Instead, what we have now is not an age of advanced information, but rather one of hyper-choreography. News networks and wire services with an agenda shave the presented facts to fit a pre-determined narrative. As if that were not bad enough, stories that used to count as nothing more than the postscript to an evening newscast now becomes a “BREAKING STORY!!!”, such as the balloon boy hoax or the fact that a 90-year-old actress is in the hospital (gee, we couldn’t predict THAT eventuality now, could we?).

In the world of electronic health records, it was with great fanfare this past Monday that the Office of National Coordinator for Health Information Technology (ONC) named The Drummond Group of Austin, Texas and the Certification Commission for Health Information Technology (CCHIT) as the first testing and certification bodies for electronic health record systems. Thus far, most of the articles I have come across in the news universe have been the usual straight news pieces, complete with quotes from Mark Blumenthal (the national coordinator) about beginning the process of EHR certification and encouraging vendors to submit EHR’s for testing. A press release is sufficient. Nothing to see here. Move along now…..

Because the current initiatives for EHR adoption have the stated goal of achieving improved access to information as well as interoperability, the choosing of vendors to test EHR systems for meaningful use is an important first step. Finding out who the players are behind the initiative is equally important. I have a lot of questions that my unstoppable curiosity want answered:

• What’s the background of these companies?
• Who manages these companies?
• Whose viewpoint is best represented and advanced by the selection of these companies to be the EHR certifiers?
• (the true skeptic’s question:) Is there a hidden agenda to be found?

With a mouse and keyboard as my only tools, I set about the task of filling my head with information about the Drummond Group and CCHIT.  

According to their website, the Drummond Group has been in existence since 1999. They specialize in software compatibility testing across a range of operating systems and standards. They currently offer their own certification for tested products that sufficiently demonstrate interoperability. They make it very clear that they do not endorse or produce software in order to maintain “strict vendor neutrality”.

A few members of the management team of the company have ties to the oil industry, with founder Rik Drummond having served with the American Petroleum Institute for four years prior to founding his company. In the past, Mr. Drummond has also contributed to re-election campaigns for Rep. Joe Barton of Texas, the last donation coming in 2002. If that name sounds familiar to you, that is because Joe Barton is the man who humbly apologized to BP executives during Congressional hearings for the federal government forcing them to clean up the recent oil spill in the Gulf of Mexico. Based on the Drummond Group’s reputation for the quality of their testing, I’ll chalk these curious facts up to occupational and social associations. It would be hard to be optimistic about the future of EHR if Mr. Barton’s kind of thinking was represented in the certification of healthcare record systems. Mr. Drummond also has extensive experience in Electronic Data Interchange, which comes in handy when testing and certifying an EHR that presumably would double as a billing system.  

CCHIT is something of a known entity in the world of EHR certification. Founded in 2004 as a non-profit and run by volunteers, their focus is strictly trained on health information technology, as 60% of their name intimates. They have been offering certification and testing of EHR’s since 2006, which makes them something of a lead pipe cinch as a first selection, as they have experience testing  for functionality, interoperability and security.

This past April, Karen M. Bell, MD became the chair of CCHIT. Dr. Bell’s resume is peppered with past work done for payers and community medical groups in New England, such as her stint as the medical director for Blue Cross Blue Shield of Rhode Island.  She also worked as the Director of Health IT Adoption at ONC prior to taking her post at CCHIT. She has spent a good portion of her professional life in a variety of positions related to quality improvement. She also has experience as a practicing internist, albeit one that, given her medical training at Brown and Tufts Universities, was more than likely not one where the everyday headaches of  insurance reimbursement was ever a first-tier concern.

More certification agencies will be named in the near future. Thus far, despite my best efforts, I find no readily apparent hidden agenda, but I am beginning to wonder if the interests and input of small group practices are being adequately represented, or whether the journey towards mandatory EHR is most comparable to the creation of a series of bitter pills for physicians to choose to swallow. Only time will tell, one can only speculate, move along now, nothing to see here…….

As a physician advocate, I would add “yet”.

To date, because of the monetary incentives built into the RAC program, services paid under Medicare Part A have been the preferred target of the four regional RAC contractors. Hospitals and other facilities paid by Part A continue to deal with the ever-expanding demands of the contractors in the realms of both DRG validation and medical necessity. Simultaneously, individual physicians and groups have been existing in a world seemingly beneath the radar of the RAC’s.

