Community-based Cardiac Surgery
The Massachusetts House and Senate have concluded their FY 2001 budget proposal, which includes a community hospital-based cardiac surgery pilot program. A total of seven sites would be permitted, as the House proposed, including North Shore, South Shore, Metrowest, South Coast, Brockton, Cape Cod, and Lowell.
In the initial phase of the program, three hospitals would be approved under the “308” demonstration project authority by July of 2001. Two more would be considered under the determination of need (DON) process by July 2003, and the last two would be considered under the determination of need (DON) process by July 2005. The proposal does not specify which hospitals would be approved first.
Community hospitals must meet the following criteria to be considered for the pilot program:
(a) Each applicant must have executed a written affiliation agreement with an academic medical center having an accredited primary cardio-thoracic surgery residency program for a term of at least five years. No single academic medical center may have affiliation agreements with more than two community hospitals.
(b) Each applicant must be operating a fixed cardiac catherization lab in accordance with standards established by the department of
public health at the time of application.
(c) Each applicant must be performing at least 1,000 cardiac catheterization procedures
per year or have a projected annual cardiac catheterization volume of 1,000 procedures
per year by the end of the third year.
(d) Each applicant must have a projected open heart surgery volume of at least 300 procedures per year and a projected open heart surgery volume per surgeon of 100 procedures per year by the end of the third year.
(e) Each applicant must demonstrate an ability to finance any necessary capital improvements and operating expenses for said program.
(f) Each applicant must develop programs for cardiovascular disease prevention and health promotion aimed at reducing the incidence of cardiovascular disease.
(g) Each applicant must comply with clinical standards for program quality developed by the department of public health.
Finally, the bill establishes an oversight and an evaluation process for the project.
More details about the pilot program will be available through PSU in the months ahead.
BBA news
Seventy-six House members have signed onto a letter to House Speaker Dennis Hastert
(R-IL) and Minority Leader Dick Gephardt (D-MO) asking for action on additional BBA relief before Congress adjourns in October. A similar letter circulating in the Senate has attracted 30 signatories. President Clinton urged the nation’s governors in July to support his $40 billion (over 10 years) BBA relief plan. Eleven House Republicans also went on record supporting action on the AHA’s Medicaid DSH proposal before the end of the year. Finally, the Office of Management and Budget (OMB) announced that the Medicare surplus for this fiscal year is $24 billion and will total $403 billion over 10 years.
The Senate seeks ROI for its NIH investment. An amendment to the Senate Labor-HHS appropriations bill would require NIH to draft a plan for recouping a reasonable rate of return on profits made by pharmaceutical companies that result from government-funded research. The NIH plan would be due by March 31, 2001, and would detail the circumstances under which drug companies would reimburse the Federal government when they have profited from Federal research. The bill, which passed the Senate last week, includes a $2.7 billion increase in NIH spending for fiscal year 2001.
Massachusetts House and Senate agree on a managed care bill After years of negotiation, the legislature agreed on a package of managed care reforms.
A summary of the provisions of interest to Partners follows:
• Consumer protections - The agreement guarantees access to emergency services for all citizens of the Commonwealth. It mandates a health plan report card and requires additional disclosure by HMOs. It also establishes a managed care oversight board within the Executive Office of Human Services and an office of patient protection within the Department of Public Health. A bureau of managed care will establish and monitor minimum standards for the accreditation of carriers, as well as a grievance review process. Finally, it mandates an independent analysis of the feasibility and fiscal implications of universal coverage and consolidated health care financing with recommendations by December 31, 2001.
• Timely payments - The agreement requires private payers to pay in 45 days or explain to the provider the reasons why payment has not been made. Interest accrues to the insurer and is paid to the provider for failure to comply. The language does not apply to Medicaid.
• Physician compensation arrangements - The agreement requires that risk arrangements contain stop loss protection, specify the minimum patient population size for the physician, and identify the services for which the physician is at risk.