June 16, 2000
WEEKLY UPDATE for June 16, 2000
***LEGISLATIVE UPDATE Patient
Protections Labor-HHS Appropriations ***REGULATORY
UPDATE OIG Issues Draft Compliance Program Guidance
for Physicians MedPAC Issues Report to Congress on
Medicare OIG Issues Guidance on Corporate Integrity
Agreement Compliance
LEGISLATIVE UPDATE
Patient Protections
The patients' bill of rights conference has been at a
stand still since the failed attempt to amend the
Defense Authorization bill (see June 9 Weekly Update).
No meetings of the conference committee are scheduled.
The authorization committees are addressing HCFA
oversight and Medicare prescription drug issues this
week.
Despite the setback, there are some in the Congress
and in the White House who still believe an agreement
can be reached this year. The White House has indicated
that it is willing to compromise on patient liability,
one of the most contentious issues. The White House
plans to bring pressure to bear on five vulnerable
Republican Senators who are up for reelection. They
include Sens. Spence Abraham (R-MI), Rick Santorum
(R-PA), John Ashcroft (R-MO), Slade Gorton (R-WA), and
Bill Roth (R-DE).
House and Senate Republicans may try to come together
on an agreement that builds on compromises reached thus
far. They may also incorporate an appeals process that
resembles the language of Coburn-Shadegg (suits may only
be filed in federal court with limits on damages). No
mention has been made of how the Republicans might solve
the scope issue (every House bill covered all insured
Americans but the Senate bill covered only self-insured
plans.)
Conferees continue to hear from constituents about
the difficulties that the tentative agreement on post-
stabilization (1-hour/3-hour provisions) presents. The
American Hospital Association has joined ACEP in
requesting that the provision be changed. Senate
leadership staff have indicated that they may be willing
to reduce the post-stabilization time to
1-hour/1-hour.
Labor-HHS Appropriations
The Labor-HHS Appropriations bill passed the House
floor this week with all House Republicans voting for
the bill along with a handful of Democrats. The Senate
version of the bill is expected to reach the Senate
floor within the next two weeks. The House bill kept to
the rigidly low budget numbers, while the Senate bill is
anticipated to contain significantly increased spending
amounts. Conferees will then be appointed to reconcile
the differences between the two bills. The funding bills
contain two provisions of particular importance to ACEP
members:
- Poison Control Centers-- Centers would receive
$6.6 million under the House-passed bill. The Senate
committee bill sets a $6 million level. This is a
significant increase over last year's appropriations
of $1.3 million. ACEP is working with other interested
organizations for the increased funding.
- Trauma Care Systems Planning and Development-- In
November 1998, President Clinton signed into law P.L.
105-392, the "Health Professions Education and
Partnership Act." The "Trauma Care Systems Planning
and Development Act," (TCSPDA) was one of the programs
included in this public law. This title of P.L.
105-392 authorizes federal grants to states for
planning, implementing, and developing statewide
trauma care systems. Last year's House/Senate
conference agreement on the Labor-HHS Appropriations
bill dropped all funding for this federal grants
program. This year, ACEP is working with the Trauma
Care Coalition in support of funding for the TCSPDA.
Funding in the House was omitted again because of
strict spending limits. The Senate committee bill
however contains $3 million.
After the conferees are appointed on the Labor- HHS
bill we will be asking you to call or write your
Representatives to urge the conferees to retain the
Senate language for Trauma Center Funding.
REGULATORY UPDATE
OIG Issues Draft Compliance Program Guidance for
Physicians
On June 12, the Office of Inspector General (OIG)
published draft compliance program guidance for
individual and small group physician practices. Comments
on the draft must be submitted to the OIG by July 27.
While the OIG's compliance program guidance is not
mandatory, it represents the OIG's recommendations
regarding how individual and small group physician
practices can best establish internal controls to
prevent fraudulent and other improper activities. The
OIG notes that the applicability of its recommendations
will depend on the circumstances of the particular
physician practice. To date, the OIG has issued
compliance program guidance for the following sectors of
the health care industry: hospitals; home health
agencies; clinical laboratories; third-party billing
companies; suppliers of durable medical equipment,
prosthetics, orthotics and supplies; hospices;
Medicare+Choice organizations; and nursing
facilities.
Like the OIG's previous compliance program guidances,
the draft guidance for physicians contains the seven
elements set forth in the Federal Sentencing Guidelines:
implementation of written policies; designation of a
compliance officer or contact; comprehensive training
and education; accessible lines of communication;
internal monitoring and auditing; enforcement of
standards through well publicized disciplinary
guidelines; and prompt response to detected offenses and
corrective action.