The new world under PPACA is about to change this set of circumstances, with RAC’s gearing up to train their sights on a distracted physician population that after years of federal warnings and compliance guidance, remains ill-prepared to weather the storm. The planned expansion of the RAC program into avenues currently traveled by Medicaid Integrity Contractors (MIC’s) only makes the need for data on practice vulnerabilities, and opportunities for coding and documentation improvement, that much more important.

Stepping into this information void comes…….The RAConteur.

As the RAC contractors begin to circle above the heads of the individual and group physician populations, there are steps that can be taken pre-emptively to:

• Identify probable RAC audit targets;
• Determine practice vulnerability based on these targets; THEREBY
• Strengthening your practice’s defenses against your RAC contractor.

Every Wednesday, The RAConteur will focus on RAC information specifically tailored for the physician practice. In future posts, it is my hope that I can assist practices to begin to view the paper trail that accompanies their daily work product with the same highly trained critical eyes developed and possessed by all physicians as part of their medical training. Rather than leaving physicians to continue guessing about where their vulnerabilities may exist. Instead it is my mission to empower the physician to detect errors and modify long-held thinking and behaviors, which will hopefully lead to decreased risk and increased peace of mind.

The paved-over swamp that is official Washington, D. C. has decided that increased audit recoveries are the pathway to offsetting the cost of healthcare reform for the next decade. While the opportunities to weed out the fraud in the American healthcare system is a task for which we all have a positive financial stake, The RAConteur will relate as much information and advice as possible to ensure that you are not the physician providing a high percentage of this healthcare funding.

As we go forward together, I look forward to your comments and questions on specific elements of physician RAC audits, coding, documentation and best practices in a world of hyper-investigation.

Welcome to The RAConteur!

Coltrane was known for taxing the patience and constitution of his many band mates. One incident involved a drummer who became so tired of trying to keep up with one of Coltrane’s saxophone marathons that in order to end the solo and earn a break, he felt he had no other option but to throw a cymbal at Coltrane. There is a legendary story about John Coltrane and Miles Davis having a conversation about the physical limits of music. John Coltrane was asking Miles Davis how he could control his innate need to continue to play until the musical resolution was discovered, if at all. Davis, in his legendary, gravelly whisper of a voice, looked at Coltrane and said “Take the horn outcha mouth!”.

I love this story for two reasons, one being that it continues to make me laugh after repeated telling, but more so because here we have a perfect illustration of finding a simple solution to a complex problem.

If only the solution to physician documentation and medical records were so easy. Sadly, as we get closer to the beginning of the incentive period for meaningful use of an electronic health record, it appears that the “solution” offered in the form of mandatory EMR is looking a lot like the beginnings of a Rube Goldberg device.

The Office of National Coordinator for Health Information Technology (ONC) projected this week that 50,000 additional IT workers will be needed by providers across the country in order to meet the meaningful use criteria. Without the gift of a calculator on my desk, I quickly compute in my head that with a maximum incentive of $44,000 over a five-year period (remembering that not every provider will qualify for this dollar amount), you would have to find one IT person at a salary of $8,800 a year to break even. If you’d like to place a wager on your odds of finding this unicorn of the IT world in today’s economy, give me a call.

Let’s look at a timeline for a moment to put this in perspective. In order to qualify for maximum incentives, registration of meaningful use of an EHR begins this coming January. At the time of this writing, that’s 126 days away! The Certification Commission for Health Information Technology (CCHIT) is still reviewing applications for companies that will test and certify EHR systems to determine whether they have the ability to meet the meaningful use criteria. Also in the equation is the plan for regional extension centers to assist providers during the transition. Currently, 5 states lack an extension center and 28 states, including California,  have only one center currently open to offer assistance.

Seventy community colleges across the nation are also part of the plan, offering non-degree training courses for IT professionals to bring them up to speed. While the ONC’s website gives a time frame of “six months or less” for this training, the issue of whether 4 months of instruction prior to registration is sufficient will go unanswered up until the moment when the training is most needed.

We all crave simple solutions. The Great Migration currently underway towards the goal of electronic health records, given the rampant shortcomings of paper records, is a noble goal. Yet I may not be alone in rethinking whether the established timeline to qualify for maximum incentive payments is too short to be of value in the long run. Unfortunately, unlike the removal of a saxophone from one’s mouth, an easy fix does not appear to be readily available.

