Tag Archives: Physician Ownership

OIG Reviews Overlap Between Physician-Owned Hospitals and Physician-Owned Distributors (PODs) of Spinal Devices

 The Office of Inspector General (OIG) of the Department of Health and Human Services has issued a report on “Overlap Between Physician-Owned Hospitals and Physician-Owned Distributors.”  The OIG reviewed 12 hospitals that self-identified as physician-owned and previously reported having purchased spinal devices from PODs.  The OIG attempted to determine whether physicians had an ownership interest … Continue Reading

CMS Issues Proposed CY 2015 Medicare OPPS/ASC Rule

On July 14, 2014, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule to update the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rates and policies for calendar year (CY) 2015. The following are highlights of this major rulemaking:… Continue Reading

GAO Examines Self-Referral of Anatomic Pathology, IMRT Services

The Government Accountability Office (GAO) has issued two reports on trends in physician referrals to entities in which the provider or the provider’s family members have a financial interest – both of which conclude that financial incentives are likely a major factor driving increases in referrals. In the first report, “Medicare: Action Needed to Address … Continue Reading

CMS Releases Physician Payments Sunshine Act Final Rule

This post was written by Elizabeth Carder-Thompson, Katie C. Pawlitz, and Nancy E. Bonifant. The Centers for Medicare & Medicaid Services (CMS) released late today its final rule implementing the physician payment transparency provisions of the Patient Protection and Affordable Care Act (Section 6002), commonly referred to as the "Physician Payments Sunshine Act." Among other things, the … Continue Reading

GAO Report Examines Medicare Costs From Self-Referrals of Advanced Imaging Services

A recent GAO report examines the growing prevalence of physician self-referral (referral to the physician’s own practice) for advanced imaging services (e.g., magnetic resonance imaging (MRI) and computed tomography (CT) services) and its effect on Medicare spending. The GAO reports that while the number of both self-referred and non-self-referred advanced imaging services increased from 2004 through … Continue Reading

CMS Announces Data Collection for the Physician Payments Sunshine Act Will Not Be Required Before 2013

The Centers for Medicare & Medicaid Services (CMS), tasked with implementing the Physician Payments Sunshine Act, announced yesterday that it will not require pharmaceutical, device, and other applicable manufacturers and group purchasing organizations (GPOs) to begin collecting reportable data before 2013.… Continue Reading

New Hampshire Quietly Considers Prohibition Of Physician Relationships With Medical Device Companies

On March 29, 2012, the New Hampshire House of Representatives recommended for passage HB 1725.  If passed, HB 1725 would prohibit all health care practitioners from prescribing or referring any U.S. Food and Drug Administration class II or class III implantable medical device if the practitioner stands to profit, directly or indirectly, from the sale … Continue Reading

CMS Releases Information on Physician Self-Referral Prohibition Exception Process for Physician-Owned Hospitals

The final CY 2012 Medicare Outpatient Prospective Payment System (OPPS) final rule implemented a statutory mandate that CMS develop an exceptions process related to the ACA’s prohibition on expanding an existing physician-owned hospital’s facility capacity. The rule provided that in order to be eligible for an exception, the physician-owned hospital must satisfy eligibility criteria to … Continue Reading

Overview and Analysis of the Proposed Federal Sunshine Regulations

On December 19, 2011, the Centers for Medicare & Medicaid Services ("CMS") published a proposed rule (the "Proposed Rule") related to section 6002 of the Affordable Care Act, commonly referred to as the "Physician Payment Sunshine Act" (so referenced herein, or as the "Act"). The Physician Payment Sunshine Act requires applicable manufacturers of drugs, devices, biologicals, or medical supplies covered under Medicare, Medicaid, or CHIP to report annually to the Secretary of the Department of Health and Human Services ("Secretary") certain payments or other transfers of value to physicians and teaching hospitals. Additionally, applicable manufacturers and applicable group purchasing organizations ("GPOs") must report certain information regarding the ownership or investment interests in them that are held by physicians or their immediate family members.… Continue Reading

CMS Guidance to Surveyors on ACA Physician-Owned Hospital Provisions

CMS has issued guidance to state survey agencies on limitations on new and expanded physician-owned hospitals (PoHs) under the ACA. The memo notes that the ACA provision does not prohibit licensure by the states or Medicare certification by the CMS of new or expanded PoHs. Specifically, survey agency and regional office survey and certification personnel … Continue Reading

