I appreciate all the input about the changes in HCFA regs related to
the "teaching attending." Unfortunately, I remain concerned about
these changes. It is hard to rely on the supposed "intent" of the
regulations, especially since hospitals that have not complied with
the "law" have recently come under fire (eg., the mandated
"Professional Fee Billing Compliance Program" at U of Penn after
problems related to billing for teaching physicians). The problem is
that if there is a review of billing practices at an institution,
major dollars (from years prior to the review) may have to be repaid.
In addition, my understanding is that although we may see a small
medicare population in pediatric emergency medicine, the issue is that
there is medicare GME reimbursement for housestaff and some fellows.
For this reason, the HCFA regulations, I think, apply to *all*
patients, not just medicare.
I think the reality is that real compliance with these regs is all but
impossible unless more attendings are hired to supervise all "key"
parts of exams/ procedures. Given the current fiscal constraints of
most institutions/ Departments, this is most unlikely.....
The URL for the PED-EM-L Web Page is: