Healthcare Law Briefs
1. HHS Demonstration Project Will Pay Quality
Performance Bonuses To Hospitals
HHS and Premier, Inc., a national group purchasing organization with a
network of over 1500 hospitals, have announced a 3 year demonstration
project to pay quality performance bonuses to approximately 500
non-profit facilities in the Premier network. The project will measure
35 processes in 5 clinical areas and reward hospitals which achieve the
top 20%. Hospitals in the top decile will receive a 2% Medicare bonus
and hospitals in the second decile a 1% bonus. Beginning in the final
year, hospitals in the lowest two deciles would lose 1 and 2 percent,
respectively. HHS expects to pay $21 million in bonuses but recoup more
than that amount in savings attributable to the quality initiatives.
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2. FTC Consent Order Shuts Down Maine
Hospital/Physician Network
Hospitals and physicians participating in the Maine Health Alliance
agree to halt joint negotiations with 3rd party payers. The
Alliance
was formed in 1995 and included approximately 85% of the doctors and 70%
of the hospitals in a 5-county region in Maine. In re
Maine
Health Alliance, FTC, File No. 021-0017, July 18, 2003.
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3. FTC Settles Price-Fixing Charges Against St.
Louis Doctors
A large physicians' organization in the St. Louis metropolitan area
that allegedly engaged in price-fixing on behalf of its members reached
an accord with federal regulators, the Federal Trade Commission
announced July 11 ("In re Washington University Physician Network, "FTC,
No. 021 0188, 7/11/03). The FTC challenged the group's conduct as
detrimental to consumers in the St. Louis area, and said it has resulted
in higher prices for the services the Washington University Physician
Network's doctors provide. The proposed consent order with WUPN, a
nonprofit corporation that includes approximately 1,500 faculty and
independent community doctors, is designed to remedy the group's
allegedly anticompetitive collective bargaining practices.
July 15 -- BNA's
Health Care Daily Report
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4. Cancellation of the Automatic July 2003 Mass
Adjustments 2003 Medicare Physician Fee Schedule
CMS has determined that it will NOT require Medicare carriers to go
forward with the automatic July mass adjustments and resulting
collection of overpayments. If an overpayment exists, you will not be
receiving a "Demand" letter related to an incorrect payment based on
the delay of the 2003 MPFS. This also means that Medicare beneficiaries
will not be receiving copies of those "Demand" letters that would have
potentially caused unnecessary confusion to them. You should be aware,
however, that if you bring to the attention of the Medicare carrier that
an incorrect payment for January or February 2003 was received, the
carrier will still process such an adjustment.
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5. Delay in Outpatient Therapy Payment Caps
To address issues arising in litigation in federal court, CMS has
elected to delay implementation of the outpatient therapy payment
limitations from the previously announced implementation date of July 1,
2003, to a new implementation date of September 1, 2003. The fully
amount of $1590 for each cap may be applied to therapy services rendered
between September 1 and December 31, 2003. Contractors must amend the
therapy caps alert that is included on all Medicare Summary Notices no
later than July 7, 2003
Program Memorandum,
Tans. No. AB-03-097,
July 3, 2003
<Top >For more information about the
topics presented in this newsletter please contact one of the Healthcare
Attorneys:
>Read
the June/July 2003 issue of our HEALTHCARE
NEWSLETTER.
 Tucker Arensberg,
P.C.
1500 One PPG
Place Pittsburgh, PA 15222 412/566-1212
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