The CMS may soon find itself writing some pretty big checks.
Here's why: Congress is expected to pass the so-called Deficit Reduction Act next month-a much-delayed bill that has volleyed back and forth and back again between the House and Senate. Lawmakers in the House, which approved the bill once already, have scheduled a vote for early February. If the bill passes, then Medicare payers will have to reprocess all claims filed since Jan. 1. The "do over" comes courtesy of a provision that stops the current 4.4% cut in physician reimbursement and effectively brings it up to no change from the prior year rate.
Both the CMS and its contractors-the fiscal intermediaries that process the claims-have been quiet about the details, and neither party is commenting on cost overruns that may incur. On average, the CMS says that last year, the cost of processing a single claim was 96 cents for Part A billings and 65 cents for Part B. Now, multiply that by the estimated 20 million claims that are filed each week and you get-well-a lot. While the CMS is keeping the data close to the vest, a spokeswoman-in a surprising moment of candor-commented that it will cost the federal agency a "boatload" of money.
The costs won't be incurred by Medicare fiscal intermediaries, as the intermediaries make clear: "Any economic impact as a result of this proposed legislation would be on the Medicare Trust Fund and not on the contractors," says a spokeswoman for Blue Cross and Blue Shield of South Carolina.
The contractors will, however, have to work fast. Lump-sum payments for at least 80 million claims would have to be cut no later than July 1.
Lord of the ring
Ultimate Fighting-no-holds-barred mixed martial-arts bouts in which caged fighters duke it out to the sometimes grisly end with hands, feet, elbows, fingernails-might sound like one way for hospitals, manufacturers and group purchasing organizations to settle their differences. Actually, it is the newest rage on the cable network Spike TV, but it turns out there is a GPO connection.
Anyone who happened to be channel surfing earlier this month and landed on "Ultimate Fighter" might have seen a re-run of a light heavyweight bout featuring 42-year-old Randy Couture. Couture was reportedly knocked out in the first round, but when he finally woke up, he was interviewed in the ring with John Bardis, chairman, president and chief executive officer of MedAssets, standing beside him with his arm around Couture's shoulder.
According to a bio of Couture on the knucklepit.com Web site, Bardis is one of Couture's sponsors. In 2004, Couture was one of several "inspirational speakers" at MedAssets' annual meeting in Las Vegas, according to the company.
Couture also got up on stage at the same event for the warm-up act to assist a magician and his wife as they sawed MedAssets Supply Chain Systems President Rand Ballard in half, says Gary Johnson, a MedAssets spokesman. Couture, a former Greco-Roman wrestler, has known Bardis for more than 10 years through their mutual U.S. Olympic wrestling experiences, Johnson says.
For those wondering how former HealthSouth Corp. chief Richard Scrushy enjoyed fervent support from some in the black Christian community in Alabama during his corporate fraud trial last year, new evidence offers significant insight.
Charles Russell, a spokesman for Scrushy, says he gave freelance writer Audrey Lewis in Birmingham, Ala., $2,500 in May 2005 after she asked him in the middle of the trial for transportation money to travel to Detroit for a family funeral. "I thought it doesn't make sense to give her a loan. But I'm going to need some help after the trial with someone here in Birmingham who can help me with the black community," Russell says, adding that he was surprised by Lewis' request. On a sheet of notebook paper, a copy of which he gave to Modern Healthcare, Russell drafted an agreement with Lewis "on matters relating to community relations in Birmingham, Ala., after the jury delivers a verdict in the case of USA v. Richard Scrushy on as-needed basis."
And there's more. On Jan. 19, the Associated Press ran a story that said Audrey Lewis had been paid $11,000 through the Lewis Group, Scrushy's public relations firm, to write favorable news stories about Scrushy in the weekly Birmingham Times, the city's oldest black-owned newspaper. The company's owner is Times founder Jesse Lewis Sr. (no relation), the story said. Jesse Lewis did not return Outliers' calls seeking comment. The story went on to say that Scrushy paid the Rev. Herman Henderson, pastor of Believers Temple Church-a prominent church in Birmingham's black community-$25,000 during and after Scrushy's trial. Henderson could not be reached for comment.
Russell confirms that the Richard M. Scrushy Charitable Foundation gave three payments totaling $15,000 to Henderson during and after the trial, but he says the money was intended for Henderson's church building projects and a hurricane relief fund request. He also says Scrushy "did have some contract with the Lewis Group for $20,000," but that when Scrushy learned the firm had paid Ms. Lewis and Henderson, Scrushy told the firm to stop payments.
"My foundation donated to his church building fund and to a Katrina relief effort that his church sponsored," Scrushy wrote in a statement. "That's it. Period."