Thursday, May 26, 2005
An article on Modernhealthcare.com reports that Sen. Chuck Grassley, chairman of the Senate Finance Committee, has asked 10 hospitals and health systems for information on their charitable activities, patient billing and partnerships with for-profit companies. This inquiry comes in advance of legislation he will propose that aims at preventing non-profit organizations from abusing their federal tax-exempt status. He complains that not-for-profits shift the most profitable practices and income streams to joint ventures to share in greater profits. In a letter included in Grassley's press release, the senator posed 46 questions to the 10 organizations, including: define charity care; specify their percentage of uninsured, Medicare, and Medicaid patients; and indicate by how much charges typically exceed costs of charity care.
The House Ways and Means Committee will hold a hearing Thursday on tax-exempt status for hospitals. Earlier this year, the House Energy and Commerce Committee asked 10 large hospital systems, including HCA and Ascension Health, to detail the full effect of billing disparities on patients and provide information about the bills sent to consumers (press release).
Thanks to my research assistant, Lindley Bain, for he help in preparing this post. [tm]
POSITION ANNOUNCEMENT – FELLOW IN BIOTERRORISM LAW, POLICY, AND PUBLIC HEALTH
POSITION ANNOUNCEMENT – FELLOW IN BIOTERRORISM LAW, POLICY, AND PUBLIC HEALTH
GEORGETOWN UNIVERSITY LAW CENTER and the Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities are seeking qualified candidates for a fellowship in bioterrorism law and policy and public health law. Full-time candidates will be based at Georgetown University Law Center and work with faculty and students at Georgetown and Johns Hopkins Universities on a two-year project. The project involves analyzing the federal framework for response to a high consequence public health event.
Candidates must have their J.D. degree, and exceptional academic credentials, including publication and strong research interests and knowledge or experience in public health law and ethics. Candidates with an M.P.H. degree or public health experience may be preferred.
Application by July 15, 2005, should be made by letter, with accompanying resume, writing sample, official law school transcripts, and public health school transcripts (if applicable).
For further information or to apply, please write, call or email: Professor Lawrence Gostin, Director, Center for Law and the Public’s Health, Georgetown University Law Center, 600 New Jersey Ave, NW, Washington, DC 20001; (202) 662-9373; email@example.com.
Wednesday, May 25, 2005
According to an article in the UK's Independent (subscription only), a new study reveals that, " . . .that the more committed and successful a woman is at work, the worse her partner feels." The study blames this finding on a syndrome called (and I am not making this up) "unfulfilled husband hypothesis", which makes men feel inadequate when women depart too dramatically from their traditional roles. The article does not contain much information about the study or how it was conducted but the conclusions seem rather unhelpful. I don't like it when my husband has to work late or fails to pick up the dry cleaning - perhaps I have "unfilled wife hypothesis."[bm]
Update: While not scientific, Matt Miller's editorial in the New York Times seems to provide an answer to the problems identified in the above study.
The good folks over at Jurist have this story:
Indiana governor Mitch Daniels refused [press release] to grant clemency or a 90-day stay of execution for Gregory Scott Johnson, a convicted murderer [Indiana Supreme Court's denial of post conviction relief] who hoped to give his kidney and liver to his sister, who suffers from non-alcoholic hepatitis. In a statement released after his death Wednesday morning, Johnson accused the parole board of failing to recognize he had changed while in prison and was capable of this humane act. The governor said he would have been amenable to a short delay if Johnson's donation offered "a clear, demonstrated medical advantage to his sister." Doctors decided Johnson was not a good match because of his weight and hepatitis B diagnosis, and the doctors reasoned Johnson's sister would likely get a liver and kidney from the transplant waiting list shortly.
A Reuters story on the execution points out that death-row transplant requests have occurred, albeit rarely, before:
In a 1995 Delaware case a condemned man donated a kidney to his mother, and returned to death row. In Alabama, a prisoner awaiting execution won permission for an organ donation, but he was not a correct match, [Richard] Dieter [executive director of the Death Penalty Information Center] said.
In a Florida case, an inmate was denied a request to donate a kidney to his brother. The condemned man was later exonerated and released from jail, but his brother died waiting for a transplant, Dieter said.
