April 1998 Bulletin

Late breaking news

GAO to report on IG methods in PATH audits

The General Accounting Office is expected to release a report next month reviewing the government’s investigation of Medicare billing practices of teaching hospitals. GAO is reviewing the authority of the Department of Health and Human Services Office of Inspector General (IG) to conduct the Physicians at Teaching Hospitals (PATH) audits, the IG’s methodology in conducting the audits and the significance of the billing problems in the completed audits. The GAO report is in response to a request from Bill Thomas, (D-Calif.) chairman of the House Ways and Means Health Subcommittee.

IG investigates 'cherry-picking' by managed care

A nationwide investigation is focused on the process used by Medicare HMOs to enroll beneficiaries. A recent survey by the Department of Health and Human Services’ Office of Inspector General (IG) found 18 percent of beneficiaries were asked their health status as part of the screening process for HMO enrollees. The practice of "cherry picking" enrollees is against the law. The IG is being aided by 300 FBI agents.

Academy opposes proposed rule on supervising nurse anesthetists

Douglas W. Jackson, MD, 1997 Academy president, informed HCFA that the Academy strongly opposes a proposal to eliminate the federal requirement that nurse anesthetists be supervised by either the operating practitioner or an immediately-available anesthesiologist in all approved hospitals and ambulatory surgical facilities. "If approved, the policy would leave the issue of nurse anesthetist supervision to individual state law," Dr. Jackson said in a letter to HCFA. "The Academy is concerned that this proposal ignores the substantial difference in training and qualifications between a nurse anesthetist and a physician. Physicians receive at least seven years of medical education, including hands-on residency experience in a hospital. By contrast, over one-third of nurse anesthetists have not even received a bachelor’s degree."

'Stark’ comment period extended; new fact sheet on home page

Responding to the pressure of several health care professionals groups most affected by the "Stark II" physician ban on self-referral law, HCFA extended the comment period on the proposed rule to May 11, 1998 from March 10. More than 50 medical, hospital and health care delivery associations including the Academy, signed a joint letter, initiated by the American Medical Association, urging the 60-day extension. The major concerns of the orthopaedic community are: providing designated health care services, such as durable medical equipment, as an in-office ancillary service; compensation arrangements, such as "installment payments" of sold facilities, or invention royalties; the widespread use of shared facilities (rather than one corporate group practice with one billing number); and the direct supervision requirement. The Academy has posted an updated fact sheet, Ban on Physician Self-Referral (The 'Stark’ Provisions) in the "What’s New section" of the Academy’s home page http://www.aaos.org.

James D. Heckman, MD new Academy president

James D. Heckman, MD, was named Academy president at the 65th Annual Meeting in New Orleans. Robert D. D’Ambrosia, MD, is first vice president. S. Terry Canale, MD, who was secretary of the Board of Directors, was named second vice president. William J. Robb III, MD, was named secretary. Stuart A. Hirsch, MD, was reelected treasurer.

Congress gets Patient Choice, Access bill

Rep. David Weldon, (R-Fla.) and Rep. Sherrod Brown (D-Ohio) are cosponsors of The Patient Choice and Access to Quality Health Care Act developed by the Patient Access to Specialty Care Coalition, which is comprised of 130 patients and physician groups. The coalition is cochaired by Nicholas Cavarocchi, director of the Academy’s Washington Office. The bill requires that all managed care plans should allow consumers the right to see doctors and/or specialists outside the network for a reasonable copayment; consumers should have the opportunity to choose from multiple plans with complete information to select the best health care plan; all health plans should fully disclose any financial arrangements between the managed care organization and doctors that would influence the highest quality of patient care; all health care plans should have an expedited independent appeals mechanism to review any denial of patient care; and financial incentives or disincentives that can influence a physician’s decision about a patient’s care should be prohibited.

3 new NIH awards for clinical research

The National Institutes of Health announced three new types of career development awards aimed at increasing the participation of clinical researchers in medical research and enriching the pipeline of people properly trained to do clinical research. The new awards, which NIH expects to begin funding in fiscal 1999, will support young investigators who have just completed specialty training and mid-career investigators; institutional curriculum awards will be offered to help teach the essentials of clinical research to young trainees and junior faculty.

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