OK, so one of those things is atypical. I’ll give you a hint: I usually eat breakfast.

For more information on my 14th minute and 58th second of fame in my lifetime, click here (I’m the guy with the orange guitar). The story accompanying my grainy image is self-explanatory. So as not to worry readers who may not click through about the reasons for appearing in the newspaper, it doesn’t involve an indictment, a drunken man running onto a baseball field or (surprisingly, to those who know me) a vicious automobile accident. In these troubled and trying times, it’s nice to be part of a good story for a change, and I’m looking forward to tomorrow’s events as described in the article.

So now that we all know what a happy story looks like, let’s explore the flip side as it applies to health care compliance. I came across a story out of Florida that is a good case in point. A couple from a town called Land O’ Lakes (like you, I immediately thought of butter) were making their Sunday run to their local recycling center. When they got there, they found that there was no room for their paper items in the designated dumpster at the center. This was because someone had filled the paper bin to capacity with discarded medical records. In some cases, the records included Social Security, credit card and driver’s license numbers in addition to medical information.  

The first thing I thought of with this story was regarding EHR, and how stories like this may become obsolete within five years. Then I begin to think the opposite, with the personal theory that as practices transition from a paper record to an electronic record, we may see instances like this more often thanks to record destruction companies attempting to cut corners.

Then I begin to daydream, first about dancing in rain made of Newcastle Brown Ale to the music of the Who, then shaking my head and quickly transitioning to the government’s recent re-dedication to recovering money lost from Medicare and Medicaid due to fraud.

Having been involved with coding and compliance for several years, I’ve learned that there really is no end to to the devious machinations of the ethically-challenged in our business. From podiatrists who bill foot care on patients who have had previous foot amputations to DME suppliers forcing unneeded power mobility devices on the local population of elderly residents, extending to the virus of identity theft currently infecting  some medical practices, you need a chain saw to cut through the levels of immoral behavior in this industry.

The damage that these assorted criminals inflict is not restricted to the CMS trust funds. Medical providers who spend their waking hours operating by the rules inadvertently find themselves in the outer remnants of the spotlight that shines on the crooks. The doctors acting above board and rendering legitimate services ultimately pay a high price for the actions of the bad seeds in increased regulation, investigation and bad public relations for the health care industry as a whole.

The current administration has doubled down on recovery of overpayments through fraud and abuse investigations. For the future of Medicare and Medicaid, I see this as overdue. There are many ways to make the news, but perhaps the best approach for the honest medical provider is to implement and follow policies that insure that you end up in the non-”perp walk” portions of the local news.

To start out with a bracing dose of truth, I tend to live by very few rules, mainly because I fall back on survival instincts for most of my decision making process. This includes not dancing barefoot in poison ivy, realizing that I’m not cut out for living in the forest and stopping at the occasional red light. However, when it comes to what is referred to in more puritanical quarters as a moral code, my list of rules is rather short: don’t kill, don’t steal and don’t profit from other people’s bad luck (there’s one more multitiered rule that’s rather graphic and won’t be shared in this forum).

A good example of the application of these ideas is the fact that on the side, I’m a singer. My mother once suggested to me that there could be money to be made singing hymns at funerals and I found this idea incredibly revolting and insulting. It’s not enough that someone has just lost a loved one, but you’re going to stick a hand in the family’s pocket for the act of ushering the deceased into the next life with song? I find the very thought disgraceful.

As an extension of this rule, I have a deeply wired disdain for anyone who makes a living profiting from human misfortune. My hit list of occupational vultures includes funeral homes, pawn shops, payday and title loan stores and drug dealers. For purposes of this posting, let’s add an obvious one to the list: health insurance companies.

It is a well-documented reality that since the introduction of “managed care”, insurance companies are making out pretty well on the profit side. Hand in hand with this is the fact one study indicates that in 2007, 62% of all bankruptcies filed were due to outstanding medical expenses. Of that number, 80% had health insurance coverage. Given this statistic, why are we calling the purchased product “insurance”, as the very definition of this term suggests a contract that provides a guarantee against loss?

The effects of this same industry upon the provider community are no less damaging. Due to over 20+ years of deleterious contract terms, providers across the country are struggling with the costs of practice operation. With the proliferation of PPO plans that expand abhorrent fee schedules and payment rates to insurers across the country through the use of silent PPO’s and wraparound plans, the reimbursement playing field is evolving into a mine field.

