February 28, 2023

1. Navigating Anesthesia:

Thursday, March 2 Zoom for PHA Members

2. PHA Participates in HHS's Bi-Weekly Stakeholder Calls; We Need Your Thoughts

3. Physician-Led Hospital Legislation Introduced in Congress; Media Coverage

4. PHA's May Capitol Hill Fly-in: May 16-17

5. Leadership Summit Keynote Spotlight: Ed Gaines; Latest No Surprises Act Update

6. Physician Ownership Guidance Related to the End of the Public Health Emergency

7. AAOS Encourages Physician-Led Hospitals in FTC Non-Compete Letter

8. Site Neutral Payment: Legislation in the States & in Washington

9. CMS Proposal to End Physician Ownership Reporting

10. PHA's 2023 Sponsorship Opportunities

1. Navigating Anesthesia: Thursday, March 2 Zoom for PHA Members

Join PHA on Thursday, March 2 on Zoom for "Navigating Anesthesia."

Details can be found in the graphic. Click here to learn more and to RSVP for the link.

The Zoom is open to PHA members only.

2. PHA Invited to HHS's Bi-Weekly Calls; PHA Needs Your Feedback

PHA was invited by the U.S. Department of Health and Human Services (HHS) to participate in bi-weekly stakeholder calls with hospital stakeholders, including the American Hospital Association, Federation of American Hospitals and the Children's Hospital Association.

Your Input Will Be Needed

The calls are designed to help the administration understand hospital needs. CMS spotlights a particular topic related to hospital operations that we be discussed on each bi-weekly call.

PHA will provide the agenda topics as soon as they become available, and we ask that your hospital consider providing feedback to prepare PHA. In addition, PHA may ask for a PHA member to serve as PHA's representative on the stakeholder call.

The last call asked for stakeholder feedback on drug shortages.

Please reply to this e-mail with any issues that you would like to see addressed.

3. Physician-Led Hospital Legislation Introduced in Congress; Media Coverage

Click here to view PHA's announcement about the physician-led hospital legislation that was introduced in both chambers of Congress and the new competition policy paper calling for a lifting of the ban on physician-led hospitals.

Contact Your Members of Congress

Click here to ask your members of Congress and senators to co-sponsor the legislation.

Media Coverage

The introduction of the bills continues to receive extensive media coverage, and PHA has several media interviews scheduled this week.

Wall Street Journal - "End ObamaCare's Ban on Physician-Owned Hospitals" in the Wall Street Journal by Senator James Lankford (R-OK) and Brian Miller, MD, MPH, MBA.

STAT News - "Government Antitrust Officials Consider Letting Physician-Owned Hospitals Expand" coverage in STAT News.

Politico Pulse - Politico Pulse, which covers health policy, covered the topic:

A PLAN TO END BAN ON PHYSICIAN-OWNED HOSPITALS — Legislation that would end the Affordable Care Act’s ban on new physician-owned hospitals has been introduced in both chambers of Congress, a policy proponents say will increase competition in the industry.

The bills, supported mainly by Republicans, would be a win for physician groups that have been eyeing the issue for some time.

Existing fears of physician-owned hospitals driving up health care costs and prioritizing the most profitable patients (which helped pass the ban) have been countered by the theory that lifting the ban would push back against hospital consolidation — believed to be a major driver of rising costs.

“As a doctor, getting the best care to patients is always the priority,” Sen. Bill Cassidy (R-La.) said in a statement announcing the legislation. “This bill reduces the amount of government red tape separating patients from the care they need, especially in rural communities.”

PHA's Messaging

Click here to read PHA's latest messaging, "Who Can Own a Hospital?"

4. PHA's Capitol Hill Fly-in: May 16-17 in Washington

Mark your calendar to join PHA for the Washington, DC, Capitol Hill fly-in on May 16 and 17.

The event will begin with a lawmaker reception on the evening of Tuesday, May 16. Wednesday, May 17 will consist of all-day visits on Capitol Hill.

Stay tuned for registration and hotel information. PHA will once again feature a room block at the Thompson Hotel in Washington's Navy Yard near the Capitol.

Frederic Liss, MD, PHA's president, is featured with Congressman Michael Burgess, MD, and Senator Roger Marshall, MD, at last year's fly-in.

5. 2023 Leadership Summit Keynote Speaker Spotlight: Ed Gains; September 10-12 in Arizona

PHA is pleased to welcome Ed Gaines of Zotec Partners as PHA's keynote speaker on Tuesday, September 12 at PHA's 2023 Leadership Summit in Arizona.

Ed is viewed by many health policy experts as one of the nation's leading experts on the No Surprises Act and the independent dispute resolution process.

He advises Zotec clients across their hospital based and multi-specialty practice settings on healthcare regulatory issues including reimbursement policy, out of network (OON) federal and state laws, MACRA/MIPS, Medicare & Medicaid programs and health plan payor issues. He serves as industry liaison to physician specialty societies and industry trade organizations across Zotec’s client base.

Ed brings over 29 years of healthcare experience with Zotec. Since 2008, he has been a member of the ACEP Reimbursement Committee where he chairs Work Group 2 focusing on OON and bad payor issues. Ed has served as faculty for the national ACEP Reimbursement and Coding conference for over 16 years.