A similar request by death-row prisoner Jonathan Nobles was denied by Texas prison officials in 1998 (Abilene Reporter-News). Those of us who are old enough to remember Jack Kevorkian before he became the media-saturated "Dr. Death" may recall his campaign in the 1970s and 1980s to allow death-row prisoners to donate organs that would otherwise be needed to keep them alive. [tm]
According to Professor Paul Caro of TaxProf, a new study has been completed concerning what factors are important to students when evaluating courses. The abstract for the study follows:
College students publicly rate their professors' teaching at RateMyProfessors.com, a web page where students anonymously judge their professors on Quality, Easiness, and Sexiness. Using the data from this web site, we examine the relations between Quality, Easiness, and Sexiness for 3,190 professors at 25 universities. For faculty with at least 10 student posts, the correlation between Quality and Easiness is 0.61, and the correlation between Quality and Sexiness is 0.30. Using simple linear regression, we find that about half of the variation in Quality is a function of Easiness and Sexiness. Accordingly, these results suggest that about half of the variation in student opinion survey scores used by universities for promotion, tenure, and teaching award decisions may be due to the easiness of the course and the sexiness of the professor. When grouped into sexy and non-sexy professors, the data reveal that students give sexy-rated professors higher Quality and Easiness scores. Based on these findings, universities need to rethink the use of student opinion surveys as a valid measure of teaching effectiveness. High student opinion survey scores might well be viewed with suspicion rather than reverence, since they might indicate a lack of rigor, little student learning, and grade inflation.
The full article is available here. Of course, Professor Caron notes that tax professors may be disadvantaged because their courses are not easy - has he heard of ERISA, Fraud and Abuse and HIPAA?? Anyway, I am not sure why sexiness is being rated on the RateMYProfessor.com. I don't think that anyone I know would change their teaching style or appearance if law school student evaluations suddenly did consider such a factor. Now if a study showed that teacher sexiness improves a school's U.S. News and World Report Ranking, well -- I cannot say what various administrations would do but . . . . [bm]
The N.Y. Times reported today that the House of Representatives passed two bills that would allow federal funding of embryonic stem-cell research (click for the roll call votes on H.R. 810 and H.R. 2520). This legislation will reverse President Bush's ban on using federal money to conduct embryonic stem-cell research on new (post-8/9/2001) stem-cell lines. (H.R. 2520 would promote contracts with cord-blood banks to promote stem-cell therapies. It passed by a 431-1 vote.) If H.R. 810 becomes law, embryonic stem-cells would come from live human embryos scheduled to be discarded at fertility clinics. Even though President Bush has already said he will veto this bill if necessary (see previous post), 50 House Republicans broke with him and voted with 187 Democrats. The House vote fell short of the 290 votes needed to override a presidential veto. The issue will go to the Senate where an identical bill is pending.
The Times article also states that President Bush has said that despite the potential for medical breakthrough, the use of human embryos in the studies was too high a cost to pay. According to the Washington Post, one of his supporters, House Majority Leader Tom DeLay (R-Tex.), said that the "bill would force taxpayers to finance 'the dismemberment of living, distinct human beings'." Many members -- Democrat and Republican alike -- indicated their intention to vote for both bills, saying that together they represented hope for the largest number of people with illnesses or conditions that might be treated with stem-cell therapies.
