Reimbursement Roundup
Nurse anesthetist rule in trouble
The Bush administration says it will cancel a new rule that would allow nurse anesthetists to administer anesthesia without a physician’s supervision. Department of Health and Human Services Secretary Tommy Thompson said the department will issue a new rule that will require a physician’s presence when nurse anesthetists administer anesthesia. Administration officials also said they would postpone the new rule for six months to give them time to revise it.
However, under the new rule, states will be able to avoid the requirement if they already allow nurse anesthetists to work alone and if local health experts feel this would benefit patients.
Supporters of nurse anesthetists argue that the rule was needed to ensure access to anesthesiology services in rural areas. Physician groups, including the American Society of Anesthesiologists and the American Medical Association, opposed the rule, arguing that nurses cannot provide the same level of care as physicians.
Doctors retire earlier in HMO-heavy markets: Study
There is a 13% greater chance a generalist physician will retire by age 55 if he or she practices in markets where HMO penetration is greater than 45%, finds a study published by Health Services Research (www.hsr.org), a medical research group. Female physicians were more likely to retire than male physicians, whereas international medical graduates had lower retirement rates. For specialists, the chances of retirement were 17% greater than in markets with 5% or lower managed care penetration.
The "findings suggest that many older physicians have found it preferable to retire rather than adapt their practices to an environment with a high degree of managed care penetration," the study concluded. "Because the number of physicians entering the older age categories will increase rapidly over the next 20 years, the growth of managed care and other influences on physician retirement will play an increasingly important role in determining the size of the physician work force," the study said.
HCFA updates SNF rates
The Health Care Financing Administration has published a proposed rule updating Medicare payment rates for skilled nursing facilities (SNFs) for fiscal year 2002, plus moving so-called swing bed hospitals under the new prospective payment system (PPS). Under the proposal, once SNF PPS rates rise 2.1%, swing bed hospitals would start their changeover to the SNF PPS system (except for critical access hospitals, which are exempt from the PPS).
ESRD payments to rise
Medicare+Choice payment rates for end-stage renal disease (ESRD) beneficiaries will increase 1% beginning in 2002, say sources at the Health Care Financing Administration (HCFA). The payment increase was mandated by Congress in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 as part of the give-back package for Medicare managed care plans.
Managed care plans are paid 95% of the fee for service rate under Medicare. The ESRD payment rate incorporates a new payment methodology for plans in which rates are adjusted for age and gender. Currently, payments are based on state-level rates without being risk-adjusted. Beneficiaries with ESRD are the only group prevented from enrolling in Medicare risk health maintenance organizations and Medicare+Choice plans, although those developing the disease after enrolling may stay with their plan. Health plans are required to submit their Adjusted Community Rate proposals to HCFA by July 1.
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