September 7, 2000

As noted in a prior ALS Member Update regarding the hospital outpatient department payment rates, the Health Care Financing Administration ("HCFA") set the final payment rate for lithotripsy provided in a hospital outpatient department at $2,265.32. ALS believes that in setting this rate, HCFA failed properly to consider the costs of providing lithotripsy and that HCFA's methodology for setting the payment rate is inconsistent with the statutory mandates of Congress. As you may recall from our member update, the law which grants HCFA the authority to establish the hospital outpatient rates specifically prohibits any judicial or administrative challenge to HCFA's rates or methodology. This prohibition likely precludes a court challenge by the American Lithotripsy Society (the "ALS") of the sort successfully prosecuted against the ASC rate in the early 90's.

The ALS believes it is inappropriate to eliminate all avenues of challenge to the hospital outpatient rates or the calculation methodology of such rates. Accordingly, in an effort to protect the interests of lithotripsy providers, the ALS has initiated correspondence with the President of the American Urological Association ("AUA"), the American Hospital Association ("AHA") and the Federation of American Health Systems ("FAHS") requesting that we all work together. The ALS hopes that by joining forces, we can develop a strategy for amending or eliminating this prohibition on legal challenge. For example, we may be able to lobby Congress successfully to pass appropriate legislation or engage in additional meetings with HCFA to convince HCFA of the inadequacy of the rate it set. The ALS is following-up with these organizations to gauge their level of interest in undertaking this important cause. If the ALS is unable to persuade these other organizations to participate, the ALS will pursue other options.



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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