The JCAHO has announced their usual over reaction to national events. The newest one in a 24-page advisory is that after January 1, 2002 all inspections will include emergency preparedness. The Joint also states the disaster plan must contain mitigation, preparedness, response and recovery. This includes a list of CDC and FBI contacts as well as bioterrorism specific decontamination plans and an identification of possible hazardous threats to the area. The institution must also be aware of other institutions that might accept patients in the event of overcrowding and work with community agencies. For a change, the Commission has only required sensible items, except for the obvious "one must" participate annually with the outside community. If the outside community does not have or does not wish to have a disaster plan for whatever reason, read money, there can be no community interaction and the hospital may get dinged.
It is estimated by the AHA that the cost to prepare for future terrorism is $11.3 billion. This includes multiple spaceman suits for hospitals in Podunk.
The new JCAHO rules for blanket and range orders are on its web site. Basically there can be no blanket orders such as post surgery "restart previous medications". If prn orders are used the lowest amount is to be given first and if not helped then the dose or frequency may be increased.
The Joint has backed off its statement that a hospital will be scored as to how they read and utilized the Sentinel Event missive. They will still require you read their alerts and see how you plan to implement them. Top
At the last moment President Bush decided the Department of Veterans Affairs should not restrict enrollment into its health system. The plan was to cover a $400 million shortfall by only allowing those veterans with service connected disabilities and below $24,000 income level into the program. Now its all comers as it has been. This allows more about 1/3 of the total number of veterans using the system to continue to use a system that is overtaxed and under funded. The enrollment limitation would have saved $142 million this year alone. There comes a time when entitlements must be re-evaluated. There is no question that we owe health care to those with service connected disabilities, no matter their income. But, do we owe medical care for newly diagnosed diabetes to a 63 year old person that was discharged from the service in 1966? I think not. Should there be a means test for Medicare as there is for Medicaid? I believe this should be considered. For those Veterans with service connected disabilities, would the care be more cost efficient and better by bringing them into the private system without deductibles or pharmacy limitations? As one who spent part of his medical training and taught in the VA system, I found it to be a large non needed bureaucracy. As a veteran of the Viet Nam era, I want choice of physicians and hospitals. I do not want to be forced to live near a VA facility. When considering entitlements of all types, think and do not react. Top
If a hospital has an actual or potential exposure to Anthrax or other bioterrorism agent their responsibility is to meet its EMTALA obligations. There is a question and answer series on this at www.hcfa.gov/medlearn/terror_ltr.htm Top
All hospitals must by January 1 have a plan to reduce medication errors. This is part of licensure. The Department also gave suggestions for what these plans should contain. All acute hospitals, surgical clinics and special hospitals are to have the plan implemented by January 1, 2005. The hospitals will also need to have a system to evaluate errors and to review the plan annually. Top
As part of its new work plan the OIG has decided to look at MCO profitability. This may lead to either increased or decreased Medicare funding in the future. The OIG will also look at the cost of any additional benefits it provides and the value of these benefits. The OIG will also look at the physician satisfaction with the MCO. In the last study (1998) 18% stated they were somewhat or very satisfied with their MCO arrangement. This was in line with the 43 % who stated somewhat or very dissatisfied. Top
The Las Vegas Journal reported on the Nevada licensing board. The November 25, 2001, article talks about the good of the Board in having the toughest standards for who gets to practice in the country. The article then rehashes the old saw about not having enough disciplinary actions. The number of actions has remained stable for the past 22 years despite the increase in malpractice cases. The paper confuses malpractice cases filed to bad physicians. In terms of money the Board has a positive but less than the number of full time employees. There are also only two investigators for the entire state and its up to 1000 complaints filed each year against physicians. Most of these are for perceived over-billing or rudeness which the Board does not (nor should not) investigate. In Nevada, as opposed to other states, it is unusual for a less than severe malpractice case to result in a disciplinary action. Top
The West Virginia House has passed a bill to help alleviate the malpractice crisis of the state. The plan is a stop-gap state run malpractice insurance. Some of the legislators have got it right. They state that this stop-gap measure does not solve any of the underlying problems and fear the state run program will become insolvent in the near future unless there is tort reform along with the insurance. On December 1, about 1200 physicians will lose their coverage. Top
Kaiser has appealed a $1.1 million fine by the California Department of Managed Care for shoddy emergency room service. They are not appealing it on the grounds it doesn't exist but on the technical ground that one of the patients was a Medicare patient. Kaiser states that since the patient is Medicare, federal law preempts state law and therefore that patient's poor care should not be considered. Top
The Dallas Morning News reports that the Texas Department of Insurance will audit 17 health plans to make sure they will pay their providers what they are due. To date the plans have paid under the Commissioner's eye $12 million to 5700 physicians and 4200 hospitals. Physicians received 23% of the money paid. Humana states that this is a windfall for the providers above what they are contracted to receive. I wonder why the Texas medical community continues to deal with people with this mentality. They should all refuse to deal with Humana until such time as the company becomes more compliant. Texas has an antitrust exemption for the medical community. 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.