I’m on some kind of roll. I got two stupid bureaucrat stories in quick succession last week.
Number one story: Representative Pomeroy (D-ND) came to our town to meet one-on-one with our local hospital administrator.
Yours Truly, the Congressman’s aid and one radio journalist sat in.
Here’s an excerpt from my story:
“…in rural hospitals it has long been established practice that routine therapeutic services can be performed by nurses and other professional staff as long as a doctor or other mid-level practitioner such as a physicians assistant is within 30 minutes of the hospital. At Mercy Hospital, that means almost always, since the Meritcare Clinic is physically attached to the hospital and its staff have hospital privileges.
The significant line in the Center for Medicare and Medicaid Services rules states, “The physician supervision requirement is generally assumed to be met where the services are performed on hospital premises.”
…Then in late 2009 somebody at CMS issued a “clarification,” interpreting the rule as requiring a physician or mid-level practitioner has to be physically present, or nearby and not otherwise occupied, even for procedures that nurses have always done. CMS made the hospital aware of the new policy a couple of weeks ago.
Pomeroy called the ruling, “Completely absurd” and said Medicare gets greater value in this region of the country than anywhere else, and Medicare patients get better care than anywhere else.
“This would be a wrecking ball on the rural health care infrastructure,” Pomeroy said. “The administrator who came up with this one could not have had experience in a rural facility.”
Heuser called the ruling “a death knell for small rural hospitals,” and said the effect of the new rule on Mercy Hospital would be to mandate the hiring of at least five new mid-level practitioners, assuming they could be found, increasing operating expenses by at least $650,000 per year.
Worse, CMS could decide to audit Medicare billing going back to 1998 and decide procedures done by nurses were overcharged, then demand the hospital pay back reimbursements amounting to as much as a $1 million per year…”
Well, what if this wasn’t just stupid? What if some people who want socialized medicine think a great way to bring it about is to drive private (OK, semi-private) medicine out of business starting with rural health care?
This has crossed the minds of more than one person I’ve talked to.
Second stupid bureaucrat trick, this one from the Army Corps of Engineers.
Federal rules state for highway construction, improvement, and repair with federal money involved (which is everywhere in the lesser-populated states) every acre of wetland must be replaced with one or two (depending on “quality”) of wetlands created or restored from previously-drained wetland.
(Some years back, in the ’80s maybe, farmers were encouraged to drain wetlands. Now the guvmint wants them back. Go figure.)
Previously, the counties have been allowed to contribute to a “bank” of wetlands created elsewhere in the state. The state Fish and Game Department was fine with this.
Now the Corps is insisting on a rule that wetlands created to make up for losses caused by grade raises in county roads and state highways (when you raise the roadbed, you have to widen the slope) must be within the same region.
The problem is, there’s too damn much water in the state. We’ve had years of wet conditions and a major flood last year. The reason the roadbeds have to be raised to begin with is because the wetlands were encroaching on them.
County road improvements around the state are being put on hold because the counties can’t find farmers who want to sell 99 year easements on their land.
Catch-22!