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Showing 5 posts in Hospital Operations.

Hooper, Lundy & Bookman, P.C. (HLB) wants to make hospitals aware of current adjustments being imposed by certain MACs denying pass-through treatment of allied health program costs, including nursing, pharmacy and pastoral care. The denial of pass-through treatment is based on the view of some MACs that any administrative involvement by a home office means that the hospital does not appropriately incur the costs of the allied health program and do not, as a result, comply with 42 C.F.R §413.85(f).  We expect that this improper practice could spread to other MACs.

This is improper because nearly all hospital chains use a home office to perform administrative functions for their hospitals, such as processing payroll, and these costs are allocated to each of the hospitals in the chain.  Such functions, and the allocation of various administrative costs, does not mean that a hospital does not operate, control, or incur the costs of its allied health programs.  The denial of pass-through treatment of allied health programs also is improper because it reverses long-standing agency policy that has been in place since at least 1984, without appropriate authority. Read More ›

A new round of putative class action lawsuits brought by counsel for patients who received treatment in a hospital emergency room alleging that hospitals charge emergency room patients a hidden and undisclosed “surcharge” or “cover charge” on top of charges for services provided is hitting hospitals throughout California. These suits are the progeny of prior unsuccessful putative class action lawsuits brought by the same plaintiff’s counsel alleging that hospitals’ charges for emergency services are unreasonably high and that the financial arrangements provision within the Conditions of Admission agreement signed by the patients requiring payment of charges are improper and not enforceable. Read More ›

On February 4, 2019, the California Court of Appeal affirmed a judgment awarding plaintiff, Dr. Kenneth Economy, substantial damages for his suspension and subsequent termination of his staff privileges at defendant Sutter East Bay Hospitals. The Court of Appeal held that, because Dr. Economy’s termination, even though done under the provisions of an exclusive contract, was based on “medical disciplinary cause or reason,” he was entitled to prior notice and a hearing in accordance with Business and Professions Code section 809 et seq. This decision flies in the face of the underlying premise for exclusive contracts: the ability for a hospital to enter into a contractual arrangement that allows it to set superior metrics in exchange for exclusive rights to provide services. Clinical issues have long been mandated to be within the purview of the medical staff but exclusive contracting gives hospitals the ability to contract for higher standards of quality of care. The severity of the Economy decision calls into question the accepted approach to exclusive contracts. Read More ›

On October 26, 2018, the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration released an update to the National Practitioner Data Bank (NPDB) Guidebook, a manual that provides guidance on the requirements established by the laws governing the NPDB. The Guidebook is not updated on any set schedule - the previous amendments to the Guidebook occurred in April 2015 and were the first updates since 2001. While most of the 2018 revisions can be categorized as minor changes, the 2018 NPDB Guidebook does contains a number of new sections and clarifications that Medical Staffs and other peer review bodies should be aware of. We will be following up on the effect of the revisions on an on-going basis, but want to give clients and friends a preliminary summary of some of the key revisions affecting peer review bodies. Read More ›

Over the summer, the California Department of Health Care Services (DHCS) published and disseminated through its contractor a long awaited provider bulletin dated May 13, 2016 describing the reporting requirements for any hospital that participates in the quality assurance fee (QAF) program and has undergone a change of ownership (CHOW) in 2010 or thereafter. Read More ›

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