Analysis of the health care reform package signed into law by President Obama earlier this month reveals that more people will be covered than anticipated but also that the hoped for cost  savings may not materialize: 

Economic experts at the Health and Human Services Department concluded in a report issued Thursday that the health care remake will achieve Obama's aim of expanding health insurance -- adding 34 million to the coverage rolls.

But the analysis also found that the law falls short of the president's twin goal of controlling runaway costs, raising projected spending by about 1 percent over 10 years. That increase could get bigger, since Medicare cuts in the law may be unrealistic and unsustainable, the report warned.

The newly passed health reform legislation includes an expansion of the False Claims Act, and could expose physicians to greater liability in fraud investigation cases.

The new health system overhaul law includes significant expansions of the government's reach under the federal False Claims Act, and experts warn that doctors need to be ready.

Although the changes largely enhance prosecutors' fraud-fighting tools, often with the help of whistle-blowers, they also put physicians in line for additional liability exposure, experts say.

"This is another link in the chain of events that has expanded the scope of liability under the False Claims Act, and physicians have got to be aware of these changes and ensure they have effective compliance measures in place," said Roderick L. Thomas, a partner and false claims expert with the law firm Wiley Rein LLP in Washington, D.C.

In one of its more significant false claims provisions, the health reform law imposes an explicit duty on physicians to return known overpayments to the government within 60 days of discovering an error, according to health care fraud defense lawyer Gadi Weinreich. Retaining an overpayment beyond that deadline could constitute a false claim.  "Now we have a law that says, if you've been paid in error, don't write us a letter. Write us a letter and include your check," said Weinreich.

For the full story, click here:  Health Reform Law Expands False Claims Act; American Medical News - April 26, 2010.

The first Kaiser Health Tracking Poll fielded since the passage of health reform last month finds that 8 in 10 Americans know that President Obama signed the legislation into law. But 55 percent say they are confused about the law and more than half (56%) say they don't yet have enough information to understand how it will affect them personally.   

The poll finds that the public supports many of the provisions of health reform that are set to be implemented in the short term.  When asked about 11 specific provisions scheduled to take effect this year, in each case a majority of Americans viewed them favorably, often with bipartisan support.

Still, the public remains divided on the law overall, with 46 percent viewing it favorably, 40 percent unfavorably and 14 percent undecided. Similarly, 31 percent of Americans say they expect personally to be better off because of the law, while 32 percent say they will be worse off and 30 percent say they don't expect to be affected.

For the full story, click here: Kaiser Health Tracking Poll -- April 2010; Kaiser Family Foundation - April 21, 2010.  For the complete poll results, click here. 

NPR news reports that the new health reform legislation boosts Medicad reimbursement rates for physicians but the increase may be temporary:

To ease the worries of already strained primary care doctors, the new health law includes an increase in Medicaid payment rates, bringing them up to the same level as those from Medicare. That bump is expected to be pretty helpful when a huge chunk of the increase in insurance coverage under the law comes from expanding Medicaid, the federal-state program for low-income Americans, to cover 16 million more people.

The problem? Under the new law, the Medicaid raise may only last two years.... The higher Medicaid payments would take effect in 2013 and would be funded entirely by the federal government. But the bill doesn't mention what happens after 2014.

For the full story, click here:  More Medicaid Pay For Some Doctors, But Will It Last?; NPR - April 6, 2010

An article in the New England Journal of Medicine discusses the emerging "disclosure-and-offer" approach to medical malpractice reform in light of some constitutional challenges that tort reform efforts have faced.  The authors argue that private, non legislative methods can have some significant advantages and goes on to discuss several models of the disclosure and offer approach.

In general, private, institution-led reforms have many advantages. First, most of the reforms can be pursued without legislation. In some states, it is nearly impossible to effect liability reform because of political divisions fostered by powerful interest groups. In others, the legislature is dysfunctional and unable to accomplish major reform or is hamstrung by budgetary problems. Initial optimism that federal health care reform legislation would include major liability reform eventually faded, though the Obama administration has made a substantial commitment to supporting demonstration projects in which health care systems or states implement innovative reforms.

The Physician Payments Sunshine provision of the new health care reform law is that pharmaceutical companies and medical device manufacturers reveal payments made to physicians and some hospitals.  While compliance with this part of the law isn't required until 2012, the University of Miami has a head start:

The University of Miami medical school has become one of the first in the country to offer an online, searchable database revealing its doctors' relationships with outside businesses.

``This is a growing trend,'' says Alan Coukell, director of the nonprofit Pew Prescription Project. ``I know of four other schools that are doing this. With the passage of the Sunshine Act, there's going to be a lot, lot more.''

A provision of the new healthcare reform law, the Physician Payments Sunshine section, requires all manufacturers of prescription drugs, medical devices, and supplies must reveal any payment of more than $10 to physicians and teaching hospitals.

Such requirements were pushed by lawmakers after Pew and others exposed relationships between doctors' prescribing patterns and their oft-hidden relationships with the drug makers.

The sunshine provision starts in 2012, with the federal government required to have a searchable database by Sept. 30, 2013.

For the rest of the story, click here: University of Miami Database to Reveal Payments to Doctors; Miami Herald - April 1, 2010

Related story in the New York Times about drug maker Pfizer's efforts to comply with the new health care reform law:  Pfizer Gives Details on Payments to Doctors; The New York Times - April 1, 2010

In honor of April Fool's Day, check out Timothy Noah's article in slate that discusses some of the most entertaining myths about health care reform that are circulating on the internet, including the fear that the health care reform bill that was passed into law last week will require Americans to get microchips implanted in their brains.

Enjoy:  Health-Reform Bubbemeises - Slate, March 31, 2010

BusinessWeek reports that the Medicare payment cut scheduled for April 1 has been put on hold for a couple of weeks:

Doctors slated to have their Medicare reimbursements cut 21 percent on April 1 got a reprieve from the Centers for Medicare and Medicaid Services, which is delaying lowered payments until after Congress reconvenes.

The agency, which administers the U.S. health program for people 65 years and older and the disabled, has ordered that claims submitted on or after April 1 be held for an added 10 days before being paid, said spokesman Peter Ashkenaz. That's on top of the 14 days the Baltimore-based CMS usually holds claims.

The decision delays scheduled reductions in Medicare payments until after Congress reconvenes April 12. Lawmakers have put off those cuts every year, except one, since they were introduced as part of the Balanced Budget Act in 1997. The American Medical Association says the reductions will make doctors less willing to accept Medicare patients and is pushing lawmakers to increase payments.

For the whole article, click here:  Doctors Get Reprieve From 21% Medicare Payment Cut; BusinessWeek - March 29, 2010

In the April 5 edition of The New Yorker, Dr. Atul Gawande, using the passage of Medicare as a model, discusses some of the hurdles that still  face the health care reform package that just gained final approval from both Congress and President Obama last week:

On July 30, 1965, President Lyndon Johnson signed Medicare into law. In public memory, what ensued was the smooth establishment of a popular program, but in fact Medicare faced a year of nearly crippling rearguard attacks. The American Medical Association had waged war to try to stop the program, and doctors weren't about to abandon the fight against "socialized medicine" simply because it had passed into law. The Ohio Medical Association, with ten thousand physician members, declared that it would boycott Medicare, and a nationwide movement began. Race proved an even more explosive issue. Many hospitals, especially in the South, were segregated, and the law required them to integrate in order to receive Medicare dollars. Alabama's Governor George Wallace was among those who encouraged resistance; just two months before coverage was to begin, half the hospitals in a dozen Southern states had still refused to meet Medicare certification.

Either boycott could have destroyed the program. Hundreds of thousands of elderly and black patients would have found their hospitals and doctors' offices closed to them. But, as David Blumenthal and James A. Morone recount in "The Heart of Power," their riveting history of health-care politics, Johnson recognized the threat and outmaneuvered his opponents. With the doctors, he cajoled and compromised, giving the A.M.A. a seat on an advisory council that oversaw the rules and regulations, and working with it on a series of thirty "improving" amendments to the legislation. With hospitals, however, the President brooked no compromise. He convened a battle council of top advisers; set Vice-President Hubert Humphrey phoning mayors to pressure resistant hospitals; and deployed hundreds of inspectors to make sure that participating hospitals integrated their wards. There was fury and acrimony. In the final weeks before Medicare's start, though, the hospitals decided to abandon segregation rather than lose federal dollars. Only then was Medicare possible.

Erza Klein writes in Sunday's Washington Post that the historic passage of health care reform last week is just the first piece of the puzzle and that how the legislation is implemented will have a big effect on how big of a change is in store:

As someone who has spent the past year tangled in the minutia of excise taxes and curve bending and subsidy levels, it is good to finally say this: With the passage of the reconciliation fixes, the health-care reform debate is finally over. But if you're thrilled to hear that, then I also have some bad news: Health-care reform itself is just beginning.

This bill marks an evolution, not a revolution, for our health-care system. Whether it proves the cornerstone of a better, fairer, more affordable system or simply another expansion of the federal welfare state has as much to do with what happens when the law is implemented as with what's written in the legislation.

The system will not change in a year. Even by 2014, when it is broadly implemented, life will not change for most people. This is not single-payer (though you wouldn't know it listening to the GOP) or the ambitious Wyden-Bennett reforms. Come 2019, about 10 percent of Americans will have a different insurance arrangement than they would have had without the bill. Most of us won't notice any difference.