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

Several month ago I posted an entry on this Blog about a lawsuit the New York Attorney General was threatening to file to prevent United Healthcare from ranking its participating physicians.  Well, according to an article on USAToday.com, CIGNA and the Attorney General have reached a settlement in a similar case.  While CIGNA will move forward with its public ranking system, it has agreed to do the rankings on factors other than cost alone and to make available to the public details of how the ranking is performed including the relative weight placed on various cost and non-cost factors.   

Clearly physician ranking systems are the waive of the future.  How much weight patients will actually place on these systems remains to be seen but physicians should monitor these developments closely and gain a firm understanding of how these systems will apply to their practices.  

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In a recent Stark law Advisory Opinion (CMS-AO-2007-01), the Centers for Medicare and Medicaid Services (CMS) found that a hospital could not change the terms of an existing physician recruitment assistance agreement where that change would effectively result in additional compensation to the recruited physician.  Specifically, the original recruitment assistance agreement between the hospital and the physician included an excess receipts provision which obligated the physician to remit to the hospital any collections in excess of the physicians' expenses and guaranteed compensation.   

The hospital sought CMS' opinion on whether (1) an excess receipts provision was required in recruitment assistance agreements by the Stark regulations, and (2) whether the hospital could delete the provision from the existing agreement.  CMS declined to opine on the first issue (although they did note that the recruitment assistance exception does not require such a provision) but found with respect to the second issue that deleting the excess receipts provision would have the effect of providing more compensation to the recruited physician than he would originally have been entitled to.  On this, CMS stated the following:  "Because the Physician has already relocated his medical practice, the additional compensation is not for the purpose of inducing relocation and may directly or indirectly reflect the volume or value of the recruited physician’s actual or potential referrals."

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According to a recent DOJ Press Release, five medical device companies (comprising approximately 95% of the hip and knee joint implant market) have settled kickback allegations relating to payments to surgeons by agreeing to pay a total of $311 million and entering into five-year Corporate Integrity Agreements.  The companies include Zimmer Inc., Depuy Orthopaedics, Inc., Smith & Nephew Inc., Biomet Orthopedics, Inc., and Stryker Orthopedics, Inc.  Physicians who deal with these and other implant manufacturers clearly need to take a close look at their device relationships to be sure they conform to the anti-kickback statute and other applicable laws.

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Just when physicians thought it was safe to start investing in electronic medical records systems, Microsoft may be changing the ground rules altogether.  On October 4, 2007, Microsoft took a giant leap into the health information arena by announcing the launch of it's new web site "HealthVault".  According to the web site, HealthVault will serve as a secure electronic repository for where patients can "collect, store, and share" their health information with their physicians and other treating providers.   Data accuracy and privacy issues aside, a national shared electronic health record may not be so far off!

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