Lawmakers Question CMS on Medicare Reimbursements to Texas Specialty Hospital

Three lawmakers have asked CMS for information on Medicare reimbursements to West Texas Hospital, a physician-owned specialty hospital, during an 18-month moratorium on payments to such facilities after a patient entered respiratory arrest and died last month as a result of complications from elective spinal surgery performed at the hospital, CQ HealthBeat reports (CQ HealthBeat, 2/9). According to the Houston Chronicle, the lawmakers -- Senate Finance Committee Chair Max Baucus (D-Mont.), committee ranking member Chuck Grassley (R-Iowa) and House Ways and Means Health Subcommittee Chair Pete Stark (D-Calif.) -- "have seized on the bewildering Texas case to bolster their contention that some physician-owned hospitals skimp on basic medical care to boost profits." The patient, 44-year-old Steve Spivey, underwent spinal disk fusion surgery at West Texas and entered respiratory arrest several hours later. West Texas staff, who could not help Spivey, called 911, and an ambulance transferred him to Abilene Regional Medical Center, where he died (Roth, Houston Chronicle, 2/10). In a letter to acting CMS Administrator Leslie Norwalk, the lawmakers wrote that the federal government "clearly must take action and ensure that physician-owned facilities that hold themselves out to the public as 'hospitals' have the requisite staff and abilities to ensure that basic lifesaving measures can be employed" (CQ HealthBeat, 2/9). CMS made an exception to the moratorium for West Texas, which has received $4.1 million in Medicare reimbursements, according to the Senate Finance Committee. The lawmakers asked CMS for more information on the decision to make an exception for West Texas.

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Baucus in a statement said, "It seems to me that if you call a place a hospital, it should have facilities to handle an emergency, but all this facility could do was call 911." Grassley said, "The fundamental problem with physician-owned specialty hospitals is that decision-making is more likely driven by financial interests rather than what is best for patients" (Houston Chronicle, 2/10). However, West Texas CEO Ron Rives said, "We were never part of the moratorium as it existed because we are not a specialty hospital." He added that West Texas attempted to help Spivey and that "it was only as a last resort and in the interest of saving a life that a call was placed to 911" (Dallas Morning News, 2/10).