March 1, 2001 Legislative News

San Francisco Sex Change
California Consumers ask for all Documents in Health Care Arbitration Disputes
Medical Board of California Bureaucratic Thinking
Medical Marijuana
Bush Delays HIPAA
FBI Wants More Money for Health Care Fraud Investigations
JCAHO
Nursing Training
Institute of Medicine has new Report

San Francisco Sex Change

Only in San Francisco. Starting July 1, San Francisco will allow benefits for a sex change operation. This includes the surgery and associated hormone treatments and related medical needs. This is called a civil rights issue and equal benefits for equal work. It also relates to a city medical fund that is now flush with money. The cost for the surgery from male to female is about $37,000 and about $77,000 for the reverse. The city is to cap their expense at $50,000 for life. It also expects a co-pay of 15% if a city affiliated physician does the surgery and a 50% co-pay if another physician does the surgery. The potential patient would need to be on the payroll for at least a year before becoming eligible for the benefit. This benefit will add $1.70 per month to all employees in the Health System. Top

California Consumers ask for all Documents in Health Care Arbitration Disputes

Two consumer groups have asked the Department of Managed Care to require health plans to disclose all documents and information obtained during a health care dispute resolution. The groups state this would give "patients the edge" in negotiating with health plans over health care disputes. This would unlevel the playing field and give rise to significant privacy issues. One of the great benefits of arbitration is the ability to have confidential settlements quickly. If this goes through, I believe the plans will lengthen the process to protect their name. This will add significantly to the costs of arbitration. Top

Medical Board of California Bureaucratic Thinking

The San Diego Union-Tribune reports that the Medical Board of California executive director, Ron Joseph believes that hospitals are hiding bad doctors. He bases this on the theory that since patient complaints to the Board have increased there should be an incremental increase in 805 reports from the hospitals to the MBC. In fact there has been a decrease in 805 reports in the past 10 years from 282 to about 100. He and Sen. Figueroa feel hospitals are not reporting due to fear of bad publicity. These two smart people want random audits of hospital peer review reports by the MBC. They donít take into account that many MBC complaints are trivial and based on office communication problems, not involving hospitals. Fortunately, the CMA testified that focusing on 805 reports make little sense. There is no standard to judge how many reports should be generated in any setting. If the MBC wants to focus on something, they should try focusing on those managed care organizations (Permanente Medical Group) that do not report physicians when during malpractice settlement the physician names are dropped and only the organization remains as a party to the suit. Top

Medical Marijuana

In the continued swing toward state sponsored medical marijuana initiatives, the New Mexico House Public Affairs Committee has passed 5-3 a bill to allow medical marijuana in the use of certain diseases. The bill is supported by the governor and would update New Mexicoís current policy for marijuana use only for medical research. Top

Bush Delays HIPAA

Secretary of Health Thompson has delayed by 60 days the implementation of HIPAA. This is to allow a new 30-day comment period. The new start date for HIPAA is April 14, 2001, with compliance two years after. President Clinton promulgated the orders under HHS since Congress failed to do so. However, Clintonís HHS forgot to send them to the GAO for their review, thus the delay and possible changes. Top

FBI Wants More Money for Health Care Fraud Investigations

The FBI wants to continue to prioritize health care fraud and the highest white-collar crime. In order to do that they have asked for an increase in their funding. In the past year the FBI has recovered $290 million in fines and repayments plus the large HCA and Bayer Settlements. They have also gotten 560 federal convictions. The FBI believes that about 10% of health care spending is lost to fraud each year. This is about $100 billion. If this is true, does anyone wonder where we can get more money for Medicare, Medicaid and the uninsured? Top

JCAHO

The JCAHO in its new patient safety standards wants hospitals to focus at least once a year to prospectively doing risk assessment. A new Sentinel Event Alert allows hospitals to use a model to help them meet this standard. The web site is

www.jcaho.org/edu_pub/sealert/sea16.html. Top

Nursing Training

A new bill has been introduced into the California Senate that would expand nurse training programs and create scholarships and loan forgiveness programs for nurses that work in underserved areas. The author wants to train an additional 4000 nurses each year. Currently about 5000 nurses graduate each year from California nursing programs. The bill (SB317) would allot $30 million to training programs in the first year and "additional funds thereafter". Top

Institute of Medicine has New Report

The IOM has released its new report on the quality of medicine in the United States. This report makes recommendations for increased quality and communication improvement. It can be seen at 
www.nationalacadenies.org/
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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.