Leave it to Rep. Fortney "Pete" Stark (D-Calif.) to find the Achilles heel of health plans' campaign to boost their Medicare payments.
Stark last week introduced legislation that would prohibit plans from including lobbying costs as a reimbursable expense in their annual adjusted community-rate proposals, which HCFA uses to calculate Medicare+Choice capitation payments.
He cited letters in which HHS Inspector General June Gibbs Brown raised concerns over whether Medicare ought to reimburse Medicare-risk plans for those expenses.
"HMOs have been recruiting enrollees to send in form letters to members of Congress urging higher payment rates," Stark said in a written statement. "What is annoying is that they are spending some Medicare money to do this. The legislation I am introducing will save the taxpayer from footing the bill for lobbying to spend more taxpayer money."
Caveat provider. Law professors and public interest groups are already testing the new rules that make not-for-profits' federal tax returns more accessible to the public.
The final rules, which became effective June 8, require not-for-profits to provide a copy of their returns, called Form 990, to interested parties upon request. And academics and others want to make sure not-for-profit organizations follow the letter of the law.
These advocates are reportedly recruiting volunteers throughout the country to see how responsive various not-for-profits, including 80% of the nation's hospitals, are to such requests.
Professors and public interest groups will then record how well the organizations complied and publish their findings in one or more reports, according to a client newsletter distributed by accounting and consulting giant KPMG.
Friendly rivals. Publicly, the American Association of Health Plans and the Health Insurance Association of America, which are competing to keep many of the same companies on their roster, tend to downplay their rivalry. But HIAA, in announcing the hiring of a top official, gave a small hint of what lies beneath that tranquil image.
The press release announcing the appointment of Donald Young, M.D., as HIAA's chief operating officer and medical officer, played up Young's accomplishments as a "well-known Washington expert on health and healthcare financing issues" and his tenure as the executive director at the Prospective Payment Advisory Commission.
Only after first mentioning his posts at HCFA, the American Lung Association and private practice did the HIAA statement mention Young's tenure as senior vice president for policy and clinical services at the AAHP.
Duo to Triad. What do a professional football hall-of-famer and a former U.S. postmaster general have in common?
They've both been named directors at for-profit Triad Hospitals, Dallas, one of two companies Columbia/HCA Healthcare Corp. spun off in early May.
Gale Sayers, 56, a former star running back for the Chicago Bears, has shown he also knows how to run with the ball in the business field. Sayers is president and chief executive officer at Sayers Computer Source, a computer resale firm based in Mount Prospect, Ill., which he founded in 1984 with his wife, Ardythe. He also runs a consulting company and a sports marketing and public relations firm.
Marvin Runyon, 74, who retired last year as the 70th postmaster general, previously was chairman at the Tennessee Valley Authority and president and CEO at Nissan Motor Corp.'s first American manufacturing plant in Smyrna, Tenn.
Triad, which operates 33 hospitals, is still looking for two more outside directors to bring its total to 10.
Pointing up. WellPoint Health Networks, the for-profit parent of Blue Cross of California, benefited recently when another company's fortunes hit the skids.
Thousand Oaks, Calif.-based WellPoint was added to the Standard & Poor's 500 Index on June 8, replacing mining-equipment manufacturer Harnischfeger Industries, which was dropped from the closely watched S&P index after filing for Chapter 11 bankruptcy protection.
WellPoint has about 6.9 million managed-care enrollees, including nearly 4.6 million in California. The news that WellPoint was joining the prestigious index pushed its stock price up by nearly $3 a share to $86.13-a not uncommon boost for a new member of the S&P club.
As of early last week, the stock was trading at $86.81 a share, not far away from its 52-week high of $89.19.
Quotables. "If pharmacy becomes a covered benefit under Medicare, the drug companies will have to deal with him."-Wendy Krasner, a healthcare attorney with the Washington firm McDermott Will & Emery, introducing James Sheehan, the assistant U.S. attorney in Philadelphia known for his aggressive efforts in prosecuting Medicare fraud.
"In an election year, there's a premium on candy and a bear market on spinach."-Dean Clancy, policy adviser to House Majority Leader Richard Armey (R-Texas).
"Medicare reform is always spinach, unless you're talking about adding a prescription drug benefit."-Sarah Lyons, healthcare aide to Sen. John Breaux (D-La.), author of a leading Medicare reform bill.