Practice Beat

February 5, 2001

Self-referrals, Con Games, Euthanasia, Managed Care

 

Practice Beat

By Joan R. Rose, Senior Editor

Jump to:Choose article section...Self-Referrals: HHS gives doctors more wiggle room Con Games: Beware of the thief in your mailbox Euthanasia: Another step closer to legalization in the Netherlands Managed Care: That black eye is deserved, these physicians say Why patients were shortchanged under managed careAspects of managed care doctors say are most likely to . . . What doctors would do to improve managed care

Self-Referrals: HHS gives doctors more wiggle room

Under the so-called Stark laws, physicians have been prohibited from referring certain Medicare services to entities with which they have an ownership or compensation arrangement. Now, HCFA has issued the first part of a final rule addressing such referrals, and doctors may find it more to their liking.

While the regulation still bans referrals to entities that doctors own, it generally allows referrals to those in which they have a compensation arrangement—provided their compensation is no greater than that paid to any other practitioner for the same service. In defining what practices the law exempts from the self-referral prohibition, the final rule expands the law's exceptions for services provided in a physician's office and for services provided by managed care plans.

In addition, HCFA has revised the definition of group practice, broadened the types of arrangements that qualify as a single legal entity, created a more flexible definition of a unified business, and modified the productivity bonus and profit-sharing regulations.

The rule will become effective on Jan. 4, 2002—one year after its publication in the Federal Register (www.access.gpo.gov/su_docs/fedreg/a010104c.html). The second part of the final rule will address comments on provisions of the proposed rule that aren't covered in part 1, as well as comments on the first part of the final rule. HCFA will accept written comments on part 1 until April 4.

For your opinion to be considered, send a letter (original and three copies) to:

Health Care Financing AdministrationDepartment of Health and Human ServicesAttn: HCFA-1809-FCPO Box 8013Baltimore, MD 21244-8013

Con Games: Beware of the thief in your mailbox

Physicians' offices are popular targets for scam artists, according to the Better Business Bureau. BBBs nationwide report complaints regarding office-supply telemarketers selling computer and copier machine supplies, light bulbs, and cleaning materials. The con artists pretend to be the doctors' regular supplier, and ship outrageously priced products without authorization.

Another recent con involves a solicitation to be listed in an international fax directory. The mailing, designed to mislead recipients into thinking it comes from a legitimate publisher—like the Yellow Pages—claims that the directory will be distributed annually with a circulation of 3,000 CD-ROMs, and includes an invoice for $965.15. Even if the directory is ever produced, its distribution will be very limited, warns Karen Stanek, vice president of Yellow Pages Publishers Association.

Other schemes falsely advertise the availability of venture capital or notify businesses, including medical practices, that they automatically qualify for a line of credit for a large loan. These ploys emanate from Nigeria and other countries, the BBB says. The perpetrators blanket American businesses through fax machines and office e-mail.

Advice on how to identify suspicious solicitations and report them to appropriate law enforcement agencies is available at the Federal Trade Commission's Web site (www.ftc.gov/bcp/conline/edcams/mailbox). Click on "Catch the Thief in Your Mailbox."

Euthanasia: Another step closer to legalization in the Netherlands

Holland is expected to become the first country to regulate physician-assisted mercy killing by law. The lower house of Parliament recently voted to adopt legislation legalizing euthanasia, and the upper house is expected to rubber-stamp that decision this year. Although euthanasia is still technically a criminal offense in the Netherlands, the Dutch have tolerated it for years.

About 400 people there die by physician-assisted suicide annually. Doctors are supposed to report the circumstances of each induced death to a pathologist, who in turn submits a report to the public prosecutor. The physicians generally aren't prosecuted—as long as they meet certain criteria for ensuring due care—but it's estimated that fewer than half of the doctors who participate in assisted suicides report their actions.

Under the proposed law, not all cases will go to the public prosecutor. A review panel will notify the prosecutor only if it thinks the doctor didn't follow established guidelines. The government hopes that change will make physicians less fearful of prosecution, and thus more willing to report all cases.

Managed Care: That black eye is deserved, these physicians say

Does managed care really warrant the negative publicity it generates? Yes, according to a poll of physicians conducted for Connecticut's attorney general, Richard Blumenthal.

Ninety percent of survey respondents believe that managed care policies shut doors on necessary treatment and that drug formularies deny patients the safest and most effective medicines. And although about one in four respondents participates in capitated plans, more than one-third report that patients enrolled in such plans received a lower quality of care than their fee-for-service counterparts.

Moreover, nearly a third of respondents said they were personally aware of cases in which patients died because HMOs denied or delayed necessary care.

  

Why patients were shortchanged under managed care

 

Aspects of managed care doctors say are most likely to . . .

Interfere with ability to provide careResult in compromised care
89%Formularies85%
92Procedure approval process84
80Gatekeeper process70
69Capitation payment rate64
61All-products clauses54
10Fee-for-service payment rate8
89Other88

 

What doctors would do to improve managed care

 



Joan Rose. Practice Beat.

Medical Economics

2001;3:16.