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Several days after Scully stated that the CMS would continue to decrease payments to physicians at least through 2005, HHS Secretary Thompson (Scully's boss) testified that he hopes to send Congress a recommendation for a boost in physician payments. This would mean that under the BBA the increases would need to be balanced by a decrease in other programs. The AARP has stated that they do not want any raise in physician payments until the seniors, no matter their income, get pharmacy benefits. Top
The nurses are losing. The Florida House voted 71-47 to allow non-nurses to work after a year of clinical training as anesthesia assistants with physician supervision. The vote is now in the Senate. The problem is one of quality of care and of course, the bottom line. The physicians argue that there are not enough nurses and do not see that improving in the near future. The physicians could pay the anesthesia assistants less than a nurse but still charge the same, thereby making more money. The nurse anesthetists state that this is poor patient care and that the one year of clinical training is not adequate. they would also lose their monopoly as the sleepers. Top
Two members of the House have sent a letter to HHS Secretary Thompson calling for lessening of the privacy rules. They don't like the consent provisions or the business associate areas. It is ironic that the reason HHS wrote the HIPAA regulations is that Congress did not do its duty under their own bill. The bill stated that if Congress failed to act, which it did, then HHS would need to write the regulations. Now these people don't like what was done so they are threatening legislation, which hey should have done in the first place. Top
The Nevada Medical Board has said by its inaction "no" to a request by a hospital to do a criminal check of all physicians at every renewal. This silly idea came from Washoe Hospital and it is probable that they got it from a consultant who is pushing his own products in this cause. If the hospital wants to waste its money it is their concern. Top
CMS Rejects California Proposal
California recommended that sexual partners of Medicaid patients with Chlamydia be allowed to be given a prescription for an antibiotic to be paid for by Medicaid. This was to be done without a physician appointment. CMS said that the idea was good but they could not do a paper trail that is required. This means that many women will become infertile due to multiple infections. This spokesperson was also against a prescription by a physician for antibiotics for unseen partners as not good medicine. I agree it is not good medicine in the traditional sense but it is good public health. Top
Mt. Sinai Fined in Liver Donor Death
Mt. Sinai in New York has been fined and forbidden to do adult transplants for six months due to the poor post-operative care given to a liver donor who died. The patient was the second liver donor to die in the United States. He apparently died by vomiting and aspirating. He and 37 other transplant patients were being "cared for" by an intern. No attending saw the patient for three days. His brother, the recipient and physician, is doing fine and has publicly criticized the hospital. The law suit is next. Top
Some states are attempting to cut back the money paid to pharmacies to fill prescriptions. The pharmacies are saying that if you do that we will stop filling Medicaid prescriptions or cut back our hours. As of now they get the cost of the prescription plus a flat fee for the filling of the medicine. This was started by the Feds who stated the pharmacists were overstating the average wholesale price of the medication and therefore getting paid too much. This allowed 16 states to either consider cutting back the fees or actually do so. CVS, Walgreens, Rite Aid and Albertsons have stated they will either stop Medicaid or will reduce hours and close stores. State officials put it on the pharmacies stating they should drive a harder bargain with managed care organizations to make it up. So far, Illinois, New York and Oregon were defeated by the pharmacists and Indiana is now in court challenging the reduction.
Oklahoma pharmacies just got a permanent 1.5% reduction. The state is now paying 12% less than the average wholesale price plus $4.50 filling fee. The pharmacies are still making a very small profit at this level. Top
Your friends at JCAHO are at it again. They're here to
help you. In case you missed it, here are some of their helpful
suggestions:
In conscious sedation the person doing the sedation must be able to reverse the
sedation. They can be certified by either a ACLS course or a hospital
course. This may be part of the requirement for privileges in endoscopy and not
as a separate privilege. A available "on call" Code Blue team is not
an acceptable alternative. I actually think this one has merit and tried to
get it in to one of my hospitals several years ago. This would have meant
some extra work for the physicians and was not put into place. Now they
will have to do it.
The JCAHO also has announced new clarifications regarding restraints and
seclusions including who may do the face to face and what continuous monitoring means.
The also have a continuation of their sentinel events policy, which I hope all
hospitals ignore except for the drill down for the root cause. Remember, if you
report the event to them it may no longer be protected in the event of a
malpractice action. This depends on the state law of the state in which
the incident occurs. Top
Georgia has fined One Health Plan $200,000 for late payments to providers. They were also fined $95,604 for the same thing in December, 2000. The Georgia Commissioner of Insurance takes this seriously and has fined as much as $400,000 against Humana for the same late payments. Top
Malpractice Premiums and Reform
Nevada's Governor has stepped into the malpractice fray. He is using money from a disaster fund to help physicians get insurance at an affordable rate. The physicians will be charged $32,000 annually and pay $105,000 over a period of time to buy their nose coverage. He believes that this is only a short term solution until the legislature can meet and enact the necessary tort reforms to keep the premiums at an affordable rate. The state physicians are also attempting to form their own malpractice company but this will take time to develop and fund.
Pennsylvania has passed minimal tort reform. This is
major for this tort lawyer state. The legislature has passed a bill to
reduce to $1 million the required malpractice amount. It was $1.2
million. They also passed a collateral source rule and structured payments
for those awards over $100,000. They did not touch any cap on pain and
suffering which is the main cause of large jury verdicts. I predict
this will reduce some of the premiums but only for a short time. The
legislature must break from the trial lawyers and continue to pass controls
including limits on pain and suffering and controls of the lawyers fees.
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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.