>For purposes of Stark II, "designated health services" include clinical<
>laboratory services, equipment and supplies, home health services,<
>outpatient prescription drugs and inpatient and outpatient hospital<
>services. We believe that the language and legislative history of Stark II<
>and Phase I of the final Stark II regulations indicate that Congress did<
>not intend to include dialysis services and the services and items provided<
>incident to dialysis services as a part of designated health services. For<
>example, the final Stark II regulations exempt from the referral<
>prohibition referrals for clinical laboratory services furnished in an ESRD<
>center if payment for those services is included in the ESRD composite rate<
>and for EPO and other dialysis-related outpatient prescription drugs<
>furnished in or by an ESRD center. However, our provision of, or<
>arrangement and assumption of financial responsibility for, certain other<
>outpatient prescription drugs, center dialysis services and supplies, home<
>dialysis supplies and equipment and services to hospital inpatients under<
>our dialysis services agreements with hospitals, include services and items<
>that still could be construed as designated health services within the<
>meaning of Stark II. Although we bill the hospital and not Medicare or<
>Medicaid for hospital inpatient services, our medical directors may request<
>or establish a plan of care that includes dialysis services for hospital<
>inpatients that may be considered a referral to us within the meaning of<
>Stark II.<
><
><
><
>Because the Stark II regulations do not expressly address all of our<
>operations, it is possible that CMS could interpret Stark II to apply to<
>parts of our operations. Consequently, it is possible that CMS could<
>determine that Stark II requires us to restructure existing compensation<
>agreements with our medical directors and to repurchase or to request the<
>sale of ownership interests in subsidiaries and partnerships held by<
>referring physicians or, alternatively, to refuse to accept referrals for<
>designated health services from these physicians. We would be materially<
>impacted if CMS interprets Stark II to apply to us and we either could not<
>achieve material compliance with Stark II or the cost of achieving that<
>compliance would be substantial.<
><
><
>.......Major components of<
>dialysis revenue include the administration of EPO and other drugs as part<
>of the dialysis treatment, which represents approximately 37% of operating<
>revenues.<
> <
>.....The average dialysis revenue recognized per treatment (excluding prior<
>years" services revenue) was $291, $278 and $256 for 2002, 2001 and 2000,<
>respectively. The increase in average dialysis revenue per treatment in<
>2002 was principally due to increases in our standard fee schedules<
>(impacting non-contract commercial revenue), changes in mix and intensity<
>of physician-prescribed pharmaceuticals, continued improvements in revenue<
>capture, billing and collecting operations, and payor contracting. The<
>increase in 2001 was principally due to continued improvements in revenue<
>realization due to improved clinical operations and billing and collection<
>processes, and a 2.4% increase in the Medicare composite reimbursement<
>rates.
*****************************************************************
About time
Joined: 07 Jun 2003
Posts: 1
Posted: Sat Jun 07, 2003 3:15 pm Post subject: It appears that the Anti kickback and Stark Law
--------------------------------------------------------------------------------
We have been hammering at this conflict of interest since 1998. It appears that it is a good possibility that the light has been shined in this arena of healthcare.<
><
>We have always questioned this arrangement of purchasing patients for dollars. The physician owns the patients and tell them where they can dialize at.<
><
>Once one gets out of the "self policing" structure that this industry has had, and the government now has to own up to the fact that the public is not going to be pleased with what many patients have had to endure.<
><
>It is still under Federal Investigation and Public awareness is happening. This means that the dirty little secret got out. <
><
>These physicians are in conflict of interest as who do they belong to? You or the investors and themselves. One would not care how much they made, if the patients received proper care and quality care. This didnt happen and it looks as if the gravy days will soon be over.<
><
>They can not convince the public when the purchase of patients mostly on federal dollars were made. Patients on the stock market, the highest mortality rate in the world....it appears that the good ole days may be over. Which can only benefit the patients as they are not even given rights in many of these clinics.<
><
>Talked to the Office of the Inspector General's Office a couple of weeks ago and faxed them our concerns on what is happening to this group of patients. Should be hearing from Scully's office next week.<
><
>I do feel that we need to stay strong and make our public officials accountable. Every patient needs to not be afraid of retaliation for asking what is their right under the constitution. Keep faxing, calling and refaxing the fact that they are not responding. <
><
>Personally a group of us are going to start going to the town halls for Senator Wyden....he needs to be accountable with flyers on the fact that he fired this group of patients from ever contacting his office. What a worm...we will be there..!<
><
>It is an election year and its continue the pressure or continue to let this industry operate silently again. This has been happening for over 30 years. Now everyone will know it.<
>Arlene
DaVita's stock disclaimer on the Antikickback and Stark Law
Interesting
Joined: 08 Jun 2003
Posts: 1
Posted: Sun Jun 08, 2003 1:23 am Post subject: Davita's ownership arrangement
--------------------------------------------------------------------------------
Now it is clear to us. There always was some confusion on who actually owned this place now, Davita with their name all over the clocks and door mats or the nephrologist who is saying that he still owns the clinic. This arrangement almost sounds like a ownership of sorts like a hair salon where one individual owns the shop and leases back the chairs to beauty operators and you may purchase Vidal Sassoon products to use on your patrons for a discount!
*****************************************************************
My read on this00000
Joined: 08 Jun 2003
Posts: 1
Posted: Sun Jun 08, 2003 5:01 am Post subject: 0h it all could disappear over night with the Stark Law
--------------------------------------------------------------------------------
This arrangement is against the Stark Law for any other physician. Now you can see why it was put into effect.<
><
>But the government can take their immunity away at any moment with no explaination. It is also stated in the Stark Law.<
><
>Personally I believe that it was so covered up with the self policing that the industry has been allowed to do for years.<
><
>Remember, no matter where you go to complain on any quality of care issue, you would go back to the abuser. Then you were in the circle and not able to get your complaint out, or the lack of patient rights, or the fact that the money goes to the investors and the patients are not getting the care that they were paid for by the government etc. To many hands in the pot and the patients in many cases get the left overs. <
><
>My question has always been, who does the physician belong to? the patient or themselves and investors. As you can plainly see with your own eyes, it is the investors and themselves that have won.<
><
>Once again until the self policing of the industry dressed in the ESRD NETWORKs to handle the patient complaints and to give the statistics to the federal government. They were found at the Senate Hearings not doing their job. They are a private non profit that has to bid for the contract from the federal government. They are the only ones who bid, even would be suprised if they did bid, as no one appears to know, or they were handed the contract as Medicare
only pays and are not doctors. So this is how the ESRD NETWORKs were
ought to life. THey need to stay away from patient complaints, they just like the Stark Law are profiting off the patients and the patient have had to put up with the abuses for to long. THis enity needs to go, until then you will never have a Standards of Care that will work. They were caught sleeping at the wheel, as they had all the power and this industry never believed that they would be accountable. To date, they are allowed to excuse their behavior and have not been accountable as every other part of this industry. They need to be. Everyone working in unison for the protection of themselves and not what they were contracted to do,.<
><
>Soon we will be posting the job they were suppose to do according to the contract. Bet you cant find one that they have done. <
><
>I feel that this industry will have a hard time explaining to the country what many patients have had to deal with. All patients deserve a good clinic and the laws of the land to protect them from fear of asking questions and of retaliation.<
><
>The beauty salon is a good example, now just think if that is the only one you can go to. It may be the only one that will accept you as the operators tell you where to go.