The OIG identified potential risk areas for which
physicians should develop written policies. These risk
areas include coding and billing; reasonable and
necessary services; documentation; and improper
inducements, kickbacks and self-referrals. The OIG
identified physician's relationships with hospitals as
an additional risk area. This category included the role
of the physician in EMTALA, with a focus on the
responsibilities of on-call physicians; teaching
physicians; and gainsharing arrangements. The draft
compliance program guidance is available on the OIG's
web site at: http://www.dhhs.gov/progorg/oig/oigreg/cpgphysiciandraft.pdf.
MedPAC Issues Report to Congress on Medicare
The Medicare Payment Advisory Commission (MedPAC)
recently issued its annual report to Congress on issues
affecting Medicare. The report contains recommendations
regarding prescription drug coverage for Medicare
beneficiaries and Medicare's quality assurance system.
The report also addresses several Medicare payment
policy issues, including the hospital outpatient
prospective payment system, payments to teaching
hospitals and payment updates for physician
services.
Regarding the hospital outpatient prospective payment
system (OPPS), MedPAC supports the goals and broad
outlines of the OPPS, but has concerns about elements of
its design and implementation. MedPAC notes that the
administrative burden on hospitals of moving to the new
system should not be underestimated. MedPAC stated that
HCFA must ensure adequate payment levels to hospitals so
that beneficiary access to care and quality of care are
not compromised. MedPAC makes the following specific
recommendations:
- The Secretary should monitor changes in practice
patterns across ambulatory care settings to ensure
that differences in payment do not lead to
inappropriate shifts in site of care.
- The Secretary should study the accuracy of and
changes in coding practices with the implementation of
the outpatient prospective payment system.
- The Congress should enact legislation to
accelerate the rate of beneficiary coinsurance buy
down under the OPPS and establish a date certain for
achieving a coinsurance rate of 20 percent. This date
should result in a time frame for implementation
consistent with other Medicare payment policy changes.
- The Secretary should carefully monitor
implementation of the OPPS to ensure that:
- it does not have unintended, adverse consequences
on beneficiaries' access to care,
- it does not compromised the quality of care
delivered, and
- the annual reductions in beneficiary coinsurance
as a share of total payment are realized.
Regarding payments to teaching hospitals, MedPAC
provided additional detail regarding its August 1999
recommendations to Congress that Medicare's payments for
inpatient hospital care be revised to recognize the
higher value of patient care services provided in
teaching hospitals. MedPAC recommends combining
Medicare's current additional payments to teaching
hospitals into a single adjustment to PPS payments for
patient care. The new adjustment would replace the
current IME adjustment and direct GME payments for
residents providing inpatient care. Hospitals would,
however, continue to receive direct GME payments for
care provided by residents in outpatient and other
settings. MedPAC's specific recommendation is:
- The Congress should fold inpatient direct graduate
medical education costs into prospective payment
system payment rates through a revised teaching
hospital adjustment. The new adjustment should be set
such that the subsidy provided to teaching hospitals
continues as under current long-run policy. This
recommendation also should be implemented with a
reasonable transition to limit the impact on hospitals
of substantial changes in Medicare payment and to
ensure that beneficiaries have continued access to the
services that teaching hospitals provide.
Regarding payment updates for physician services,
MedPAC reviewed HCFA's recently released preliminary
estimate of the update for payments to physicians in
2001. HCFA preliminarily estimated that the sustainable
growth rate (SGR) for 2001 will be 2.8 percent. MedPAC
is concerned that one of the factors for calculating the
SGR, growth in traditional Medicare enrollment, is too
low. HCFA's estimate of the change in traditional
Medicare enrollment in 2001 appears too low because its
estimate of the change in Medicare+Choice enrollment is
too high. MedPAC notes that if HCFA continues to
underestimate the growth in traditional Medicare
enrollment, conversion factor updates will be too low.
MedPAC's specific recommendation is:
- When preparing the final 2001 update to the
physician fee schedule's conversion factor, the
Secretary should review the data and methods used to
project growth in the enrollment in traditional
Medicare and explain the methods used to project that
growth. The report is available on MedPAC's web site
at: http://www.medpac.gov/.
OIG Issues Guidance on Corporate Integrity Agreement
Compliance
The OIG recently issued guidance to health care
providers that are operating under corporate integrity
agreements. The OIG typically requires health care
providers that settle civil fraud cases to operate under
corporate integrity agreements. The corporate integrity
agreement is usually in place for five years and
requires specific compliance measures to be adopted. The
recently issued guidance includes and annual report
checklist and answers to frequently asked questions
about corporate integrity agreements. These documents
are available on the OIG's web site at: http://www.dhhs.gov/progorg/oig/new.html. |