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Wednesday, August 12, 2009

Continuing Our Healthcare Review - Pg 300-325

Page 299 starts with a section that talks about

IN GENERAL.—The Secretary of Health and Human Services (in this section referred to as the ‘‘Secretary’’) shall develop a detailed plan to reform payment for post acute care (PAC) services under the Medicare program under title XVIII of the Social Security Act (in this section referred to as the ‘‘Medicare program)’’.

POST ACUTE SERVICES.—For purposes of this section, the term ‘‘post acute services’’ means services for which payment may be made under the Medicare program that are furnished by skilled nursing facilities, inpatient rehabilitation facilities, long term care hospitals, hospital based outpatient rehabilitation facilities and home health agencies to an individual after discharge of such individual from
a hospital, and such other services determined appropriate by the Secretary.
(b) DETAILS.—The plan described in subsection (a)(1) shall include consideration of the following issues:
(1) The nature of payments under a post acute care bundle, including the type of provider or entity to whom payment should be made, the scope of activities and services included in the bundle, whether payment for physicians’ services should be included in the bundle, and the period covered by the bundle.
Seems to me like this gives them the leeway to not only decide what dollar amount will be paid for PAC care, but to determine what services can be included.

Page 304 - And since this is yet another pilot program, they are going to fund it:
there are appropriated to the Secretary for the Center for Medicare & Medicaid Services Program Management Account $15,000,000 for each of the fiscal years 2010 through 2012. Amounts appropriated under this paragraph for a fiscal year shall be available until expended.
How much money are we spending on actual health care versus paying government or other employees to do studies and pilot programs and regulatory work?????? In just the past 2 sections of the bill we're looking at $40 million on 2 studies/pilot programs.

Page 309 talks about rebasing home health prospective payment amounts:
‘‘(IV) Subject to clause (iii)(I), for 2011, such amount (or amounts) shall be adjusted by a uniform percentage determined to be appropriate by the Secretary based on analysis of factors such as changes in the average number and types of visits in an episode, the change in intensity of visits in an episode, growth in cost per episode, and other factors that the Secretary considers to be relevant.
Now, does this read to you like the Secretary is going to have to be intimately involved in knowing about the types of visits, how those visits change, etc. for every home health provider???? How in the world do they think they can track stuff like this???

Page 311 incorporates productivity improvements for home health care payments.

Page 313 requires detailed disclosure regarding home health care providers to the "Secretary":
‘‘(1) IN GENERAL.—Each entity providing covered items or services for which payment may be made under this title shall provide the Secretary with the information concerning the entity’s ownership, investment, and compensation arrangements, including—
‘‘(A) the covered items and services provided by the entity, and
‘‘(B) the names and unique physician identification numbers of all physicians with an
ownership or investment interest (as described in subsection (a)(2)(A)), or with a compensation arrangement (as described in subsection (a)(2)(B)), in the entity, or whose immediate relatives have such an ownership or investment interest or who have such a compensation relationship with the entity.
Page 314-315 extends this disclosure requirement to physicians who have ownership interest in hospitals:
‘‘(A) submit to the Secretary an initial report, and periodic updates at a frequency determined by the Secretary, containing a detailed description of the identity of each physician owner and physician investor and any other owners or investors of the hospital;
‘‘(B) require that any referring physician owner or investor discloses to the individual
being referred, by a time that permits the individual to make a meaningful decision regarding the receipt of services, as determined by the Secretary, the ownership or investment interest, as applicable, of such referring physician in the hospital; and
‘‘(C) disclose the fact that the hospital is partially or wholly owned by one or more physicians or has one or more physician investors—
‘‘(i) on any public website for the hospital; and
‘‘(ii) in any public advertising for the hospital.
You got that, right - read carefully section "B" - the physician who tells you that you need to have surgery is now required to disclose to you if he is an owner or investor in the hospital where you'll be admitted. He is supposed to tell you the ownership and investment interest he has in the hospital, and he is supposed to do this with enough time for you to consider it all before you are admitted.

And on page 316 - it says that any person who fails to disclose to the Secretary - or to anyone as noted above in section "B" - can have a civil penalty of $10,000 per day:
‘‘(A) REPORTING.—Any person who is required, but fails, to meet a reporting requirement of paragraphs (1) and (2)(A) of subsection (f) is subject to a civil money penalty of not more than $10,000 for each day for which reporting is required to have been made.
‘‘(B) DISCLOSURE.—Any physician who is required, but fails, to meet a disclosure requirement of subsection (f)(2)(B) or a hospital that is required, but fails, to meet a disclosure requirement of subsection (f)(2)(C) is subject to a civil money penalty of not more than $10,000 for each case in which disclosure is required to have been made.
So, do you think this will have a positive impact on physicians desiring to establish hospitals / outpatient care clinics, etc in your community?

Page 317 clearly states that hospitals are prohibited from expanding:
‘‘(C) PROHIBITION ON EXPANSION OF FACILITY CAPACITY.—Except as provided in paragraph (2), the number of operating rooms, procedure rooms, or beds of the hospital at any time on or after the date of the enactment of this subsection are no greater than the number of operating rooms, procedure rooms, or beds, respectively, as of such date.
Here's the paragraph (2) they are talking about above - way over on page 321:
‘‘(i) ESTABLISHMENT.—The Secretary shall establish and implement a process
under which a hospital may apply for an exception from the requirement under
paragraph (1)(C).
So in other words, your hospital cannot make plans to expand without approval from the Secretary. Currently, this is done on a local basis in most areas, based on beds already in the area and the need the community has for additional services.

Now it will be up to the government to decide if your community can expand - although they do mention that they will allow community input. Well gee, if the community input is received as well as the community input they've been getting on this Healthcare Bill - do we really expect to have any say at all????

Page 323 - get this one:
Any increase in the number of operating rooms, procedure rooms, or beds of a hospital pursuant to this paragraph may only occur in facilities on the main campus of the hospital.
So let's get this straight. The local hospital who wants to expand beds and wants to do so by opening another branch because they are land-locked in their current location would not be able to do so based on this rule??????

The next several pages go on to set limits and parameters that must be met for hospitals to expand, followed by this:
‘‘(H) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of the exception process under this paragraph, including the establishment of such process, and any determination made under such process.
Am I reading this correctly? Your local hospital doesn't like the way their review went - they want to challenge some legal aspect of it - but this paragraph right here tells them they have no right to do so????

Gotta put a stop here for now and go make some pear butter with the last 50 pounds of pears I picked from my tree this week. Mull these things over in your head and I'll be back later this evening with more.

1 comment:

erniesjourney said...

Oh great breakdown - you are really breaking this down - how awesome!!! Keep up the great work!

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