The American Hospital Association's board of trustees, which met in Chicago last week, instructed AHA staffers to come up with a plan next year to get the issue of access to care back on the national agenda. The board said access has "fallen off the table" in the ongoing debate over Medicare and Medicaid reform, said Richard Wade, the AHA's senior vice president for communications. In other action, the AHA board froze hospital membership dues in 1996 and expanded its Committee on Governance, which replaced the Congress of Hospital Trustees, to 24 members from 18. The AHA also eliminated nine positions in its Chicago office as it strives to meet its budgetary requirements for next year. The jobs were in mail and computer services.
Some primary-care training programs will be exempted from a new HCFA Medicare payment policy that will require teaching physicians to be physically present when residents are treating Medicare beneficiaries. In its 1996 physician fee schedule regulation, HCFA said Medicare can reimburse teaching physicians who oversee residents involved in low- to mid-level primary-care services-sometimes called "evaluation and management" services-in such programs as family practice residencies. Such services, however, must be provided in such centers as hospital outpatient departments or ambulatory-care clinics, the regulation said. HCFA originally had proposed requiring teaching doctors to be physically present during the key portions of the service for all residency programs. In the regulation, however, the agency said such a requirement would be "inherently incompatible" with primary-care programs and would "endanger the financial viability of these programs."
In a 227-190 vote, the House has passed a compromise spending bill for the Department of Veterans Affairs that calls for a $16.6 billion healthcare budget in fiscal 1996. The House last month sent the spending bill back to a House-Senate conference committee because members wanted $213 million more for medical care, equal to a spending bill the House had passed earlier in the year. The vote last week left the compromise spending bill unchanged, however. The Senate is expected to vote this week on the compromise measure.
An anonymous donor mailed an early holiday gift to St. Jude Children's Research Hospital, Memphis, Tenn., in the form of a million-dollar winning game piece from McDonald's "Monopoly" gameboard promotion. "Somewhere, a wonderful anonymous donor will sleep very well this holiday season," said Richard C. Shadyac, national executive director of ALSAC-St. Jude, the hospital's fund-raising arm. According to game rules, St. Jude is ineligible to win the prize, but McDonald's franchisees are honoring the donor's intention by giving the $1 million to St. Jude through $50,000 annual donations over the next 20 years. St. Jude specializes in treating and researching children's catastrophic diseases and is supported primarily through public contributions.
Cape Coral (Fla.) Hospital last week hired a consulting firm to evaluate proposals for a possible affiliation or sale. Lee Memorial Hospital in Fort Myers, Fla., and Columbia/HCA Healthcare Corp. signed confidentiality agreements with the firm, Cambridge Partners, New York, to enter into discussions. Two weeks ago, Naples, Fla.-based Health Management Associates terminated its deal to acquire 201-bed Cape Coral, which has lost more than $28 million over the past two years. HMA also offered to extend indefinitely its contract to manage the hospital.
HemaCare Corp. filed suit against American Red Cross Blood Service's Los Angeles operations, charging unfair competition and antitrust violations. The suit, which asks for more than $4 million in damages, was filed in U.S. District Court in Los Angeles. HemaCare is a Los Angeles-based blood provider with about $11.5 million in annual revenues. It's opening a second service in St. Louis with an executive who recently settled an antitrust lawsuit against the Red Cross (Nov. 13, p. 10). HemaCare contends the Red Cross unfairly awards preferred discounts and other considerations to buyers committing 90% of purchases for each blood product type, regardless of volume. But a Red Cross official defended its practices. "We are confident that our acts are lawful, that they are consistent with the spirit of good and fair competition, and they do provide a good value for our customers," said Rich Krieg, acting principal officer of the Southern California region of Red Cross Blood Service.
Columbia/HCA Healthcare Corp.'s proposed acquisition of an 80% stake in a suburban Boston hospital was given a full once-over by proponents and foes of the first for-profit foray into community hospital ownership in Massachusetts.
The standing-room-only hearing was conducted by state Attorney General Scott Harshbarger. More than 20 speakers took the podium to toss concerns or kudos at the deal worked out between Columbia and MetroWest Medical Center, a healthcare organization with facilities in Framingham and Natick (June 19, p. 8).
Several opponents of the agreement, which includes 50% community representation on the MetroWest board, said the equal split in control was illusory because the contract gave Columbia control over budget and strategic planning issues.
In addition, provisions requiring the hospital to maintain current levels of indigent care and other responsibilities such as medical education were "not spelled out in any way that would satisfy the community," said Linda Miller, president of the Washington-based Volunteer Trustees of Not-for-Profit Hospitals.
Some speakers reacted to the general stir created by the prospect of a for-profit force in the state. "In Massachusetts, our strong, 200-year-old heritage of not-for-profit, acute-care hospitals has produced, pure and simple, the best hospitals in the country," said Michael Collins, M.D., president of eight-facility Caritas Christi Health System based in Boston. "We should move very carefully" before allowing a for-profit model "that challenges the fundamental tenets of our not-for-profit hospital tradition," Collins said.
Arnold Relman, M.D., former editor of the New England Journal of Medicine and staunch for-profit opponent, said he was "convinced that transfer of control to Columbia (under the deal) would seriously weaken this community's ability to plan for and control its own healthcare and that it would destabilize the entire voluntary hospital system in this region."
But others said that's just what Massachusetts needs. "I think we should welcome the entry of an investor-owned competitor with high performance standards into our nonprofit-dominated state, which currently has one of the most costly healthcare systems in the country," said Nancy Kane, a lecturer in management at Harvard School of Public Health.