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May 19, 2000

WEEKLY UPDATE for May 19, 2000

***LEGISLATIVE UPDATE
Patient Protections-Conference Committee
Quality Health Care Coalition Act (HR 1304)
***REGULATORY UPDATE
NCHS Publishes Emergency Department Data
OIG Issues Regulation Regarding Civil Money Penalties
HCFA Proposes New Criteria for Coverage Decisions
HCFA Issues Report on Medicare Spending
***WELCOME NEW 911 NETWORK MEMBERS!

ACEP concluded this year's Leadership & Legislative Issues Conference on May 18. Four Members of Congress-Reps. Nancy Johnson (R-CT), Rob Andrews (D-NJ), Pete Stark (D-CA) and Senator Bob Graham (D-FL) came to speak to attendees. Each provided a perspective on the prospects for the patients' bill of rights in general and on post-stabilization in particular. They fielded a number of questions on the 1-hour/3-hour health plan callback and indicated their willingness to address it. ACEP members visited more than sixty Representatives and Senators on Thursday. They conveyed their concern with the callback provision. The results of their visits are being tabulated and evaluated, but it is safe to say they were well received on Capitol Hill.

***LEGISLATIVE UPDATE

Patient Protections-Conference Committee

House-Senate conferees met Wednesday and Thursday-- the first time in several weeks-- to explore their differing positions on liability, scope, and medical necessity. Despite some encouraging words from some, it is apparent little progress has been made on any of these issues. It seems likely the latest deadline, May 25, will be missed. The House and Senate will be in recess for Memorial Day from May 26 through June 5. Little has changed since we began our campaign on the post-stabilization provision several weeks ago. If you have not done so already call or visit your legislators.

You, your colleagues, and your patients must call or visit your Representative or Senators. Tell them that the "three-hour limit must go." We must use the Memorial Day recess as an opportunity to keep the pressure on Congress to finish the work on the patient protection conference. Although we need to reach out to all legislators, we must target the following Members, especially the Republicans:

Conferees from the House of Representatives -- Reps. Bill Archer (R-TX), Mike Bilirakis (R-FL), Tom Bliley (R-VA), John Boehner (R-OH), Dan Burton (R-IN), Ernie Fletcher (R-KY), Porter Goss (R-FL), Nancy Johnson (R-CT), Jim McCrery (R-LA), Joe Scarborough (R-FL),John Shaddegg (R-AZ), Jim Talent (R-MO), Bill Thomas (R-CA).

Conferees from the Senate -- Sens. Mike Enzi (R-WY), Bill Frist (R-TN), Phil Gramm (R-TX), Judd Gregg (R-NH), Tim Hutchinson (R-AR), Jim Jeffords (R-VT), Don Nickles (R-OK), John Ashcroft (R-MO), Chuck Hagel (R-NE), Rod Grams (R-MN), Spencer Abraham (R-MI), Bill Roth (R-DE), Jon Kyl (R-AZ), John McCain (R-AZ), Rick Santorum (R-PA).

Quality Health Care Coalition Act (HR 1304)

The Campbell bill has once again reached a critical point in the legislative process. The bill, which was recently approved in the Judiciary Committee, will be debated on the floor of the House on May 24. Since the bill now has 220 cosponsors (more than a simple majority), it should pass. Nonetheless, opposition from employer groups and insurers continues unabated. The Rules Committee will meet on Tuesday May 23 to determine what amendments (if any) will be made. The debate in the Rules Committee could lead to a complex floor debate. ACEP and the AMA have called on the House to pass the bill without any amendments. Once passed by the House, the bill faces an uncertain future in the Senate.

Budget Committee Hearing Held on HCFA's Burdensome Medicare Rules

Hospital administrators testified Thursday that the staff resources needed to comply with HCFA and other government agencies' regulations are "taking away from time that could be spent on patient care." The House Budget Committee's Task Force on Health heard from hospital administrators, who urged lawmakers to reform the health care system rather than "concentrate solely on the bottom line." Witnesses complained of the nearly 111,000 pages of Medicare regulations and the "increasingly complex" rules of the 29 different federal agencies responsible for overseeing health care facilities. Page Vaughan, executive director of Carolina Pines Regional Medical Center in South Carolina, said, "The focus in Congress should be on how to reform the overall Medicare program to bring it into the 21st century, and away from persistent cutting of provider reimbursement for budget reasons unrelated to health policy." Congressional oversight of HCFA, the regulations it develops and its enforcement of policies appear to be issues of growing interest to Congress.

Cardiac Arrest Survival Act

The House Commerce Committee unanimously approved the Cardiac Arrest Survival Act earlier this week by voice vote. The full House may consider the bill as early as next week. It is expected to pass without difficulty.

