THIS JUST IN….Another blow to the Constitution

 

This just in: A federal judge in Detroit Thursday afternoon rejected a request for a preliminary injunction to halt the health-care overhaul signed into law by President Obama back in March.

In his 20-page opinion, Judge George Caram Steeh upheld the constitutionality of the law, finding that Congress possesses the authority under the Constitution’s Commerce Clause to require that every American purchase health insurance. Click here for the Bloomberg report; here for the opinion; here for other LB coverage of challenges to the health-care law.

Steeh’s analysis under the Commerce Clause was broken into two parts. First, he found that the economic decisions that the Act regulates as to how to pay for health care services affect the interstate health care market. He wrote:

decisions to forego insurance coverage in preference to attempting to pay for health care out of pocket drive up the cost of insurance. The costs of caring for the uninsured who prove unable to pay are shifted to health care providers, to the insured population in the form of higher premiums, to governments, and to taxpayers. . . . These decisions, viewed in the aggregate, have clear and direct impacts on health care providers, taxpayers, and the insured population who ultimately pay for the care provided to those who go without insurance.

Next Steeh found that the individual mandate, the provision that requires everyone to have health coverage, was essential to the act’s larger goal of regulating “the interstate business of health insurance.

 

This decision is only the first shot across the bow of Obamacare. There are numerous actions in several state and district courts, see here,  and here, and here.   A word from the Supreme Court

Justice Steven Breyer

del.icio.us Tags: APPA,Supreme Court,Obamacare

Pomegranate Juice, What is ??

The Wall Street Journal reports an impending battle between the marketers of Pomegranate Juice and the Food and Drug Administration.  In their report which contains this video clip

POM  vs.. The FTC

 

The FTC official who has accused the company (which Resnick runs with her husband Stewart) of making false health claims about the beverage has gone “crazy” on this issue and is a “zealot,” as she says in the WSJ today. She says unlike other major food producers, the company won’t back down from the spat — let’s call it a battle, at this point — in part because her husband hates “bullies.”

Now would it not be wonderful if we “impotent physicians took a lesson from this company.  They have done the research, and it is going to be up to the FTC and perhaps the FDA to disprove their ‘preventive nutritional product”.   I see lots of federal dollars being appropriated to perform an official trial. More wasted taxpayer dollars !

At a time when CMS and all the insurers are beating their chests about outcomes and prevention it once again points out the schizophrenia of HHS.

To the Resnicks I say thank you ….All of us should. This will be a landmark case.  It took awhile for ‘allopathic medicine to catch on to the benefit of omega 3 fatty acids and it’s role in immunology.

del.icio.us Tags: immune system,pomegrante,resnick,health train express,ftc,fda

Discrimination in Play for Health Reform in California

 

Discrimination in Play for Health Reform in California

CALHIPSO, or California Health Information Partnership & Services Organization has issued a brief regarding it’s services which will only be available to primary care physicians.

The California Health Information Partnership and Services Organization (CalHIPSO) is an organization founded by clinical providers, for clinical providers, to help them successfully navigate through the complicated world of electronic health records (EHR) implementation. Our founding organizations are the California Medical Association (CMA), the California Primary Care Association (CPCA) and the California Association of Public Hospitals & Health Systems (CAPH).

  

CalHIPSO is primarily supported through stimulus funding made available from the federal Office of the National Coordinator for Health Information Technology to support the ability of 100,000 clinical providers nationwide to adopt EHR by the year 2014. Beginning in 2011, Medicare and Medi-Cal will make payments between $44,000 and $63,750 per provider to those who can demonstrate that they are “meaningfully using” EHRs. The sooner you can demonstrate “meaningful use,” the more funding you will receive since EHR incentive payments will end in 2014.

It is apparent that although federally funded by all our tax dollars these funds are unavailable to specialists.

It seems to me that communication between primary care and specialty practices is not a meaningful use for EMRs according to CMS & HHS. It is also blatantly apparent the guise of EMR is to extract data from EMRs and not to improve quality of care. Without a tight integration between primary care and specialty care there is a breakdown and further decrease in efficiency. How are outcomes going to be truly assessed without input from specialty care, (aren’t most surgeries performed by surgeons?) many of whom do primary care medicine.

Apparently the California Medical Association also does not support specialty care. Regardless of whether one supports the implementation of EMR and HIE it behooves all physicians to notify CMA of our displeasure at being de-selected from their representation.

