Tweaks only

The CMS gave no new ground on the healthcare reform law's provision that strictly curtails physician-owned hospitals.

In the final rule on hospital outpatient and ambulatory surgery center payments, the CMS made a few tweaks to the federal rules that curtail the expansion of physician-owned hospitals and tighten physician self-referral prohibitions and patient notification requirements.

Scott Christiansen, spokesman for the Physician Hospitals of America trade association, said in an e-mail that the rule doesn't contain any “real changes or surprises,” and the CMS summarized that the tweaks conform to the Patient Protection and Affordable Care Act.

“We also believe the new regulations will help minimize anticompetitive behavior that can affect the decision as to where a beneficiary receives healthcare services and would possibly enhance the services furnished,” the CMS said in the rule.

The document mostly deals with the processes a physician-owned hospital must go through to request exemptions to restrictions on self-referral and expansion and summarizes comments that the CMS received on proposals it made in July. The rule also includes provisions that physician-owned hospitals must not “discriminate against beneficiaries of federal healthcare programs” or “permit physicians practicing at the hospital to discriminate against such beneficiaries,” and that—if capacity increases are permitted—they do not result in a hospital increasing its number of licensed operating rooms, procedure rooms and beds by more than 200%.

Among the country's approximately 6,100 hospitals, 265 are owned by physicians, according to CMS figures.

The rule clarified patient-notification regulations that mandate how “dedicated emergency departments” must conspicuously post notices if a facility does not have a physician on site 24 hours a day, seven days a week. The CMS said that medical residents would qualify as physicians and that the notification would apply to all hospitals—not only physician-owned institutions.

Another change was that inpatients and outpatients who receive observation services, surgery or services involving anesthesia must be given written notice that a hospital may not have a physician on-site 24 hours a day and that this would be followed by a signed acknowledgment from the patient of this fact.

In the rule, the CMS responded to a commenter who indicated that this notification could “potentially alarm patients.”

“In the years since the current regulation first took effect, we have not received any feedback of patients being unduly alarmed as a result of receiving notice,” the CMS said in the rule. “We believe consumers have certain expectations concerning availability of care by doctors of medicine or osteopathy in hospitals and (critical-access hospitals), and that, as patients, they have a right to make informed decisions concerning their care … It is important to ensure that patients receive notice when a doctor of medicine or osteopathy is not always on site, and how the hospital ... handles patient emergencies when a doctor of medicine or osteopathy is not present.”