In the July 15, 2007, update I wrote about a new law in Tennessee that allows restrictive covenants for physicians. One of my astute readers emailed me about another Tennessee law of the Bar that forbids restrictive covenants for lawyers. Why is it ok for lawyers to go from firm to firm? According to the Bar so people will have access to legal help. I guess people don't need access to medical help if it steps on those who pay the attorneys. He goes on to state that a teaching hospital had a restrictive covenant for their residents so they wouldn't go out and compete with the university. The AMA stepped in and the university rescinded its restrictive policy. The writer wonders when physicians will raise their standard of ethics to that of lawyers. I learned something. I didn't know they had any.
Pennsylvania will not give an inch on their med mal policies to keep physicians in their state. This means there are less physicians and less access to medical care. The legislators put on their thinking caps and came up with a bill to allow certified nurse practitioners to see home patients and order products. Dental hygienists will be allowed to clean teeth with no dental supervision. Certified midwives will be able to prescribe meds. Physicians will be able to supervise four physician assistants, up from two. Top
Ain't the government fun. They continue to think about new ways to screw up the practice of medicine. Currently, there is an exemption in place to allow physicians to use electronic faxes instead of digital transmissions for sending prescriptions to pharmacies. Our friends at CMS are considering dropping that exemption so that all electronic transmissions between the physician and the pharmacy will need to be digital. This would require training for over 150,000 physicians and their staff. It is being done to eliminate a possible error when the fax is manually entered into the pharmacy computer. This may make some physicians forego electronic prescribing rather than go thru the expense and time involved in being retrained. Congress has introduced a bill to delay implementation of this stupidity.
CMS has changed the reimbursement schedule for ambulatory surgical centers. They increased the amounts to be paid over the miserly amounts originally suggested but not enough. They also updated the list of procedures that may be done in an ASC.
We all know who has the most money to give to the pols, the hospitals. Congress has voted to prevent the CMS from cutting money for inpatient hospital services. It would also delay for one year the required Medicare Severity Diagnosis related Groups. However, the CMS wants to stop the current bill to decrease physician payments by 10%, even though the cheapest part of Medicine is the physician. Top
In the July 13, 2007, Update I reported on the JC's movement back to the medical staff with MS 1.20. A legal colleague, Michael Tucker, in his blog made certain suggestions regarding peer review and putting these in the bylaws. His first suggestion was to allow the affected practitioner be allowed to appoint or at least approve one member to any ad hoc committee investigating the physician. The rationale is to avoid secrecy. His second suggestion was to allow the physician to meet with the investigative committee prior to the committee making any recommendation. All know that it too late after a decision has been made. The last suggestion that in the hearing or judicial review committee, the physician be allowed to have a representative on the committee. One of the main reasons for law suits is the secrecy that occurs throughout the process especially when the panel meets with the hearing officer or the physician head of the committee. Top
Portugal has joined most of the European nations allowing abortion in the first 10 weeks of pregnancy. This came after a low turnout referendum in February where a majority voted to legalize the procedure (59.25%). This leaves only Malta, Ireland and Poland with restrictive abortion laws.
Libya has suspended the death sentences for five Bulgarian nurses and one Palestinian physician. The charge was giving AIDS to children deliberately. The sentences were changed to life with parole in eight years. The death sentences and the blood money paid by the USA and the EU are not good for Libya's chances of reduced international isolation. Top
All physicians and medical students in the country, whether or not a member of the AMA, is having their personal information sold by the AMA to pharmaceutical companies. There is apparently an opt out provision however only a small percentage of physicians knew about the sale (the AMA calls it licensing). Big brother is watching. Top
The North Carolina Assembly has passed a bill to cap monetary damages on medical providers that agree to undergo binding arbitration. I see nothing in the bill that requires the plaintiff to go to arbitration. Maybe that is the reason it was given the seal of approval by the lawyers. Top
In an important piece of news, the feds are attempting to get rid of the whole hospital exception and eliminating physician owned hospitals. This is stuck on page 390 of a 485 page bill that originally was for children's healthcare. Those hospitals that are grandfathered can be owned only 40% by physicians and no one physician may own over 2% of the hospital. There are also disclosure rules set in place.
Some of the other things that are in the bill that still have to be decided are the jurisdiction of the Joint Commission, the reduction of nursing home monies, the funding and the expansion of the bill to older children and immigrants. The Joint accreditation would not give automatic meeting of the conditions of participation under the bill. Nursing home monies would be reduced by $2.7 Billion.
Talk about stupidity! Martin King Hospital in LA is the worst. They have a group of inspectors on campus to determine if they will remain open. At the same time they are again cited for placing another patient in immediate jeopardy. This is a psychiatric patient who got hold of a scalpel and cut herself while in the ED. The nurse on duty was fired and the supervisor placed on leave. This satisfied the inspectors, but I don't know why. The hospital deserves to close in order to protect the community.
