Beginning around July 2009, Medicare will provide financial incentives for nursing homes in Arizona, Mississippi, New York and Wisconsin to improve their quality of care over the next three years. Both free-standing and hospital-based facilities may opt to participate in the program. Measure areas will include staffing, avoidance of hospitalizations, outcomes and survey deficiencies. Participants in each state will be randomly assigned to a demonstration group or a comparison group. Top performers for performance and top performers for improvement may each be eligible for a cash incentive drawn from a pool of savings attributable to the quality improvement (i.e. avoiding hospitalizations) in their state. Click here for CMS’s news release or here for additional information.
von Briesen Health Law Blog
March 31, 2009
March 27, 2009
“Conscience Rights” Rule Set to be Overturned. Open Comment Period for Providers Until April 9.
HHS is proposing to rescind its recent rule (published in the Federal Register on December 19, 2008, 73 FR 78072, 48 CFR Part 88) protecting healthcare providers from providing services that conflict with their religious beliefs, such as abortion. Church-affiliated healthcare groups are pushing for retention of the rule, which was enacted in part to support existing laws protecting “conscience rights” decisions and prohibiting discrimination against providers refusing to perform abortions or related activities. Critics of the rule are concerned that it limits access to patient care and increases the potential that individuals, especially underserved individuals, will be denied access to services. The Department is soliciting public comment to aid in its consideration of whether to rescind the rule.
A link to the March 10, 2009, Federal Register notice is available here.
A link to a March 23, 2009, article discussing Catholic criticism of the proposed rule rescission is available here.
March 19, 2009
United States Reaches $355,000 Settlement With Three Arizona Cardiologists
The United States has reached a settlement with three Arizona cardiologists resulting from alleged violations of the Stark Law. The cardiologists formed a nuclear-imaging practice in January of 2007. The cardiologists later learned of potential Stark Law violations and self reported the errors. The United States contended that from January 2007 to October 2007, the three cardiologists submitted claims for payment to the Medicare Program in violation of the Stark Law. The three cardiologists agreed to pay $355,000 to settle the matter. The settlement information released by the U.S. Attorney’s Office in Arizona does not include details of the business practices or the legal violations. View a copy of the press release here.
March 16, 2009
New Recovery Act Office Created by HHS to Promote Transparency in Stimulus Spending
As of March 11, 2009, the Department of Health and Human Services had disbursed more than $3 billion in stimulus funds, mostly in Medicaid dollars. Led by former HHS Health Resources and Services Administration Deputy Administrator Dennis Williams, HHS’s new Office of Recovery Act Coordination intends to “enhance and streamline” the stimulus spending, promising quick, organized, and transparent distribution of the estimated $137 billion in federal healthcare stimulus spending. You can view weekly spending reports, funding opportunities, and state-specific Medicaid allocations at the office’s new web site: http://hhs.gov/recovery/.
AMA Develops Code of Conduct to Address Disruptive Behavior
In response to the Joint Commission’s new standard requiring hospitals to have a code of conduct that defines acceptable and unacceptable behavior and addresses how to handle unacceptable behavior, the American Medical Association (AMA) has unveiled a new model code of conduct.
A sample code developed by the AMA can be accessed here.
March 13, 2009
Three House Committee Chairs Aim for Health Reform Legislation to Reach the House Floor Before Congress’ August Recess
Chairs Henry Waxman (Energy and Commerce), Charles Rangel (Ways and Means), and George Miller (Education and Labor) have sent a letter to President Obama expressing their intent to bring national health care reform legislation to the House floor before Congress’ August recess. The chairs have agreed to coordinate efforts to pass the legislation. The full text of the letter is available here. As discussed below, Senator Max Baucus has already expressed an intent to bring health care reform legislation to the Senate floor by early summer.
March 9, 2009
CMS to Begin Enforcing Stricter Provider Enrollment Rules
CMS will begin enforcing new restrictive provider enrollment policies beginning April 1. Under the new policies, physicians, non-physician practitioners, and physician or non-physician practitioner organizations may bill for services provided no more than 30 days prior to the effective date of enrollment. The effective date of enrollment will be the later of either the application date or the date the provider started seeing patients at the practice location. Providers should take steps to ensure timely submission of enrollment applications in order to avoid claim denials.
In addition, under the new rules, providers must report major changes such as changes in ownership or practice location and final adverse actions within 30 days.
A link to the CMS transmittal detailing the new rules as well as illustrative examples of how the new regulations will affect providers can be found here.
March 5, 2009
National Study Identifies Key Factors of Good Governance For Hospitals
On March 3, 2009, a hospital governance study conducted by accounting firm Grant Thornton LLP, in collaboration with the American Hospital Association and the University of Iowa, identified six factors of good governance that contribute to a hospital’s effective operations. The study surveyed over 100 community health systems and polled chief executives on how well their boards followed 39 governance benchmarks. An examination of 10 “high-performing” systems pinpointed the following key factors that influence a hospital’s operating performance, according to hospital board members and trustees surveyed:
- Strong values-based CEO leadership, often with emphasis on the importance of strong management teams;
- Well-understood system-wide mission, vision, and values;
- A highly committed and engaged board of directors;
- Strong clinical leadership and capabilities;
- Clearly-defined organizational objectives, targets, and metrics; and
- Healthy organizational culture.
Read the full report, Governance in High-Performing Community Health Systems: A Report on Trustee and CEO Views, here.
March 4, 2009
Stimulate the Economy with HIPAA Actions by States Against Health Care Providers and Plans?
The National Law Journal is reporting noticed provisions in the proposed stimulus bills – providing state attorneys general with new enforcement power for HIPAA violations, including civil damages and injunctions in federal courts. Marcia Coyle writes…read more
March 2, 2009
Sixth Circuit Case Holds That Medical Residents May Be Exempt From FICA Tax
On February 26, 2009, the U.S. Court of Appeals for the Sixth Circuit joined the Seventh and Eleventh Circuits in holding that medical residents were not per se ineligible for the “student exception” from FICA tax. At issue in the case was whether residents at Detroit Medical Center qualified as “students” under Internal Revenue Code sections allowing an exemption from FICA tax for students. The Sixth Circuit rejected the IRS’s assertion that the residents were not students, and remanded the case to district court for further proceedings. To date, every U.S. Court of Appeals that has rendered a decision regarding the applicability of the student FICA exception to medical residents’ stipends has rejected the IRS’s position that medical residents were not students and therefore ineligible for the FICA exemption. Read the complete opinion here.