From the Hill
- Medical Liability Reform Defeated in U.S. Senate On April 7 the U.S. Senate failed for the third time in nine months to allow debate on medical liability reform legislation. Largely along party lines, the cloture vote on the motion to proceed with consideration of S. 2207, the “Pregnancy and Trauma Care Access Protection Act” failed by a vote of 49 to 48; three senators did not vote. Sixty votes were necessary to bring the bill to the floor for consideration. S. 2207, among other things, would have applied a $250,000 cap on noneconomic damages in trauma, emergency, and obstetric and gynecological liability cases. The Senate is expected to bring additional medical liability reform measures to the floor for consideration later this year. Federal liability reform is the focus of the specialty physicians’ Protect Patients Now campaign and of the Bulletin’s cover story, page 11.
- House Approves Medical Errors Bill On March 12 the U.S. House of Representatives approved H.R. 663, which aims to reduce the number of healthcare errors. A main feature of the bill is a voluntary medical errors reporting system. The system would consist of private and public patient safety organizations, “PSOs,” that would be certified by the secretary of the U.S. Department of Health and Human Services. The PSOs would analyze data on medical mistakes, determine their causes, and provide the information to healthcare providers for their action to prevent future mistakes. The Bush administration has endorsed the House bill, and the Senate is expected to bring its version of the legislation to the floor this year.
- CMS Defines Specialty Hospital Exceptions The Centers for Medicare and Medicaid Services issued guidance on March 19 for exceptions to the specialty hospital moratorium enacted by Congress on Dec. 8, 2003. Under the moratorium, physicians may not refer patients to a specialty hospital in which they have ownership or investment interest, and the hospital may not bill Medicare or any other entity for services provided as a result of a prohibited referral. The moratorium applies to hospitals that are primarily or exclusively engaged in the care and treatment of patients who receive surgical procedures and who have orthopedic or cardiac conditions. Some types of hospitals are excluded from the moratorium: children’s hospitals, psychiatric hospitals, rehabilitation hospitals, long-term care hospitals, and cancer hospitals that are not paid under the inpatient hospital prospective payment system. Also excluded are “grandfathered” hospitals, those institutions that were in operation before or under development as of Nov. 18, 2003. CMS considers specialty hospitals that had Medicare provider agreements in effect on Nov. 18 to have been in operation. Information is available at www.cms.hhs.gov/manuals/pm_trans/r62otn.pdf.
- Resident Match System Doesn’t Violate Antitrust Laws A law signed on April 10 effectively ended an antitrust challenge to the National Resident Matching Program. Section 207 of Public Law 108-208, the “Pension Funding Equity Act of 2004,” declares that graduate medical matching programs do not violate federal or state antitrust laws. The stated purpose of the provision is to “ensure that those who sponsor, conduct or participate in such matching programs are not subjected to the burden and expense of defending against litigation that challenges such matching programs under the antitrust laws.” The lawsuit alleges that hospitals in the matching system fix wages below competitive levels. According to Modern Physician, Sherman Marek, plaintiffs’ attorney in the antitrust case, said an exemption for price-fixing will allow the suit to continue. However, Thomas Campbell, the matching program’s attorney, was quoted as saying, “This will be a death blow to the plaintiffs’ antitrust cast.”
- CMS Modifies HIPAA Contingency Plan On Feb….. 27 the Centers for Medicare and Medicaid Services issued a notice of modification to the Health Insurance Portability and Accountability Act contingency plan. The modification, effective July 1, 2004, continues to allow noncompliant electronic claims, but payment of these claims will take an additional 13 days. Additional information is available at www.cms.hhs.gov/medlearn/matters/mmarticles/2004/MM2981.pdf.
- MD at CMS
On March 12 the Senate confirmed Mark McClellan as the new administrator of the Centers for Medicare and Medicaid Services. McClellan, a physician and economist, previously headed the U.S. Food and Drug Administration.
For frequent updates to legislative news, see the Legislative Activities area of www.AANS.org.
NEURO NEWS
- End of CME Cycle: Dec. 31, 2004 For members of the American Association of Neurological Surgeons (AANS), Dec. 31, 2004, marks the end of the current cycle for continuing medical education credit. Active and Active Provisional members are required to document 60 neurosurgical credits between Jan. 1, 2002, and Dec. 31, 2004, to maintain membership. Detailed information is available on the CME Tracking page, www.AANS.org/education/cme.asp.
- New Survey Reports Steepest Drop in On-Call Coverage for Neurosurgery The specialty that most dramatically reduced participation in on-call coverage was neurosurgery, according to hospital administrators, with just 50 percent reporting neurosurgical coverage in 2004 compared with 90 percent in 2002. The February 2004 fax survey by the San Diego-based Governance Institute was in follow-up to a similar survey performed in 2002. Most respondents to the 2004 survey, 77 percent, said that the revisions to the regulations for the Emergency Treatment and Labor Act (EMTALA) issued by the Centers for Medicare and Medicaid Services in September have made no difference in relieving pressure for on-call coverage, while 13 percent of respondents said that the revisions actually made things worse. The EMTALA final rule published in the Federal Register https://www.gpoaccess.gov/fr on Sept. 9 clarifies, among other things, that neurosurgeons are not required to provide on-call services 24 hours per day, 7 days per week, 365 days per year, and that hospitals with flexibility to structure their call lists in a manner that reflects the limited number of neurosurgeons available to take call. Regarding stipends for on-call coverage, 54 percent of survey respondents said they do not provide or do not plan to provide stipends; of those that do, 46 percent pay a daily stipend with the average payment ranging from $407 to $878. The survey has restricted availability at www.governanceinstitute.com.
- Physicians Turn to Entrepreneurialism According to a report published in the March/April Health Affairs, “A common theme across markets was that harsh business realities had left physicians feeling financially beleaguered, forcing them to become more business oriented.” Authors of the report, Financial Pressures Spur Physician Entrepreneurialism, used data from Round Four of the Community Tracking Study, including 270 interviews with healthcare leaders in 12 metropolitan areas from September 2002 to May 2003. The report concludes that financial pressures have influenced physicians to increase prices and service volume, while providing fewer of the services that are less lucrative. Because these practices could impact some patients’ access to care, the report calls for policymakers to consider regulations and incentives to counteract this trend.
- ACGME Clarifies Duty Hour Limits Misperceptions In February the Accreditation Council for Graduate Medical Education denied the request of several surgical residency review committees for flexibility in resident work hour limits for chief surgical residents. The ACGME directed the duty hours subcommittee to study the implications of such a change on the quality of patient care, continuity of care, resident well-being, and the volume of procedures that surgical residents are expected to complete. As of January, less than 1 percent of the 7,900 ACGME-accredited programs had applied for the eight-hour weekly increase in duty hours-from 80 hours per week averaged over a four-week period to 88 hours. Of the 70 programs requesting the increase, 53 programs-30 of them in neurosurgery-were granted the increase, and 17 programs were denied. Additional information is available at www.acgme.org.
- President Appoints Neurosurgeon to Bioethics Council
Benjamin Carson Sr., MD, director of pediatric neurosurgery at the Johns Hopkins Medical Institutions, was appointed to the President’s Council on Bioethics in February for a two-year term expiring on Jan. 15, 2006. The Bioethics Council is charged with advising the president on bioethical issues that may emerge as a consequence of advances in biomedical science and technology.
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