Category: reason

In his
State of the Union address on Tuesday, President Obama repeated
his shop-worn mantra about being prepared to bypass
Congress “wherever and whenever I can take steps without
legislation.” Whatever slack Americans may still be willing to cut
the president at this late date doesn’t extend to unilateral
action, however—fewer than a third of us are on-board with that
idea.

A
CNN/ORC poll taken after the speech askied people, “In general,
would you rather see Barack Obama attempt to reach a bipartisan
compromise with Congress on major issues, or would you rather see
Obama take unilateral action without Congress to make changes in
government policy that are not supported by Republicans?”

Only 30 percent said they wanted Obama to take action without
Congress, while 67 percent held out for bipartisan compromise.

Overall, the poll found the weakest response to the State of the
Union addresses given by the current president since he took
office. The “very positive” column has drifted downward from 68
percent at the first speech, to 53 percent last year, to 44 percent
this time (though the meh “somewhat positive” numbers are
up a bit).

Americans seem a bit jaded about the guy in the White House, and
letting him go it alone isn’t in the cards.

• President Obama was at Costco
  shilling for a higher minimum wage, a policy that would give
  the store an advantage over its much smaller competitors.
• A top Senate Republican, Jeff Sessions of Alabama,
  sent a package to all 232 Republican members of the House
  rebutting possible arguments against the immigration reform effort
  in Congress.
• 50 percent of doctors and patients consult Wikipedia,
  according to a new report from a healthcare institute.
• A Brooklyn school
  discontinued its gifted program over concerns about lack of
  “diversity.”
• Scarlet Johansson has stepped
  down as an ambassador for Oxfam after an outcry from some over
  her relationship with an Israeli soda company that operates a
  factory in the West Bank.
• The United Kingdom and France are teaming up to
  develop a new generation of killer drones.

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“President of National School Choice Week Andrew Campanella
Talks Progress in the Movement” is the latest offering from
Reason TV. Watch above or click on the link below for video, full
text, supporting links, downloadable versions, and more Reason TV
clips.

View this article.

Pot prohibitionists reacted with dismay to
President Obama’s observation that marijuana is safer than
alcohol—not because it was false, says Jacob Sullum, but because it
was true. As measured by acute toxicity, accident risk, and the
long-term health effects of heavy consumption, marijuana is
clearly safer than alcohol. That does not mean smoking pot
poses no risks, or that drinking is so dangerous no one should ever
do it. It simply means that the risks posed by alcohol are, on the
whole, bigger than the risks posed by marijuana. So if our drug
laws are supposed to be based on a clear-eyed evaluation of
relative risks, Sullum writes, some adjustment would seem to be in
order.

View this article.

Pot prohibitionists reacted with dismay to
President Obama’s observation that marijuana is safer than
alcohol—not because it was false, says Jacob Sullum, but because it
was true. As measured by acute toxicity, accident risk, and the
long-term health effects of heavy consumption, marijuana is
clearly safer than alcohol. That does not mean smoking pot
poses no risks, or that drinking is so dangerous no one should ever
do it. It simply means that the risks posed by alcohol are, on the
whole, bigger than the risks posed by marijuana. So if our drug
laws are supposed to be based on a clear-eyed evaluation of
relative risks, Sullum writes, some adjustment would seem to be in
order.

View this article.

Following President Obama’s State of the Union
Address, Andrew Napolitano has some questions. What if the state of
the union is a mess? What if the government spies on all of us all
of the time and recognizes no limits to its spying? What if its
appetite for acquiring personal knowledge about all Americans is
insatiable? What if the government uses the microchips in our
cellphones to follow us and listen to us as we move about?

View this article.

Four Venezuelan
newspapers have stopped publishing, and many others have been
slashing pages or circulation because of a shortage
of newsprint. The country imports almost all its newsprint, but
publishers say that currency controls imposed by the government
make it difficult to acquire the dollars they need to buy
newsprint. They say the government is making it difficult for them
because newspapers are the only part of the media still willing to
criticize it.

Tonight’s live episode of Fox Business Network’s The
Independents (9 pm ET, 6 pm PT, repeats at midnight) will
feature a sobering reminder: Never miss the online-only
“Independents After Hours” (which streams at the website
just after 10 pm, including tonight). Why? Because you miss some
seriously free-wheeling, structureless conversations with the
various beautiful freaks who populate the show. Like
Monday’s conversation with Penn Jillette, a solid chunk of
which has been edited down for consumption tonight.

Did you want to see a little P.J. from the actual telecast? Well
here you are:

Also on the program: Party Panelists Buck Sexton from The
Blaze and Andrew
Kirell from Mediaite will be on to discuss the

divergent GOP approaches to welfare politics, President Barack
Obama’s
mixed foreign policy messages in last night’s State of the
Union address, what Justin Bieber’s many troubles
tell us about immigration policy, and New Jersey’s
butt-hurtedness about
not getting enough revenue from the Super Bowl.

Intense journalist Charlie LeDuff will be on to talk about his
book
Detroit: An American Autopsy, recently retired NFL
cornerback Chris
Carr will discuss what it’s like to be a libertarian-leaning independent
in a professional locker room, and Independents heartthrob
Kmele Foster will tell us
the latest news about Bitcoin (you may even see a snippet from our

recent Reason.tv video on same). Also eligible for discussion:
The farm bill, Jay Carney’s beard, Duck Dynasty’s
SOTU-selfies, Vin Diesel’s dance moves, and more. And REMEMBER:
Make sure to watch the after-show, and send your tweets out to
@IndependentsFBN.

News headlines have focused on
the
bureaucratic mandates,
financial looniness, and
unlikely assumptions that seem designed to drive medical
providers away from the Affordable Care Act or out of business
entirely. But this year, a non-Obamacare bureaucratic car bomb is
set to explode in the medical world in the form of
ICD-10—a new coding system for patient diagnoses and inpatient
procedures. Mandated by the Centers for Medicare & Medicaid
Servives, the coding system standardizes communications among
providers and insurers. Well, it standardizes them more,
since ICD-9 has been in place for 30 years. Uncertainty over
hitches in replacing the old coding system with a brand new one has
industry experts advising practices to keep several months
worth of cash on hand to cover lags in reimbursement. Practices
lacking that much liquidity under the mattress may be truly
screwed.

Theoretically, the new coding system covers inpatient care
involving Medicare, Medicaid, and “everyone covered by the Health
Insurance Portability Accountability Act.” The government says up
and down that the new codes aren’t really necessary for private
practices providing outpatient care. A handy FAQ insists:

Will ICD-10 replace Current Procedural Terminology (CPT)
procedure coding?

No. The switch to ICD-10 does not affect CPT coding for
outpatient procedures. Like ICD-9 procedure codes, ICD-10-PCS codes
are for hospital inpatient procedures only.

But as EHRIntelligence
points out, “While it’s true that CPT/HCPCS codes will continue
to be the gold standard for outpatient
procedures, providers will be required to include ICD-10
diagnostic codes with their claims in order to receive
reimbursements from payers.”

So, if doctors want to be compensated by anybody other than
cash-only patients, they need to adopt the new codes, too.

The problem is that glitches are anticipated in switchover to
the new coding system, since nobody is allowed to use it before
October 1, 2014, and everybody is required to use it after
that day. That’s right, another government-mandated healthcare
industry hard launch, exactly one year after Healthcare.gov
debuted.

Actually, ICD-10 and Healthcare.goc were originally scheduled to
launch on the same day in 2013.

The Healthcare Billing & Management Association
warns that “it is possible that not all payors will be ready
for ICD-10 on October 1, 2014,” so “it will be important that you
are able to submit in both ICD-9 and ICD-10 formats.” The group
further recommends that practices “establish a line of credit to
tide the office over during the first months following the
implementation of ICD-10” to acommodate reimbursement delays.

The CMS itself notes in its
Implementation Guide for Small and Medium
Practices:

The transition to ICD-10 will result in changes to physician
reimbursements. … [C]hallenges with billing productivity combined
with potential payer claim processing challenges may result in
signicant impact to cash flow. This may require the need for
reserve funds or lines of credit to offset cash flow
challenges.

According to
HealthcareITNews:

Healthcare providers may face disruptions in their payments even
if they are on target to operate using ICD-10 codes on Oct. 1,
2014. 

Since providers will, and indeed need, to be able to
pay rent and staff salaries if the transition does not flow as
smoothly as testing has indicated, experts advise having up to
several months’ cash reserves or access to cash through a loan or
line of credit to avoid potential headaches.

“Just figure that with the transition to ICD-10 there will be
delays in reimbursement,” said April Arzate, vice president of
client services at MediGain, a Dallas-based revenue cycle and
healthcare analytics company.

