Healthcare Law Briefs
1. Circuit
Court Affirms PRO Disclosure
In Public Citizen, Inc. v. HHS and CMS 2003
U.S. App. Lexis 12719 (June 20, 2003), the federal Circuit Court for the
District of Columbia affirmed a District Court holding that the PRO
manual promulgated by HHS (now CMS) violated the Social Security Act
(Act) provisions regarding disclosure. The Act requires PROs (Peer
Review Organizations) to review complaints regarding physician Medicare
services and inform the complainant of the "final disposition of the
complaint". The PRO manual prohibits disclosure of any details without
physician consent. The Court concluded that the manual language is
inconsistent with the statutory requirements.
>Top
2. HIPAA
Enforcement Confusion
Light HIPAA Enforcement
Predicted by CMS
A CMS speaker at a recent conference (HIPAA
Solutions: Achieving Compliance), which was cosponsored by WEDI, stated
that an extension of the October 16, 2003 transaction and code set
deadline was unlikely, but "the likelihood we will act on enforcement at
this point is very remote". BNA Healthcare Daily; June 30, 2003.
Health Care Providers Urge
HHS Secretary Thompson to Prevent Disruption From HIPAA Transaction Rule
WASHINGTON, July 8 /PRNewswire/ -- A broad-based
coalition of health care providers has written Secretary of Health and
Human Services Tommy Thompson urging him to act to prevent the
disruption in the health care system that may occur with implementation
of the HIPAA Transaction Rule this fall. The letter was hand-delivered
to Secretary Thompson by the American Clinical Laboratory Association (ACLA).
"We were very encouraged by Secretary Thompson's
response," said Alan Mertz, President of ACLA and the chair of the
coalition of providers. "He clearly understands the magnitude of the
problem and wants to work with the provider and payer communities to fix
it."
The rule, which will go into effect on October 16,
2003, requires all electronic health care transactions to meet new
format and content specifications. Without an implementation plan and
clear guidance, the rejection of the new claims could lead to disruption
of payments to providers under Medicare, Medicaid and private sector
health plans.
>Top
3. HHS Moves
Forward on Electronic Medical Records
The Department of Health and Human Services (HHS)
announced two recent actions to facilitate development of electronic
medical records (EMR).
-
HHS signed an agreement with the College of
American Pathologists to license its standardized medical vocabulary
system, i.e. SNOMED - CT (Systemized Nomenclature of Medicine -
Clinical Terms)
-
HHS commissioned the Institute of Medicine to
design a standardized EMR, which is expected to be ready by 2004.
>Top
4. Study Links
Higher Physician Supply to Limits on Non-Economic Damages
States that have
enacted limits on non-economic damages in medical lawsuits have about 12
percent more physicians per capita than states without such a cap,
according to a study released today by HHS' Agency for Healthcare
Research and Quality (AHRQ).
The study is the first
of its kind to associate caps on non-economic damages with increased
physician supply. It looks at the growth of physician supply since
1970, before any state had enacted caps, and finds that physician supply
has grown more in states with caps than in states without caps. "Our
broken medical litigation system is affecting patients' ability to find
a doctor," HHS Secretary Tommy G. Thompson said. "This study confirms
and quantifies the association between reasonable limits in medical
lawsuits and the supply of physicians available to treat patients who
need them. It is critical that we fix this broken litigation system
now. In the current system, the fear of excessive awards stimulates
wasteful defensive medicine and deters doctors and hospitals from
identifying and addressing medical errors, thus increasing costs and
decreasing quality." The study analyzes state experiences over the past
30 years, and adjusts for the impact of multiple factors that are
believed to affect physician supply (such as per capita income and
physician residency training programs.) According to the study's
authors, Fred Hellinger, Ph.D. and William Encinosa, Ph.D., "these
findings demonstrate that state laws limiting non-economic damages in
medical malpractice cases increase the number of physicians who practice
in the states."
The authors find that
by 2000, states that had enacted caps had a significantly higher number
of doctors per 100,000 county residents (135) compared to states that
didn't enact caps (120). By contrast, in 1970 there was no
statistically significant difference between states in their per capita
supply of physicians.
"The robustness of
these findings is quite remarkable," said Carolyn M. Clancy, M.D.,
director of AHRQ, which sponsored this research. "Even when adjusting
for numerous state characteristics, states with caps had a significantly
higher number of doctors per person compared to states that didn't enact
caps."
President Bush has
proposed a framework for improving the medical litigation system,
placing reasonable limits on non-economic damages, as has been enacted
in many states. In addition, HHS is devoting new efforts to improving
quality of care and reducing medical errors.
The complete AHRQ
study can be found at
http://www.ahrq.gov.
July 7, 2003 HHS
Release--Higher Physician Supply
>Top
5. New Jersey
to Establish Public Database of Physician Profiles
New Jersey will
develop and make available to the public over the Internet and through a
toll-free telephone number profiles of all the state's licensed
physicians and podiatrists, including their credentials, experience, and
disciplinary and malpractice histories, as a result of legislation (S.
571) signed by Gov. James E. McGreevey (D) June 23. "Currently, a
provider's right to privacy keeps too many patients in the dark about
the minority of dangerous doctors who could do them harm," Assemblyman
Willis Edwards III (D), one of four primary sponsors of the measure,
said in a statement. "Responsible, competent doctors should not oppose
this reform. They should work to ensure the accuracy of the information
in the prospective profiles." The New Jersey Health Care Consumer
Information Act gives the state Division of Consumer Affairs, in
consultation with the State Board of Medical Examiners, one year to
develop a comprehensive data collection system and establish an online
system to give consumers access to the information so they can make more
informed choices of physicians and podiatrists.
http://pubs.bna.com/ip/BNA/hce.nsf/is/a0a6z2a2z1
June 26 -- BNA's
Health Care Daily Report
>Top
6. Provider Payments to Rise by $40 Million in
Pennsylvania Blues Pact
Independence Blue
Cross will make changes to its payment policies that will increase
provider reimbursements by at least $40 million over the next two years,
under terms of a class action settlement that received preliminary
approval from a state court in Philadelphia June 19 ("Pennsylvania
Orthopaedic Society v. Independence Blue Cross", Pa. C.P., December Term
2002 No. 0002, "preliminary approval of settlement" 6/19/03). The
proposed settlement would resolve three lawsuits filed in Pennsylvania
Common Pleas Court by the Pennsylvania Orthopaedic Society and three
physicians over the insurer's policies and practices with regard to
reimbursement, fee disclosure, claims processing, and dispute
resolution. Independence Blue Cross agreed under the settlement to
disclose to providers the standard fee schedules it uses to process
claims and any policies or procedures that may affect the reimbursement
a provider receives for his or her services.
http://pubs.bna.com/ip/BNA/hce.nsf/is/a0a6y9v9d8
June 24 -- BNA's
Health Care Daily Report
<Top >For more information about the
topics presented in this newsletter please contact one of the Healthcare
Attorneys:
>Read
the Spring 2003 issue of our HEALTHCARE
NEWSLETTER.
 Tucker Arensberg,
P.C.
1500 One PPG
Place Pittsburgh, PA 15222 412/566-1212
<Back |
