PROPOSED BILL WOULD ELIMINATE STARK LAW EXCEPTION FOR SOME SERVICES

The “Promoting Integrity in Medicare Act of 2013," introduced in the U.S. House of Representatives on August 1, would eliminate one of the Stark Law’s exceptions for advanced imaging, anatomic pathology, radiation therapy and physical therapy services performed in a physician’s office.

The bill was introduced by Representatives Jackie Speier (D-CA), Jim McDermott (D-WA) and Dina Titus (D-NV). Congresswoman Speier released a summary of the bill. Its sponsors claim that by making the performance of certain medical services illegal, the bill would cut “unnecessary” Medicare expenditures by hundreds of millions of dollars per year.

The Stark Law prohibits a physician from referring Medicare and Medicaid patients to a facility in which he or she has a financial interest for any of ten categories of “designated health services” unless an exception is available. One of the most-used exceptions, for “in-office ancillary services,” permits the physician to refer his or her own patients for advanced treatment in the same building as his or her primary office. The proposed bill would eliminate this exception for the services listed above. In a press release, McDermott observed, “Over the years, use of the in-office ancillary services exception has dramatically increased, resulting in increased costs to the Medicare program.”

If the bill or a variation thereof were to become law, it would undoubtedly require countless “in-office” facilities to restructure or completely unwind their arrangements with referring physicians.

OREGON EXCHANGE WON’T BE COMPLETELY READY BY DEADLINE

On August 9, Oregon became the first state to admit that its online health insurance exchange will not be completely ready for use by individual insurance customers when enrollment begins on October 1. Instead of insurance buyers being allowed to review policies and sign up for coverage on their own, they will need assistance from insurance brokers or aides trained by the state.

State exchanges, or “marketplaces,” are required to be established under the Affordable Care Act. A spokeswoman for the exchange, Lisa Morawski, said, "This approach will give Cover Oregon the ability to iron out the technology, customer service and other internal processes during the first few weeks of October before consumers begin applying on their own." About 550,000 Oregonians are currently uninsured.

Many healthcare industry analysts had speculated that the new online insurance marketplaces might not be ready by the October 1 deadline in all 50 states. The U.S. Department of Health and Human Services may find the deadline particularly onerous because HHS will run exchanges for 19 states and work with 15 other states on “partnership” exchanges.

“DOC FIX” BILL ADVANCES IN HOUSE

On July 31, the House of Representatives’ Energy and Commerce Committee unanimously passed a draft bill that would reform Medicare's physician payment system. The proposed legislation, titled “The Medicare Patient Access and Quality Improvement Act of 2013,” had been approved by the Committee’s Health Subcommittee on July 23, and will now be considered by the full House. The Committee released a summary of the bill.

The bill would replace Medicare’s Sustainable Growth Rate (SGR) formula, discussed here, with a fee-for-service payment system that would be adjusted up or down based on quality measures. Fred Upton (R-MI), the Committee’s Chairman, said, "This legislation is long overdue. Since its passage in 1997, SGR has bred uncertainty and frustration.”