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The Maryland Insurance Commissioner has not allowed CareFirst BlueCross BlueShield to raise rates. The Commissioner stated that the company spends less than 75% of revenues of patient care and the law states that the company must spend 75% of the premium as a minimum with small business clients. Last year they spent 71% and only 59% the year prior. The insurance company felt their rate increases were justified but decided not to appeal the decision. Top
California has started to require labs and physicians to report all new HIV+ cases in the state with a code instead of patient names. The tension here is that the right of privacy for those affected versus the need to treat HIV differently than any other reportable disease. AIDS is reported by patient name. If the test is done anonymously the lab obviously will not have to report the test result. This stems from a CDC rule requiring all states to develop a system to track HIV cases. Most states use a name based system for the tracking. Top
Ohio has introduced a bill in the Senate to restrict jury awards. This is not unusual but it is to be used as a force to elect two republicans who favor tort reform to the state Supreme Court. The court in the past has been divided on the issue and disallowed tort reform laws passed by the legislature. The bill would restrict non-economic damages and attorney fees. Top
The new and unnecessary rules just continue to come from the Joint. The new one is to show how staffing and patient care are related. Each hospital must pick two of 21 indicators, one from HR and one from the clinical side and compare the two. This increase in paper work has no potential for any good. All know that the more nursing staff one has the better the care. The question has been and will continue to be "where do we get the nurses?" I will state again there are alternatives to the JOINT. Look at the American Osteopathic Assoc., who is older than the joint and who has the same deeming authority but without all the hassle. They also cost less and are hospital friendly. The State Department of Health will also deem for free but are not consultive.
JCAHO in their July newsletter has stated that maybe it might be a good idea to explain why the sentinel events are required and what are some examples. Starting January 2003 their will be new patient safety goals. More for those hospitals to do that insist on using this organization. In the same newsletter the Joint has explained MS1.14.4.1 regarding how to credential in times of disaster. It would only require a hospital picture ID and a copy of the license or a verification of the person by someone on the staff. Now, the organization is going after labs and pathology in their quest for staffing effectiveness. This is before they know how well it works on the nursing portion. You know the saying "you get what you pay for". In the case of the Joint, this is not true. Top
San Francisco's St. Luke's Hospital was told they will be hit with a one day nurses strike. They were given a standard 10 day notice of the strike. Most hospitals would curtail surgery that day and the day prior, but not St. Luke's. The CEO started immediately to curtail surgery and stop admissions. Not only that, but he ordered his emergency room closed so no new patients could be admitted. Of course, this is against state law and one day later the state ordered the ED to reopen. The reopening is only to do medical screening exams, stabilization and transfer if hospital admission is needed. I wonder how the parent company, Sutter Health, feels about this action by the hip-shooting CEO. Top
CMS has released the new improved ABN.
If you are interested in the process, and you should be, go to
cms.hhs.gov/medicare/bni/
The HHS advisory board has agreed with the physicians that the E&M codes are terrible. They voted 20-1 against the continuation of the codes since they have not achieved the goals and they are a mess for physicians. It is hoped by January 2003 there will be changes. Top
New Hampshire is the latest state to allow nurse anesthetists to work as independents and not under the control of physician anesthesiologists. Medicare required the supervision but after re-thinking the decision changed to keep the rule but allow states to opt out of the supervision. This is the fifth state to waive the supervision. The other states are Iowa, Idaho, Nebraska and Minnesota; all state with a significant rural population. Florida is also considering the supervision issue and leaning to non-supervision. The Anesthesiologists, my colleagues, state this is a patient safety issue but they know it's a turf issue. The other side is that many rural hospitals can not recruit anesthesiologists and would have to stop doing surgery if the nurse anesthetists were banned. 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.