Rounds NEWS FROM AMERICA’S BEST MEDICAL SOCIETY
TMA, Physicians Foundation support physician-owned hospitals
TMA and The Physicians Foundation have filed a legal brief with the U.S. Court of Appeals for the 5th Circuit challenging the Affordable Care Act, which prohibits expansion or construction of physician-owned hospitals (POHs). The brief says hos- pitals owned by physicians have better health care outcomes, shorter hospital stays, and much higher patient satisfaction ratings than other hospitals. The brief supports a lawsuit to overturn the prohibition filed by Physician Hos- pitals of America and the Texas Spine & Joint Hospital of Tyler against U.S. Health and Human Services Secretary Kathleen Sebelius. The brief asserts that the arguments against PHOs, upon which Congress relied upon to enact the law, are flawed and unreasonable. It contends the Affordable Care Act does not remedy alleged financial conflicts of interest but rather worsens them, removes competition, and limits physicians’ ability to make important health care decisions.
“These aggressive non-POHs have eliminated the competition, and the result will
be greater financial conflicts of interest, higher health care costs, fewer choices for patients, and less innovation,” the brief says. It also applauds the significant com- munity benefit POHs provide, contrasting it with the very profitable “not-for-profit” hospitals, which do not pay federal or state income, property, or sales tax, resulting in billions in tax breaks per year. “Whether through paying [billions in] taxes and employing thousands, providing
hospital access in poor areas, or providing charity care, physician-owned hospitals provide a contribution to society which is unmatched,” TMA and the Physicians Foundation contend. The Physicians Foundation, created by the settlement of organized medicine’s federal antiracketeering lawsuit against for-profit HMOs, advances practicing physi- cians’ work and improves the quality of health care through a variety of activities, including awarding grants. TMA Executive Vice President and Chief Executive Officer Louis J. Goodman, PhD, is the foundation president.
CMS issues final RAC rules
The Centers for Medicare & Medicaid Services (CMS) released the Medicaid Recovery Audit Contractor (RAC) program final rules and, the American Medical Association says, it appears the rules adopt many of the recommendations TMA, AMA, and 78 other state and specialty societies made in January.
According to AMA, the final rules:
• Establish a three-year maximum claims look-back period;
• Require RAC contractors to hire full- time physician medical directors and certified coders;
• Require states to set limits on the number and frequency of medical re- cord requests;
• Order RACs to provide outreach and notify providers of audit policies and protocols;
• Require RACs to accept submission of electronic medical records by fax or CD/DVD;
• Prohibit RACs from auditing claims that have already been audited or are currently being audited by another entity;
• Require RACs to return the contingen- cy fee if an overpayment determina- tion is reversed at any level of appeal;
• Require states to adequately incen- tivize the identification of underpay- ments; and,
• Order states to coordinate the RACs’ efforts with other auditing entities.
The final rule sets an implementation deadline of Jan. 1, 2012. The RAC program — created by the
Tax Relief and Health Care Act of 2006 — examines claims to identify Medicare overpayments and underpayments. CMA hires auditing firms to examine Medi- care payments. The firms receive a per- centage of the improper overpayments and underpayments they collect from providers.
The auditors may review the last three years of claims from physicians,
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