Arzate recommends keeping enough cash on hand to cover medical
supplies, payroll, rent, and the rest of a medical practice’s
overhead for three to six months.

In a
separate document on risk-mitigation strategies for
implementing IDC-10, the CMS specifies a “minimum of six months of
cash reserves to mitigate revenue impacts over the ICD-10
transformation period.”

Lines of credit might step in where available cash is
short, but banks issue lines of credit to good risks—not medical
practices already struggling in an uncertain regulatory
environment.

If you’re a doctor, now is a good time to look at your cash
flow, or your retirement options. If you’re a patient, you might
just consider buying your favorite doc a good-bye drink.

News headlines have focused on
the
bureaucratic mandates,
financial looniness, and
unlikely assumptions that seem designed to drive medical
providers away from the Affordable Care Act or out of business
entirely. But this year, a non-Obamacare bureaucratic car bomb is
set to explode in the medical world in the form of
ICD-10—a new coding system for patient diagnoses and inpatient
procedures. Mandated by the Centers for Medicare & Medicaid
Servives, the coding system standardizes communications among
providers and insurers. Well, it standardizes them more,
since ICD-9 has been in place for 30 years. Uncertainty over
hitches in replacing the old coding system with a brand new one has
industry experts advising practices to keep several months
worth of cash on hand to cover lags in reimbursement. Practices
lacking that much liquidity under the mattress may be truly
screwed.

Theoretically, the new coding system covers inpatient care
involving Medicare, Medicaid, and “everyone covered by the Health
Insurance Portability Accountability Act.” The government says up
and down that the new codes aren’t really necessary for private
practices providing outpatient care. A handy FAQ insists:

Will ICD-10 replace Current Procedural Terminology (CPT)
procedure coding?

No. The switch to ICD-10 does not affect CPT coding for
outpatient procedures. Like ICD-9 procedure codes, ICD-10-PCS codes
are for hospital inpatient procedures only.

But as EHRIntelligence
points out, “While it’s true that CPT/HCPCS codes will continue
to be the gold standard for outpatient
procedures, providers will be required to include ICD-10
diagnostic codes with their claims in order to receive
reimbursements from payers.”

So, if doctors want to be compensated by anybody other than
cash-only patients, they need to adopt the new codes, too.

The problem is that glitches are anticipated in switchover to
the new coding system, since nobody is allowed to use it before
October 1, 2014, and everybody is required to use it after
that day. That’s right, another government-mandated healthcare
industry hard launch, exactly one year after Healthcare.gov
debuted.

Actually, ICD-10 and Healthcare.goc were originally scheduled to
launch on the same day in 2013.

The Healthcare Billing & Management Association
warns that “it is possible that not all payors will be ready
for ICD-10 on October 1, 2014,” so “it will be important that you
are able to submit in both ICD-9 and ICD-10 formats.” The group
further recommends that practices “establish a line of credit to
tide the office over during the first months following the
implementation of ICD-10” to acommodate reimbursement delays.

The CMS itself notes in its
Implementation Guide for Small and Medium
Practices:

The transition to ICD-10 will result in changes to physician
reimbursements. … [C]hallenges with billing productivity combined
with potential payer claim processing challenges may result in
signicant impact to cash flow. This may require the need for
reserve funds or lines of credit to offset cash flow
challenges.

According to
HealthcareITNews:

Healthcare providers may face disruptions in their payments even
if they are on target to operate using ICD-10 codes on Oct. 1,
2014. 

Since providers will, and indeed need, to be able to
pay rent and staff salaries if the transition does not flow as
smoothly as testing has indicated, experts advise having up to
several months’ cash reserves or access to cash through a loan or
line of credit to avoid potential headaches.

“Just figure that with the transition to ICD-10 there will be
delays in reimbursement,” said April Arzate, vice president of
client services at MediGain, a Dallas-based revenue cycle and
healthcare analytics company.

Arzate recommends keeping enough cash on hand to cover medical
supplies, payroll, rent, and the rest of a medical practice’s
overhead for three to six months.

In a
separate document on risk-mitigation strategies for
implementing IDC-10, the CMS specifies a “minimum of six months of
cash reserves to mitigate revenue impacts over the ICD-10
transformation period.”

Lines of credit might step in where available cash is
short, but banks issue lines of credit to good risks—not medical
practices already struggling in an uncertain regulatory
environment.

If you’re a doctor, now is a good time to look at your cash
flow, or your retirement options. If you’re a patient, you might
just consider buying your favorite doc a good-bye drink.