Hunting season is about to open, and the targets will be about a dozen specialty hospitals caught in the cross hairs last year when Congress imposed a moratorium on Medicare payments to physician-owners of those facilities, a lobbyist for a specialty hospital trade group predicts.
CMS is expected yet this month or in early February to issue its official guidance to physician owners and hospitals administrators explaining the details of the moratorium in the Medicare reform law signed by President Bush on Dec. 8, said Randy Fenninger, who represents the American Specialty Hospital Association.
Of particular interest will be discretion given to HHS Secretary Tommy Thompson on just what defines a specialty hospital and how a Nov. 18 deadline for a grandfather clause in the law will be enforced, Fenninger said.
Given the strong lobbying for the moratorium by the AHA, it's no leap to assume hospitals will police their own neighborhoods looking for specialty hospitals that are planned or under construction, he said.
The AHA was unable to provide a spokesperson for comment by deadline.
"It's not that the IG (Inspector General) is going to come hunting for you," Fenninger said. "It's the hospital down the road that will cause mischief, if nothing else.
"They consider us the enemy, and they spent a significant amount of political capital at the state and local levels. They will be primed to drop a dime on any specialty deal they can.
"The real tricky ones are the ones under development," said Fenninger. "Some heavy investment has already been made. Those folks are really concerned."
Fenninger said he expects to see the sniping begin once the HHS guidance is issued.
The General Accounting Office, which looked into specialty hospitals and reported about them twice to Congress last year, estimated there were about 100 facilities in the country but refused to publicly name them.
Modern Physician, in an independent survey, portions of which were published in December, identified 80 specialty hospitals.
Fenninger estimated there were about 25 physician-owned specialty hospitals either being planned or under construction on Nov. 18. Maybe 10 to 15 of them are on the bubble, he said.
Fenninger said the law spells out four criteria that physician-owners must have met before Nov. 18 to be eligible for their physicians to still receive Medicare payments under the grandfather clause that exempts surgical hospitals already built before the cutoff date.
These new owners must be able to show that before then they had:
- Their financing in place
- Met local zoning requirements
- Received state government approvals
- Building plans approved.
Due to time constraints, Fenninger said HHS will probably not issue a formal, proposed final rule but something less time-consuming instead.