Newsline -from the Hill

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January 1, 2004

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CMS Issues New EMTALA Guidelines On May 13 the Centers for Medicare and Medicaid Services issued revised Emergency Medical Treatment and Labor Act interpretive guidelines to all CMS regional offices and state survey agencies. The guidelines serve to interpret and clarify the existing statutory and new regulatory requirements set forth by EMTALA and are meant to be used to assist the enforcement agencies in making consistent determinations about a provider’s compliance with EMTALA. Neurosurgeons can consult this document, available at www.cms.hhs.gov/medicaid/survey-cert/sc0434.pdf”, to ensure that they are meeting the on-call requirements of EMTALA.
Antitrust Report Raises Questions The Federal Trade Commission and Department of Justice jointly released a report in July on antitrust violations in healthcare. The report opposes physician collective bargaining and questions the anticompetitive nature of independent practice associations, messenger model physician networks and other types of provider networks. The report did, however, provide greater guidance on the “clinical integration” requirement of such networks. Instead of giving physicians countervailing powers to oppose insurer pricing tactics, the agencies instead favor further monitoring of the insurance industry for signs of anticompetitive behavior. The report stated that low reimbursement levels in themselves are not a sign of antitrust violations, but may be an indication of an insurer’s market power. It also denounced as anticompetitive “most favored nation” clauses, which require physicians to give an insurer its best price at all times, and “any willing provider” laws, which require insurers to accept all physicians willing to enroll in its network. The report is available at www.usdoj.gov/atr/public/health_care/204694.htm.
CMS Advisory Opinion Says Specialty Hospital Is Not Subject to Moratorium A physician-owned orthopedic and neurological surgery hospital will be exempt from the 18-month moratorium imposed on specialty hospitals in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, known as the MMA, according to a rare advisory opinion issued June 23 by the Centers for Medicare and Medicaid Services. Physician-owned specialty hospitals have, until now, qualified for the whole-hospital exception in the physician self-referral regulations, meaning doctors with ownership interest in a specialty hospital could refer Medicare patients to the facility. However, some lawmakers and acute care hospitals have criticized the whole-hospital exception as a loophole for physicians to self-refer inappropriately for financial gain. The 18-month moratorium in the MMA was to allow CMS time to study the effect of specialty hospitals on the industry. The opinion, with the hospital’s name redacted, is available at www.cms.hhs.gov/medlearn/ao-sh-2004-06-01.pdf.
Doctors for Medical Liability Reform Launches Additional Television Programs On July 6 Doctors for Medical Liability Reform launched new and updated 30-minute television newsmagazines in Georgia, North Carolina, South Carolina and Washington state. DMLR’s Protect Patients Now programs tell the story of the medical liability crisis and feature physicians, patients, public officials and concerned activists who are deeply troubled by ever-decreasing access to healthcare. The programs will be televised in every media market in these four states from now until October. Additional programming and campaign materials are forthcoming. The newsmagazines are fully downloadable from the DMLR Web site at www.protectpatientsnow.org. The American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons are members of DMLR through their advocacy organization, Neurosurgeons to Preserve Health Care Access. Information about the campaign and medical liability reform in general is available from the AANS/CNS Washington Office, (202) 628-2072.

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