Also, because the number of specialty care physicians outweigh the number of primary care physicians our combined membership in CMA would carry significant weight. (or perhaps specialty physicians have already quit CMA and AMA realizing they do not represent us.

This message is personal opinion only and does not represent the opinions of Docs4PatientCare. 

 

Gary M. Levin M.D.

How Statistics Lie

The New England Journal of Medicine in an article written by Thomas Bodenheimer M.D., Ph.D., And David West M.D analyze  Medicare statistics from the beloved Dartmouth Study. The Dartmouth Atlas of Health Care study reveals a wide disparity in the number of coronary bypass procedures in Golden Colorado compared to other areas.

The report reveals a 60% reduction in the number of procedures as compared to Miami, Florida.  The Dartmouth Atlas Study has been used to justify changes in payment systems by Medicare. The study has previously criticized for a number of flaws.

One factor which may  explain the disparity regarding numbers of cardiac cases is Golden Colorado’s proximity to a major heart center in Denver, Colorado.  A quick google map search will reveal that is is a short 15  minute ride to the outskirts of Denver, and a 25 minute ride to downtown Denver and the University of Colorado.

This is a very important factor in the numbers differences.

“Centers of Excellence”  became a buzzword about ten years ago for cardiac, orthopedic, and other specialties.

The typical scenario for a patient with cardiac problems would be to travel and  seek out the best experts in a region for a cardiac problem.

Would you seek out a surgeon or cardiologist in Golden if you could drive down the road for fifteen or twenty minutes to have a cardiac surgery at a university center? 

The article attempts to justify the differences in cost as a result of managed care organizations with primary care as the ‘gatekeepers’. They attribute risk management coupled with witholds of physician payments, rewarding groups that manage costs well with a financial reward and a form of rebates.

In my opinion there were some very good observations that might be transferrrable to other communities, regardless of reimbursement algorithms.

1.Rocky and Grand Junction’s family physicians made another unusual decision: to pay physicians Medicaid fees equal to those for other patients. As a result, Medicaid patients gained access to private primary and specialty care — and became less likely to utilize expensive care in emergency departments. This policy is probably responsible for the low per-enrollee cost for Medicaid acute care

2.The most important event in Grand Junction’s health care history was the assumption of leadership by family physicians.⁴ In the early 1970s, a group of primary care physicians and specialists founded the physician-run Rocky Mountain Health Plans (“Rocky”) and the Mesa County Physicians Independent Practice Association (MCPIPA). Family physicians gained substantial control of these organizations and fostered a culture of incentives for cost control and cost transparency. In 2006, Grand Junction had 85% more family doctors per capita than the national average.

3.Many medical communities have two or more hospitals with cardiac-surgery units and other expensive services. To compete for cardiologists and cardiac surgeons, such hospitals create more cardiac-catheterization facilities and perform more coronary angiography and revascularization procedures. In Grand Junction and its surrounding hospital referral region, there is only one tertiary care hospital, St. Mary’s, providing interventional cardiac care, neurosurgery, and other subspecialized services. St. Mary’s is fed by smaller secondary care hospitals that do not offer expensive interventional services. Moreover, thanks in part to the control of the primary care community over Rocky, St. Mary’s has kept its number of beds and amount of expensive equipment at reasonable levels. Because only one hospital can offer interventional cardiac procedures, there isn’t room for many cardiologists in Grand Junction; with such limits on facilities and workforce, the rates of such procedures remain low.

4.Finally, with the encouragement of family physicians, low-cost end-of-life care became a prominent part of the region’s health care system. Thanks to the area’s single nonprofit hospice, which also offers palliative care, physicians are educated about initiating discussions with elderly patients about advance directives, and the public is informed about end-of-life choices. As a result, Grand Junction’s population spends 40% fewer days in the hospital during the last 6 months of life and 74% more days in hospice than the national averages, and 50% fewer deaths than average occur in the hospital.

google.com Tags: Grand Junction Colorado, Darmouth Atlas Study, cardiac cath, risk management, hospice, West, Bodenheimer

Jerry vs. Carla (not Simon)

 

California is a reflection of what ails our great nation. The major party gubernatorial candidates offer us very little to chose from with their ‘platforms’…During the recent debate between former Governor, Mayor Jerry Brown and ex-CEO entrepreneur Carla Fiorina several points were glaringly apparent.

