Hospitals,
Physicians Competing for Same Dollars
In February, ACC member Bruce E. Murphy, M.D., received a
letter threatening to end his privileges at Baptist Health
hospital, part of a major health care system in Little Rock,
Arkansas, because he practices at and sends his patients to
Arkansas Heart, a cardiology hospital in which he owns an
interest. Baptist Health claims that the competition between
the two hospitals creates a conflict of interest for Dr. Murphy.
His situation mirrors the experiences of many physicians across
the nation. Healthcare systems and large general or community
hospitals, such as Baptist Health, claim that physicians send
the "profit" patients to their specialty hospitals,
leaving the general hospitals with the patients who cannot
afford to pay or who have complicated and costly conditions.
Specialty hospitals, on the other hand, claim that they provide
highly specialized, and high quality, coordinated care that
benefits patients, and that revoking physicians’ privileges
at general hospitals limits patient choice and access. Murphy
has sued to keep his privileges, as have physicians in Ventura,
California, and Columbus, Ohio. The new Medicare law includes
an 18-month moratorium on new physician investments of specialty
hospitals while the Medicare Payment Advisory Commission (MedPAC)
and the Department of HHS study the effects of the hospital
exception for physician-ownership in specialty hospitals and
recommend any legislative or administrative changes. (The
New York Times, April 13)
HHS
Issues Warning About Boutique Care Fees
Physicians who treat Medicare beneficiaries and charge extra
fees for "boutique" care need to take extra care
that their billing does not include services covered by Medicare.
"Boutique" care refers to specialized, personal
care such as 24-hour access and home visits in exchange for
additional fees. Dara Corrigan, acting chief of the Health
and Human Services Office of Inspector General, warns that
physicians who charge such fees could face fines or expulsion
from the Medicare program. Jennifer Leonardo, an OIG attorney,
points out that Medicare regulations allow a physician to
contract with beneficiaries to provide services not truly
covered by Medicare, but not for services covered under the
program. A provision in the new Medicare law calls for the
General Accounting Office to review the practice of boutique
care. (The New York Times, April 13)
CPR
Study Finds Many Professionals Ventilate Excessively
According to a study
conducted at the Medical College of Wisconsin, many emergency
medical workers and professionals hyperventilate patients
excessively, which contributes to a low survival rate. Dr.
Tom Aufderheide and his colleagues examined how emergency
medical workers administered cardiopulmonary resuscitation
(CPR) to 13 cardiac arrest patients before and after additional
training. Before, the workers ventilated at 37 breaths per
minute, exceeding the recommended 12 to 15 breaths per minute.
After training, they still averaged 22 breaths per minute.
The excessive ventilation might actually harm cardiac arrest
patients by causing harmful blood pressure changes. (Milwaukee
Journal Sentinel, April 6) The study applies only to
emergency medical workers using ventilation tubes and bags,
not bystanders who administer CPR; however, for reasons not
related to the study, in many cities, 911 personnel are recommending
that bystanders simply do chest compressions until emergency
personnel arrive.
Health
Care Professionals Struggle to Cross HIPAA Finish Line
A survey of 1,200 health care privacy professionals conducted
by the American Health Information Management Association
(AHIMA) reveals that fewer than one in four health care organizations
are in full compliance with the Health Insurance Portability
and Accountability Act of 1996 (HIPAA). Two-thirds report
their organizations as between 85 percent and 99 percent compliant;
however, two trouble spots emerge in this first year of full
HIPAA implementation. Thirty-nine percent say that accounting
for the release of protected health information is an ongoing
problem area. Most organizations have several possible areas
that could release patient information, making it difficult
to track and deliver a full accounting of disclosures if requested.
Another 33 percent have problems obtaining patient information
from other sources. Health care officers have asked the Department
of Health and Human Services (HHS) to modify or lift some
of the reporting regulations, but to no avail. Mark Rothstein,
who chairs the subcommittee on privacy and confidentiality
under the National Committee on Vital and Health Statistics,
HIPAA's advisory panel, reports that the committee is not
ready to recommend changes to HHS Sec. Tommy Thompson. Modifications
to HIPAA may be made once a year only. (Modern Healthcare,
April 12)
Florida Becomes Battleground Between
Physicians and Lawyers
Fighting for the past two years over medical liability reform,
the Florida Medical Association (FMA) and the Academy of Florida
Trial Lawyers (AFTL) are facing off this year, both calling
for ballot initiatives that would amend the state constitution.
The FMA initiated the face-off by posting a constitutional
amendment to drastically limit lawyers’ contingency
fees. The AFTL responded swiftly with three constitutional
amendments, one of which would force the state to strip the
licenses of doctors who lose or settle three malpractice suits.
The other two would also seriously damage physicians in the
state. The AFTL has acquired the required number of signatures
for its amendments while the FMA is struggling to do so. Business
groups and industries have pleaded with the two organizations
to drop the amendments, pointing to the serious damage to
Florida’s health care system that could result. The
AFTL says it will withdraw its amendments when the FMA does
the same. Thus far, the FMA refuses to withdraw. (Miami
Herald, April 12)
Idaho ACC Achieves Smoking Ban
On April 2, Idaho Governor Dick Kempthorne signed a law that
bans smoking in restaurants, stores, and all public buildings
except bars and bowling alleys. At times it seems that the
legislation would be derailed, the ID-ACC openly supported
the initiative and contacted the legislature to ensure passage.
"This victory was a genuine grassroots effort of many
organizations and ID-ACC was proud having been able to contribute
to the passage of this bill. This will truly improve the health
of our residents," said, Charles Rasmussen, MD, FACC,
Idaho’s ACC Governor. California, Connecticut, Delaware,
Florida, Massachusetts, Maine, New York and now Idaho have
passed smoke-free workplace legislation. Connecticut, Maine,
Massachusetts, California, Utah and New York have banned smoking
in bars and restaurants. Delaware implemented a stricter prohibition
on indoor smoking in November 2002. (Boise Democrat,
April 2)
Drug Importation Gathers
Political Support
With supporters on both sides of the aisle in Congress, legislation
allowing the importation of prescription drugs from foreign
countries may move forward this year. Despite the break off
in talks between Sens. Charles Grassley (R-IA) and Edward
Kennedy (D-MA) on a bipartisan approach to drug importation,
negotiations continue between Senate Republicans and Democrats.
There is also speculation that the Bush administration’s
panel on drug importation may issue its report this summer,
months before originally scheduled. Both political parties
would like to show action on this hot issue, but congressional
staffers working on the mechanics of any legislation are running
into the complex legal and technical issues involved in drafting
guidelines for safe importation. That and the election-shortened
legislative year may impede a final outcome on the issue.
(The Wall Street Journal, April 13)
Advocacy
Weekly is a product of the Advocacy Division of the American
College of Cardiology. Questions or comments regarding this
publication should be directed to the Advocacy Division at
800-435-9203 or to advocacydiv@acc.org.
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