Medical Errors

Buried within the report language of the Labor-HHS appropriations bill, approved by the Senate Appropriations Committee last week, is a provision addressing medical errors. Based on Senate Labor-HHS appropriations subcommittee Chair Arlen Specter's (R- PA.) and ranking member Tom Harkin's (D-IA) Medical Error Reduction Act, the provision would allocate $50 million to the Agency for Healthcare Research and Quality to "develop guidance on the collection of uniform data related to patient safety." The agency would then report to Congress by the end of the year on how errors should be identified and reported. The measure also would set up a program for health care facilities and organizations to test best practices for reducing errors and to determine ways to improve provider training in order to reduce errors. The provision is not included in the House Appropriations Bill.

***REGULATORY UPDATE

NCHS Publishes Emergency Department Data

On May 10, the Center for Disease Control and Prevention's National Center for Health Statistics published emergency department data from its 1998 survey. During 1998, there were 100 million visits to hospital emergency departments in the United States - approximately 37 visits per 100 persons. The highest visit rate occurred for the population 75 years of age or older. The most frequently reported reason for visiting the emergency department was abdominal pain, with chest pain, fever and cough also receiving high ranks. Leading medical diagnoses included upper respiratory infections, asthma and heart disease. Approximately 37.1 million visits to the ED were due to injuries, particularly injures due to falls, being struck by objects or people, and motor vehicle crashes. Over 2 million visits to the ED were related to unintentional injuries, including 1.6 million assaults. Just under 500,000 visits were related to self-inflicted injuries, most of which were poisoning. Approximately 1.2 million visits were associated with adverse drug reactions and complications from surgical procedures and medical care. The survey also showed that patient came to the ED in a fairly constant stream between 8:00 a.m. and midnight, with the peak number of visits during the late afternoon and early evening. On average, patients waited about 40 minutes to see a physician. The report, "National Hospital Ambulatory Medical Care Survey: 1988 Emergency Department Summary," is available on the CDC's web page at http://www.cdc.gov/nchs.

OIG Issues Regulation Regarding Civil Money Penalties

In late April, the Office of Inspector General (OIG) issued a final rule that expands the OIG's authority to impose civil money penalties (CMPs) on providers who commit health care fraud. Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the final rule increases the amounts and scope of the CMPs. Under HIPAA, maximum fines for false claims increased from $2000 to $10,000 per false claim, and maximum penalties increased from double to treble damages. In addition, the final rule expands CMP authority beyond programs funded by the Department of Health and Human Services to other federal health care programs, including TRICARE, Veterans Affairs and the Public Health Service. The rule also provides for CMPs of up to $10,000 per day for each day and individual excluded from participating in a federal health care program retains a prohibited relationship with a participating health care entity. HIPAA

established a new basis for CMPs for physicians who falsely certify the medical necessity for Medicare-covered home health services. In addition, the OIG's authority was expanded to penalize providers who upcode, bill for medically unnecessary services, and offer remuneration to induce a beneficiary to order from a particular Medicare provider. The final rule includes exceptions to the definition of "remuneration," including waiving coinsurance and deductibles for indigent beneficiaries. The final rule became effective on April 26.

HCFA Proposes New Criteria for Coverage Decisions

In early May, HCFA issued a proposed rule to standardize Medicare coverage nationally. The proposed rule includes criteria that HCFA proposes to use to make decisions about which services Medicare will cover. HCFA had initially published proposed national criteria in 1989, but the proposed rule was very controversial and was never finalized. HCFA proposes applying two criteria when making a national coverage decision. First, the item or service must demonstrate medical benefit, and the item or service must demonstrate added value to the Medicare population. HCFA would measure the medical benefit and the added value criteria by clinical scientific evidence.

HCFA Issues Report on Medicare Spending

In early May, HCFA issued a report regarding Medicare spending in the third quarter of 1999. Part A income increased 23.3 percent in the third quarter, while outlays fell by 6.9 percent. HCFA stated that a strong economy was responsible for the increase in income and that provisions of the Balanced Budget Act of 1997 and anti-fraud and abuse efforts helped constrain growth. The third quarter of 1999 was not as positive for Medicare Part B, with income rising by 4.4 percent, while outlays rose by 15.2 percent. The report also stated that medical inflation rose at an annual rate of about 3.5 percent in the third quarter. In addition, hospital employment slowed - private hospitals' third quarter growth rate of 0.9 percent was the first increase of less than one percent since the first quarter of 1996. The report, "Health Care Indicators: Hospital, Employment and Price Indicators for the Health Care Industry: Third Quarter 1999," is available on HCFA's web page at http://www.hcfa.gov/stats/indicatr.

***WELCOME NEW 911 NETWORK MEMBERS!

Robert Kowalski, MD, FACEP (Rep. Max Sandlin D-TX)
William Falco, MD (Rep. John Porter R-IL)
Brad Butler, MD (Rep. John Shadegg R-AZ)
Elaine Josephson, MD, FACEP (Rep. Ben Gilman R-NY)
James Bellone, MD, FACEP (Rep. Richard Baker R-LA)
Geoffrey Renk, MD, FACEP (Rep. Jim Clyburn D-SC)