In a commentary for MSNBC, Arthur Caplan criticized President Bush's position on stem-cell research. He stated that President Bush and his supporters have made a mockery of the moral issues involved and that his policy makes little ethical sense to most Americans. He criticizes the president's moral reasoning as inconsistent, since he claims embryo destruction is wrong but still would permit research on embryos destroyed before August 2001 and has done nothing to prevent the daily destruction of embryos in fertility clinics. Rep. Mike Castle (R-Del.) is a proponent of the stem cell research bills and has collected a lot of commentary on the issue on his "Stem Cell Research and Resource" page. [tm]
Tuesday, May 24, 2005
I don't think we've remarked upon an otherwise remarkable series about the practice of medicine that appears from time to time in the Wall Street Journal. The pieces occasionally display some of the editorial bias of that newspaper, as in today's installment, with its commentary on the increasing unavailability of obstetrical services in a rural county in Illinois (quietly described as having relatively high malpractice insurance costs). But mostly they are nicely drawn snapshots of medical practice in these here United States. Here's a list of the titles since November:
- 05/24/05 When a Doctor Departs or Dies
- 05/10/05 Waiting Isn't Good for Patients, or Profits
- 04/26/05 How Mistakes Happen in the Doctor's Office
- 04/12/05 A Father's Character, and Cancer, Influence a Career
- 03/31/05 A Doctor's Struggles at End-of-Life
- 03/15/05 Plan May Hurt a Patient, and Taxpayers
- 03/01/05 When a Baby Doesn't Make It
- 02/15/05 The Doctor Is In, 24/7
- 02/01/05 Payoffs of a Patient-Friendly Office
- 01/18/05 Hospitals Can Improve Quality and Safety
- 01/04/05 When a Pregnant Patient Struggles to Find Care
- 12/21/04 The Doctor's Antidepressant Dilemma
- 12/07/04 Even Adults Need a Spoonful of Sugar
- 11/23/04 Helping Patients in a Post-Vioxx World
Of course, there's a catch: The electronic version of the Wall Street Journal requires a paid subscription, and it ain't cheap. [tm]
As was noted in this space on May 4, the Associated Press has reported that government-funded researchers have tested AIDS drugs on hundreds of foster children over the past two decades without providing a guardian. The foster children received medical care from world-class researchers, which slowed their death rate and extended their lives, but it also exposed them to significant risks. Even though the government was supposed to appoint independent advocates as of 1983, most research institutions promised but did not provide advocates. Some foster children died during the studies, but no agency can find any record that any death was directly caused by experimental treatments.
In response to the AP story, on May 10 the Alliance for Human Research Protection filed a complaint with the FDA and DHHS' Office of Human Research Protection about AIDS drug experiments on foster children in New York City.
In an op-ed piece in the Toledo Blade, Dr. Mark Kline, professor of pediatrics at Baylor College of Medicine and director of the Baylor International Pediatric AIDS Initiative, responded to an editorial in the Blade that criticized researchers who enrolled foster children with HIV in studies of anti-AIDS drugs without appointing an outside advocate for these children. He wrote that foster children were not singled out but included with other children in the same research. He insisted that the decision to use foster children for research was in part due to the deadliness of AIDS for children during that time since available treatments offered only partial, short-lived benefits. Many of the potent drugs approved for adults in the mid-1990s were not approved for children because no pediatric studies had been done. He stated that researchers did not provide advocates because the treatments could potentially be beneficial and foster children were being put at no more risk than other children in the same situation.
A DHHS official recently stated that "current regulations are adequate to ensure that foster children enlisted in federal medical experiments are protected" (Washington Post).
Thanks to research assistant Lindley Bain for her help with this post. [tm]
The House of Representatives is set to vote on the Castle-DeGette bill permitting funding for research on stem cells from embryos created at fertility clinics that would not otherwise be used. They will also vote on a separate bill, supported by many pro-life representatives, which encourages research on stem cells drawn from umbilical cord blood. Supporters are predicting passage of both bills.
The NewsHour ran a short piece last nice discussing the various political aspects of the stem cell research and the two bills. [bm]
Monday's LA Times has an excellent article discussing the trends, specifically the new popularity of health savings accounts, in health care. The article reports,
For years, they were the kinds of health insurance plans one found at small businesses or among the self-employed, plans that had huge deductibles and required workers to pay a lot of medical bills themselves — such as allergy shots, chest X-rays and the cost of a new baby.
They weren't the policies most people preferred, but they were the best some people could afford, better than no insurance at all.
Now, as medical costs keep climbing, those high-deductible plans are spreading to the giant corporations that have long been the backbone of traditional job-related, low-deductible health insurance. And if the trend continues, it could reshape the medical insurance landscape and sharply redistribute costs, risks and responsibilities for many of the 160 million Americans with private coverage.
Monday, May 23, 2005
The Journal of the American Medical Association has an article by Lucian L. Leape, MD; Donald M. Berwick, MD., which provides a commentary on the five years since the "To Err is Human" report by the Institute of Medicine. They argue that the report has not dramatically improved health care safety although they are somewhat hopeful about future trends.
USA Today ran a brief story on this article. As Professor Ross Silverman (who kindly pointed out these articles to me) noted, however, the USA Today piece misrepresents the nature of Leape's piece, which is a commentary and not a study. Thank you to Professor Silverman and a big congratulations on his tenure!! [bm]
The Supreme Court this morning granted cert. in a 1st Circuit case that declared a New Hampshire parental-notification statute unconstitutional. The case is Ayotte v. Planned Parenthood, No. 04-1144. The First Circuit's opinion is here. According to the Associated Press story on the case, the case raises two issues: (1) whether a parental-notification statute must contain an explicit exception to protect the minor's health in the event of a medical emergency, and (2) what is the legal standard to be applied in assessing the constitutionality of a state abortion statute. The First Circuit applied the "undue burden" standard announced by the plurality opinion in Casey.
