Medicare has agreed to cover the diagnosis and treatment of actinic keratosis. The treatment may be surgical or medical and can include observation, liquid nitrogen, curettage, excision or photodynamic therapy.
The AMA has come out with their recommended screening for colon cancer. The recommendations are for those at average risk and over 50 years old should have an annual fecal occult blood and/or flex sigmoid exam yearly or a colonoscopy every 10 years or a double contrast barium enema every 5-10 years. If the patient is at high risk colonoscopy should be performed at intervals individualized for age, duration of disease and comorbidities. Top
Apria has been told that on the basis of a review of 300 cases by the government that they may face a huge liability of fines. Apria denies all and states that all errors are bookkeeping minor errors. Top
In an article in the East Bay Business Journal there was a reprinted article from the Sacramento Business Journal. This article shows that the press has no idea about medicine. The article begins with the statement that people are dying due to medical errors, the IOM report stuff. The next paragraph states that the Medical Board of California has only received 110 reports of serious discipline from hospitals. The reporters link the two even though they are true, true, unrelated. All who have studied the problem of medical errors have concluded that the physicians share a small part of the blame with the majority of the problem being medical systems. The errors are systemic and not individual errors. These reporters have not studied Deming nor his work. If they would have, they would not have equated apples and oranges. Could it be there are not as many reports by the hospitals as the Medical Board would like because there are not as many problems that are serious enough for the hospitals to report under the current standards? Could it be that the Medical Board is judged by how many disciplines they do per year? Could it be the reporters were just dupes and forgot to ask the proper questions of the proper people?
I just received my quarterly copy of Action Report, the Medical Board of California newsletter. Normally there are nothing but blasting of physicians in the report. This time the Executive Director actually made a factual report without showing his jealousy of physicians. This is because it explains his organization is to blame for the delays in licensure of physicians in the State.
The President of the Board actually inferred that maybe the scalp count of physicians is not the best way to judge how good a Board is in relation to other Boards.
Lastly, I am seeing a trend in the Board actions on physician licenses. There is an increasing amount of actions for minor and possibly not necessary actions. There is also an increasing amount of public reprimands, a punishment that fits the misdemeanor. Top
Washington State proposes a regulation that all insurance plans that cover prescription drugs or devices must also cover prescription contraception. This is a result of a recent 9th Circuit ruling stating a self-insured company must provide such coverage. The insurance companies believe that the insurance commissioner does not have the right to regulate the companies, only the legislature has that right. The infamous Milliman USA states that the regulation would increase the total cost of care by 0.3%. They also believe insurance is only for things that can not be budgeted. They also are mainly consultants to insurance plans who are against the regulation. Top
Bexar County hospitals have refused to obey a Texas law that states public hospitals can not provide no cost or discounted care to undocumented immigrants. According to the Attorney General it is against federal law to provide care unless state law says it is okay. The Texas legislature has not spoken on the issue, although there is a provision in the law for State override. The Bexar County Health System has stated they will continue to provide the non-emergency care. They believe their only obligation is to determine residency and that this is a local issue. They state they do not have the resources to become an INS enforcer. There is no federal penalty but may be legal consequences under state law for continuing to provide the care.
In Houston's Harris County the DA is threatening to prosecute and ask for jail for the hospital officials that approved the expenditures for taking care of undocumented aliens. The potential sentence is 5-99 years or life when more than $200,000 is involved. The charge would be felony misapplication of fiduciary property. Must be someone who wants to get name recognition and run for higher office.
The Hispanic community is not happy about the actions of the Attorney General or the District Attorney. They believe one way to get back at the politicos is to flood the emergency rooms with non-emergency patients. This could get interesting especially with elections next year. Since elections are coming up a Texas member of the House is introducing a bill to allow hospitals to make the decisions. He is introducing the bill now since " Congress moves like a glacier." Top
A lawsuit has been filed by the South Carolina Medical Association to stop the implementation of the new privacy rules. The association believes that Congress did not give the power to draw up the rules to a federal agency. They will also argue the regulations are too vague, especially with criminal penalties. They will lose.
