this happen? Let’s not find out.

One thought on “HR3200 : Division B : Day Five : Part One

  1. Most States have already enacted laws requiring hospitals to publicly report HAI’s. The section on healthcare infections is already being done at the state level. Some include additional reporting to NHSN (National Health Safety Network) – the CDC’s hospital infection database. Pennsylvania is one of those state requiring reporting to NHSN. The database has the capability of collecting DOB, race, age and SSN when a healthcare worker reports a HAI to NHSN. Indeed, big brother is watching. Joint Commission only requires two patient identifiers to be used when communicating patient data, yet NHSN requires 3 patient identifiers. It seems unnecessary.

    Publicly reported HAI’s are aggregate numbers, which are a poor indicator of quality. The definitions used to determine a HAI are fuzzy, and open to differing interpretation and the training for NHSN is poor, to put it mildly. This section of the bill reminds one of the phrase ‘GIGO’ – garbage in, garbage out.

Comments are closed.