CMS Releases Long-Awaited Physician Payments Sunshine Act Proposed Rule

The Centers for Medicare & Medicaid Services ("CMS") released today a proposed rule implementing the physician payment transparency provisions of the Patient Protection and Affordable Care Act (Section 6002), commonly referred to as the "Physician Payments Sunshine Act." Among other things, the Act requires drug, device, biological or medical supply manufacturers to report payments or other transfers of value to physicians and other covered recipients. In addition, the Act requires manufacturers and group purchasing organizations (GPOs) to report certain information regarding ownership or investment interests held by a physician in the manufacturer or GPO.… Continue Reading

House Approves Tax/Jobs Bill with Medicare Provisions; Fate Uncertain

On December 13, 2011, the House of Representatives approved H.R. 3630, the Middle Class Tax Relief and Job Creation Act of 2011, a wide-ranging bill making payroll tax, unemployment insurance, energy, and other policy changes. Among many other things, the bill would avert a scheduled 27.4% cut in Medicare physician fee schedule (MPFS) payments in … Continue Reading

ACA “Physician Payment Sunshine Act” Rule at OMB

The Centers for Medicare & Medicaid Services (CMS) has sent to the White House Office of Management and Budget (OMB) its long-awaited proposed rule to implement the Transparency Reports and Reporting of Physician Ownership of Investment Interests (also called the Physician Payment Sunshine Act) provisions of the ACA. These provisions are intended to encourage greater … Continue Reading

CMS Finalizes CY 2012 OPPS/ASC Rates, Policy Changes

On November 30, 2011, CMS is publishing its final rule updating the Medicare hospital outpatient prospective payment system (OPPS) and the ASC payment system rates and policies for CY 2012. The following are highlights of the lengthy rule: The final OPPS update for 2012 is 1.9%, which reflects a 3.0% market basket update reduced by … Continue Reading

MedPAC Meeting

The Medicare Payment Advisory Commission (MedPAC) met on October 8 and 9, 2009 to discuss a variety of Medicare payment and policy issues, including the in-office ancillary exception to the physician self-referral law, provider consolidation, physician fee schedule prices, and medical education. … Continue Reading

MedPAC Report on Medicare Payment Policy

MedPAC has issued its June 2009 "Report to the Congress: Improving Incentives in the Medicare Program."   Among other things, the report addresses follow-on biologicals, chronic care management, physician self-referrals involving imaging services, physician resource use measurement, graduate medical education, accountable care organizations, Medicare benefit design, and Medicare Advantage payment policy.… Continue Reading

MedPAC Report to Congress — Medicare Payment/Transparency Provisions

On February 27, 2009, MedPAC released its March 2009 Report to the Congress: Medicare Payment Policy. The report includes a series of recommendations for Medicare payments designed to assure beneficiaries’ access to care and preserve Medicare’s long-term sustainability, particularly through reductions in payment updates for 2010. The report also includes recommendations to increase transparency of physician financial … Continue Reading

CHIP Expansion

On February 4, 2009, President Obama signed into law H.R. 2, the Children’s Health Insurance Program (CHIP) Reauthorization Act of 2009. The legislation extends the CHIP program through FY 2013, expands funding to cover an additional 3.9 million uninsured children, and makes a number of reforms to the program. Note that the legislation does not include an … Continue Reading

CHIP Expansion/Specialty Hospitals

On January 14, 2009, the House approved H.R. 2, the Children’s Health Insurance Program (CHIP) Reauthorization Act of 2009. The legislation would extend the CHIP program through FY 2013 and expand funding to cover an additional 4 million uninsured children. The House bill also would limit the "whole hospital" exception to the Stark law’s self-referral prohibition to … Continue Reading

Finance Chairman Baucus Outlines Health Reform Priorities

On November 12, 2008, Senate Finance Committee Chairman Max Baucus released a white paper entitled "Call to Action: Health Reform 2009." The document details Senator Baucus’ goals for health care reform in the broad areas of coverage, quality, and cost. Highlights of the lengthy plan include the following.   Ensuring Health Coverage for All Americans. The Baucus plan seeks universal … Continue Reading

Practicing Physicians Advisory Council Meeting

On December 8, 2008, the Practicing Physicians Advisory Council is holding its quarterly meeting to discuss Medicare policy changes related to physicians’ services. Agenda items include: Physician Fee Schedule Final Rule; Outpatient Prospective Payment System/Ambulatory Surgical Center Fee Schedule Final Rule; Stark Reform; Value Based Purchasing—Efficiency Measures; CMS-FDA Collaboration; and Medically Unlikely Edits Update. … Continue Reading

MedPAC Meeting

On October 2-3, 2008, the Medicare Payment Advisory Commission (MedPAC) is meeting to discuss a number of health care policy issues, including reporting of physicians’ financial relationships, medical education training, MA payment and quality, frequently-rehospitalized skilled nursing facility patients, the use of drug data in risk adjustment, the psychiatric hospital prospective payment system, and health … Continue Reading