Health Policy/Government Affairs

The Large Urology Group Practice Association is here to keep the interests of our members at the forefront. For more information on any of the information provided you can contact us at info@lugpa.org.

House Energy & Commerce Committee Passes Medical Malpractice Reform

Yesterday, the Energy and Commerce Committee reported HR 5, The HEALTH Act, by a vote of 30-20 along party lines.

H.R. 5 would limit noneconomic damages in medical malpractice awards to $250,000. It also would limit punitive damages in medical malpractice awards to twice the economic damages or $250,000, whichever is greater.

Twenty-eight states have already enacted medical liability reform that includes caps on non-economic damages. The HEALTH Act is modeled on these successful state laws, protecting patients' rights while curbing junk lawsuits that drive up costs for everyone.

According to the Congressional Budget Office (CBO), medical liability reforms, such as those included in H.R. 5, would reduce the federal deficit by $62 billion.

Details of The HEALTH Act

Ensures plaintiffs can recover full economic losses, but limits non-economic damages to $250,000. H.R. 5 establishes a fair share rule that apportions damages based on a defendant’s degree of fault.
Establishes a sliding scale for attorney contingency fees to ensure patients can access legal representation without forfeiting an exorbitant share of the damages they are awarded to trial lawyers.
Allows evidence of collateral source benefits to be introduced to prevent double recovery, which is when a plaintiff has already had medical expenses covered (by, for example, an insurance plan or through Medicare or Medicaid) and is awarded those same costs in a trial.
Sets standards for the award of punitive damages, including a limit on the amount of punitive damages to two times the amount of economic damages awarded or $250,000, whichever is greater. Punitive damages are not intended to compensate the injured party but rather punish malicious behavior. H.R. 5 would limit punitive damages to instances where a person acted with malicious intent or deliberately failed to avoid injury that was substantially certain to occur.
Allows courts to require periodic payments of damage awards.

Accountable Care Organizations (ACOs) - An Overview of the Potential financial impact on Urologists

By: Susan Charkin, President, Healthcents, Inc.; Steve Selbst, CEO, Healthcents, Inc.; Regina Vasquez, VP Accounts, Healthcents, Inc.

In an effort to slow the rate of rise in spending and in an effort to broaden the benefit to the commercial insurance market, It is clear to stakeholders such as Medicare, government policy makers, Hospitals, payers and physician groups that the current system is unsustainable. These stakeholders are looking at ways to move from fee-for-service payment models toward shared accountability/shared savings episode treatment models or what has been termed Accountable Care Organizations (ACOs) for chronic medical conditions such as diabetes as well as certain heart and urology episodes.

While joining or forming an ACO is not urgent in the immediate future, urology physicians cannot afford to put their head in the sand. Because the delivery model is PCP centered, it is important now for urology Urologists to understand the ACO concept and develop strategies to make it work for them.

Please click here to read the full report

Doctor-owned centers spark criticism, scrutiny - Washington Post

Click here to read the Letter from the LUGPA President | Link to the full article.

Raoul S. Concepcion, MD
President, Large Urology Group Practice Association (LUGPA)

House Judiciary Committee Passes Medical Liability Reform

The House Judiciary Committee voted 18-15 along party lines Wednesday to send a Republican-sponsored medical malpractice tort reform bill to the full House.

H.R. 5, the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act would place a $250,000 cap on the amount of noneconomic damages (or twice the amount of economic damages, whichever is greater) that juries could award patients who bring suit for injuries suffered during the course of medical treatment.

The HEALTH Act has a good chance of clearing the Republican led House of Representatives. The real question is whether or not it will make it through the Senate and the White House. President Obama has said he opposes caps, but announced in his recent State of the Union address that he is willing to look at alternatives to the current system in order to bring down healthcare costs.

New Stark Disclosure Rule Goes Into Effect

Revisions to the Stark Law went into effect on January 1, 2011. Section 6003 of the Patient Protection and Affordable Care Act (PPACA) adds a requirement that physicians who furnish MRI, CT or PET services for their Medicare patients inform the patient in writing at the time of the referral that the patient may obtain the MRI, CT or PET test from another provider. The physician is also required to provide a written list of suppliers who furnish those services in the area where the patient resides.

The final rule, released in November, includes a number of changes over proposed rules shared in June. The change brings down the number of alternative suppliers suggested from 10 to five, and it does away with the need to obtain a patient's signature on the disclosure form or to save it in the patient's medical file.

The rule does allow an exception for providers practicing in areas where less than 5 suppliers are located within a 25 mile radius. Those providers should list all of the suppliers within the area. Hospitals are not considered suppliers, but may also be listed

As always, LUGPA will keep its membership informed of any new information that comes about. If you have any questions regarding this, or any other issue, please contact us at info@lugpa.org.

Congress Passes 1 Month Doc Fix
Following the Senate's lead, the U.S. House Wednesday voted to extend current Medicare reimbursement rates for physicians through the end of the year. This is was two days before physicians were set to be cut by 23 percent on December 1st.

Senate Finance Committee members Sens. Max Baucus and Charles Grassley are expected to introduce a 12 month fix before the most recent action expires (sometime in December).

For more information on this issue please visit our website or contact us at info@lugpa.org.

New CPT Codes for FISH Test

LUGPA has become aware of new changes to the 2011 Physician Fee Schedule that includes changes to coding for Fluorescence in situ hybridization ( FISH ). The changes are listed below:

New CPT Codes Paid from Medicare Physician Fee Schedule:

88120 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual

88121 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology

The Centers for Medicare and Medicaid Services will be accepting comments on the new rule until January 3, 2011. We encourage members who would like to submit a comment to do so here http://www.regulations.gov/search/Regs/home.html#documentDetail?R=0900006480b7ee52 .

If you would like to read the final rule in its entirety please click here http://www.ofr.gov/OFRUpload/OFRData/2010-27969_PI.pdf .

LUGPA will be monitoring this and will keep the membership apprised of any new information that comes about.