It is my duty to inform the provider community that after six paragraphs, 400+ words and a brief discussion of funeral music, I’ve reached the point in this narrative where I can relay some good news; these mine fields have maps, and these would be your insurance carrier contracts.

Provider contracts make for interesting reading. What at first presentation will sound like an opportunity to expand your patient base to another insurance population can quickly shift in shape to something more resembling indentured servitude with the simple act of a signature. Knowing this, there is no longer any valid reason for not reviewing your insurance contracts on a regular basis, at the very least yearly.

In addition to the base contract, it is equally important to be wary of any and all amendments to that contract that are offered after initial contracting. I recently came upon a case where a physician had been under contract with an insurer for 4 years (with no legitimate review of the base contract language in that time span) and was sent an amendment that he dutifully signed which gave the insurer permission to share their pricing structure with other insurers. This had the effect of extending already negative contract terms far afield to insurers to which the provider had never been formally introduced.

Health care delivery finds itself on the brink of entering a world of increased physician cost and time investment. If a provider looks at his or her bottom line today and can see beyond all doubt that the current path is unsustainable, the best way to plug the income leak engulfing the practice is to go right to the source, which would be your insurance contracts. There are many directions that can be taken with regard to building a successful and sustainable medical practice. Given what we know about the singularly predatory nature of the modern insurance industry, the time has come to ask the most important question; where are your contracts taking you?

The first positive thing is just knowing that the World Cup of soccer won’t be occurring for another 4 years. My mind marvels at the fact that the rest of the world loves this sport with a passion. On television, a great majority of this sport looks like ping pong expanded to fit onto a field. In addition, apparently if you breathe on someone the wrong way in soccer, it’s common practice that the offended party throws themselves on the field as if they have just been assassinated. I haven’t seen acting this bad since the explosion scenes in the second and final season of The Rat Patrol. Thankfully, ice hockey training camps open in 7 weeks to assist me in getting memories of this “sport” out of my head.  

The second positive thing that occurred holds the promise of transforming a great deal of the health care system in the United States. The final rule was released by CMS this week involving the meaningful use of electronic health records (EHR).

The rule clarifying meaningful use differed slightly from the proposed rule. Originally, there were 25 standards that had to be satisfied in order to meet the definition of meaningful use. In the final rule, only 20 markers will need to be met in the beginnings of the program, with the 25 standards having been divided into two groups.

The first group consists of 15 “core” standards which must be met. These include such things as electronic prescribing, implementing and maintaining lists of drug interactions and drug allergies, the recording of patient smoking status and the reporting of quality measures to CMS. The remaining 10 standards are now placed in what is called a “menu set”. In order for a provider to demonstrate meaningful use, one can meet any five of the remaining ten criteria from the menu in addition to the core standards. This would be in effect for the first part of the incentive program, with the expectation that the remaining 5 standards on the menu will eventually be satisfied. 

Based on the number of comments received on the proposed rule about the burdensome nature of meeting some of the core standards, CMS has sharply reduced the percentage of patients that must fall under 8 of the standards.

With the release of this final rule, providers can now begin a one-year journey toward demonstrating meaningful use and maximizing incentive payments from CMS. The process of selection of a certified EHR system can now begin in earnest, if it has not already. As stated in a previous post here, the Office of the National Coordinator for Health Information Technology (ONC) is currently in the process of certifying health systems with the ability to meet the meaningful use standards. After selection of a certified EMR system, a registration link through the CMS website will become available sometime in January of 2011 that will allow providers to register to participate in the incentive program.

It is a time of paradigm shift in American health care. The release of this final rule brings all of us one step closer to fundamentally altering the doctor/patient end of the delivery system. A period of high drama, either from dread anticipation of this final rule or from attempting to guess which soccer player pretends he’s just been killed, has come to an end, with many new beginnings to follow.

I like making fun of old people.

There are a number of reasons for this, but when I try to get to the root of my mocking attitude towards the elderly, it comes down to two influences on my psyche that are the most extreme examples of poor behavior in one’s twilight years: Abe Simpson from the now-iconic TV show The Simpsons and my own father.