Congress is starting an investigation of the non profit hospital industry. They want to know if they are doing enough to warrant their non profit status. The IRS has issued a report that the hospitals are spending 3% or less on care for the poor. The hospital industry counters with how much they write off. The problem is that they write off the inflated full numbers and not the cost or even the negotiated numbers. There are about 200 of the nations hospitals that are truly cash poor with almost no day to day money. The non profit hospitals in 2002 received over $12 Billion in tax breaks. This is at the same time that a report by the CBO found that the for profits and the non profits do the same amount of charity work. The non profits say they provide a community benefit but there is no definition of the meaning of the term. The hospitals also claim the money lost on Medicare and Medicaid as part of their community benefit. That is nonsense. If they didn't make money on those services they wouldn't take the patients unless they came through the ED. The hospitals love the Medicare patients. True, they don't show as much love to the Medicaid patients and they get more for the care if they are not contracted. Sen. Grassley wants at a minimum spending of 5% of the greater of operating expenses or revenue in order to qualify for non profit status. Of course, physicians who treat these patients get no tax benefits as they are for profit centers. Has any physician ever considered becoming a non profit corporation?
St. Vincent Hospital in Indianapolis was fined $2 million for poor recordkeeping allowing an employee to steal painkillers and sell them. The pharmacy clerk stole over two years more than 600,000 tablets of hydrocodone. Top
All pols love to tinker, especially Sen. T. Kennedy. This time he wants to change HIPAA. A new bill with three main parts has been introduced. In part one the individual gets to see, copy, amend, destroy, mutilate and staple all information about them. They can also opt out of all electronic records. Part two makes privacy information difficult to get as it requires the current treatment, payment and operation exemptions be only disclosed if agreed to by the patient. Part three is the new Office of Health Information Policy which will oversee all the problems and dish out the criminal penalties found in this part. Mr. Kennedy should stick to tinkering with alcohol and driving. Top
A Bill has been introduced in Congress that would limit an insurer's ability to deny individuals health insurance coverage based on preexisting medical conditions. If a person changed insurances, they would only have a three month waiting preexisting period, not one year. We will see how much the insurers pay the pols to get this quashed.
In Rhode Island, the Governor has vetoed legislation that would have required infertility coverage for unmarried couples. The Governor is a Republican and the maker of the Bill is a Democrat.
An editorial in the Wall Street Journal blasts the Wisconsin Democrats for proposing a universal healthcare bill that will cost $3 Billion more each year than it collects in total taxes. The proposed cost is $15.2 Billion annually. The proposal would impose a tax of 14.5% on wages and a potential escalator of 1.5% to higher outlays in the future. The supporters claim they will save $1.8 Billion by efficiency of eliminating administrative costs of the private insurers. The government will have the costs but it will be paid by the taxpayers.
The law of unintended circumstances continues in the People's Republic of Massachusetts. When they enacted their stupid law, they forgot so much it is amazing. The most important thing they forgot was there are not enough primary physicians willing to take what the state is paying. The now insured cannot find a private physician and will continue to wait long hours in the clinics or go to the ED as they did in the past. This also goes to the med schools who are turning out less and less primary care physicians due to the hard work and lack of pay.
California has no budget since July 1. There is no immediate outlook that suggests there will be one soon. Without a budget payments can not be made. Those providers of medical care to Medicaid patients are in jeopardy of not being paid. The state has a slush fund of $2 Billion for payments that they say will run out in the next month. I believe that with what the state is paying for care the $2 Billion should last much longer.
An article in the New York Times states that someone from the left Stanford Health Policy Center believes physicians are not only paid too much but they all should be on salary with bonuses for patient health. They state that European physicians get average salaries of $60,000 to $120,000. Gee, I wonder what their medical school debt is and what their cost of living is? Dingbats.
The Congressional Democrats are attempting to dismantle private healthcare in a piecemeal fashion. First they passed the Children's Bill that will be vetoed and now they want to cut back the federal subsidies for Medicare HMOs. There are now 8 million enrollees in the program. This one I can have some sympathy with. The bill faces more problems in the Senate and will not be veto proof. Top
California has finished their investigation of Kaiser and their lack of processing patient complaints. They found Kaiser so lacking in fairness that they fined them $3 million. The state is ready to forgive $1 million of the fine if Kaiser makes improvements. Kaiser peer review was extremely varied between individual hospitals and seldom did they attempt to improve care. Kaiser had the physicians under review looking at their own cases and also stopped reviews partway through.
Kaiser has promised to do many things but it is doubtful if the most important will be done. They say they will spend $10-$13 million to fix the problems. This is for the standardization f their peer review which now is non existent. The most important thing they could do is put in place a true patient complaint system that does not stonewall and helps the patients. This will not be done.
New Jersey has fined Aetna $9.5 million for there non coverage of out of network services by providers. Aetna will contest the fine and hopefully lose the money plus the time of their inhouse attorneys. Aetna states that they will pay ou of network providers 125% of Medicare and 75% for lab and durable medical equipment. The state has ordered them to pay billed charges plus 12% interest. 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