The Republican-controlled Florida Legislature has voted to place a constitutional amendment on the ballot that would ban any laws that compel someone to "participate in any healthcare system." Republican legislators said the amendment was needed to block an attack on freedom and individual rights by Congress. Sixty percent of voters must approve the amendment in order for it take effect.
Montgomery County business leaders have sent a joint letter to Maryland hospital regulators in support of Adventist HealthCare's hospital plan for Clarksburg, one of two proposals vying to build the county's next hospital. The decision to grant the hospital certificate of need is in the hands of the Maryland Health Care Commission. The commission has already received competing requests for approval from Adventist and Holy Cross Hospital, which aims to build a new hospital in Germantown, the Washington Business Journal reports.
A Duke oncologist is warning that the emphasis on comparative effectiveness studies may present obstacles for the field of cancer research. At a recent American Association for Cancer Research meeting, Duke's Amy Abernethy outlined several stumbling blocks, starting with the notion that while oncology is increasingly moving towards personalized treatment, comparative effectiveness research is based on large populations. There's also a dearth of evidence to actually direct physicians to the most "medically effective and cost-effective treatment for individual patients," she said.
In the past, many physicians considered their medical staff leadership responsibilities a privilege. Therefore, they did not demand compensation. However, in recent years, it has become common practice for hospitals and medical staffs to compensate chiefs of staff and medical staff presidents, committee chairs, and department chairs for their leadership involvement. This trend is occurring for two reasons.
First, decreased reimbursement and higher overhead have strained physicians' wallets. Many are no longer willing to spend time on volunteer leadership responsibilities when they could be seeing patients and generating revenue.
The second reason is that the scope of medical staff leadership responsibilities has grown in recent years. "If you look at all the responsibilities The Joint Commission and other regulatory bodies place on department chairs, it is arguably a full-time job," says Michael Callahan, Esq., partner at Katten Muchin Rosenman in Chicago.
There is no magic formula to help hospitals determine which leaders to compensate and how much. However, there are some questions that medical staffs and hospital executives should ask themselves before putting their John Hancock on a check.
The first question is should medical staff leaders get paid? If physicians are willing to take on leadership responsibilities because they feel that it is their civic duty, the medical staff or hospital can choose not to compensate them. However, if a hospital has difficulty finding individuals to volunteer, it may need to open up the checkbook. If your organization decides to compensate leaders, it should clearly spell out which leaders receive compensation in an administrative policy.
Your organization may also be asking itself, "If we decide to compensate medical staff leaders, which leaders should get compensated?" According to Mary Hoppa, MD, MBA, senior consultant with The Greeley Company, a division of HCPro, Inc. in Marblehead, MA, hospitals most commonly pay medical staff presidents and chiefs of staff because they spend a significant amount of time way from their clinical practices to tend to their responsibilities.
When deciding how much to pay leaders, hospitals should ensure that the amount of money a physician leader receives is commensurate with his or her responsibilities and stays within fair market value, thus complying with federal regulations. If hospital administration pays a leader exorbitantly to attend one medical staff meeting per month, that may throw up a red flag for the Internal Revenue Service and the Office of Inspector General, which enforce the Stark Law and Anti-kickback statute.
"If it looks like a payment for referrals—meaning that the real reason they made this person the medical director of a service line is to buy his loyalty and patients," says Callahan, "you are arguably violating these federal statutes."
To determine fair market value, medical staffs and hospitals should start by estimating how many hours a leader would need to dedicate to his or her post. "It isn't uncommon for people to say that the value of these administrative services is between $100 and $150 per hour," says Callahan. But this simple calculation may not be enough. Callahan suggests reaching out to other hospitals in your area to find out what they are paying their medical staff leaders. Most hospitals are curious whether they are on the same page as their peers and are willing to share such information, he says.
Who's going to fork over the money—the medical staff, hospital administration, or both? Hoppa says that traditionally, hospital administration has funded the stipend because it wants to ensure that the medical staff has leaders who can carry out their board-delegated duty to promote high quality care. However, some medical staffs feel uncomfortable with that arrangement because they are concerned that medical staff leaders who receive money from hospital administration will act in administration's best interests rather than the medical staff's.
But it might not be as financially sound for medical staffs to compensate leaders rather than the hospital. To afford medical staff leaders' stipends, many medical staffs must increase their annual dues or divert dues away from other purposes, such as the medical staff library or scholarships for up-and-coming physicians. "What we are seeing more often than in the past is that it is a shared responsibility. The hospital puts in half and the medical staff puts in half," says Hoppa.
