Articles Posted in Uncategorized

On September 30, 2010, the Arkansas Supreme Court held that Baptist Health, a private, charitable, nonprofit corporation, may not impose an Economic Conflict of Interest Policy (Policy). In this case, “the Policy mandates the denial of initial and renewed professional staff appointments or clinical privileges at any Baptist hospital to any practitioner who, directly or indirectly, acquires or holds an ownership interest in a competing hospital.” The Court held that this Policy’s “motive was to make patients choose between their doctors and Baptist” and agreed with the lower court that it was improper. Cecil B. Wilson, M.D., President of the American Medical Association, released a statement in which she stated the Court “preserve[d] the patient-physician relationship and promotes competition in Arkansas by permanently prohibiting an economic credentialing policy…” She continued to state that “the primary factor in credentialing physicians should be competency, not economic factors unrelated to quality.”
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Health and Human Services (HHS) announced that it launched its new HealthCare.gov Facebook page. According to HHS Secretary, Kathleen Sebelius, “HealthCare.gov on Facebook offers Facebook users a new tool to understand and stay informed about the Affordable Care Act…This new page is another resource that people can use to learn about and discuss health care issues that are important to them, their family, or their small business.” HealthCare.gov on Facebook provides a search function for insurance coverage, a medium through which people can discuss their healthcare ideas, and a new way to stay informed.
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On September 21, The Hill and the American College of Cardiology (“ACC”), hosted a discussion with Sen. Tom Coburn (R-OK), Rep. Brian Baird (D-WA), Dr. Ralph Brindis–the President of ACC–Dr. Jack Lewin, and Dr. John Tooker–the CEO of American College of Physicians (“ACP”) to discuss patient payment reform. While the two congressmen represent opposite parties, they had one message: the current Medicare system is not efficient and reform is imperative. Coburn attested, “we have designed exactly the tragedy that we have.” Specifically, he referred to the fact that Medicare does not take the quality of care into account; rather, it only considers quantity. Likewise, Baird called for an end to Medicare and Medicaid, replacing it with a needs-based voucher system. Lewin, echoing the congressmen, stated that while health reform will not get repealed, it is up to the media, physicians, and law makers–collectively–to change the delivery and payment of healthcare. Reform “isn’t about getting more money for doctors, this is really about improving the way healthcare is delivered to patients,” Tooker said.
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Under the proposed Medicare physician fee schedule rule (the “Proposed MPFS”) released by the Centers for Medicare and Medicaid Services (CMS) on June 25th, physician reimbursement rates would decrease by 6.1% as of January 1, 2011. On the day that CMS issued the Proposed MPFS, the 21% cut in physician reimbursement was deferred until at least November 30, 2010 by operation of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (H.R. 3962) being signed into law. Under H.R. 3962, physicians were designed to receive a 2.2% positive adjustment to rates, retroactive to June 1, 2010, the date upon which the 21% reduction became effective. Clearly, the vicissitudes in the Medicare physician reimbursement landscape are the cause of significant consternation in the physician provider community, leading substantial numbers of physicians to critically evaluate their continued participation in the program … or, at a minimum, whether to admit any new Medicare patients into their practices. Note that the Proposed MFPS’s focus is not confined to the payment update, and also operates to implement a number of initiatives contemplated under the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act. Please see The HLP Blog for coverage of other aspects of the Proposed MPFS, which is scheduled to be published in the July 13 Federal Register, with comments due by August 24.
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Compliance continues to be a hot topic given the continued increase in enforcement, audits and other aspects of health care reform. On May 7, 2010, the Office of Inspector General (OIG) posted on its website an excerpt from a keynote address that the Inspector General for the Department of Health & Human Services recently gave entitled “Some Questions Compliance Professionals Should Ask As They Prepare for Health Care Reform.” It should come as no surprise that the focus of the questions relate to transparency, quality as a compliance issue and accountability.
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Huping Zhou, a former UCLA Healthcare System cardiothoracic surgeon is the first defendant in the nation to receive a prison sentence for a HIPAA privacy violation. After admitting that he illegally read private electronic medical records of patients and obtained individually identifiable health information without a valid reason, Zhou was sentenced to four months in prison.

According to a Department of Justice press release, on the day in 2003 that Zhou received notice that he was being dismissed from his job, he accessed and read the medical records of his supervisor and colleagues. Over the next few weeks (even after he was formally terminated), Zhou illegally accessed the patient records system 232 times, including reviewing the medical records of several celebrities – Sharon Osbourne, Barbara Walters, Elizabeth Banks, Leonardo DiCaprio, Tom Hanks, Drew Barrymore, and Arnold Schwarzenegger.
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On Monday, April 6, 2010, CMS updated its RAC website by announcing a series of nationwide calls as detailed below:

April 28, 2010, 1:00pm – 2:30pm EST: Nationwide RAC 101 Call, 1-877-251-0301 May 4, 2010, 1:00pm – 2:30pm EST: Nationwide RAC 101 Call for Home Health and Hospice Providers, 1-877-251-0301 May 5, 2010, 1:00pm – 2:30pm EST: Nationwide RAC 101 Call for DMEPOS, 1-877-251-0301 May 12, 2010, 1:00pm – 2:30pm EST: Nationwide RAC 101 Call for Physicians, 1-877-251-0301 Continue reading →

On March 15, 2010, the Joint Commission announced revisions to Medical Staff Standard MS.01.01.01 (formerly known as MS.1.20). The revisions are based on the unanimous recommendations of an 18-member expert task force representing the American College of Physicians, American College of Surgeons, American Dental Association, American Hospital Association, American Medical Association, Federation of American Hospitals and the National Association of Medical Staff Services, as well as hospital trustees and medical staff attorneys. MS.01.01.01 addresses the medical staff’s self-governance and its accountability to the governing body for the quality and safety of patient care, and recognizes that while a hospital’s governing body is ultimately responsible for the quality and safety of care, the governing body, medical staff and administration must collaborate to achieve this goal. To facilitate this collaboration, the new standard makes significant changes to the requirements for a hospital’s medical staff bylaws and represents a shift of power from the hospital’s medical executive committee to the broader voting medical staff. The revised standard becomes effective on March 31, 2011, providing hospitals and their medical staff a full year to understand and incorporate the new requirements and the Joint Commission an opportunity to provide any necessary clarifications.
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Rep. Sander Levin, an expert on trade issues, has been tapped to take over the House Ways and Means Committee after Rangel stepped down and Rep. Pete Stark stepped aside. It has been widely reported that concerns by fellow members of the House Ways and Means Committee over Rep. Pete Stark’s politics, background and history of controversial statements led to the surprise decision on March 4th to have Congressman Levin replace the embattled Rep. Charles B. Rangel as the committee chairman. Stark had been in line for the powerful post after Rangel announced Wednesday that he was stepping down until a House ethics panel finished investigating him. Based upon the positions that Pete Stark historically has taken to limit revenue-generating opportunities for physicians, the prevailing assumption is that the physician community breathed a collective sigh of relief upon learning of this development.
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Physician reimbursement under the Medicare program will not face a 21% cut, at least not for the next 30 days. Yesterday, on March 2, 2010, the Senate passed the Temporary Extension Act of 2010 (H.R. 4691, 111th Cong. § 5 (2010)), which postponed the effective date of a planned 21% fee reduction for an additional 30 days – until March 28, 2010. CMS has stated its belief that Congress will continue to work to avoid implementation of the negative fee schedule update.

The Health Law Partners, P.C. (“The HLP”) will continue to keep you apprised as updates occur.
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