AHA comments on CoP proposed rule   04/04/2013
The Centers for Medicare & Medicaid Services should drop a proposal that would prevent some multi-hospital systems and their affiliated medical staffs from opting for a single integrated medical staff structure, AHA yesterday told the agency in comments  on its Feb. 7 proposed rule to revamp certain existing Medicare regulations. "While we support many of CMS’s proposed changes, we oppose the agency’s intention to preclude the leaders and medical staffs of some multi-hospital systems from implementing a single unified, integrated medical staff structure," wrote AHA Executive Vice President Rick Pollack. "We believe that CMS should allow multi-hospital system leaders and medical staffs to decide, together, which medical staff structure best enables them to deliver high-quality care for their patients and communities." The proposed rule also would ease some regulatory requirements for critical access hospitals, and would rescind a regulation requiring hospital governing boards to include a member of the medical staff. Comments on the proposed rule are due April 8.
OIG issues alert on physician-owned distributorships    04/04/2013
The Department of Health and Human Services Office of Inspector General recently issued a special fraud alert focused on specific practices of physician-owned distributorships that the agency believes produce substantial fraud and abuse risk and pose dangers to patient safety. The alert reiterates OIG’s position that the opportunity for a referring physician to earn a profit, including through an investment in an entity for which he or she generates business, could constitute illegal remuneration under the anti-kickback statute. According to the alert, because the anti-kickback statute ascribes criminal liability to parties on both sides of an impermissible "kickback" transaction, hospitals that enter into arrangements with PODs also may be at risk under the statute. In evaluating these arrangements, OIG says it will consider whether one purpose underlying a hospital’s decision to purchase devices from a POD is to maintain or secure referrals from the POD’s physician-owners.
House Republicans release updated proposal to repeal SGR   04/04/2013
House Republican leaders yesterday released a revised proposal  for repealing Medicare’s sustainable growth rate physician payment formula, which has required an annual "doc fix" by Congress for the past several years. Ways and Means Committee Chairman Dave Camp (R-MI) and Energy and Commerce Committee Chairman Fred Upton (R-MI), along with the chairmen of their health subcommittees, are circulating a draft plan that expands on their Feb. 7 proposal  to replace SGR with more "predictable, statutorily-defined" payments based partly on patient experience and development of quality and efficiency measures that evaluate physicians’ performance. The proposal does not specify how Congress would pay for the measure. Lawmakers sent a letter to the "provider community" and asked for input by April 15.
Court finds three hospitals to be federal subcontractors   04/04/2013
A federal trial court in Washington, DC, on March 30 found three hospitals affiliated with the University of Pittsburgh Medical Center to be government subcontractors obligated to comply with federal affirmative action mandates administered by the Office of Federal Contract Compliance Programs of the Department of Labor. Upholding a previous determination made by the DOL’s Administrative Review Board, the court specifically rejected the hospitals’ argument that they were not federal subcontractors because their agreements with the UPMC Health Plan, which contracted with the federal Office of Personnel Management to provide coverage for federal employees, expressly stated that a provider of medical services is not a "subcontractor." "The Secretary of Labor, not OPM, has been given the authority to administer the statutes and Executive Order [establishing affirmative action obligations for federal contracts] and to issue regulations implementing them," the court said."In light of this apportioning of authority, OPM and the Health Plan have no power to limit the[ir] scope … by contractually agreeing to a narrower definition of ‘subcontractor’ than the Secretary has adopted."The court also rejected several other arguments advanced by the hospitals to support their contention that they were not federal subcontractors, including that supplying medical care is not "nonpersonal services" that fall within the subcontractor definition; the hospitals’ arrangement with the Health Plan is not necessary to the performance of the primary contract nor a "partial performance or undertaking" of that because the Health Plan promised only to insure the federal employees and not to provide them with medical care; and the hospitals never consented to be bound by the affirmative action requirements because their agreements did not explicitly indicate that the hospitals would become government subcontractors by accepting them.For more information on the case UPMC Braddock v. Harris, Acting Secretary, United States Department of Labor, click here
IRS issues proposed rule on reporting requirements for charitable hospitals   04/04/2013
The Internal Revenue Service yesterday released a proposed rule  that provides guidance to charitable hospital organizations on the community health needs assessment requirements, and related excise tax and reporting obligations, enacted as part of the Patient Protection and Affordable Care Act. These proposed regulations also clarify the consequences for failing to meet these and other requirements for charitable hospital organizations. Hospitals must conduct a community health needs assessment at least once every three years and adopt an implementation strategy to meet the community health needs it identified through the assessment. For more information on specific provisions of the proposed rule, see the Treasury Department fact sheet. The agency noted that it intends to finalize its new proposal in conjunction with finalizing a June 2012 proposed rule relating to financial assistance and emergency care policies, charges for certain care provided to individuals eligible for financial assistance, and billing and collections. Yesterday’s proposed rule will be published in the April 5 Federal Register, and comments will be accepted for 90 days. AHA members will receive a Special Bulletin with further details in the next few days.