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DJP Update 3-8-2011 Mardi Gras ends at midnight! Check out photos & Plan for 2010 Mardi Gras! LAGNIAPPE

DJP Update 3-8-2011 Mardi Gras ends at midnight!  Check out photos &  Plan for 2012 Mardi Gras!  LAGNIAPPE

It is not too early to plan for Mardi Gras 2012: Tuesday, February 21, 2012.

You have to experience it at least once.

Robin and I go to the French Quarter for the morning and early afternoon on Mardi Gras Day.

Here are some of the sights we saw including the Rex Parade passing on Canal Street.  I posted 16 photos at:  http://twitpic.com/photos/DJPNEWS

Click on each picture to enlarge and see full scene.  Also if you click on “More Photos” at bottom of that page, you will get to 2010 images I posted after clicking through a few pages.

As many of you know, a Tulane Medical School classmate of mine, Dr. Ronnie French, was Rex, King of Carnival in 2007.  And previously, the lovely and kind Flora, his wife, was Queen.

LAGNIAPPE:  For the photographers among you, I used my Nikon D90 with 18-200 lens and the small Canon S95.  Both allow capturing the image in JPEG and RAW at the same time.  Digital Negative has the most detail and ideal for Photoshop etc.  Exposure errors and more can be corrected with RAW images.

I posted reduced pixel images at the TwitPic site above.

For those not yet photographers, photography is a wonderful hobby.  You don’t have to feed it every day and you can store the equipment for long periods.  Just remember to remove batteries for long storage. Wonderful to reflect back on family and friend images as the years go by.  Memories may fade but the images take us on a time machine journey of joy.

My nature photography is at:  http://www.naturesreflectionslimited.com/

Great relaxing hobby that clears the mind of daily stresses and the strange happenings in Congress!  Not unlike clearing out the RAM when doing aerobatics in a plane.

Click on the Sample Image Gallery to view some of the photos.  My latest adventure in photography is painting with light.  You can see a one of those images on the cover of The Journal of the Louisiana State Medical Society  Nov/Dec 2008 issue at:  http://www.naturesreflectionslimited.com/pdfs/cover.pdf

The cover of the March/April issue of The Journal of the Louisiana State Medical Society will have another one of my photos painted with light entitled “Aura 3 Women Fiddlers”.  It is  is my interpretation of the aura of three women fiddlers I saw in Australia when lecturing there on leadership.  Inside the same issue is another light motion image I did of a 50’s Jukebox.  Lots of fun.

Will alert you when posted.

Stay well,

Donald

Go to:  http://www.youtube.com/user/IntrepidResources

Leave a comment and encourage others to visit!

P.S. Stop by http://twitter.com/DJPNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at:  http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

DJP Updates:  http://donaldpalmisano.com/djp_update/

Twitter:  www.twitter.com/DJPNEWS

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to 2334 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an  email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

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DJP Update 3-7-2011 Various tweets PPACA, a contest, & Happy Lundi Gras!

DJP Update 3-7-2011 Various tweets PPACA, a contest & Happy Lundi Gras!

Click on the links in the tweets to read the stories.  Check out the contest for one minute video about PPACA.  You might win $5000.00.  Past this link into your browser:  www.iwvoice.org

Don’t forget PCORI in PPACA!

DJPNEWS Donald Palmisano

@WSJOpinion http://tinyurl.com/48mrpl9 Turner Cortes Higgins “ObamaCare’s March Madness” #hcr #PPACA #teaparty #dems #TCOT

3 minutes ago

DJPNEWS Donald Palmisano

Letter to editor St Louis Post-Dispatch re #PCORI of #PPACA by Dr Palmisano & Dr Gale http://tinyurl.com/48kq9wh #hcr

10 minutes ago

DJPNEWS Donald Palmisano

Independent Women’s Voice #IWV offers $5000 1st prize for one-minute or less video regarding harm of #PPACA www.iwvoice.org #hcr

7 hours ago

DJPNEWS Donald Palmisano

Judge #Vinson “clarification” statement #PPACA decision#DJPUpdate 3-4-2011 http://tinyurl.com/328kxgg #law #hcr #tcot#teaparty

5 Mar

DJPNEWS Donald Palmisano

Week of my operation! RT @LAHospitals: Louisiana hospitals prepare to celebrate National Patient Safety Awareness Week http://cot.ag/h0R6ma

4 Mar

DJPNEWS Donald Palmisano

Now in Orlando to give #speech on #leadership#hcr to Florida Chapter of American College of Surgeons #ACS #PPACA

———

Stay well,

Donald

Go to:  http://www.youtube.com/user/IntrepidResources

Leave a comment and encourage others to visit!

P.S. Stop by http://twitter.com/DJPNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at:  http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

DJP Updates:  http://donaldpalmisano.com/djp_update/

Twitter:  www.twitter.com/DJPNEWS

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to 2334 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an  email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

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DJP Update 3-4-2011 In Orlando to give speech to ACS; Judge Vinson’s “clarification” statement on PPACA decision

DJP Update 3-4-2011 In Orlando to give speech to ACS; Judge Vinson’s “clarification” statement on PPACA decision

ITEM ONE:  Now in Orlando to give speech in morning to Florida Chapter of American College of Surgeons.

Title of presentation for 8:00 a.m. Saturday, March 4, 2011:

Mayday! Mayday! Mayday! Physician Leadership in Health System Reform

ITEM TWO:  Judge Vinson’s 20 page clarification of his decision in PPACA in response to Federal Government request to “clarify” ruling – issued March 3, 2011

State of Florida, by and through Attorney General Pam Bondi, et al.;

Plaintiffs,

v.

United States Department of Health and Human Services, et al.,

Defendants

Read the entire 20 pages at:

http://www.scribd.com/doc/49955429/Vinson-Clarification

or

http://online.wsj.com/public/resources/documents/030311vinsonruling.pdf

Interesting how the news reports put different headlines on this issue.  You make your own decision.

DJP COMMENT:  The judge repeats what he said in the first opinion: the entire “Act” must be declared void.  However, he grants stay “conditioned upon the defendants filing their notice of appeal within seven (7) calendar days of this order and seeking an expedited appellate review.”

In other words, you want a stay?  OK, you have it BUT you have 7 days to seek an expedited appellate review.  The clock is ticking!

I pasted a few excerpts from the decision below if you don’t have time to read the entire 20 pages. Thus you can read the judge’s words and not rely on my interpretation.

Page 14

So to “clarify” my order and judgment: The individual mandate was declared unconstitutional. Because that “essential” provision was unseverable from the rest of the Act, the entire legislation was void. This declaratory judgment was expected to be treated as the “practical” and “functional equivalent of an injunction” with respect to the parties to the litigation. This expectation was based on the “longstanding presumption” that the defendants themselves identified and agreed to be bound by, which provides that a declaratory judgment against federal officials is a de facto injunction. To the extent that the defendants were unable (or believed that they were unable) to comply, it was expected that they would immediately seek a stay of the ruling, and at that point in time present their arguments for why such a stay is necessary, which is the usual and standard procedure. It was not expected that they would effectively ignore the order and declaratory judgment for two and one-half weeks, continue to implement the Act, and only then file a belated motion to clarify (6).

Page 18

Finally, for the last factor, I must consider “where the public interest lies.”  Although the defendants’ pleadings present a reasonably persuasive argument for why the “public interest lies” in having my declaratory judgment and de facto injunction stayed pending appeal, almost every argument that the defendants have advanced speaks much more persuasively to why the case should be immediately appealed and pursued in the most expeditious and accelerated manner allowable.  As both sides have repeatedly emphasized throughout this case, the Act seeks to comprehensively reform and regulate more than one-sixth of the national economy.  It does so via several hundred statutory provisions and thousands of regulations that put myriad obligations and responsibilities on individuals, employers, and the states. It has generated considerable uncertainty while the Constitutionality of the Act is being litigated in the courts. The sooner this issue is finally decided by the Supreme Court, the better off the entire nation will be. And yet, it has been more than one month from the entry of my order and judgment and still the defendants have not filed their notice of appeal.

Page 19

After careful consideration of the factors noted above, and all the arguments set forth in the defendants’ motion to clarify, I find that the motion, construed as a motion for stay, should be GRANTED. However, the stay will be conditioned upon the defendants filing their anticipated appeal within seven (7) calendar days of this order and seeking an expedited appellate review, either in the Court of Appeals or with the Supreme Court under Rule 11 of that Court. See, e.g., NML Capital Ltd. v. Republic of Argentina, 2005 WL 743086, at *5 (S.D.N.Y. Mar. 31, 2005) (district court granted motion to stay its own ruling, “conditioned on as prompt as possible appeal and a motion for an expedited appeal”).

Page 20

Therefore, the defendants’ motion to clarify (doc. 156) is GRANTED, as set forth above. To the extent that motion is construed as a motion to stay, it is also

GRANTED, and the summary declaratory judgment entered in this case is STAYED pending appeal, conditioned upon the defendants filing their notice of appeal within seven (7) calendar days of this order and seeking an expedited appellate review.

DONE and ORDERED this 3rd day of March, 2011.

/s/ Roger Vinson

ROGER VINSON

Senior United States District Judge

———

Stay well,

Donald

Go to:  http://www.youtube.com/user/IntrepidResources

Leave a comment and encourage others to visit!

P.S. Stop by http://twitter.com/DJPNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at:  http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

DJP Updates: http://donaldpalmisano.com/djp_update/

Twitter: www.twitter.com/DJPNEWS

YouTube: http://www.youtube.com/user/IntrepidResources

This DJP Update goes to 2334 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an  email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

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DJP Update 3-2-2011 Regulations for PPACA, the new health care law, are coming your way; Lagniappe: Host weekly radio show soon

DJP Update 3-2-2011 Regulations for PPACA, the new health care law, are coming your way; Lagniappe: Host weekly radio show soon

With laws come regulations.  With a law that is more than 2400 pages long, there will be lots of regulations.  And subsequent laws passed sometimes add in other provisions that affect the PPACA law.  The average medical doctor is too busy to monitor the proposed regulations, offer comments in the comment period, or testify.  It is hoped that your medical association or specialty society is up to date on all of these proposed regulations and takes steps to preserve ethical science-based medicine.  You can bet the final regulations for PPACA will exceed the length of the law.  As I wrote in the editorial published in the Journal of the Louisiana State Medical Society, think Gulliver:

Imagine Gulliver tied down by the Lilliputians! Swift relates how Gulliver tried to break the stands that bound him to the ground, “But the harder he fought for freedom, the more the little men shot arrows into him, and some of them even tried to run their spears into his sides.”

Complete article at:  http://journal.lsms.org/images/stories/Editorial.pdf

If you were too busy to notice Federal Government announcement about PCORI (Patient-Centered Outcomes Research Institute), there is a public hearing in St. Louis on March 7-8.

Complete schedule and more about PCORI:  Go to: http://pcori.org/

Note:  This PCORI is NOT the IPAB (Independent Payment Advisory Board) IPAB is a new price-fixing group.  One summary of IPAB is at:  http://healthreformstat.com/2010/06/08/independent-payment-advisory-board/

Most medical organizations oppose IPAB.  As for PCORI, one has to monitor it carefully to make sure it doesn’t lose the educational purpose and turn into a rationing board.

PCORI:  Public Comments are allowed for 30 minutes on Monday March 7 and again for 30 minutes on Tuesday March 8.  Note that 30 minutes each day are for the entire universe of those who wish to comment.  Not 30 minutes per person.

PATIENT-CENTERED OUTCOMES RESEARCH INSTITUTE

Board of Governors Meeting

March 7-8, 2011 (starts at 1 p.m. on Monday and 8 a.m. on Tuesday; all times Central)

The Westin St. Louis Hotel

811 Spruce Street, St. Louis, MO  63102

Below you will find some activity in health system reform.  Here are a few excerpts taken  from the Louisiana Hospital Association mailing to its members (LHA Health Reform Resource Weekly Update – March 2, 2011).  You will note the links and you can visit the links to see the letters written or view the regulation.

For example, look at the comparative effectiveness.  Clicking on the link will take you deeper into the issues raised by the proposed regulations as well as the goal of the regulations.

Here is one excerpt from the Comparative Effectiveness Research and continuing education link below that takes you to this Web address:

http://edocket.access.gpo.gov/2011/pdf/2011-4130.pdf

“AHRQ is expanding its continuing education to include nurses, nurse practitioners, physician assistants, medical assistants, pharmacists, respiratory therapists, and other allied health professionals, as well as physicians. In addition, AHRQ wants to assess the impact continuing education has on clinician behavior, its perceived value, and whether or not education on comparative effectiveness research made a difference in a clinician’s confidence in applying comparative effectiveness research in practice, understanding the application of such research, and improved ability to counsel patients on treatment and management alternatives.”

EXCERPTS FROM LOUISIANA HOSPITAL ASSOCIATION NEWSLETTER

LHA & AHA RESOURCES

·       Letter to Secretary Sebelius regarding Proposed Rule for Rate Increase Disclosure and Review under the PPACA: OCIIO -9999-P, American Hospital Association

·       Letter to Director Berwick regarding  Medicare Program; Solicitation of Comments Regarding Development of a RAC Program for the Medicare Part C and D Programs; File Code CMS-6041-NC, American Hospital Association

  • LHA Letter to HHS/CMS regarding Medicare Program; Solicitation of Comments Regarding Development of a RAC Program for the Medicare Part C and D Programs; File Code CMS-6041-NC

·       AHA Comment Letter Regarding CMS-3239-P, Medicare Program; Hospital Inpatient Value-Based Purchasing Program; Proposed Rule (Vol. 76, No. 9), January 13, 2011

·       AHA Letter to Agency for Healthcare Research and Quality regarding  RE: CMS-2420-NC, Medicaid Program; Initial Core Set of Health Quality Measures for Medicaid-Eligible Adults; Notice (Vol. 75, No. 250), December 30, 2010

——

RULES & REGULATIONS

  • Final Rule: Regulation for the Enforcement of Federal Health Care Provider Conscience Protection Laws, Effective March 25, 2011, HHS
  • Proposed Rule: Community First Choice Option, Comments due 5 pm EST April 26, 2011, HHS/CMS
  • Comment Request regarding Comparative Effectiveness Research— Continuing Education; implements TeamSTEPPS, an evidence based framework to optimize team performance across the healthcare delivery system with the goal of improving patient safety, Comments due March 30, 2011, HHS
  • Improving Patient Safety System Implementation for Patients with Limited English Proficiency, Comments due March 30, 2011, HHS

·       Guidance on the “maintenance of effort” (MOE) provisions in the Patient Protection and Affordable Care Act, P.L. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010; P.L. 111-152 (together known as the ACA), HHS/CMS

  • Comment Request regarding Rate Increase Disclosure and Review Reporting Requirements (45 CFR Part 154) Use: Under the Section 1003 of the ACA (Section 2794 of the Public Health Service Act), the Secretary, in conjunction with the States, is required to establish a process for the annual review, beginning with the 2010 plan year, of unreasonable increases in premiums for health insurance coverage; Comments due May 2, 2011, HHS/CMS

————————

LAGNIAPPE: Later this month, I will start hosting a weekly one-hour radio show.  More details to come.

Stay well,

Donald

Go to:  http://www.youtube.com/user/IntrepidResources

Leave a comment and encourage others to visit!

P.S. Stop by http://twitter.com/DJPNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at:  http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

312-560-0180 cell

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

Twitter:  www.Twitter.com/DJPNEWS

DJP Updates:  http://donaldpalmisano.com/djp_update/

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to 2334 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an  email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

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DJP Update 2-18-2011 2nd Edition ON LEADERSHIP in press; see titles of new chapters and new cover

DJP Update 2-18-2011 2nd Edition ON LEADERSHIP in press; see titles of new chapters and new cover

Hear is a sneak preview of the 2nd edition of my book published by Skyhorse Publishing in New York City.  It is now at the printer.

Two additional chapters in 2nd edition of On Leadership.  It will be a paperback and it has a new cover and a new subtitle.

Chapter 17:  Leadership in Crisis:  The British Petroleum Gulf Oil Spill

Dramatic tale of the explosion.  Images that won’t be forgotten.  Features Governor Jindal of Louisiana and his comments about and interaction with the administration in Washington, DC.

Chapter 18:  Emerging Leaders in a Time of Crisis

This chapter includes the disaster of PPACA, what is needed to fix the healthcare financing system,  airport screening, border control, in addition to discussing potential new leaders in Washington, DC.  It tells of a new grassroots movement to make Congress accountable.  I think you will love the cartoons I added to the 2nd edition.

—–

You can view the alert about the 2nd edition and see the new cover online.

www.onleadership.us

or

http://onleadership.us/

Go to bottom of home page and click on links about 2nd edition.

If you have any ideas about spreading the word to companies, think tanks, or schools to encourage large purchases, please let me know.  I think the two new chapters are very timely and powerful.  The book will be available at Barnes and Noble and other book sellers, including an electronic version on Kindle.  Would love for pre-orders to make the publisher increase the print run!

ALERT:  If you like what you have read in the DJP Updates in the past, you will enjoy the book.  If you do not agree with the DJP Updates, you should not spend your money on a copy of the book.

Stay well,

Donald

Go to:  http://www.youtube.com/user/IntrepidResources

Leave a comment and encourage others to visit!

P.S. Stop by http://twitter.com/DJPNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at:  http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

Twitter:  www.Twitter.com/DJPNEWS

DJP Updates:  http://donaldpalmisano.com/djp_update/

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to 2334 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an  email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

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DJP Update 2-14-2011: FYI re USA President’s 2012 Fiscal Year Budget and SGR

DJP Update 2-14-2011: FYI re USA President’s 2012 Fiscal Year Budget and SGR

The price-fixing Sustainable Growth Rate (SGR) cuts are pushed down the road again for 2 years if this budget is implemented.

Of course, the real fix is to let government pay what it can afford to pay and allow doctors and patients to privately contract for any “gap” in what the government pays and what the doctor says the service is worth.  That is what Australia does with its Medicare program.  People can negotiate a fair fee.  That concept also works in the rest of America and is the hallmark of the Free Enterprise System.  But I keep repeating myself.

I look forward for a strong campaign about private contracting and balance-billing from AMA.  The House of Delegates emphasized with overwhelming vote that this concept is AMA policy and AMA will advocate for it.  We watch and wait.  Price-fixing, coercion, and penalties for private contracting with Medicare patients while in the Medicare program result in loss of access to care. That is what the focus should be on with policies:  prevent loss of access to care!  A medical insurance card from the government is worthless if the patient can’t find a doctor in the hour of need.  Want to see the future of loss of access to care with Medicare?  Just look at Medicaid.  Read the surveys.  Sad.

The proposed budget info below.

READ IT YOURSELF rather than taking the analysis of the media and pundits.

Overview of sections

http://www.whitehouse.gov/omb/budget/Overview/

To download entire budget

http://www.whitehouse.gov/sites/default/files/omb/budget/fy2012/assets/budget.pdf

Be sure to read items related to footnote 3 about SGR on page 194 to see where the money will be removed to extend SGR payments at current levels.

One article with more information about “Doc Fix” is in The Hill at:

http://thehill.com/blogs/healthwatch/medicare/143765-obama-budget-proposes-healthcare-cuts-to-pay-for-two-year-medicare-qdocq-fix-

or

http://bit.ly/icHs7v

Healthcare cuts proposed to pay for two-year Medicare fix

By Julian Pecquet – 02/13/11 04:16 PM ET

President Obama’s 2012 budget proposal delays a steep cut in Medicare reimbursement rates for doctors by squeezing healthcare payments for a broad cross-section of medical providers, administration officials said.

The budget proposal would postpone for two years a scheduled 25 percent cut in the Medicare physician payment formula, known as the Sustainable Growth Rate (SGR), that’s set to go into effect at the end of the year. The $62 billion “doc fix” would be paid for by “changes that squeeze Medicare and Medicaid payments to hospitals and doctors and expand the use of generic drugs in federal health programs,” according to The New York Times.

Physicians’ groups are lobbying for a permanent repeal of the SGR, and it’s not clear how they’ll respond to a two-year solution. In any event, the proposed offsets are almost certain to attract considerable criticism when the administration releases additional details on Monday.

Indeed, the proposed “squeeze” comes at a time when hospitals and doctors’ groups are already clamoring for Congress to repeal the healthcare reform law’s payment advisory board, which is tasked with recommending future cuts to Medicare payments. And Medicare’s chief actuary, Rick Foster, has testified several times that cuts already required by the law may be unsustainable.

“It is important to note that the estimated savings for one category of Medicare provisions may be unrealistic,” Foster testified before the House Budget Committee last month. “The Affordable Care Act requires permanent annual productivity adjustments to price updates for most providers…While such payment update reductions will create a strong incentive for providers to maximize efficiency, it is doubtful that many will be able to improve their own productivity to the degree achieved by the economy at large.”

The White House disagrees with Foster’s assessment.

“The Actuary has also raised concerns that implementing these cost-control measures may not be possible,” healthcare messaging guru Stephanie Cutter wrote on the White House blog last month. “Once again, we disagree. History shows that it is possible to implement measures that will save money for Medicare and the federal government.”

Last year’s recommendations from the president’s fiscal commission offer some indication of possible cuts. They include:

• Cutting payments to hospitals for medical education (saves $60 billion through 2020);

• Ending Medicare payments to hospitals and other providers for unpdaid deductibles and copays owed by beneficiaries (saves $23 billion through 2020); and

• Requiring higher savings from home health providers (saves $9 billion through 2020).

——–

Stay well,

Donald

Go to:  http://www.youtube.com/user/IntrepidResources

Leave a comment and encourage others to visit!

P.S. Stop by http://twitter.com/DJPNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at:  http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

Twitter:  www.Twitter.com/DJPNEWS

DJP Updates:  http://donaldpalmisano.com/djp_update/

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to 2334 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an  email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

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DJP Update 2-12-2011 Some of my recent tweets at DJPNEWS and LAGNIAPPE

DJP Update 2-12-2011 Some of my recent tweets at DJPNEWS and LAGNIAPPE

FYI:  Newspaper editorial page editor (Times-Picayune) and then movie editor later agreed with my tweet comment that any list of 10 most romantic movies of all time had to include Dr. Zhivago.  Dr. Zhivago was not on published list!  See tweet below.  Also read Mitch Daniels’ speech and see if you like it.

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All tweets are at: www.twitter.com/DJPNEWS

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LAGNIAPPE:

-Don’t forget a Valentine message to your loved ones!

-Had a good time with the Leadership in Medicine seminar Thursday afternoon that I teach at Tulane Medical School.  Bright future doctors.  Good participation in discussion.

-Modern Medicine in action:  I did a followup visit to the acclaimed sports medicine doctor at Tulane, Dr. Felix “Buddy” Savoie, Thursday morning.  MRI confirmed his diagnosis of rotator cuff tear in my right shoulder and showed spur that is cutting into supraspinatus portion of rotator cuff.  Operation scheduled for March and will be done with scope and spur removed.  High tech a great addition to medicine.  Imagine the future the young doctors will have with biologics and treatments that destroy certain cancers that frustrate us now because they metastasize early.  The science fiction of yesterday will become their reality.

-Finally, applause to all of you who do volunteer work in USA and in foreign countries.  I have the privilege to know of the work that many of you do.  Thanks for your help to others and the enhancement of the reputation of the medical profession.

Stay well,

Donald

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Also, recent selected DJP Updates can be found at:  http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

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312-560-0180 cell

DJP@donaldpalmisano.com

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www.onleadership.us

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DJP Update 2-5-2011 Annual Meeting Louisiana State Medical Society (LSMS) ended today – Policy votes of LSMS: oppose Individual Mandate & Repeal PPACA

DJP Update 2-5-2011 Annual Meeting Louisiana State Medical Society (LSMS) ended today – Policy votes of LSMS: oppose Individual Mandate & Repeal PPACA

Wonderful Annual Meeting of LSMS this weekend in Baton Rouge, Louisiana.

Good attendance and spirited debate.  Impressed with the participation of younger physicians.

Great seeing the past presidents at our Thursday night dinner.  Some of the past presidents could not make the meeting because of the unusual icing conditions and difficulty traveling.  They were missed.

Highlights:  As with AMA, the LSMS House of Delegates is the policy-making body of the Louisiana State Medical Society.

Resolutions passed included those below.  Note opposition to individual mandate to purchase health insurance and vote to repeal the new healthcare law, PPACA, and support new reform.  That is now policy of Louisiana State Medical Society.  Previously LSMS had sent a letter opposing PPACA.

Great job conducting the business of the House by speaker of the HoD, Dr. Bart Farris and the vice-speaker Dr. Gregory Sossaman.

New Orleans cardiologist Dr. Patrick C. Breaux of Ochsner Clinic completed his outstanding year as LSMS president and Dr. F. Dean Griffen, surgeon from Shreveport, was installed as the new president.  Dr. Andrew (Andy) P.  Blalock was elected president-elect.

Our beloved and now retired Mr. Dave Tarver, EVP for over 29 years, was missed.  We have an able new EVP in Jeff Williams and of course, the talented Mrs. Geraldine Leche, Executive Assistant remains with us as does the rest of our outstanding team.

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Tweets I sent out from Annual Meeting of Louisiana State Medical Society.  Meeting ended today.

www.twitter.com/DJPNEWS

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Another interesting event was the presentation today by Louisiana Department of Health and Hospitals new Secretary Bruce D. Greenstein.  He discussed the new plans for Medicaid in Louisiana.  Great comments by members of House of Delegates who told him of problems with the system and an alternative way to fix it developed by the LSMS.  Several members have worked on committees and studied this issue for years.  I hope the Secretary will be receptive to the views of the LSMS.  To name just a few who urged a better way:  Dr. Mike Ellis, Dr. Floyd Buras, and Dr. Stormy Johnson.  They all spoke at the microphone in the Q & A with the Secretary and during the meeting.  They are very informed on this topic.

LAGNIAPPE:  Thought for the day:  If we don’t save the medical profession, who will?  Washington, DC does not have a passing grade on this issue.

Stay well,

Donald

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P.S. Stop by http://twitter.com/DJPNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at:  http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

312-560-0180 cell

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

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This DJP Update goes to 2323 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

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DJP Update 2-1-2011 Breaking news: Sources say U.S. Senate to vote on repeal of 1099 report requirement of PPACA health law bill today

DJP Update 2-1-2011 Breaking news:  Sources say U.S. Senate to vote on repeal of 1099 report requirement of PPACA health law bill today

DJP comment:  That is what my sources say.  I predict it will pass with bipartisan support.  There goes one of the onerous provisions of the rush to pass bill that became PPACA.

More repeal needed to restore liberty and eliminate burdensome regulations and micromanagement that make health care more expensive & less accessible plus puts quality at risk.

Stay well,

Donald

Go to:  http://www.youtube.com/user/IntrepidResources

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P.S. Stop by http://twitter.com/DJPNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at:  http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

312-560-0180 cell

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

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DJP Updates:  http://donaldpalmisano.com/djp_update/

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to 2326 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

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DJP Update 1-31-2011 Federal health law, PPACA, declared unconstitutional in U.S. Fed Ct in Florida (Pensacola Division)

DJP Update 1-31-2011 Federal health law, PPACA, declared unconstitutional in U.S. Fed Ct in Florida (Pensacola Division)

DJP Comment:  Haste makes waste.  In the rush of Congress to pass PPACA after Senator Brown’s election (no longer had 60 senate votes for cloture), someone failed to insert a “severability clause”.  Thus, if one part of law unconstitutional, then the entire law falls.  Or maybe the framers of PPACA did not want the law to stand if the individual mandate was declared unconstitutional.  Who knows?  Perhaps Congress doesn’t know what they wanted in the rush.

Short excerpt from opinion:

“In sum, notwithstanding the fact that many of the provisions in the Act can stand independently without the individual mandate (as a technical and practical matter), it is reasonably “evident,” as I have discussed above, that the individual mandate was an essential and indispensable part of the health reform efforts, and that Congress did not believe other parts of the Act could (or it would want them to) survive independently. I must conclude that the individual mandate and the remaining provisions are all inextricably bound together in purpose and must stand or fall as a single unit. The individual mandate cannot be severed.”

More info from State of Florida Attorney General’s Office below in media notice plus there is a link to the full opinion.

DJP

Case 3:10-cv-00091-RV -EMT Document 150 Filed 01/31/11

http://www.myfloridalegal.com/newsrel.nsf/newsreleases/3C1041AF8C36B957852578290073A9B8

January 31, 2011

Media Contact: Jennifer Krell Davis

Phone: (850) 245-0150

U.S. District Court Judge Finds the Federal Health Care Law Unconstitutional

TALLAHASSEE, FL – Attorney General Pam Bondi today announced that Florida, along with 25 other states and the National Federation of Independent Business, prevailed in federal court where Judge Roger Vinson struck down the federal health care law as unconstitutional. The Attorney General’s Office filed the lawsuit in response to President Obama signing the Health Care Reform Bill into law last March.

“Today’s ruling by Judge Vinson is an important victory for every person who believes in the freedoms granted to us by our Constitution,” said Attorney General Bondi. “This proves that the federal government requiring Americans to purchase health insurance is in fact unconstitutional. In addition, the bipartisan effort from Attorneys General across the country shows the federal government that we will not back down from protecting the constitutional rights of our citizens.”

The lawsuit, filed last March, alleged the new law infringed upon the constitutional rights of Floridians and residents of the other states by mandating all citizens and legal residents have qualifying health care coverage or pay a penalty. The law would also coerce citizens into an expansive Medicaid program which would result in enormous costs to taxpayers.

“NFIB is extremely pleased with Judge Vinson’s decision,” said Bill Herrle, executive director of NFIB/Florida. “NFIB joined this case to protect the rights of small-business owners to own, operate, and grow their businesses free from unconstitutional government intervention. The individual mandate gives the federal government entirely too much power. Small business owners are delighted Judge Vinson agreed with NFIB and Attorney General Bondi on this critical issue.”