Judicial nominations, a true blood sport in recent times, have become vicious in the past couple of months as the Senate debates changes in the Senate's rules and the possibility of a "nuclear option." Much of the reason for the heat is ascribed to the expected announcement by Chief Justice Rehnquist of his retirement or resignation from the Court, as well as the politics of abortion. With this grant, the latter just got a lot more immediate. If the other shoe falls and the Chief announces his departure at the end of the Term, expect all hell to break loose.
Update: Here's some additional commentary from Scotusblog . . .
The Supreme Court on Monday agreed to decide a long-unsettled issue of abortion law: the standard to be used in judging the constitutionality of a restriction on a women's right to end a pregnancy. The question is whether such a restriction is to be upheld if there is any circumstance in which it could be applied constitutionally. The Court for some time has not followed that approach in abortion cases, but has never explicitly repudiated it. The working standard the Court has applied is whether a restriction, as written, would put a burden on the abortion rights of a significant number of women.
According to the N.Y. Times, the Bush Administration is revising the 2006 Medicare Handbook due to inaccurate, misleading, or unclear statements in the new benefits guide. The handbook fails to mention the gap in coverage (the infamous "doughnut hole") and inaccurately emphasizes the private fee-for-service option without clearing distinguishing it from traditional Medicare. According to the Washington Post, the Medicare prescription drug benefit will costing senior citizens an average of $772 annually, and those with chronic conditions will probably pay double that amount and will have 5 month gaps in coverage. The gap in coverage may induce many with chronic conditions to forego filling prescriptions, which will have significant negative health implications. However, most Medicare recipients should have some savings.
The Arizona Republic reports that Medicare recpients that make less than $14,364 a year may be eligible for a subsidy of up to 95% for their premiums and co-pays as long as their assets are not too high. Generally this low-income subsidy has been seen as very good, however issues such as recipients being ineligible for other federal programs further complicates the decision a Medicare recipient will have to make.
Thanks to research assistant Lindley Bain for her help in preparing this post. [tm]
The Associated Press reports that the American Psychiatric Association has approved a statement urging legal recognition of gay marriage. The statement supports same-sex marriage "in the interest of maintaining and promoting mental health" and cites the "positive influence of a stable, adult partnership on the health of all family members." According to the news report, if the APA's directors vote approval in July, the measure would make it the first major medical group to take such a stance. [bm]
Sunday, May 22, 2005
On the heels of the recent announcement of the breakthrough by South Korean researchers, who reported the relative ease with which human embryos can be cloned in order to produce new stem-cell lines, President Bush told reporters in the Oval Office Friday that he would veto any legislation that attempts to make federal funding more readily available for stem-cell research:
Q Mr. President, on stem cells, specifically, would you veto legislation that loosened the requirement on federal funding for stem cell research? And secondly --
PRESIDENT BUSH: Deb --
Q -- what is your reaction to the news about the South Koreans on embryonic --
PRESIDENT BUSH: I'm -- first, I'm very concerned about cloning. I worry about a world in which cloning becomes acceptable. Secondly, I made my position very clear on embryonic stem cells. I'm a strong supporter of adult stem cell research, of course. But I made it very clear to the Congress that the use of federal money, taxpayers' money to promote science which destroys life in order to save life is -- I'm against that. And therefore, if the bill does that, I will veto it.
The President's comments appear to have been directed at H.R. 810 ("The Stem Cell Research Enhancement Act of 2005"), a bipartisan bill with 147 House sponsors. According to the Congressional Research Service's summary, the bill would "[a]mend . . . the Public Health Service Act to require the Secretary of Health and Human Services to conduct and support research that utilizes human embryonic stem cells, regardless of the date on which the stem cells were derived from a human embryo. Limits such research to stem cells that meet the following ethical requirements: (1) the stem cells were derived from human embryos donated from in vitro fertilization clinics for the purpose of fertility treatment and were in excess of the needs of the individuals seeking such treatment; (2) the embryos would never be implanted in a woman and would otherwise be discarded; and (3) such individuals donate the embryos with written informed consent and receive no financial or other inducements." [tm]
Doctor and author Robin Cook has a interesting editorial in today's New York Times. In the editorial, he argues that the increased understanding of the human genome creates the need for universal health insurance. He states,
In this dawning era of genomic medicine, the result may be that the concept of private health insurance, which is based on actuarially pooling risk within specified, fragmented groups, will become obsolete since risk cannot be pooled if it can be determined for individual policyholders. Genetically determined predilection for disease will become the modern equivalent of the "pre-existing condition" that private insurers have stringently avoided.
As a doctor I have always been against health insurance except for catastrophic care and for the very poor. It has been my experience that the doctor-patient relationship is the most personal and rewarding for both the patient and the doctor when a clear, direct fiduciary relationship exists. In such a circumstance, both individuals value the encounter more, which invariably leads to more time, more attention to potentially important details, and a higher level of patient compliance and satisfaction - all of which invariably result in a better outcome.
But with the end of pooling risk within defined groups, there is only one solution to the problem of paying for health care in the United States: to pool risk for the entire nation. (Under the rubric of health care I mean a comprehensive package that includes preventive care, acute care and catastrophic care.) Although I never thought I'd advocate a government-sponsored, obviously non-profit, tax-supported, universal access, single-payer plan, I've changed my mind: the sooner we move to such a system, the better off we will be. Only with universal health care will we be able to pool risk for the entire country and share what nature has dealt us; only then will there be no motivation for anyone or any organization to ferret out an individual's confidential, genetic makeup.
Saturday, May 21, 2005
Mexicans Go To Arizona for Medical Help
(USA Today, May 17, 2005)
"Along the border from Chula Vista, Calif., to Brownsville, Texas, U.S. hospitals serve as a medical safety net for undocumented immigrants and residents of northern Mexico. Each year, their care costs American medical centers, consumers and taxpayers hundreds of millions of dollars...After years of pressure from the health care industry, the federal government last week announced a plan to repay hospitals across the USA for up to 30 percent of the unpaid bills they rack up for such patients from now through 2008."
The action took the form of a "final guidance" published by CMS indicating that it would start making payments to hospitals out of the $1 billion that was authorized by the 2003 Medicare reform law (§ 1011, Pub. Law No. 108-173). See also CMS' "Section 1011 Page." [tm]
Preparing for the Inevitable:
Bioterriosm and Emerging Infectious Diseases
June 9th, 2005
8:30 AM-12:30 PM
Member Room, Jefferson Building
Library of Congress
Washington, DC 8:30 - 9:00 a.m. Continental Breakfast
8:30 - 9:00 a.m. Continental Breakfast
9:00 – 9:45 a.m. Session I - Unfinished Business: Facing the Dual Threat of Bioterrorism and Emerging Infectious Disease Senator Lieberman and Representative Cox
9:45-10:00 a.m. Coffee Break
10:00 -11:45 a.m Session II Countermeasures and Responses to Bioterror and Emerging Infectious Diseases: Realistic Assessment of National Preparedness and Next Steps
Assessment of Preparedness, Realistic Scenarios: Attack, Outbreak, Response, Quarantine and Isolation, Hard Choices. Randall Murch, Associate Director for Research Program Development, Virginia Tech Expert Panel Discussion: Preparedness and Response: Where are we? Where do we need to go? How do we get there? Moderator: Tara O’Toole, MD, MPH, President and CEO, Center for Biosecurity,University of Pittsburgh
Expert Panel Discussion: Preparedness and Response: Where are we? Where do we need to go? How do we get there? Moderator: Tara O’Toole, MD, MPH, President and CEO, Center for Biosecurity,University of Pittsburgh
Panel: George Poste, D.V.M., Ph.D., Director, Arizona Biodesign Institute, Arizona State University; Richard Falkenrath, PhD, Visiting Fellow, Brooking Institution; former Deputy Homeland Security Advisor and Deputy Assistant to the President; Michael McDonald, Dr..P..H., President, Global Health Initiatives; Elin A. Gursky, Sc.D., Principal Deputy for Biodefense, National Strategies Support Directorate
