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

According to a recent article in the Patriot News, Governor Rendell has outlined the costs associated with his plan to provide health insurance for Pennsylvania's uninsured population.  The plan calls for increases in taxes on tobacco products and would tap into the MCARE fund to cover the health insurance costs.  However, according to Rendell, the plan would result in enough money to ultimately eliminate the MCARE premiums currently charged to physicians.  According to the article, Governor Rendell is seeking physician support of his plan, which, with minor modification, the Pennsylvania House of Representatives has already approved.  Rendell has already said that unless Pennsylvania legislators are able to work out a deal to expand the State’s uninsured health insurance program, he will not approve extension of the MCARE abatement program.  

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More not-so-good news for Pennsylvania: according to an article in the Times Tribune, Pennsylvania Medical Society officials are predicting a shortage of physicians in Pennsylvania in the foreseeable future.  Citing the Society's recently released demographic report (See The State of Medicine in Pennsylvania), the article suggests that Pennsylvania could be short 10,000 doctors within 10 years.  Pennsylvania's physician population is aging, with a large percentage of physicians approaching retirement age.  According to the article, 50% of Pennsylvania's physicians are over the age of 50.

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Much to the chagrin of practicing Pennsylvania physicians, the issue of MCare premium subsidies became a political football earlier this month when Governor Ed Rendell said he would not approve the 2008 MCare subsidy until Pennsylvania lawmakers acted on his proposal to expand the state insurance program to uninsured adults.  The proposal calls for using a portion of the MCare surplus to pay for the expanded insurance benefits.  However, according to an article in the Philadelphia Inquirer, Governor Rendell is considering allowing physicians to delay paying their MCare premiums until the debate over the proposed program is resolved and the MCare subsidy legislation is officially extended.  This approach, according to the Governor, likely makes better sense than requiring the premiums to be paid and then later refunding them.  Stay tuned ...  

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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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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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Notwithstanding the fact that 13 Philadelphia area hospitals have stopped delivering babies since 1997, Governor Ed Rendell's office has concluded from a recent study that in fact there is no obstetric physician crisis in Pennsylvania.  According to an article in the Philadelphia Inquirer (found here), the number of practicing OB-GYNs was stable from 2004 to 2006, but 18 percent of OBGyns in southeastern Pennsylvania surveyed in 2006 indicated that they planned to stop delivering babies in 12 months suggesting that a crisis may in fact be coming.  

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At least one Pennsylvania lawmaker is hoping loan forgiveness will stem the flow of physicians out of Pennsylvania.  According to a recent article in the Pittsburgh Tribune-Review, State Rep. John Shapiro of Montgomery County has introduced legislation (House Bill 1093) which would forgive medical school debt at the rate of 10% per for physicians who practice in Pennsylvania for at least 10 years.   

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According to a March 28, 2006 Press Release, the boards of directors of Highmark Inc. and Independence Blue Cross (IBC) have agreed to merge. The new company will continue to have dual headquarters in Pittsburgh and Philadelphia and is expected to generate more than $1 billion in savings over a six year period, but whether providers or benficiaries will see any part of those savings is unknown.  Of course, if the merger goes through, the administrative difficulties that physicians now face in dealing with either Highmark or IBC are likely to get considerably worse before they get better.    

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A recent bill proposed by the Pennsylvania House of Representatives would, among other things, reinstate the Certificate of Need (CON) program in Pennsylvania.  Specifically, House Bill 305, introduced on February 7, 2007, would require anyone proposing to make capital expenditures in excess of $500,000 for replacement technology or $1,000,000 for equipment or improvements in connection with a covered health care facility, to obtain a CON.  Facilities subject to the CON requirements would include, among others, ambulatory surgery centers, imaging centers and cancer treatment centers using radiation therapy. 

Of even more concern to physicians is the fact that the legislation includes self-referral prohibitions similar to the federal Stark statute that would prohibit physicians from referring to health care entities (including ASCs which are not currently covered by Stark) in which they have a financial interest.  All physicians with ancillary service arrangements in Pennsylvania need to pay close attention to this and other efforts by State legislators to curb physician investment in ancillary services.

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In the December 2, 2006 Pennsylvania Bulletin, the Secretary of the Pennsylvania Department of Health published the annual update to the rates a health care facility or provider may charge to produce copies of medical records.  With only a few exceptions, these charges apply to any request for a copy of a medical chart or record, including in response to a subpoena.

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The Pennsylvania Insurance Department published today the annual MCARE assessment to be levied for calendar year 2007.  The 2007 assessment will be 23% of the prevailing primary premium for each participating health care provider -- 6% less than for calendar year 2006.  The MCARE statute defines ''prevailing primary premium'' as the schedule of occurrence rates approved by the Insurance Commissioner for the Joint Underwriting Association.  The 2007 assessment is published in today's Pennsylvania Bulletin.  More information on the assessment and the MCARE program in general (including the abatement application form) can be found at the Office of MCARE website.

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Those of you keeping a close watch on Pennsylvania MCARE developments may be interested to know that the Commission on the MCARE Fund will be holding a public hearing to give citizens and organizations the opportunity to provide relevant information, opinions and suggestions that concentrate on the Commission's guiding principles.  The Commission was formed to make recommendations to the Governor and General Assembly by November 15, 2006, regarding the continuation of the MCARE assessment abatement and the elimination or phase-out of the MCARE Fund.  The hearing is scheduled for Thursday, November 2, 2006, from 9 a.m. to 12 p.m. and will be held at the Pennsylvania Housing Finance Agency, 211 North Front Street, Harrisburg, PA.  The public notice can be found here [Public Notice].

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Pending PA legislation would limit most insurance refund demands and retroactive payment denials by third party payors to a one-year lookback period except where fraud or miscoding occurs. The full text of the bill can be viewed here:physicianlaw.foxrothschild.com/HB2178P4462(1).pdf . The bill was passed by the House by a vote of 195 to 2 on June 30. It's still pending before the Senate and was referred to the Senate Banking Committee on July 5. For more information on this possible development, contact Bill Maruca at Fox Rothschild LLP.

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