A copy of today’s ruling is available at:
http://myfloridalegal.com/webfiles.nsf/WF/JDAS-8DMNTD/$file/VinsonRuling1312011.pdf

DJP Comment:  Here is an important excerpt from the 78 page opinion:

Severing the individual mandate from the Act along with the other insurance reform provisions — and in the process reconfiguring an exceedingly lengthy and comprehensive legislative scheme — cannot be done consistent with the principles set out above. Going through the 2,700-page Act line-by-line, invalidating dozens (or hundreds) of some sections while retaining dozens (or hundreds) of others, would not only take considerable time and extensive briefing, but it would, in the

Case No.: 3:10-cv-91-RV/EMT

Case 3:10-cv-00091-RV -EMT Document 150 Filed 01/31/11 Page 72 of 78

Page 73 of 78

end, be tantamount to rewriting a statute in an attempt to salvage it, which is foreclosed by Ayotte, supra. Courts should not even attempt to do that. It would be impossible to ascertain on a section-by-section basis if a particular statutory

provision could stand (and was intended by Congress to stand) independently of the individual mandate. The interoperative effects of a partial deletion of legislative provisions are often unforseen and unpredictable. For me to try and “second guess” what Congress would want to keep is almost impossible. To highlight one of many examples, consider the Internal Revenue Service Form 1099 reporting requirement, which requires that businesses, including sole proprietorships, issue 1099 tax forms to individuals or corporations to whom or which they have paid more than $600 for goods or services in any given tax year [Act § 9006]. This provision has no discernable connection to health care and was intended to generate offsetting revenue for the Act, the need of which is greatly diminished in the absence of the “health benefit exchanges,” subsidies and tax credits, and Medicaid expansion (all of which, as the defendants have conceded, “work in tandem” with the individual mandate and other insurance reform provisions). How could I possibly determine if Congress intended the 1099 reporting provision to stand independently of the insurance reform provisions? Should the fact that it has been widely criticized by both Congressional supporters and opponents of the Act and the fact that there have been bipartisan efforts to repeal it factor at all into my determination?

In the final analysis, this Act has been analogized to a finely crafted watch, and that seems to fit. It has approximately 450 separate pieces, but one essential piece (the individual mandate) is defective and must be removed. It cannot function as originally designed. There are simply too many moving parts in the Act and too many provisions dependent (directly and indirectly) on the individual mandate and other health insurance provisions — which, as noted, were the chief engines that drove the entire legislative effort — for me to try and dissect out the proper from

Case No.: 3:10-cv-91-RV/EMT

Case 3:10-cv-00091-RV -EMT Document 150 Filed 01/31/11 Page 73 of 78

Page 74 of 78

the improper, and the able-to-stand-alone from the unable-to-stand-alone. Such a quasi-legislative undertaking would be particularly inappropriate in light of the fact that any statute that might conceivably be left over after this analysis is complete would plainly not serve Congress’ main purpose and primary objective in passing the Act. The statute is, after all, called “The Patient Protection and Affordable Care Act,” not “The Abstinence Education and Bone Marrow Density Testing Act.” The Act, like a defectively designed watch, needs to be redesigned and reconstructed by the watchmaker.  If Congress intends to implement health care reform — and there would appear to be widespread agreement across the political spectrum that reform is needed — it should do a comprehensive examination of the Act and make a legislative determination as to which of its hundreds of provisions and sections will work as intended without the individual mandate, and which will not. It is Congress that should consider and decide these quintessentially legislative questions, and not the courts.

In sum, notwithstanding the fact that many of the provisions in the Act can stand independently without the individual mandate (as a technical and practical matter), it is reasonably “evident,” as I have discussed above, that the individual mandate was an essential and indispensable part of the health reform efforts, and that Congress did not believe other parts of the Act could (or it would want them

to) survive independently. I must conclude that the individual mandate and the remaining provisions are all inextricably bound together in purpose and must stand or fall as a single unit. The individual mandate cannot be severed. This conclusion is reached with full appreciation for the “normal rule” that reviewing courts should ordinarily refrain from invalidating more than the unconstitutional part of a statute, but non-severability is required based on the unique facts of this case and the particular aspects of the Act. This is not a situation that is likely to be repeated.

Case No.: 3:10-cv-91-RV/EMT

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Stay well,

Donald

Go to:  http://www.youtube.com/user/IntrepidResources

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P.S. Stop by http://twitter.com/DJPNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at:  http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

312-560-0180 cell

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

Twitter:  www.Twitter.com/DJPNEWS

DJP Updates:  http://donaldpalmisano.com/djp_update/

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to 2318 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

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