In Abe Simpson, we have an extreme study of a stereotypical senile old man who spends his time watching Matlock, falling asleep mid-sentence while trying to verbalize a flight of ideas and yelling at clouds. In my father, I see a man so internally and ideologically consumed by resistance to change that when he begins to verbalize his belief system in horrifying detail, I begin to look around me to make certain that no one who may have any small control over my human fate isn’t around to hear the man with whom I share DNA spouting such abominable and atavistic nonsense. It is in the general – if not exact – example of my father where today’s journey begins. 

“Set in their ways” is one of the most common terms I hear from others in describing older people. We’re often told that the 18-54 age group is “the money demographic” in advertising terms, as the belief goes that this age range hasn’t found one particular product, lifestyle or set-in-stone place in society to the point where they can’t be convinced to change their mind about something. By extension, people beyond this age range are seen as having made up their minds about everything and are less able to be convinced to try something new or make a switch to a different product.

For better or worse, we all reach different definitions of “comfort zone”, from the cars we select to drive to the music we choose to hear. If you’re a provider of medical services, the way in which you practice medicine is developed after years of study and one-to-one patient interactions. While you’ve weathered the dozens of adverse changes in the reimbursement for your services, the fundamentals of your practice may not have seen such a drastic overhaul to the point where the root of your profession is adversely affected.

Over the next roughly 42 months, a paradigm shift is going to occur within the walls of the comfort zone that is your medical practice. From the moment a patient enters your sphere of treatment, your well-honed approach must be modified. I wish I could tell you that this is mere opinion, but the volume of changes about to sweep over the landscape moves this into the realm of impending fact.

The mandatory conversion to an electronic health record (if you haven’t already) will change the way your information is stored and shared. What is documented in that record will need to change to accommodate the long-delayed conversion to ICD-10 for diagnostic reporting. With quality reporting and patient outcome indicators moving from its current voluntary model to one of compulsory permanence, the patient record will need to include a level of detail that will require you to go through a period of adjustment.

Many providers should begin a short period of assessment immediately to decide how these changes will be handled on the practice level. The first uncomfortable idea I’d like to bring forward is this one; nothing is off the table. Many providers have no doubt begun to enter a self-examination phase, questioning the changes and the effect these will have on them as doctors. My advice is to expand that analysis to every aspect of your practice as it currently stands. Perhaps you have a front desk staff that has been with you for many years, but are these trusted people savvy enough to handle the coming environment? Do your billing agents have the expertise to seize every reimbursement opportunity for your practice? Are the documentation habits of any ancillary staff such that they could pose a risk in the days to come?

3 1/2 years seems like a long time, but one by one, the changes in our industry will transform from ideas and initiatives to possibly uncomfortable new realities. Channel the mental anguish you may be feeling about the future into a vision for a pliable yet compliant medical practice.

As a postscript, I know that some of you who may be older are saying, “just wait, sonny. Your time to be mocked is coming”. In answer to that, I approach age in this way. As long as there’s one person on the Earth who’s older than I am, I’m still a young man. Recently, a 130-year-old woman was discovered in Russia. I figure I’ve got a lot of young living to do, so go get in your Buick and get ready for bed.

While the spending going on currently in my house is mostly in the realm of personal happiness and general frivolity, medical providers are currently contemplating an investment of a more serious nature. With incentives of up to $44,000 from the government for the adoption of electronic health records on the horizon, and with the mandatory use of EHR following close behind, practices are on the brink of making what could become the most important decision of their careers.

On June 18th, buried amidst the Sturm und Drang of the latest Medicare Physician Fee Schedule fix, HHS’ Office of the National Coordinator (ONC) for Health Information Technology released a final rule concerning standards for gaining certification of an EHR system. This sets the stage for the final rule defining “meaningful use” of an EHR system, which is set to be released within the next few weeks. This rule release can be considered the humble beginning of the providers’ decision process. 

The final rule for certification did not differ dramatically from the proposed rule, but there were some interesting tidbits. First. the final rule opens the door for more than one certification agency being involved in the process. Currently, the Certification Commission for Health Information Technology (CCHIT) is the only certifying agency, but as of yesterday HHS began to accept applications from companies wishing to become certifying agencies. I’m interested to see how this particular corner of the process develops, particularly as it relates to business relationships between certification agencies and software developers. While the certification standards come from ONC, how will compliance to the standards be measured to guarantee transparency in the certification process?

Once the testing agency applications are approved and certifications are granted, ONC will keep a list of certified software products on its website. Even though the approved certification agencies will more than likely publish the same listing, I recommend going right to the source once this list begins to be compiled.

