Tuesday, August 29, 2000

Several ALS members informed us that Dr. Logan Holtgrewe, the Chair of the Health Policy Council of the American Urological Association ("AUA"), has recently provided inaccurate information on the Stark II final regulations. According to reports, Dr. Holtgrewe stated that the final Stark II regulations will be out this week and that physician ownership of lithotripsy ventures will be prohibited.

Adding to the misinformation, Dr. Holtgrewe claimed the situation would be resolved in three months when the Health Care Financing Administration ("HCFA") implemented the $2,107 payment rate for lithotripsy provided in an ambulatory surgery center ("ASC"). Dr. Holtgrewe also allegedly stated that the $2,107 rate was acceptable and doctors should not demand any more. (It should be noted that Dr. Holtgrewe's statements are entirely consistent with the ill-advised letter the AUA sent to HCFA several weeks ago supporting the ASC rate of $2,107 and tacitly acceding to the Stark law's applicability. In ALS Member Update 2 (August 16, 2000), the ALS advised of its response to HCFA regarding the AUA letter.)

ALS' information, gleaned from constant contact with HCFA, is that (1) the final Stark II regulations are not likely to be published before late September, with a 75 to 90 day comment period and a "very long delay" in the effective date after publication; and (2) the agency has been looking for a way not to ban physician-owned lithotripsy ventures while finding "under arrangement" services to be "designated health services" under the Stark law. We have consistently shared this information with the AUA. In a series of calls, both the AUA and Dr. Holtgrewe acknowledged that Dr. Holtgrewe had been making these statements, with some misquotation. In his own self-defense, Dr. Holtgrewe related that he just received information from HCFA consistent with ours and that he did not have this information when he made the aforementioned comments. He agreed to send out a legislative update, with the new accurate information, shortly.

We explained to the AUA how harmful the information was to its members who own lithotripters. Many hospitals, who have been spearheading the effort to ban physician ownership, are using the proposed Stark II rules and statements like those attributed to Dr. Holtgrewe as a basis for refusing to enter into "under arrangement" agreements with physician-owned lithotripsy ventures and seeking to lease the physician-owned equipment at cost.

The Executive Committee and the Board of the ALS are incredulous that the Chair of the Health Policy Council of the AUA would take action to attack directly the economic interests of 40% of its membership without so much as a phone call or meeting to clarify the facts of the matter with the ALS, which has done the most to represent the lithotripsy interests of urologists. One cannot begin to understand the actions of the Chairperson and it defies logic to understand why the AUA leadership would continue to tolerate such actions which are not in the best interests of its members or, in the long run, Medicare patients. Inadequate funding for high tech services will, in the end, limit access more than any limitation on site of service in the short run.

Many ALS members were obviously upset by the inaccurate information spread by the AUA. Unfortunately, this incident demonstrates that a lot of the news circulating is misinformed. In addition, we note that Dr. Holtgrewe has cancelled the fall meeting of the AUA Health Policy Council due to "financial constraints" and because he believed there were "no pressing issues." Accordingly, ALS would recommend that its members verify or confirm with the ALS any information they hear regarding lithotripsy. The ALS will continue to monitor the situation and conduct damage control on your behalf.


Paul W.F. Coughlin, M.D.

Visit us again to receive up-to-the-minute reports on major issues such as the Health Care Finance Administration's (HCFA) proposed implementation of the Stark II (Physician Ownership) regulations and HCFA's proposed rates for lithotripsy performed in/out patient and ambulatory surgical center settings.

For additional information contact, Wesley E. Harrington, CAE, Executive Director of ALS at American Lithotripsy Society, 305 Second Avenue, Suite 200
Waltham, Massachusetts 02451
Telephone: (781) 895-9098
Fax: (781) 895-9088


American Lithotripsy Society
305 Second Avenue, Suite 200
Waltham, Massachusetts 02451
Telephone: (781) 895-9098
Fax: (781) 895-9088

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