He is a co-founder, past chairman, and current Board of Directors and executive committee member of the Emergency Department Practice Management Association (EDPMA). 

Latest No Surprises Act Activity

The Centers for Medicare and Medicaid Services announced on February 24 that independent dispute resolution (IDR) entities may begin processing disputes or services furnished before October 25, 2022.

CMS previously halted the IDR process earlier this month following the Texas Medical Association's latest successful lawsuit.

Click here to read coverage from "Becker's Payer Issues" about the Texas Medical Association's latest successful lawsuit.

Click here for a podcast summary of the four Texas Medical Association lawsuits related to the No Surprises Act from Ed Gaines.

PHA's 2023 Leadership Summit

Click here to learn more about PHA's 2023 Leadership Summit this September 10-12 at the Boulders Resort in Scottsdale, Arizona. PHA is announcing new speakers and panels each week.

6. Public Health Emergency's Termination;

Physician Ownership Referenced

The Centers for Medicare and Medicaid Services (CMS) released updated guidance related to physician-owned hospitals and other segments of the healthcare industry in preparation for the end of the public health emergency (PHE).

Per CMS:

Stark Law & Physician-Owned Hospitals:  In addition, CMS provides information on the status of waivers of the physician self-referral law “Stark Law.” On March 30, 2020, CMS issued blanket waivers of “certain provisions of the Stark Law,” including permitting “physician-owned hospitals” to “temporarily increase the number of their licensed beds, operating rooms, and procedure rooms, even though such expansion would otherwise be prohibited under the Stark Law.” The agency states that “When the COVID-19 PHE ends, the waivers will terminate and physicians and entities must immediately comply with all provisions of the Stark Law.” Additional information on Stark Law waivers can be found at:  https://www.cms.gov/files/document/covid-19-blanket-waivers-section-1877g.pdf.

7. FTC Non-Compete Proposal; AAOS Comment on Physician Ownership

Healthcare advocacy organizations are beginning to submit stakeholder comment letters in response to the U.S. Federal Trade Commission's proposal to ban non-competes.

The American Association of Orthopaedic Surgeons (AAOS) used its stakeholder letter as an opportunity to encourage the FTC to utilize physician-led hospitals as a tool to increase competition:

"AAOS suggests that if the FTC is looking for solutions to decrease health spending and increase competition, they consider engaging with their partners at the Department of Health and Humans Services (HHS) to explore all regulatory avenues for lifting the arbitrary ban on new and expanding physician-owned hospitals (POHs)."

AAOS & AHA Concerns About the Proposal

AAOS expressed a concern about a blanket ban on non-competes:

"Despite the positive intentions of this rule, we question whether a blanket ban on such clauses will lead to market conditions that do not account for the unique training investments and relationships that physicians have in their practices. Moreso, we are concerned by the manner in which this rule has come to fruition. In light of the breadth of the proposal and extensive lookback period, along with the limited data which the ban is based on, we believe that it will be subject to numerous legal challenges."

The American Hospital Association focused on ensuring that non-competes for employed physicians and hospitals executives would not be terminated by the proposed ban:

"Some hospital employees are highly-trained; some are lower-skilled. Some are highly-compensated; some are lower-wage. But many of these hospital employees, especially physicians and senior executives, do not present the same considerations with respect to non-compete agreements as other types of employees."

8. Site Neutral Payments: Legislation in the States & in Washington

Axios took a look at the growing list of site neutral payment proposals in various states.

The site neutral payment concept is likely to be examined by policymakers in Washington, DC, in 2023.

Site Neutral Payments: Background

In 2012 MedPAC recommended that Congress should set payment rates for evaluation and management services provided in hospital outpatient departments at the same rate that is paid under the physician fee schedule.

The Republican House and President Obama approved the Bipartisan Budget Act of 2015, which created Medicare's first site neutral payment policy. New off-campus provider departments of hospitals were no longer paid the higher OPPS rate as a result.

State Legislation

In the 2023 Texas Legislature, legislation, HB 1692, would direct Texas regulators to "by rule shall annually identify health care services that may be safely and effectively provided outside of a hospital setting.  A facility fee may not be billed or collected for services identified under this subsection."

HB 1692 is likely to make significant movement in the Texas Legislature.

"BCBS Leans Into Site Neutral Payments"

Click here to read coverage from Becker's ASC Review.

9. Proposal to End Physician Ownership Reporting

CMS issued a proposed rule on its Medicare Enrollment Application for Institutional Providers that would eliminate the reporting requirement on physician ownership. 

The American Hospital Association (AHA) asked CMS to reconsider its proposal to eliminate physician-owned hospital reporting in the CMS-855A:

"The AHA opposes CMS’ proposal to eliminate POH reporting in the CMS-855A. We urge the agency to maintain use of question 2A3, which captures whether an organization is a POH."

Click here to read AHA's comment letter.

10. PHA's 2023 Sponsorship Opportunities

Click here to learn more about PHA's 2023 sponsorship opportunities.

PHA's 2023 Title Sponsors: