DISSEMINATION OF INFORMATION ON HIGH PER DISCHARGE RELATIVE VALUES FOR IN-HOSPITAL PHYSICIANS’ SERVICES.

SEC. 4506. DISSEMINATION OF INFORMATION ON HIGH PER DISCHARGE RELATIVE VALUES FOR IN-HOSPITAL PHYSICIANS’ SERVICES. (a) Determination and Notice Concerning Hospital-Specific Per Discharge Relative Values.— (1) In general.—For 1999 and 2001 the Secretary of Health and Human Services shall determine for each hospital— (A) the hospital-specific per discharge relative value under subsection (b); and111 STAT. 438 (B) whether the hospital-specific relative value is projected to be excessive (as determined based on such value represented as a percentage of the median of hospital-specific per discharge relative values determined under subsection (b)). (2) Notice to subset of medical staffs; evaluation of responses.—The Secretary shall notify the medical executive committee of a subset of the hospitals identified under paragraph (1)(B) as having an excessive hospital-specific relative value, of the determinations made with respect to the medical staff under paragraph (1). The Secretary shall evaluate the responses of the hospitals so notified with the responses of other hospitals so identified that were not so notified. (b) Determination of Hospital-Specific Per Discharge Relative Values.— (1) In general.—For purposes of this section, the hospital-specific per discharge relative value for the medical staff of a hospital (other than a teaching hospital) for a year shall be equal to the average per discharge relative value (as determined under section 1848(c)(2) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)) for physicians’ services furnished to inpatients of the hospital by the hospital’s medical staff (excluding interns and residents) during the second year preceding that calendar year, adjusted for variations in case-mix among hospitals and disproportionate share status and teaching status among hospitals (as determined by the Secretary under paragraph (3)). (2) Special rule for teaching hospitals.—The hospital-specific relative value projected for a teaching hospital in a year shall be equal to the sum of— (A) the average per discharge relative value (as determined under section 1848(c)(2) of such Act) for physicians’ services furnished to inpatients of the hospital by the hospital’s medical staff (excluding interns and residents) during the second year preceding that calendar year, and (B) the equivalent per discharge relative value (as determined under such section) for physicians’ services furnished to inpatients of the hospital by interns and residents of the hospital during the second year preceding that calendar year, adjusted for variations in case-mix among hospitals, and in disproportionate share status and teaching status among hospitals (as determined by the Secretary under paragraph (3)). The Secretary shall determine the equivalent relative value unit per discharge for interns and residents based on the best available data and may make such adjustment in the aggregate. (3) Adjustment for teaching and disproportionate share hospitals.—The Secretary shall adjust the allowable per discharge relative values otherwise determined under this subsection to take into account the needs of teaching hospitals and hospitals receiving additional payments under subparagraphs (F) and (G) of section 1886(d)(5) of the Social Security Act (42 U.S.C. 1395ww(d)(5)). The adjustment for teaching status or disproportionate share shall not be less than zero. (c) Definitions.—For purposes of this section:111 STAT. 439 (1) Hospital.—The term “hospital” means a subsection (d) hospital as defined in section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)). (2) Medical staff.—An individual furnishing a physician’s service is considered to be on the medical staff of a hospital— (A) if (in accordance with requirements for hospitals established by the Joint Commission on Accreditation of Health Organizations)— (i) the individual is subject to bylaws, rules, and regulations established by the hospital to provide a framework for the self-governance of medical staff activities, (ii) subject to the bylaws, rules, and regulations, the individual has clinical privileges granted by the hospital’s governing body, and (iii) under the clinical privileges, the individual may provide physicians’ services independently within the scope of the individual’s clinical privileges, or (B) if the physician provides at least one service to an individual entitled to benefits under this title in that hospital. (3) Physicians’ services.—The term “physicians’ services” means the services described in section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)). (4) Rural area; urban area.—The terms “rural area” and “urban area” have the meaning given those terms under section 1886(d)(2)(D) of such Act (42 U.S.C. 1395ww(d)(2)(D)). (5) Secretary.—The term “Secretary” means the Secretary of Health and Human Services. (6) Teaching hospital.—The term “teaching hospital” means a hospital which has a teaching program approved as specified in section 1861(b)(6) of the Social Security Act (42 U.S.C. 1395x(b)(6)).