As October 1, 2012 looms in the distance as the deadline by which practices can begin to demonstrate meaningful use of EHR in order to qualify for the maximum incentive payment, there is a healthy allotment of time to choose the EHR system offering the best fit for practices. When considering such a life-changing investment of financial resources,  this time element presents itself as a positive in the process. With the impending release of the meaningful use rule, it is hoped that the map of the road about to be traveled is revealed to be the shortest distance between the two points of selection and implementation.

The legislation that originally contained the pay fix was returned to the Senate for consideration by House Speaker Nancy Pelosi on Friday June 18th. In addition to the pay increase, the larger bill contained extensions of unemployment benefits and supplemental payments to the states to augment Medicaid programs. Senate Majority Leader Harry Reid spent the second half of yesterday afternoon attempting to garner the 60 votes needed to advance the legislation to a full vote on the floor. Ultimately, his efforts failed when the cloture vote tally of 57-40 doomed the bill. Minutes after the Senate vote, the House, by an overwhelming majority, passed the breakaway bill containing the pay fix that was sent to them late last week. The legislation was signed this morning by President Obama.

CMS has been processing claims with a 21.3% cut for the last 5 working days.  It is expected that CMS will soon announce that claims are now going to be processed at the pay fix rate. Any claims that have been processed over the last week will need to be reprocessed at the new, higher rates absent the previous cut.

While this legislation brings the latest chapter in this drama to a close, the story will begin anew as December 1st approaches. If either another temporary remedy affecting the fee schedule or a permanent fix to the Sustainable Growth Rate (SGR) formula is not passed prior to this date, physicians will face a 23% across-the-board cut in reimbursement.

I invite you to look very carefully at the mathematics involved with this. The conversion factor for 2010 was frozen at the beginning of January at 36.0846. Due to the larger health care reform legislation passed earlier in the year, the conversion factor was decreased for all 2010 claims to 36.0791. This did not affect claims already processed, but if you have recently submitted claims to your contractor for dates of service from early 2010, you may have noticed that the payments are decreased by a few pennies from how similar services were processed in the beginning of the year. The 2.2% increase now in effect applies to the lower, updated conversion factor.

While the latest conversion factor for the six-month period has not been released as of yet, a 2.2% increase to 36.0791 gives you a number in the neighborhood of 36.8728. Now, let’s suppose for purposes of envisioning the worst-case scenario that a 23% cut goes into effect on December 1st. This cut would be applied not to the temporary conversion factor, but the legislated conversion factor of 36.0791, which would give you a conversion factor closely resembling (again, not exact due to a lack of CMS announcement at the time of this writing) 27.7809.

The conversion factor is slated to take a further hit at the beginning on 2011, which would result in reductions that would bring the total net cut very close to the 30% range. Words have yet to be devised that would fully describe the negative impact on the healthcare delivery system in the United States that occurs if such a cut ever takes place.

For now, enjoy the summer sun and bask in the beauty of Autumn’s color when it arrives, as it could very well be a winter longer than any other we’ve ever experienced.

This past Saturday, House Speaker Nancy Pelosi (D-CA) made it very clear that she was not inclined to pass the Senate bill unless it is part of a larger measure similar to what the House passed in late May. It appears from a cursory look at the House calendar for yesterday and today that Pelosi was not bluffing. Yesterday’s legislative session in the House was dedicated to such weighty issues as a recognition of National Caribbean-American Heritage Month and a discussion of a resolution supporting National Men’s Health Week. Today’s calendar continues the focus on just the sort of topics that should shoot straight up to the top of the legislative calendar when there is near-10% unemployment, two wars and the looming threat of Medicare patients not receiving medical treatment: a discussion of the Formaldehyde Standards for Composite Wood Products Act and the Congressional Award Program Reauthorization Act (who would want an award from these people?). Sixteen other bills and resolutions are on the House calendar for today, and the Senate pay fix bill is not one of them.

Here’s a tip for the House of Representatives: the best way to insure that National Men’s Health Week comes off as a success is to make sure that men, and indeed all people, of Medicare age do not have their relationship with their physician threatened by a 21.3% percent cut in the doctor’s reimbursement.

I’ll continue to monitor the ongoing and oh-so-important work of Congress as the payment apocalypse continues. For now, as the headline says, there is indeed no news on this front.