On March 23, 2010, President Obama signed into law H.R. 3590, the Patient Protection and Affordable Care Act (the Act). This sweeping health reform legislation requires the U.S. Department of Health & Human Services (HHS) to develop interoperable and secure standards and protocols to facilitate the enrollment of individuals in federal and state health and human services programs, and authorizes grants to state and local governments to promote the implementation of health information technology (HIT) to facilitate enrollment in the programs.
Once issued, the new standards and protocols may affect how healthcare providers conduct health plan eligibility verification transactions standardized under the Health Insurance Portability & Accountability Act of 1996 (HIPAA), as well as how providers comply with the Medicare and Medicaid electronic health record (EHR) incentive programs' "meaningful use" objectives and measures pertaining to use of an EHR for electronic insurance eligibility verification. The standards and protocols may also affect how vendors' EHR technology is certified as capable of enabling meaningful use.
HIT Enrollment Standards and Protocols
No later than 180 days after enactment, the HHS, in consultation with the HIT policy and HIT standards committees created by the Health Information Technology for Economic and Clinical Health Act (HITECH Act), is required to develop interoperable and secure standards and protocols that facilitate the electronic enrollment of individuals in federal and state health and human services programs. The standards and protocols must facilitate enrollment in such programs by providing individuals and their authorized representatives notification and verification of eligibility. The standards and protocols must also allow for the following:
Electronic matching against existing federal and state data, including vital records, employment history, enrollment systems, tax records and other data determined appropriate by HHS to serve as evidence of eligibility in lieu of paper-based documentation
Simplification and submission of electronic documentation, digitization of documents and systems verification of eligibility
Reuse of stored eligibility information (including documentation) to assist with retention of eligible individuals
Capability for individuals to apply, recertify and manage their eligibility information online, including at home, points of service and other community-based locations
Ability to expand enrollment systems to integrate new programs, rules and functionalities; to operate at increased volume; and to apply streamlined verification and eligibility processes to other federal and state programs
Notification of eligibility, recertification and other needed communication regarding eligibility, which may include communication via e-mail and cell phones
Other functionalities necessary to provide eligible individuals with a streamlined enrollment process
HHS must notify states of the standards or protocols that have been approved by the HIT policy and HIT standards committees. HHS may require, as a condition of receiving federal funds for enrollment HIT investments, that states and other entities incorporate the standards and protocols into the investments.
Grants for Implementation of Appropriate Enrollment HIT Development
The Act authorizes HHS to award grants (in amounts not specified) to state and local governments to develop new and adapt existing technology systems to implement HIT enrollment standards and protocols, reduce enrollment HIT maintenance costs, and eliminate or update legacy enrollment systems.
HHS must ensure that enrollment HIT developed through such grants is made available to state and local governments and other entities meeting qualification standards determined by HHS.
Effect on HIPAA Standardized Transactions and Meaningful Use Requirements
Whether and to what extent the enrollment standards, protocols and HIT will affect the HIPAA-standardized health plan eligibility verification transaction, the requirements for EHR technology to be certified as capable of supporting "meaningful use" under the HITECH Act's Medicare and Medicaid EHR incentive programs, and the meaningful use requirements for eligible providers remains to be seen.
It would be prudent for HHS to make enrollment standards and protocols consistent or aligned with the incentive programs' EHR technology certification criteria and meaningful use requirements in the functional areas covered by both (e.g., eligibility, interoperability and security) to maximize the significant investment the federal government is making to facilitate the adoption of a nationwide health information network.
It will also enhance HIT vendors' ability to develop efficiently and expeditiously products that will enable providers and governmental payers to make prudent use of grant funds and other incentives provided under both the Act and the HITECH Act. All stakeholders affected by the federal government's interrelated development of standards and protocols under HIPAA, the HITECH Act and the Act should closely monitor and, where possible, provide input on their development.
Bernadette M. Broccolo, Daniel Gottlieb and Jean Marie R. Pechette are partners in the law firm of McDermott Will & Emery LLP, and are based in the Firm's Chicago office.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
Leaders at medical societies and top editors at their associated journals will have to sever direct financial ties with industry as part of new ethics rules rolled out today. The Council of Medical Specialty Societies says the new code—which covers conflicts of interest, financial disclosure, independent program development, and independent leadership—has already been adopted by 13 of its 32 member societies. The American Society of Clinical Oncology, American College of Physicians, American College of Cardiology, and American College of Obstetricians & Gynecologists have already signed on.