The University of Pennsylvania Medical College Health System believes the new HIPAA regulations will cost the system about $37 million. They do not discuss the cost savings from using a standard format for all claims. They do not discuss the amount of private information on every person that is now open to the world. In the insurer's usual scare tactic, Highmark Insurance states this will increase insurance premiums. There is a two year lag period to comply with the rule which can be spent either coming into compliance or complaining. Top
Legislation has been introduced into the Ohio legislature to allow physicians to band together to negotiate with insurance companies. This law has already been passed by the California legislature and is waiting the Governor's signature. The problem with this law is that they want to form a union instead of allowing a antitrust variation. Top
JCAHO has recently explained that non-licensed practitioners can perform H&P providing state laws allow it, a delegation meets organization standards, specific training is present, the person is verified competent by the organization bylaws and a specific physician supervise and countersigns the H&P.
Some hospitals in Arizona as well as other states are questioning the value for the money in JCAHO certification. The John Lincoln Health Network dumped JCAHO due to the high fees and strict unreasonable guidelines. Lincoln beleieves that all health care services need to be survied. Lincoln had to have its home health, extended care , assisted living center, school-based health centers and physician practices done at the same time for accredidation. St. Joseph Hospital and The Arizona Heart Institute may also go for other accredittation sources. JCAHO feels the hospitals that opt out are going to regret it, a self-serving statement. When an Arizona sub-acute care facility opened in 1994, there were no JCAHO standards and they passed the State inspection. The managed care plans stated that they wanted JCAHO certification. When the JCAHO finally came up with standards, the sub-acute care said fine but we will pass the costs on to you. The MCO said JCAHO is not necessary. Last year more hospitals joined than left the organization. Top
After much teeth gnashing, the Virginia database of physicians, osteopaths and podiatrists is going online. However, no disciplinary data that is not final will be placed online. The Department of Health Professions wanted all complaints that resulted in formal action to be placed on the site, even if the provider was found not to have done anything wrong. As most medical boards they are only interested in how many they prosecute not if they deserve the prosecution. I see nothing wrong in putting up final actions against a provider. The putting up of the other information only confuses people. Top
Ohio's Governor Taft has signed the prompt pay bill passed several weeks ago by the legislature. It becomes effective in one year and requires insurers have in place a system for providers to check the claim status. It also requires payment in 30 days or 45 days if more information is needed. Top
New interpretations of EMTALA 250 yard rule, signage and
other important information is now available in a Q&A format online at
CMS has stated it will boost payments to nursing homes 10.3% starting October 1. This will increase to about $550 a day per Medicare nursing home patient requiring the highest level of care. The nursing homes are happy, but not thrilled. They believe this only restores the cuts made in the Clinton administration Balanced Budget Act 0f 1997. This really only increases the payment in line with inflation. In the past two years, five of the largest nursing home companies in the nation have filed for bankruptcy. The nursing homes are happy there is some movement by the present administration. Top
New Canadian rules allow terminal or chronically ill patients to grow or have someone grow it for them and smoke marijuana. It is also the first government paid for pot in the world. The patients need to be terminal or have two physicians give statements stating conventional therapy has not worked for the patient. The Canadian Medical Association is against the law since there has not been enough research. In Flin Flon, Manitoba, Prairie Plant Systems is growing in a former copper mine Mary Jane for a $3.5 million government contract. The first harvest is this fall and part will be used for research. They have a terrible medical system but a progressive marijuana idea. Top
Blue Cross and Blue Shield of Florida dropped 120 physicians for no cause. The State is now going to look into the matter since there is a year old law that bars adverse action against a provider by an insurance company. Top
A law just signed by the Governor allows patients to sue HMOs in state court if they believe their lives or health is in immediate danger. Prior to suit, the patient needs to go before a state appointed panel to plead their case. There is no bar to class action suits nor any limits on damages. It does shield unions and employers from lawsuits decisions made by MCOs. This law only applies to those who don't come under ERISA. Those folks will have to wait for the Congress. Top
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.