Medicare has announced that they will no longer pay hospitals for any untoward incidents that happen to patients while in the hospital. If a person comes in for pneumonia and leaves with a fractured hip, the hospital will not be paid for the care of the fractured hip. Those diagnosis that could have reasonably been prevented such as the fall that caused the fractured hip will not be paid. Also on the list that will not be paid are hospital acquired infections, foreign bodies left in surgery, wrong sited surgery, hospital acquired bedsores or pressure sores. Hospitals will be forbidden for charging patients for those items that Medicare disallows. Also private insurers will probably follow suit in the near future.
CMS has issued new proposed rules for ASCs. They will need to do certain things to be allowed to bill Medicare. These include better quality assessment and performance improvement conditions, having a disaster plan, having radiology at the ASC as they have lab, adding patient rights including telling patients about the physician owners, if any, better infection control and putting in a comprehensive patient assessment requirement. ASCs, you better get cracking.
It's been a busy time for CMS. They have issued Stark 3.0, the latest and greatest of the original Stark Law on self referrals. It is as usual short and terse, over 500 pages. It adds no new exceptions to the enumerated exemptions but does ease some of them and toughens some. One of the main things it does is to have the physicians of a group practice stand in the shoes of the practice for indirect compensation. It also expands the non monetary exemptions and expands the area a rural hospital may use to recruit a physician. There can now be non-competes in recruitment contracts and the contracts may also restrict moonlighting.
Recently CMS also considered reducing the money paid to Medicare HMOs to the same as fee for service. The acting deputy administrator of CMS said this was penny wise and pound foolish. This is where those people who can not get Medicaid and do not have enough for traditional Medicare fit. If the money is cut there may be less insurers doing the program and so less people will join. Top
CMS has issued the guidelines for their new policy that was mandated by Congress in section 7002(b) of the US Troop Readiness, Veterans Care, Katrina Recovery and Iraq Accountability Appropriations Act of 2007. Starting in October, 2007, all written prescriptions for Medicaid patients will need to be tamper resistant. This means that at least one of the following must occur: (1) the prevention of unauthorized copying of either a completed or blank prescription form (2) prevent erasures on prescription forms and (3) prevention of counterfeit prescription forms. By October 1, 2008, all three must be present. This means that faxed, electronic or called prescriptions are spared this. Also, if a MCO pays for the prescription, or if the drugs are dispensed by institutional and clinical facilities the onerous pads will not be needed. States need to get their act in gear or the prescriptions will not be paid for by the feds. Top
About 40 hospitals want a two year delay in the new IRS Form 990. This is the form that the hospitals would use to justify their non profit status. The letters from the hospitals were a form letter asking the IRS to add bad debt and Medicare losses to the form. The problem is how to define bad debt and Medicare losses as the hospitals have agreed to the amounts being paid them. Is bad debt that amount below hospital charges paid by insurers or only the care provided to the uninsured?
In Illinois, all hospitals will be required to screen all ICU patients for MRSA. The same is true in New Jersey and Pennsylvania. If MRSA is found, the patient is to be isolated and stringent hand washing and isolation is to be carried out. Another piece of legislation signed by the Illinois governor requires hospitals to analyze which infections are the most prevalent in their institutions and come up with their own plans to prevent the spread of the disease.
Swedish Hospital in Seattle has been cited by Washington health inspectors for multiple deficiencies. This was part of a routine audit. They found potential OR contamination and privacy issues. They also found medical issues. This is a good reason why unannounced visits are important. The hospital attempted but was unsuccessful in refuting the charges.
The AHA has sent a self serving letter to CMS regarding the proposed payment physician policies. It mentions the continued old saw of physician self referral. It is faulty in stating that it is better to have the procedures performed in the hospital instead of physician offices as is allowed. The AHA lies in stating that it is better for the patient to have the procedure done in the hospital. This does not take into account the ability of doing a test immediately in the office, if required and having the person seeing the test be the same as the person seeing the patient. The delay for the patient is only for the benefit of the hospital bottom line and not the patient. The AHA also believes that the physicians and hospitals should be aligned in patient care and in pay for performances. I am not sure in their letter whether they want to horn in on the P4P for physicians or want to share their money with the physicians or both. I agree with the AHA in their discussion of allowing broader med mal insurance help for the OB providers no matter their locale and the nonsensical requirement of a beneficiary signature on an ambulance transfer form. Top
The Governor of New Mexico has ordered the Department of Health to begin their planning to go forward with the legalization of the drug. Part of the state plan was the production and distribution of the weed. Top
Missouri has several new healthcare laws go into effect. The new Medicaid law expanded who is covered. Residents may now keep their health insurance when they change jobs and can deduct the cost or the premiums from their state income tax. This is true for employed and self employed individuals. Parents will be allowed to keep children on their health insurance until the child reaches age 25. Providers of health care may attach state income tax refunds to collect the debt. Of course, Missouri being Missouri, also put in a rule that all women who have a diagnosis of Down's Syndrome on their fetus must be referred to programs encouraging alternatives to abortion.
Washington's Governor has decreed that all the various licensing boards in the state should be on the same page. The state's health care providers need the oversight and must adopt the state's sexual misconduct rules and sanctions. This is to occur by March, 2008. Top
As I am sure most know or should know by now, the Joint Commission put out the final MS1.20 a month or so ago. In this document the JC stated that the important medical staff documents had to be in the bylaws and so voted on by the entire staff and not just the potential hospital controlled MEC. It also had a bypass mechanism where the medical staff could go around the MEC and go straight to the Board. This has not sat well with hospital attorneys who wish to keep control over the medical staff. On August 22, 2007 a group of ten fairly prominent attorneys who usually advise hospitals on medical staff issues wrote a letter to the JC protesting the new rules. The JC, in a letter by the JC attorney wrote back on August 30 defending the JC action. It was interesting that the signatures on the attorney letter were all from those in large firms that make their money from hospitals and medical staffs if the hospital pays for the staff's attorney fees. These issues will be further flushed out in a September 5th teleconference and another one put on by the JC in late October. The above does not effect California as it is codified (B&P 809) that all peer review protections and procedures will be in the bylaws and voted on by the entire medical staff. 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