California passed AB 632 in October, 2007. What it does is add medical staff members and hospital employees to those who are protected from whistleblowing. If a physician or hospital employee presents a grievance, complaint or report to any governmental agency including the Joint Commission or the medical staff concerning the quality of care in the institution they shall be presumed for 120 days to be protected against retaliation. This means the physician can still be peer reviewed but the medical staff must ask the court for an injunction to protect against evidentiary demands. The court will do an in camera review of the evidence and elect to enjoin until the peer review hearing is over. This may mean until all appeals are also complete. The court can also enjoin the medical staff from withholding evidence requested if the physician would suffer irreparable harm. If the court finds that there has been a breakdown of the whistleblowing protection the hospital would be fined up to $25,000 and the physician would be reinstated and paid lost income and legal costs. I am not sure if this covers legal fees to defend as well. It is a great start but it would be better if the whistleblower were protected for a longer period of time than three months.
Physicians, big brother is watching. For those physicians who use e-prescribing with Medicare Part D, the government is finalizing standards for you. CMS will collect data and share med history among prescribers, pharmacists and insurance companies along with using the data for a formulary. All physicians will need a national identifier. This is good says the companies who will be used for the collection. The physicians have not been queried. Top
There is new California legislation that requires health insurers have the same language requirements as do hospitals and physicians. The insurers must do a demographic profile of its members, detail what services will be given to those of limited English proficiency, and have a system for fielding phone calls regarding those services in the different languages. Also, starting in 2009, it will be the insurers responsibility to provide interpreters for medical appointments.
There is increasing support in Congress to postpone Medicare audits of nursing homes in the states. This is due to the companies mode of payment, a percentage of up to 30% of the money saved for Medicare. It should be noted that California's Sen. Diane Feinstein's husband is part of the company that does the auditing.
CMS is proposing changes in hospital reimbursement. Hospital payments would decrease by a flat rate in order to build a pot of money to reward hospitals for meeting quality thresholds. The changes would require Congressional approval. The hospitals don't like the idea of having money taken from them and want the quality be from a separate pool of money above the normal DRG. Top
The CMS has just re-deemed the American Osteopathic Association as a Medicare certifying organization. It is the oldest certifying organization in existence. It has the same power as the Joint Commission but is much cheaper, more user friendly and can certify any hospital or organization, not just osteopathy ones.
Rhode Island Hospital has been fine $50,000 for the third wrong side neurosurgery this year. The mistakes were with three separate physicians. The hospital is the teaching hospital for Brown University.
The US Chamber of Commerce is helping the American Hospital Association, one of their member organizations, by lobbying Congress to get rid of the whole hospital exemption under Stark. 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