Governor Brown, for all his experience seemed like a washed out politician-bureaucrat.  He has been a governor, a mayor, attorney general, and his political career seems pointless in the ‘great scheme of things. Once a possible Presidential candidate, he failed to generate enthusiasm for this post.

Brown has had a lengthy political career, spanning terms on the Los Angeles Community College District Board of Trustees (1969–1971), as California Secretary of State (1971–1975), as Governor of California (1975–1983), chairman of the California Democratic Party (1989–1991), the Mayor of Oakland (1998–2006), and is the current Attorney General of California (2007–present).[1]

Brown unsuccessfully sought the Democratic nomination for President of the United States in 1976, 1980, and 1992, and was an unsuccessful Democratic nominee for the United States Senate in 1982.

He has had a busy life of public service to California, and probably should retire, change focus, write some memoirs and books and perhaps teach political science at Berkely.

His performance in the debate failed to generate any enthusiasm on my part, and he and I are products of the 60s and 70s. He and I are about the same age, and I have decided to go quietly into the night and leave the stage to those younger, with brighter eyes, who are not singed with skepticism and cynicism.

CarlyFlorina also failed to generate any enthusiasm for me as well.

Attractive, well spoken, articulate she outshined Jerry Brown on stage and in content. There are some significant issues with her candidacy. Like Governor Schwarzenegger she has no previous governing or political cadence other than her time in the executive office and board of Hewlett Packard.

The following is quoted from Wikipedia.

Carly Fiorina (born Cara Carleton Sneed; September 6, 1954) is an American political candidate and businesswoman. She is the 2010 Republican nominee for the United States Senate representing California. Fiorina served as chief executive officer of Hewlett-Packard from 1999 to 2005 and previously was an executive at AT&T and its equipment and technology spinoff, Lucent. She currently serves on the boards of several organizations.

Fiorina was considered one of the most powerful women in business during her tenure at Lucent and Hewlett-Packard. The spinoff, from HP, of Agilent Technologies – which had been initiated by her predecessor, Lew Platt – was completed shortly after she joined the company in 1999. Under her leadership, in 2002, the company completed a contentious merger with rival computer company Compaq. In 2005, the Hewlett-Packard board forced Fiorina to resign. She attended the UCLA School of Law but dropped out after one semester. Fiorina received a Master of Business Administration (MBA) in marketing from the Robert H. Smith School of Business at the University of Maryland, College Park in 1980. She received a Master of Science in management from the MIT Sloan School of Management under the Sloan Fellows program in 1989. Fiorina worked various secretarial and receptionist positions, including a stint at Hewlett-Packard as a temporary worker through Kelly Services. She later worked as a receptionist at real estate firm Marcus & Millichap (including working briefly as a broker). During her speech at the 2006 ICSC convention in Las Vegas, Fiorina noted that her time at Marcus & Millichap helped her learn how to navigate the business world. Fiorina taught English in Italy; her first husband's career had taken them to that country.[4] She joined AT&T in 1980 as a management trainee and rose to become a senior vice president overseeing the company's hardware and systems division. In 1995, Fiorina led corporate operations for the spinoff from AT&T of Lucent, reporting to Lucent chief executive Henry B. Schacht;[5] she played a key role in planning and implementing the 1996 initial public offering of stock and company launch strategy.[6][7] Later in 1996, Fiorina was appointed president of Lucent's consumer products business, reporting to Rich McGinn, president and chief operating officer.[8] In 1997, she was appointed chairman of Lucent's consumer communications joint venture with Philips consumer communications.[9] Later that year, she was named group president for the global service provider business at Lucent, overseeing marketing and sales for the company's largest customer segment.[10][11]

In 1998, Fortune magazine named her the "most powerful woman in business" in its inaugural listing, and she was included in the Time 100 in 2004 and remained in the Fortune listing throughout her tenure at HP. Fiorina was #10 on the Forbes Magazine's List of The World's 100 Most Powerful Women for 2004.[12][13][14][15][16][17][18] She became regarded by many as being the first woman to head up a Fortune 20 company, and to have overcome the proverbial "glass ceiling".[19][20][21]

In 2008, Fiorina served as an advisor to Republican presidential candidate John McCain. In November 2009, Fiorina announced she would challenge incumbent Democrat Barbara Boxer for her United States Senate seat representing California.[1] On June 8, 2010, Fiorina won the Republican primary election.

