A measure that would effectively end further physician investment in specialty hospitals is expected to be discussed this week by conferees reconciling the House and Senate versions of the Medicare reform bill, according to an attorney closely monitoring the developments.
Lorin Patterson, an attorney based in Overland Park, Kans., adds that Sen. John Breaux (D-La.), the author of the measure, has indicated "a willingness to reach some sort of compromise on the specialty hospital issue."
The Breaux amendment, present only in the Senate version of the bill, would erase the "whole hospital" exemption for specialty hospitals from the Stark anti-referral law, which bars physicians from investing in facilities where they have an ownership stake.
The House version of the Medicare bill, on the other hand, does not have that provision and instead calls for a study on specialty hospitals.
"These meetings may prove to be a crucial turning point in the specialty hospital debate," Patterson says.
He says this week will be the first time that conferees themselves, not just their staffs, will be discussing specialty hospitals in the huge bill. The main aim of the legislation is to extend a drug benefit to Medicare beneficiaries.
Because of tense negotiations on the drug benefit and other issues, Patterson says it is "highly uncertain" whether the conference committee will meet its target date of Oct. 17 to finalize key terms of the joint legislation.
Patterson adds that the General Accounting Office is expected to release a second report on specialty hospitals later this month and that, depending on the pace of the conference committee's deliberations, the report could influence the outcome of the bill.
A first GAO report, made public in May, did not answer most of the questions lawmakers asked about specialty hospitals, and GAO officials had said they would make a follow-up report.
Also in the spring, Rep. Pete Stark (D-Calif.) and Rep. Jerry Kleczka (D-Wis.) reintroduced a bill that would require investment in specialty hospitals to be open to the public--not just to doctors, as is now the case.