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The Tennessee legislature is considering non compete clauses for physicians. This is after the state Supreme Court last year in Udom v Murfreesboro invalidated non compete clauses for physicians stating it was up to the legislature. The proposed laws would allow a 2 year ban and within either the county or a ten mile radius. The proposed bill does not differentiate between general and specialist practitioners. The Supreme Court decision did not affect non employment arrangements such as ownership of surgical or imaging centers.
The California legislature is considering a bill that would add 57 new clinical psychologists to the staff of Atascadero State Hospital. This would be over the objection of the psychiatrists currently working at the hospital. This would move patients away from medication based therapy. Top
The Joint has a new sentinel event. It's the hooking of wrong tubing to wrong lines. This includes the mistakes of putting a tube of Barium into an IV line and other such errors. The Joint has published risk reduction strategies and recommendations for purchasing the right type of tubing which can not be plugged accidentally into a wrong tube and how to check to make sure the connections are correct. Hospitals now must show on inspection that they are aware of the event and what they are doing to prevent the maloccurances.
As most know by now, the Joint is bowing to their money people, the hospitals they inspect. They have given greater latitude to the large hospitals on the number of dings they can get before getting the axe. The top Joint exec, Dennis O'Leary has written to the Los Angeles Times after the paper gave the Commission the chewing out it deserves. O'Leary states that the changes are only to makes sure the right hospitals get the intensified review. Those that don't pay enough. Top
The People's Republic of Massachusetts has showed its true colors. The legislature has passed and is sending to the Governor a bill that requires health insurance for everyone in the state. This will be done over three years and funded by an assessment on employers who do not provide health insurance and state subsidized insurance for individuals who can not afford insurance on their own. The bill is 145 pages in length. The Governor has already stated that this is a fee and not a tax. Of course it is a tax. The tax would be paid from pre tax funds for both individuals and businesses. The insurers would offer low cost insurance with few benefits. The insurance would be private and subsidized by the state. The premiums would be on a sliding scale. If a person does not sign up for the mandatory insurance, the first thing they would lose is their state tax exemption. Later they may be fined an amount up to half of the lowest annual insurance premium. The bill gives the Governor the ability to veto any individual section of the bill and keep the remainder intact. The reason for this is to get $385 million in federal funds if the state didn't do something to reduce the number of uninsured. A thing not talked about is the Republic's high medical regulations and high premiums. Some low cost insurances such as e-insurance will not sell in the state due to the amount of regulation that raises premiums. Also the Republic mandates Chiropractic coverage which also increases the premiums. The new law will no change any of the onerous regs.
A follow-up story in the Globe stated the lobbyists for the hospitals, insurance companies and other healthcare players were paid at least $7.5 million. Most of the big money players got what they wanted in the healthcare bill.
How much will this cost the people? The original estimate was $200 per month. This was from the Governor when he originally proposed the idea. The Democratic legislature decided against some of the proposed measures so the final pill will be $325 per month per individual and about $600 per month per family. The Democrats believed in giving everybody something, depending on the lobbyist. They refused to cut infertility or pare down mental health benefits. There are deductibles for those with higher incomes of up to $4000 if you get into an HMO. The mean health insurance premium for a single male Bostonian is $400 per month.
The People's Republic Governor, a Republican who may want to run for President, vetoed that portion of the bill that would require a fee of $295 per person that some companies would have to pay. The veto will be overridden by the Democrats who control the state but the Governor's image would be intact.
Some people in California are stating this is a model for health care in the state. The problem with that is that there are so few uninsured in the People's Republic as opposed to the Left Coast.
An interesting tidbit is that the feds take an average of 10.6% of income for taxes. Maine is the worst state taking an additional 13.5%, Alaska is the best with an additional 6.5%. The People's Republic is in the middle at 28th with 10.3%. Top
Missouri was slow to start but now they are going full blast on a mission to reduce malpractice insurance premiums. First they passed caps a year ago. Now they are requiring the med mal insurer to justify any raise in premium. It does this by giving the Department of Insurance the power to reject rates that are inadequate, excessive or unfairly discriminatory. It also requires a longer lag time between the announcement of a raise that the actual implementation.
The US Senate will take up two healthcare measures in May. The first is to allow small businesses to form association health plans. The second is a national med mal plan that would cap non economic damages at $750,000 per lawsuit and $250,000 per individual defendant. The Democrats are going to oppose it, since they get paid by the trial lawyers.
Tennessee has proposed legislation that would exempt Metro Hospital in Nashville from the cap on med mal claims as a government entity. The Hospital is owned by the city of Nashville. There does not seem to be any real reason for this exemption except to see the hospital close. Top
The Florida legislature has too much time on its hands. A bill that has passed the House Committee would limit the amount of satellite offices a physician may have. The rationale is that the satellite offices are usually run by nurse practitioners or physician assistants without a physician present. The new law would allow physicians to be more available for consultations. There are provisions in the bill specifically aimed at dermatologists as to how far apart the offices may be. The provisions would only apply to the private practice and universities would be exempt. The bill is supported by the Florida Medical Society in order to decrease the numbers of non physicians practicing medicine. Top
The CMS has proposed a new rule to discharge Medicare patients from the hospital. This would be a two step process. The first is a generic notice of non-coverage given to the patient on the day prior to discharge if the physician concurs that the patient is ready for discharge. The second step is to then have an expedited review as is in the Act. If the physician does not concur the hospital may ask for a QIO review.
In what might be a devastating blow to both specialty and community hospitals, CMS has proposed a change in the payment structure. The new changes would assign weights to to DRGs based on hospital costs and not charges. They would also change the DRGs to a severity based DRG system. This may stop cherry picking that some community hospitals have accused the competitive specialty hospitals of doing. It would go into effect this fall. Top
CMS has decided again to reduce the payments to physicians. This they do yearly and then Congress overturns it yearly. The problem is the original bill that calls for neutral budgeting. This was not well thought out as they forgot that as preventive medicine takes hold and more is done as an outpatient, there will be more done under Part B. If the bill continues unchanged then the plan is for a 34% decrease in payments over the next nine years, an impossibility. No physicians will continue to see Medicare patients and no HMO will continue in Medicare. Top
California is finally changing its reporting of HIV infected individuals. In a bill going to the Governor the state will go to a name based reporting system instead of a code based one. There will be no more anonymity. The reason for the change is, as with everything, money. The feds state the system must have a names based system to get money from them and the states dutifully comply. 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.