West Virginia has agreed to hold a special legislative session to discuss and pass necessary malpractice items. The legislators want pre-session consensus on all tort reform topics including specifics almost to the point of having the bills pre-drafted. The physicians need the details for a physician owned insurance company with a majority of the board being physicians. The tort reform that must accompany the insurance needs to be worked out.
New York has legislation in the hopper for tort reform. The physicians are starting their lobbying efforts in support SB 3453/AB6956.
Nevada is having significant problems with the malpractice crisis. They are handling it as any state with an overabundance or plaintiff attorneys would. Instead of tort reform, they are looking into any collusion between the Medical Society and the insurer that pulled out of every state, not just Nevada. The State is attempting to blackmail St. Paul to pay part of the physicians tail coverage. Top
Texas continues to work for its physicians. The Department of Insurance has order the Methodist HMO and PPO to pay $2.5 million to providers in overdue payments and $250,000 to the state as a fine for their tardiness. Interesting that Methodist has a clause that if they are late they must pay the full and not the discounted rate. Several days earlier the state required 12 insurance companies to pay $2.6 million in monies owed and $1.6 million in fines. The companies agreed to pay but admitted no wrong doing. Everybody pays fines when they did nothing wrong!
The Texas Attorney General, whose word is law unless overridden by the legislature, has proclaimed the HMOs MUST reveal the codes they use to determine payments. After the Insurance Commissioner made the notice, the Governor instructed the Insurance Commissioner to submit rules for review by June 3. This ruling includes bundling and downcoding. The health plans state surprisingly that the new rule will drive up healthcare costs. The idea is it should so that the providers that contract get what they bargained for.
Georgia is attempting to keep pace with Texas. The insurance commissioner continues to level ever increasing fines against delinquent MCOs. The latest is United Healthcare for $150,000. The commissioner states that Humana still has not improved, even after a $400,000 fine several months ago. The next one should be a real doozy. Top
Oregon continues its interesting ways. It is the only state with physician assisted suicide (although by the time you read this, Hawaii may have joined in) and they are the only state that realized the finite amount of money to spend on Medicaid. When this was noted many years ago they put in a list of what would be covered and what would not be, in a prioritized basis. They enlisted providers, legislators, clergy etc into the discussions. It has helped fairly well but now needs tweaking. The new asked for federal waiver will give more people less care as opposed to more care for fewer people. This would allow 58,000 more people to qualify. This open method of discussion is opposed to the insurance companies deciding behind closed doors. Top
The San Francisco Chronicle reports a story that a state legislative committee is going to write legislation to force the medical board to put on line any physician misdemeanor convictions, concluded investigations by the Attorney General's office and settlements. This last item will take away all incentives to settle a case and will lead to more court cases. This in turn has the potential for less judicial economy and since the physician wins 80%-90% of the court cases better physician results but at a high personal cost. There would also be a high financial cost to the insurance company to fight the case in court and for the plaintiff attorney who in California is being paid a contingency fee on a fixed schedule. Attorneys would be forced to send copies of all malpractice cases filed to the medical board. This is another of Senator Figueroa's bills that has not been thought out. The legislators believes that settlements should be reported if there are more than three $30,000 settlements in a ten year period or any one settlement is more than $150,000. The Medical Board has gone further than the legislators by not putting any dollar limits on the settlements that would be reported. Top
After the bill allowing physicians assisted suicide passed the Hawaii Assembly, the Senate under intense lobbying defeated the bill. Oregon remains the only state with a legal physicians assisted suicide law. Top
The Yale-New Haven Hospital is in deep trouble. They may lose their surgical accreditation for overworking residents and paperwork deficiencies. The Accreditation Council has given the hospital until June 2003 to fix the problems. This means spending money for more surgical residents so they would not be on call as often. They are currently working every other night when the maximum is one in three. The hospital will also hire mid level practitioners to help the residents do the required paper work. This story dove tails into the story under Legal where the matching program is being sued for anti trust. Top
The administration has proposed new rules that affect hospitals. The first one is that off campus hospital facilities that do not provide emergency care will not have to do medical screening exams and stabilization. The only thing they will need to do is have in place policies and procedures as to what to do if someone has a medical emergency. This could include 911 and removal to the appropriate facility. Also, hospital owned ambulances would be allowed to have a protocol to take patients to any hospital and not only those that owned the ambulance. Also the propose rules clarify the on-call list. There is not a three physician rule. There is hospital discretion as to who may be excused from the ED roster and who and how the ED may be covered. Vacations, other patient care duties not under the control of the on-call physician may be handled by hospital policy. There will be a comment period until July. Top
Connecticut has passed a bill that would require the reporting of potential medical errors. This would need to be reported within 24 hours of any incident that kills, serious injures or endangers patients. The bill will go into effect in October. These reports will remain confidential for six months to allow the Department of Health to investigate. One of the legislators wants in the report all the names, medications and equipment that was involved in the incident to be part of the report. The law does specify what should be included in the report. Of course, this is another unfunded mandate as the Department of Health was not given extra money to do the investigation. Top
The Joint has issued a new sentinel alert which means all institutions must do something with it. The newest edict is regarding ventilator related deaths. The recommend and the hospitals must agree that alarms must be able to be heard from a distance but do not say how far, the staff is properly trained, have a competency assessment program, check equipment on a regular basis and provide direct visualization of vent patients whenever possible. These are common sense but the hospitals must codify them into their protocols. Top
The second Kindred facility has been removed from Medicare due to patient safety concerns. This one the Lexington Kentucky Center for Health and Rehabilitation. This means it will lose 84% of its current residents. Recently Kindred also had its Minnesota facility also booted and is now attempting to sell it. It still has over 300 nursing homes and 54 long term care facilities. 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.