ANSER; James G. Hodge, Jr., J.D., LL.M., Associate Professor, Johns Hopkins Bloomberg School of Public Health and Executive Director, Center for Law and the Public’s Health; Randall Murch, Associate Director for Research Program Development, Virginia Tech
11:45 A.M. - 12:30 P.M. Session III – Preparing for the Inevitable: a New Paradigm
for Security and Health Senator Barr and Senator Clinton
Summary and Conclusions: Ambassador Cynthia P. Schneider PhD., Pfizer Medical Humanities Scholar in Residence, Distinguished Professor in the Practice of Diplomacy, Public Policy Institute and School of Foreign Service, Georgetown University
12:30 p.m. Adjourn
RSVP by June 6th firstname.lastname@example.org
Co-Sponsors: Public Policy Institute, Georgetown University
Center for Law & The Public's Health at
Georgetown and Johns Hopkins University
Virginia Tech, Office of the National Capital Region
Center for Biosecurity, University of Pittsburgh Medical Center
Friday, May 20, 2005
Rebecca J. Cook, Professor and Faculty Chair in International Human Rights, and Co-Director of the International Programme on Reproductive and Sexual Health Law in the Faculty of Law at the University of Toronto.University of Toronto, has written a new article entitled, "Exploring Fairness in Health Care Reform" that appears in the Journal for Juridical Science, Vol. 29, No. 3, pp. 1-27, 2004. The abstract follows: This article considers the increasing challenge of the fair allocation of scarce public health care resources by focusing on services for women and girls. It considers different ways of thinking about fairness in health care reform, the role of courts in promoting fairness, and the use of affirmative action measures to remedy health disparities. The health of individuals and populations is shown to be affected by clinical services, the organization and functioning of health systems, and underlying socio-economic determinants. Different theories of justice are addressed that affect assessments of fairness, considering availability, accessibility, acceptability of and accountability for services. The transition in judicial dispositions is traced, from deference to governmental resource allocation decisions to evidence-based scrutiny of governmental observance of constitutional and human rights legal obligations. The appropriate use of affirmative action measures to improve equality in health status is explored, given the increasingly unacceptable disparities in health among subgroups of women within countries. The full article is available here. [bm]
Rebecca J. Cook, Professor and Faculty Chair in International Human Rights, and Co-Director of the International Programme on Reproductive and Sexual Health Law in the Faculty of Law at the University of Toronto.University of Toronto, has written a new article entitled, "Exploring Fairness in Health Care Reform" that appears in the Journal for Juridical Science, Vol. 29, No. 3, pp. 1-27, 2004. The abstract follows:
This article considers the increasing challenge of the fair allocation of scarce public health care resources by focusing on services for women and girls. It considers different ways of thinking about fairness in health care reform, the role of courts in promoting fairness, and the use of affirmative action measures to remedy health disparities. The health of individuals and populations is shown to be affected by clinical services, the organization and functioning of health systems, and underlying socio-economic determinants. Different theories of justice are addressed that affect assessments of fairness, considering availability, accessibility, acceptability of and accountability for services. The transition in judicial dispositions is traced, from deference to governmental resource allocation decisions to evidence-based scrutiny of governmental observance of constitutional and human rights legal obligations.
The appropriate use of affirmative action measures to improve equality in health status is explored, given the increasingly unacceptable disparities in health among subgroups of women within countries.
The full article is available here. [bm]
As many of you are probably aware, specialty hospitals have been a subject of dispute over the past year. As the eighteen-month moratorium on physician referrals to such hospitals in which they have an owership interest sets to expire, we see new a proposal to make such a moratorium permanent for future specialty hospitals. Last week on May 11, 2005, Senators Grassley and Baucus introduced legislation that would prohibit physicians from referring Medicare and Medicaid patients to new speciality hospitals in which they hold an ownership interest. According to the brief summary provided by the American Health Lawyers Association,
The Hospital Fair Competition Act of 2005 would essentially exclude specialty hospitals from the "whole hospital" exemption in the Stark physician self-referral law. Opponents of specialty hospitals have argued that these types of limited service facilities are more akin to a whole hospital subdivision than a whole hospital and therefore should fall outside the protection of the whole hospital exemption. . . .
The permanent ban in the bill would not apply to hospitals already in operation or under development before November 18, 2003. These "grandfathered" specialty hospitals would, however, be subject to certain restrictions on increasing their number of physician investors and expanding their scope of services, according to a summary of the bill.
For text of the legislation, please click here. [bm]