After resigning from HP, Fiorina was named to several board memberships. She was named to the boards of directors at Revolution Health Group (Steve Case-AOL) and computer security company Cybertrust. The following year, she became a member of the board of directors for chip maker Taiwan Semiconductor Manufacturing Company.[49][50][51] She joined the board of trustees of the Massachusetts Institute of Technology and the Foundation Board of the World Economic Forum. She is an Honorary Fellow of the London Business School.[52][53][54] [55]

In October 2006, Fiorina released an autobiography, Tough Choices, about her career and her views on such issues as what constitutes a leader, how women can thrive in business, and the role technology will continue to play in reshaping the world. Fiorina signed on with the Fox Business Network to become a business commentator on the network.[58] She is Chairman and CEO of Carla Fiorina Enterprises where, according to her political campaign Facebook page, she is "bringing her unique perspective and experience to bear on the challenging issues of our world, championing economic growth and empowerment for a more prosperous and secure world."[59] She has appeared at many public events. She rang the opening bell of the Wall Street stock market on the official day of the HP-Compaq merger and in 2000 she was the ceremonial host opening the largest EasyInternetcafé at Times Square and the opening of the Epcot ride Mission: SPACE.[60] In 2004, Fiorina was a member of the President's Commission on Implementation of United States Space Exploration Policy, which produced a report for George W. Bush. She has appeared many times on TV such as in 2007 on Real Time with Bill Maher.

In 2008, Fiorina joined as a part of the Senator John McCain presidential campaign. In early 2008, Fiorina was referred to in media sources as a potential vice presidential candidate.

The Los Angeles Times research of public records indicated Fiorina had failed to vote in most elections. Fiorina responded: "I'm a lifelong registered Republican but I haven't always voted, and I will provide no excuse for it. You know, people die for the right to vote. And there are many, many Californians and Americans who exercise that civic duty on a regular basis. I didn't. Shame on me."[99][100]

HP survived much because of her leadership which included axing the employment of 30,000 American workers. Her argument that it was necessary due to governmental regulations in the United States which prevent companies from operating economically on our own soil. This was a cheap shot because there are many factors that drive up costs for businesses in the United States.

Neither candidate will light fires for most voters, but if I had to vote, or lose everything I would have to vote for Jerry Brown….at least it is same old, same old, and he has been there before. Carly Fiorina has enough money to not work, having enjoyed entrepreneurship at it’s best. (however she did not start anything….she walked into several positions at the right time.) She has invested a considerable amount of her personal fortune into her campaign.

An important thing to remember is that the Governor has Veto Power.

 

And what does this have anything to do with health care? Damned if I know, but then again I am in the back 40 of the pastures.

I am going to take a hard look at lesser candidates and if nothing draws my attention I will write myself in for (other).

LiveJournal Tags: Jerry Brown,Carly Fiorina,Health train express,HP,Governor,attorney general,election

Do You Know What your Ratings are?

Internet web based rating sites have grown substantially in the past five  years.  At first I thought this would be a short lived phenomenon, however like most things on the internet they have flourished.

I must admit that I now Google for most of my colleagues’ information, because it is so efficient.  Usually the top rated first page results from a Google search brings up ‘Ucompare”, Healthgrades, Wellness, Doctor.com

If you don’t know the name and who John R. Morrow is and what he  does you need a quick brief on what he does and how it may matter to all of us.

John R. Morrow has founded, created and contributed to a variety of national and international ratings programs including; 100 Top Hospitals : Benchmarks for Success℠ a Thomson-Reuters product, The Patient Satisfaction Index™ a National Research Corporation product, The Hospital Value Index™ a Press Ganey & Associates property, and is currently in Beta with Distinguished Doctor™, a new doctor profiling initiative. Morrow was a Principal at HCIA/Solucient, CEO of CHKS (UK) Ltd, SVP at HealthGrades and is Principal at The Ratings Guy LLC.

Matthew Holt published an article by Mr. Morrow in today’s The Health Care Blog.

Understand that all of this rating stuff is here, and it will remain so. It will be better to learn how to deal with it….it is not going away (until the flow of money stops to those web publishers.

Did you Know???

The IRS would apply the withholding to physicians' tax obligations for the year. The remainder would be refunded after doctors file their tax returns the following spring, but in the meantime, the federal government would hold that money, interest-free.

Physician practices face a 3% reduction in payments, as well as potential accounting headaches, under a little-noticed tax provision.

A little-known provision tucked into a 2005 tax bill requires the Internal Revenue Service, starting in 2012 at the earliest, to withhold 3% of payments to any contractor doing work for federal, state or local governments. The Medicaid program is excluded because it provides services based primarily on patient need. But Medicare, which is age-based, is not exempt.

The GAO issued another report in March 2007 finding that approximately 5% of physicians and others who billed for Medicare Part B services continued to receive money from the program, despite having significant outstanding federal payroll and income tax liabilities.

Supporters of the withholding concept say it is a necessary response to widespread failures by contractors both to pay their taxes and to render good service.

Physicians may be able to escape the withholding, even if the provision remains in place by 2012. The MGMA's Smith said defense contractors, not the medical community, appear to be the intended target of the 2005 policy. He remains hopeful that physician practices will be exempted.

WTF ?

The Complete Meal

Thanks to Dr Wes for this,

 

“Parents the world over know the magic of McDonald's Happy Meals. There's something about the promise of a Happy Meal - the way it's packaged, the free toy - young families and especially kids find them irresistible. But anyone who's purchased one of these knows the reality: that toys within the Happy Meal are typically played with for no more than three minutes and the plastic tchotchkes are discarded faster than the accompanying 2% milk.

There's a common sense saying: "If it sounds too good to be true, it probably is too good to be true."

A complete meal for $0.99. (It may be small, but it’s what we promised.)

 

Even if we find that the $19.99 infomercial slicer/dicer doesn't work at home as it did on television, American's love the psychological reassurance that this time the government will make health care available to all without restriction, expense, or consequence, be they boys or girls, legal or illegal, young or old, right-handed or left-handed, with preexisting condition or not, - no one will be left behind in our new omnipotent era of Patient Protection and Affordability.
We should all know better, but the sad fact is, we're all suckers.
Not that some of the promises made wouldn't be useful, helpful, or even critical to many families. But to position health care reform (and the Patient Protection and Affordable Care Act in particular) as a win-win with no hard choices, no limits to health care for our seniors, no future commoditization of medicine, unlimited access to procedures and doctors, and all with no enormous financial cost, is to stick one's head in the sand.
Package it, spin it, wrap it in plastic - then put it next to a cheeseburger.
No matter what you call it, it's still Hopium.”

HOW DID JEFFERSON KNOW??????

 

It has been said the greatest volume of sheer brainpower in one place occurred when Jefferson dined alone..." John Kennedy

When we get piled upon one another in large cities, as in Europe, we shall become as corrupt as Europe.
Thomas Jefferson

The democracy will cease to exist when you take away from those who are willing to work and give to those who would not.
Thomas Jefferson

It is incumbent on every generation to pay its own debts as it goes.   A principle which if acted on would save one-half the wars of the world.

Thomas Jefferson
I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them.
Thomas Jefferson

My reading of history convinces me that most bad government results from too much government.
Thomas Jefferson

No free man shall ever be debarred the use of arms.
Thomas Jefferson

The strongest reason for the people to retain the right to keep and bear arms is, as a last resort, to protect themselves against tyranny in government.
Thomas Jefferson

The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants.
Thomas Jefferson

To compel a man to subsidize with his taxes the propagation of ideas which he disbelieves and abhors is sinful and tyrannical.
Thomas Jefferson

 

Seems to me that Thomas had it right.  Now, how can this basic principle of our Republic be applied today?

LiveJournal Tags: Thomas Jefferson,Republic,Freedom,Government,tyranny,taxes,right to bear arms,democracy,debt,kennedy,health train express

The Amazing Carelessness Of ObamaCare Grace-Marie Turner Investor's Business Daily, May 11, 2010

I don’t think Grace-Marie would mind if I give her attribution for this article she wrote.

All bets ARE off as to what really is going to transpire with health reform.  Passing this legislation was a sham for the democrats and President Obama, just to  pass something, workable or not.

