Beth Israel Hospital v. Heckler

572 F. Supp. 573, 1983 U.S. Dist. LEXIS 13316
CourtDistrict Court, D. Massachusetts
DecidedSeptember 28, 1983
DocketCiv. A. No. 82-102-C
StatusPublished
Cited by3 cases

This text of 572 F. Supp. 573 (Beth Israel Hospital v. Heckler) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Beth Israel Hospital v. Heckler, 572 F. Supp. 573, 1983 U.S. Dist. LEXIS 13316 (D. Mass. 1983).

Opinion

MEMORANDUM

CAFFREY, Chief Judge.

This is a civil action brought pursuant to 42 U.S.C. § 1395oo(f) to review a final decision of the Secretary of the United States Department of Health and Human Services (“HHS”). The Secretary reversed a decision by the Provider Reimbursement Review Board (the “PRRB”) which refused to follow guidelines promulgated by the Secretary to compute plaintiff Beth Israel Hospital’s (the “Hospital’s”) costs of providing services to Medicare beneficiaries in fiscal years 1977 and 1978. For the reasons stated below, I uphold the decision of the Secretary.

The Hospital is an approved provider of hospital services under Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395 et seq. (the “Medicare Program”). The Medicare Program requires that providers of hospital services “apportion” their operating costs between their Medicare patients and their non-Medicare patients. This appeal involves the method the Hospital used to apportion its costs.

STATUTORY AND PROCEDURAL BACKGROUND

Medicare regulations prescribe a complex method to apportion the cost of routine hospital services between Medicare and non-Medicare patients. The regulations define “routine services” to include “the regular room, dietary, and nursing services, minor medical and surgical supplies, and the use of equipment and facilities for whieh a separate charge is not customarily made.” 42 C.F.R. § 405.452(d)(2). The Secretary reimburses providers for hospital services provided to Medicare patients according to the following two-step formula:

(1) Total cost of routine

services to all patients = Average cost

Total number of inpatient of routine

days, including non-medicare inpatient services

inpatient days per diem

(2) Average cost Number of

of routine X Medicare

services per inpatient = Amount reimbursed

diem days

An inpatient day denotes one day of care to a patient. If the Hospital cares for two patients in one day, it counts two inpatient days. The Hospital is required to count the number of inpatient days by a census at midnight of each day. A routine inpatient present in a general routine care area at midnight is considered an inpatient for Medicare reporting purposes for the following 24 hours. Section 216, Hospital Manual, HIM-10. If a routine inpatient is receiving “ancillary services,” defined as “services for which charges are customarily made in addition to routine services,” 42 C.F.R. § 405.452(d)(5), at the midnight census hour, he or she is nonetheless counted as a routine inpatient in the census.

The dispute here involves the Hospital’s computation of its average cost of routine inpatient services per diem. In 1976, the Health Care Financing Administration (“HCFA”), a division of HHS, promulgated the Provider Reimbursement Manual (“PRM”). PRM, Part I, § 2345 requires that “[i]f a patient is in the labor/delivery room at the census-taking hour, an inpatient day will be counted in the routine maternity care area ...” for the purpose of apportioning general routine service costs between Medicare and other patients.

The Hospital refused to include labor/delivery room inpatient days in the count of total routine inpatient days in its financial report to Blue Cross of Massachusetts, Inc., (“Blue Cross”), its financial “intermediary” to the Medicare program. When Blue Cross adjusted the report to include labor/delivery room days, the Hospital appealed to the PRRB, an impartial hearings panel established under the Medicare program to resolve provider reimbursement disputes. 42 U.S.C. § 1395oo(a). The PRRB ruled that labor/delivery room days need not be included in the Hospital’s number of routine inpatient days. It reasoned that because providers do not incur any routine care costs for patients occupying [575]*575the labor/delivery room, it is “inconsistent” to include those patients in the count of routine inpatients. PRRB Decision at 7.

Blue Cross appealed to the Deputy Administrator of the HCFA, pursuant to 42 U.S.C. § 1395oo(f), which reversed the PRRB decision, constituting the final decision of the Secretary. The Hospital filed a timely appeal to this Court under 42 U.S.C. § 1395oo(f). The case is now before this Court on cross motions for summary judgment.

DISCUSSION

The Hospital argues that the Secretary should not include labor/delivery room patients in the number of routine inpatients because they receive no routine services while in the labor/delivery room areas. The Hospital offers the following example: Assume the Hospital incurred, in one reporting period, $1,000,000 in general routine services costs, that it counted 9,000 inpatient days of routine care during the reporting period of which 5,000 were Medicare inpatient days, and that, in addition, the Hospital counted 1,000 patient days in the labor/delivery room areas. Under the Secretary’s calculation,, which includes labor/delivery room patient days in the number of total inpatient days, reimbursement would be calculated as follows:

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By the Secretary’s calculation, then, Medicare pays a smaller percentage of the Hospital’s general routine care costs, and the Hospital is forced to shift more of those costs to non-Medicare patients. The Hospital contends that the Secretary’s calculation thus violates 42 U.S.C. § 1395x(v)(l)(A), which requires that the Secretary promulgate regulations such that

the necessary costs of efficiently delivering covered services to individuals covered by [Medicare] will not be borne by individuals not so covered, and the costs with respect to individuals not so covered will not be borne by [Medicare] ... Id.

The Hospital also contends that the Secretary’s decision ordering application of the formula in this case was not supported by substantial evidence, was arbitrary, capricious and an abuse of discretion, and that it constituted a deprivation of the Hospital’s property without due process of law.

This Court may reverse the Secretary’s decision only if it is arbitrary, capricious, an abuse of discretion, or not in accordance with law. 5 U.S.C. § 706(2)(A). The interpretation of a statute by the agency charged with administering the statute must be given considerable respect. Ford Motor Credit Co. v. Milhollin, 444 U.S. 555, 566, 100 S.Ct. 790, 797, 63 L.Ed.2d 22 (1980). And an “agency’s construction of its own regulations has been regarded as especially due that respect.” Id.

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572 F. Supp. 573, 1983 U.S. Dist. LEXIS 13316, Counsel Stack Legal Research, https://law.counselstack.com/opinion/beth-israel-hospital-v-heckler-mad-1983.