Pennsylvania Health Law Lawyer & Attorney : Fox Rothschild LLP : serving Philadelphia, Pittsburgh, Allentown, Erie, Upper Darby Twp

So it's stressful, expensive and the hours stink -- accordingly to an article on Forbes.com, medicine is still a pretty good gig.  In what will undoubtedly add fuel to the already raging debate over who is responsible for the high cost of health care, health care-related occupations fill the top 15 slots on Forbes' list of the top 25 best paying jobs in the nation.  Here's the breakdown:   

1. Anesthesiologists
2. Surgeons
3. Obstetricians And Gynecologists
4. Orthodontists
5. Oral And Maxillofacial Surgeons
6. Internists
7. Prosthodontists
8. Psychiatrists
9. Family And General Practitioners
10. Chief Executives
11. Physicians And Surgeons, All Other
12. Pediatricians, General
13. Dentists, General
14. Airline Pilots, Copilots And Flight Engineers
15. Podiatrists
16. Lawyers
17. Air Traffic Controllers
18. Engineering Managers
19. Dentists, All Other Specialists
20. Natural Sciences Managers
21. Marketing Managers
22. Computer And Information Systems Managers
23. Sales Managers
24. Petroleum Engineers
25. Financial Managers

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Much has been in the news lately about the Children's Health and Medicare Protection (CHAMP) Act of 2007 recently introduced by the House democrats.   The Bill's proponents claim that if enacted it will provide insurance coverage for millions of children and improve and strengthen Medicare for America's seniors and people with disabilities.  What Physicians -- particularly surgeons who may be thinking of developing a specialty hospital -- may not know is that  the Bill also contains language that would essentially eliminate the ability of physicians to invest in hospitals (specialty or otherwise) and would impose new requirements on existing physician-owned hospitals.  This language, found at Section 651 of the Bill, eliminates the whole hospital exception to the Stark law so that physicians could not refer to hospitals in which they have an ownership interest.  Although existing arrangements would be grandfathered, the grandfathered hospitals will have only 18 months to meet a number of new requirements related to growth, disclosure of ownership, limiting physician ownership to an aggregate of no more than 40% of the facility and no more than 2% individually, and other patient disclosure requirements.

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The New Jersey Department of Banking & Insurance has issued an order stopping Aetna's practice of limiting non-participating physician reimbursement to 125% of Medicare.  The Department has also fined Aetna almost $10,000 for violations of state insurance laws.  Non-participating physicians in other states may find this development helpful in discussions with Aetna (or their insurance department, if necessary).   

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According to a recent article in the Florida Sentinal, the Centers for Medicare and Medicaid Services has taken the unprecedented step of terminating the Medicare HMO plans run by America's Health Choice in Florida due to quality of care issues.  According to the article, termination of the plan was the result of patient complaints about delays in and denials of authorizations of care.  One would expect other Medicare contractors (HMOs and even carriers) to pay close attention to the Florida developments, and physicians and patients who have historically felt powerless when it comes to dealing with payor incompetency, may get some new leverage out of all of this.

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You may recall from a July 2 posting on this blog that the Insurance Department was considering changing the required level of malpractice coverage Pennsylvania physicians must maintain (before MCARE coverage) from $500,000 to $750,000.  Pennsylvania doctors can breath a sigh of relief, at least for now.  According to a July 20, 2007 Press Release, the Department has decided against increasing malpractice coverage requirements for physicians in Pennsylvania.  Citing an actuarial report done by Pricewaterhouse Coopers, Deputy Insurance Commissioner Randy Rohrbaugh cited a lack of evidence that the market is ready to bear such an increase at the present time. 

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In accordance with the Deficit Reduction Act, the Department of Health and Human Services (“HHS”) is undertaking an initiative to require all hospitals participating in a Medicare program to provide information to HHS on a periodic basis concerning their investment and compensation relationships with physicians. As the initial step in this process, HHS will send a mandatory disclosure report form to 500 hospitals in September of this year, on which those hospitals will be required to disclose their investment and compensation arrangements with physicians. HHS will use the information gathered to analyze the relationships for compliance with applicable federal law, including the federal Stark statute. 

The HHS notice can be found by clicking here. The mandatory information request is authorized by federal regulations found at 42 CFR 411.361.

In addition to the obligation to return any amounts improperly collected from the Medicare program, penalties for violating the Stark statute include a $15,000 fine for each impermissible referral and for each claim submitted pursuant to an impermissible referral, as well as potential liability under the False Claims Act.

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More and more payors are instituting rating systems for their participating physicians and at least one state attorney general has taken issue with the practice.  According to a recent article on CNNMoney.com, the New York Attorney General has threatened an injunction against United Healthcare if it implements a physician rating system in New York.   The Attorney General has apparently cited a number of concerns with the rating system, including that the rating data may be faulty and that patients may choose doctors based on cost rather than quality. 

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According to a recent article in the Naples Dailey News (Here), hospitals across the Country are facing a shortage when it comes to specialty physician coverage for the emergency room.   Fifty-five percent of hospitals surveyed by the American Hospital Association have experienced a coverage shortage and a third compensate physicians for ER coverage.  Specialty areas of particular concern include orthopedics and neurosurgery.

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The Centers for Medicare and Medicaid Services (CMS) announced on May 30, 2007 that it would make available online certain health care provider data contained in the National Plan and Provider Enumeration System (NPPES). This data will be available through an internet-based NPI registry in two formats – in an initial downloadable file, with monthly update files that will also be downloadable from the internet, and in a query-only database that will allow users to query by NPI number or by provider name. CMS has delayed the launch of the NPI registry until August 1, 2007 in order to allow providers to review their disclosable NPPES data and make any changes or deletions they feel are appropriate in order to protect any sensitive information provided by the providers when they initially applied for their NPI numbers. Such data includes information provided by providers in the optional data fields in the NPI application, such as other first name, other last name, address, phone and fax numbers, among others.

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Details continue to emerge over the terror attacks in Great Britain allegedly carried out by a group of physicians.  According to a recent article (See Foreign Doctors in U.S. Concerned After British Terror Plot Implicates Physicians), foreign physicians practicing in the U.S. are concerned over what the fallout on our shores might be.   While there have yet to be any formal changes to U.S. immigration policy regarding foreign physicians, we are advising our physician practice clients who employ foreign-born physicians (as well as foreign-born physician clients) to consider having an audit of their physician immigration status performed as well as to consider instituting training on immigration issues for key management and hiring personnel.

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As lucrative ancillary services continue shift from hospitals to outpatient sites, hospitals are anxious to find ways to keep they're hand in the mix.  Not surprisingly, physician-hospital joint ventures are all the rage.  While such ventures can be legally structured, the stakes of failing to comply with applicable legal requirements can be very high.  For important considerations in structuring joint ventures, see the following article in Physicians' News Digest: Structuring Contractual Joint Ventures. 

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If certain changes currently under consideration by the Pennsylvania Insurance Commissioner go into effect, Pennsylvania Physicians could end up paying a significantly larger malpractice insurance bill next year.  Specifically, the Insurance Department is considering changing the required level of coverage Pennsylvania physicians must maintain (before MCARE coverage) from $500,000 to $750,000.  According to a recent article in the Pittsburgh Post-Gazette, some physicians believe that the malpractice crisis in Pennsylvania is far from over and that such a change will only serve to reinvigorate the crisis. 

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