Medicaid, the patients' bill of rights and proposed curbs to physician ownership of hospitals are issues coming out of Washington for physician executives to watch as Congress finishes its summer recess.
In a continuing effort to reverse last-minute regulations put in place by former President Clinton, the Bush administration announced it would delay and revise patient protection regulations under Medicaid.
The rules rollback comes as Bush savors a victory in the House, where Republicans passed the more limited patients' bill of rights Bush favors.
Meanwhile, Reps. Jerry Kleczka (D-Wis.) and Fortney "Pete" Stark (D-Calif.) have pending a bill that would prevent doctors from unfairly benefiting from their ownership in hospitals.
In explaining why he was quashing Clinton's Medicaid regulations, which would have taken effect in April 2002, HHS Secretary Tommy Thompson said he wanted to allow states to interpret how to best ensure patient protections, such as the right to a second opinion and granting appeals for medical care.
The regulations were an outgrowth of the Balanced Budget Act of 1997, which sought to reduce the cost of providing health services by pushing Medicaid patients into managed care plans while protecting their rights.
"I want to have patient protections in place as quickly as possible," Thompson says. "The previously issued rule went far beyond what Congress intended with the Balanced Budget Act, and its excessive mandates actually threatened beneficiaries' access to care under Medicaid." He said he hoped to have the new regulations in place by early next year.
Nullifying regulations and proposing new ones were easy lifting for the White House.
Pressing the House to adopt patient protection legislation weaker than the version passed by the Senate was a pitched battle Bush won only after persuading Rep. Charlie Norwood (R-Ga.) to support his version. The House passed the bill, 218 to 213.
Many providers favor the Senate legislation, says James Zini, D.O., president of the American Osteopathic Association. Zini, who works in a group practice in Mountain View, Ark., says medical decisions, whether made by a physician or a health plan, should be "adjudicated in the same forum under the same guidelines. It's not fair to have different standards."
On Sept. 13, D.O.s from around the country will descend upon Capitol Hill and pressure lawmakers to adopt the Senate's bill, Zini says.
The AMA also is backing the Senate version, says AMA board chairman Timothy Flaherty, M.D.
"The House-passed bill is seriously flawed," Flaherty says. "It overrides existing state protections and takes important patients' rights away from millions of Americans."
When lawmakers return Sept. 4 from their summer vacations, they will pick members for a House-Senate conference committee to reconcile the House and Senate versions of the rights bill. The conferees have yet to be named.
If Norwood is named as a conferee, then it is more likely that a compromise bill will come out of the committee, says Shawn Martin, assistant director for congressional affairs at the AOA.
The Kleczka-Stark bill, introduced in July, aims to close loopholes in current laws named for Stark that curb physician self-referrals.
Stark I and Stark II banned physician referral of Medicare patients to laboratories and other auxiliary services owned by the physician. Hospital ownership was exempted as long as the physician's financial interest was in the comprehensive hospital and not just the department or clinic where the physician practiced.
But the proliferation of freestanding heart, orthopedic and other physician-owned specialty hospitals has piqued Stark's interest. "Clearly these arrangements are a violation of conflict of interest and conveniently circumvent coverage of the Stark laws, which were designed to halt self-referral in the first place," Stark says.
Under the proposed legislation, physicians would be allowed to refer patients to a hospital in which they had an ownership interest, but only if the interest were purchased on terms also available to the general public at the time.
Failure to comply would result in civil penalties of up to $15,000 per referral and up to $100,000 for each referral scheme.
Gadi Weinreich, a partner at Shaw Pittman in charge of fraud, abuse and compliance issues, says the legislation is part of the ebb and flow over the past few years to strengthen or weaken Stark.
"To date, those efforts have not gone very far," Weinreich says. She says the bill would affect only a small number of specialty hospitals.
