The Department of Health and Human Services issues proposed regulations on physician incentive payments by hospitals

Hospitals tempted to operate their own physician incentive plans are reminded that, under OBRA 1986, they are precluded from paying physician incentives of any kind to reduce or limit Medicare or Medicaid covered services. In light of the proposed regulations and the guidance of the preamble, hospitals should review their incentive plans to determine whether physicians providing direct patient care are receiving prohibited payments. Further, supervising physicians who are receiving incentives for certain hospital departments may not influence direct care over patients served by those departments, even through other physicians. Some risk may also exist if incentives are based on a formula that considers patients of the supervising physician's medical group. Finally, it may be useful to develop a utilization and quality of care review program specifically designed to assure that patient undertreatment does not occur as a result of any supervising physician incentive program.     

As outcomes measurement and management become widespread, providers should beware of legal pitfalls

Until new statutes and court decisions clarify the law applicable to outcomes research, providers will continue to face new questions. In the meantime, paying careful attention to satisfying the requirements of existing laws protecting peer review information will put providers in the best position to minimize their exposure. Providers should review their current outcomes measurement and management systems to ensure that (1) they are structured to take full advantage of the confidentiality protections available under state law, and (2) appropriate access to outcomes data for those who need it is clearly provided for in the relevant documentation.     

Special report on reimbursement. HCFA enacts new enforcement remedies covering nursing facilities

While the regulations are revolutionary in their use of "substantial compliance," the interpretation and application of HCFA's new remedial scheme are still uncertain, as states are given broad discretion in defining important terms and in applying and interpreting the criteria to select remedies. Further complicating the issue is the fact that some states, including California, intend to seek waivers from HCFA to substitute their own state enforcement systems for most, if not all, of the new federal system. Based upon these uncertainties, the enforcement of nursing facility standards will likely be in a state of flux for some time to come.     

A. reviews: general

WARFARE IN THE LATIN EAST, 1192–1291. By CHRISTOPHER MARSHALL. (Cambridge Studies in Medieval Life and Thought, fourth series, 17.) Cambridge, Cambridge University Press, 1992. xiv, 290pp. 7 figures, 9 plates.

MINORITES RELIGIEUSES DANS L'ESPAGNE MEDIEVALE [ = Revue du Monde Musulman et de la Méditerranée, 63–4]. Aix‐en‐Provence, Edisud, 1992. 292 pp. 150FF.

THE TRANSMISSION OF KNOWLEDGE IN MEDIEVAL CAIRO. By JONATHAN BERKEY. Princeton, Princeton University Press, 1992. x, 238pp. $39.50.

PRAGMATISM IN THE AGE OF JIHAD: THE PRECOLONIAL STATE OF BUNDU. By MICHAEL A. GOMEZ. Cambridge, Cambridge University Press, 1992. xiii, 252 pp. £35.00.

THE CHURCH OF THE EAST AND THE CHURCH OF ENGLAND. A HISTORY OF THE ARCHBISHOP OF CANTERBURY'S ASSYRIAN MISSION. By J.F. COAKLEY. Oxford, Clarendon Press, 1992. £45.00.

WOMEN, ISLAM AND THE STATE. By DENIZ KANDIYOTI. London, Macmillan, 1991. 271pp. + index.

MARRIAGE ON TRIAL: A STUDY OF ISLAMIC FAMILY LAW. By ZIBA MIRHOSSEINI. (Society and Culture in Modern Middle East Series.) London, I.B. Tauris, 1993. 200 pp. + notes and index.

WOMEN IN THE MIDDLE EAST: PERCEPTIONS, REALITIES AND STRUGGLES FOR LIBERATION. Edited by HALEH AFSHAR and MARY MAYNARD. Basingstoke, Macmillan, 1993. xiv, 250pp.

WRITING WOMEN'S WORLDS: BEDOUIN STORIES. By LILA ABU‐LUGHOD. Berkeley, Los Angeles and Oxford, University of California Press, 1993. xxiii, 266 pp., bibliography. $30.00 (hb), $12.00 (pb).

NASSER'S BLESSED MOVEMENT: EGYPT'S FREE OFFICERS AND THE JULY REVOLUTION. By JOEL GORDON. Oxford, Oxford University Press, 1992. vii, 254 pp.

WAR AND PEACE IN ISRAELI POLITICS: LABOR PARTY POSITIONS ON NATIONAL SECURITY. By EFRAIM INBAR. Boulder and London, Lynne Rien‐ner, 1991. 184pp., appendices. £21.95.

TURKEY AND THE WEST: CHANGING POLITICAL AND CULTURAL IDENTITIES. Edited by METIN HEPER, AYSE ÖNCÜ and HEINZ KRAMER. London/New York, Tauris, 1993. xiv, 289 pp.

TURKEY'S NEW GEOPOLITICS: FROM THE BALKANS TO WESTERN CHINA. By GRAHAM E. FULLER and IAN O. LESSER, with PAUL B. HENZE and J.F. BROWN. Boulder and Oxford, Westview Press, 1993. xv, 197pp.

THE SOCIALIST MOVEMENT IN TURKEY, 1960–1980. By IGOR P. LIPOVSKY. Leiden, Brill, 1992. ix, 190pp. $48.75.

ISLAM IN MODERN TURKEY: RELIGION, POLITICS AND LITERATURE IN A SECULAR STATE. Edited by RICHARD TAPPER. London/New York: Tauris, 1991. v, 314 pp.

SIBAWAYH THE PHONOLOGIST: A CRITICAL STUDY OF THE PHONETIC AND PHONOLOGICAL THEORY OF SIBAWAYH AS PRESENTED IN HIS TREATISE AL‐KITAB. By A.A. AL‐NASSIR. London and New York, Kegan Paul International, 1993. xx, 130 pp.

AL‐MADKHAL ILā TAQWīM AL‐LISāN WA‐TA'LīM AL‐BAYāN. By IBN HISHāM AL‐LAKHMī. Edited by JOSÉ PÉREZ LÁZARO. (Fuentes Arábico‐Hispanas, no. 6.) Madrid, Consejo Superior de Investigaciones Científicas & Insti‐tuto de Cooperatión con el Mundo Árabe, 1990. 2 vols. 219; 599pp.