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New Jersey Law Protects Physician ASC Referrals

According to an article from Modern Physicians, legislation that protects the ability of physicians in New Jersey to refer patients to ambulatory surgery centers in which they have ownership was recently signed by Governor Jon Corzine.  The bill will be applied retroactively.

See the full story (registration required) or go to modernphysician.com

Recession having an impact on surgical scheduling.

The New York Times reports that the economic slowdown has affected elective surgery schedules, with many patients delaying needed procedures until their conditions worsen. One recent study found that about one-third of hospitals had seen either a moderate or significant decrease in elective procedures during the previous three months; studies from New Jersey and Georgia indicate that as many as 50 percent of hospitals have noted a change. Ambulatory surgical centers, which had experienced exponential growth over the last decade, are also reporting a slowdown in some markets. The altered surgery pattern may have consequences for healthcare providers as well: according to one healthcare expert, elective operations such as joint replacement surgeries—which are typically covered by higher-paying private insurance plans—may represent only about 10 percent of a hospital’s admissions, but account for 25 percent of its income.

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New Jersey Passes ASC Legislation

American Medical News reports that a compromise bill passed by both houses of the New Jersey State Legislature is designed to reverse a 2007 court ruling that threatened to put roughly 200 physician-owned ambulatory surgery centers (ASCs) in violation of the state's anti-self-referral law. If enacted, the new bill would allow physicians to treat patients in ASCs they own as long as the following conditions are met:

• The physician who referred the patient personally performs the procedure.
• Financial compensation is not tied to the volume of patient referral.
• All clinical decisions are made by practicing physicians and are in the best interest of patients.
• Patients are given prior written notice of the physician's financial interest.

The bill also places a moratorium on new ASC construction unless the center is jointly owned by a hospital. The governor is expected to sign the legislation.

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California Supreme Court Rules Physicians Cannot Balance Bill HMO Patients

According to the San Francisco Chronicle, the California Supreme Court has ruled that physicians cannot "balance bill" patients whose health maintenance organizations (HMOs) have underpaid for care, and that the physicians can only seek redress from the insurer. The decision was praised by consumer groups, but a spokesperson for the California Medical Association stated that a ban on billing patients would shift costs from HMOs to physicians, some of whom might end their affiliations with emergency departments.

Bipartisan Senate group outlines seven principles for healthcare reform.

The 15 U.S. Senate co-sponsors of the Healthy Americans Act have sent a letter to President-elect Barack Obama outlining seven principles they believe should serve as the goal of any reform of the nation’s health care system. The bipartisan group of senators stated that healthcare reform should have the following goals:

• Ensuring that all Americans have health care coverage
• Ensuring that health care coverage is affordable and portable
• Implementing strong private insurance market reforms
• Modernizing federal tax rules for health coverage
• Promoting improved disease prevention and wellness activities, and better management of chronic illness
• Making healthcare prices and choices more transparent
• Improving the quality and value of health care services

New Jersey.

According to NJBIZ, hospitals would be prohibited from charging patients and insurance companies for medical mistakes ranging from hospital-acquired infections to leaving objects in a patient after surgery, under a bill being considered in the New Jersey Legislature. If enacted, the restrictions would mirror those used by the federal government to determine when to refuse Medicare reimbursements to hospitals for preventable medical mistakes and conditions.
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Hawaii.

According to the Associated Press, the state of Hawaii is dropping its universal child health care initiative 7 months after the program was launched. The governor cited budget shortfalls and other available healthcare options as reasons for the cut, and one state official said that some families were dropping private coverage to make their children eligible for the subsidized plan.

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California.

The Los Angeles Daily Journal reports that several physician organizations, including the California Medical Association, have filed suit to contest new state regulations barring balance billing. Some experts have argued that outlawing balance billing, in which healthcare providers bill patients an additional amount to make up for low insurance reimbursement, can reduce the availability of specialists for emergency calls.
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MedPAC considers proposals regarding physician disclosure.

On October 2, the U.S. Medicare Payment Advisory Commission (MedPAC) met in Washington, D.C., and the Commission's staff made a one-hour presentation on public reporting of physicians' financial relationships. Recommendations from the Commission may be forthcoming at a later date.
Review a copy of the meeting brief (PDF)...

Review the MedPac staff presentation (PDF)...

AAOS joins amicus brief on expert witness qualifications in Arizona.

The Executive Committee of the Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) has voted unanimously to join an amicus curiae brief in a case involving Arizona legislation on the qualifications required for medical expert witnesses. The case, Seisinger v. Sieble, is an appeal supported by the Mutual Insurance Company of Arizona (MICA) of a recent decision of the Arizona Court of Appeals. In June 2008, the appeals court held unconstitutional a state statute requiring that medical experts who testify in medical liability cases meet certain minimum qualifications, including licensure and certification. If the decision is allowed to stand, it could have a significant impact not only in Arizona, but in other states as well. The AAOS is joining the Arizona State Medical Association, the Arizona Orthopaedic Society, the Arizona Hospital Association, and several other national and state medical and specialty societies in this action.
Read the appeals decision (PDF)...