DO’S & DON’T’S

 

There are many comments circulating on the social media networks, first the blogs, now Facebook and Twitter. Rumor has it that facebook and twitter are passing google and RSS feeds by, so blogging is now old hat.  (it used to be a challenge to make a blog.) Thanks to all you super-geeks guys like me can pour it on with little effort . 

Many well known bloggers now don’t even write their own stuff, leaving it to ‘interns’ in the blogville.and syndicating many blogs into one place, such as Better Health.

 

I often wonder if these bloggers see any patients.  They always seem to be right there, posting my news just before I click on “publish”.

The big thing now is should doctors participate in social media? What are the rules? 

Fierce Practice Management analyzes this well

Despite all of the benefits and pitfalls surrounding the use of social media by physicians, formal rules for medical professionals to follow online are still in the making. But even as The American Medical Association Council on Ethical and Judicial Affairs, The American College of Physicians' Center for Ethics and Professionalism and other organizations continue to work on new policies, social media pioneers have identified some general do's and don'ts for practicing physicians

The  American Medical Association weighs in as well.

 

In summary,  or as a tweet should be, short and sweet.

Social media do's and don'ts

Here are social-media experts' answers to ethical dilemmas physicians face when using Facebook, Twitter or similar sites.

Should I accept Facebook friend requests from patients? Probably not. Keep your personal profile only for friends, family and colleagues. Create a separate business page to share general health information with your patients.

Should I respond to personal medical questions on Facebook or Twitter? No. Refer questions to the patient's physician. If the question comes from your patient, handle it through an office visit, phone consultation or encrypted e-mail exchange.

Should I post any identifying information about my patients? Absolutely not. It is unethical and illegal.

Should I blog or tweet anonymously? Probably not. Anonymity can make it easier for doctors to post content that is disrespectful to patients or that undermines patient trust in the profession.

LiveJournal Tags: social networks,doctors networks,AMA,fierce practice management,health train express

Inspector General Reports CMS to who?? or

Failure is an OPTION

 

A recent report in iHealthbeat from the California Health Care Foundation states that CMS did notcomply with identifying and reporting to the

Healthcare Integrity and Protection Data Bank as required by law, according to a new report from HHS' Office of the Inspector General, "ProPublica Blog" reports (Wang, "ProPublica Blog," 9/22).

Read more:

iHealthbeat

Since CMS cannot keep up with present reporting requirements, why should anyone believe CMS will be able to comply with  HHS’ demands for meaningful use reporting, or P4P, or outcome statistics. 

The system is set up to FAIL !!

CMS REPORTING TO THE HEALTHCARE INTEGRITY AND PROTECTION DATA BANK

Background on Data Bank

HIPDB aims to help hospitals and other organizations hire health care providers who are in good legal standing with health care regulations, and Medicare and Medicaid program requirements (Clark, HealthLeaders Media, 9/23).

Federal law requires CMS to update the database with information on:

• Civil monetary penalties levied against health care providers, managed care plans and prescription drug plans;
• Terminations of participation in Medicare; and
• Revocations and suspensions of laboratory certifications.

Report Findings

The inspector general report found that CMS disciplined numerous medical entities but failed to report many of those actions to the database.

Some of the actions that CMS failed to report include:

• 148 sanctions imposed against laboratories in 2007; and
• 30 sanctions imposed against managed care plans and prescription drug plans between January 2006 and July 31, 2009.

Although CMS banned 45 nursing homes from participating in Medicare between 2004 and 2008, the agency did not report the terminations to the database until fall 2009, according to the inspector general report.

The report also noted that a division of CMS that tracks and reports action against Medicare-certified health care providers did not report any disciplinary actions to the database between 2001 and 2008.

According to the report, CMS did not report the actions because it mistakenly believed that it should report only fraud and abuse cases to the database ("ProPublica Blog," 9/22).

Recommendations

The inspector general report recommends that CMS quickly begin reporting all disciplinary actions to HIPDB.

It also calls for CMS to "educate staff and contractors about the types of adverse actions to be reported and the time frames for reporting" (HealthLeaders Media, 9/23).

CMS Response

In a response to the inspector general's office, CMS acknowledged its reporting gaps.

The agency said it will take steps to scale back manual reporting and strengthen the necessary infrastructure for meeting reporting requirements ("ProPublica Blog," 9/22).

LiveJournal Tags: CMS,HHS,MEDICARE,NPDB,Health Leaders,Propublica

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