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There is in the Reform bill a $250 million put aside for abstinence education. This is a yearly stipend for five years. Programs must teach that abstinence is the only sure way to prevent out of wedlock pregnancy. There are those who believe that evidence based sex education shows that this teaching does not work. There is an additional $75 million for teaching abstinence and contraception and another $25 million for untested but innovative programs. States can tap into this largesse but if they do they have to put up $3 for every $4 they take from the feds.
Physician owned hospitals are getting the shaft from lobbying by the AHA. There are about 58 hospitals either undergoing construction or expansion with a total of $5 Billion frozen. The law prohibits the adding of beds, procedure rooms or ORs. The hospitals must have a end of the year deadline to be grandfathered in prior to the law taking effect. This stymies jobs and the economy but that is of no mind to the AHA who does not like any competition and will punish the country to get what it wants.
It will be interesting to see what happens when Obamacare really hits with full force. When the new presidential board takes the helm and starts to whittle away at benefits and payments. What will physicians do? Will those who can retire do so? Will new physicians be of the same quality or just quantity? We will just have to wait and see.
Approximately 28 states are in serious doubt about their ability to handle the extra patients under Obamacare. This means they will allow nurse practitioners to practice as independent agents and write narcotics. The advance degree nurses also want to be able to call themselves doctors. I wonder can an attorney with a Juris Doctorate call themselves doctor? I picked my physician as one with a family and who can not retire in the near future. He happens also to be the chief of medicine at the local hospital. Nurse practitioners are very good adjunct professionals. They, in my opinion, need some supervision and should not be allowed to write narcotics.
Georgia is the first state to opt out of forming their own pool for high risk plans. This means the feds must do it for the state. States have to April 30 to either opt out or join and figure out how to create the pools.
A sneak preview of the above may happen in the People's Republic of Massachusetts. They have their universal coverage and they are going broke. The Republic has just denied almost all the insurers increases in their premiums. Are the insurers going to just say OK? That is doubtful. They are suing the state and will probably pay less out per claim than they have been. The Republic is already in the negative column in keeping physicians trained there to stay there. Will more leave? Time will tell.
Maybe some of the newly retired physicians will want to continue to treat patients on a voluntary basis. That will be nigh on impossible due to the cost of malpractice insurance that they would have to purchase. California recognizes this and is attempting to rectify it. Almost all states do have laws protecting voluntary physicians. The state is considering the possibility of sovereign immunity for the voluntary physician to the detriment of the trial attorneys. The other possibilities are no malpractice unless gross negligence, an almost impossible standard or a state run insurance plan but there is no money to pay for it. Top
Modern Healthcare has a story stating disciplinary actions against physicians is up 6% in 2009. The major states that percentage wise increased their discipline were New Hampshire who went from 7 to 16, South Dakota did the same. Nebraska went from 32 to 69 actions. Florida and South Carolina's discipline decreased in the same time span.
In "I can't believe they did it" story a resident physician in North Carolina misdiagnosed a woman as pregnant and at term with no ultrasound and no fetal heart tones. The attending was called for permission to induce labor and when that failed to perform a C-Section. The kicker is the patient was not pregnant but had a psychological condition called pseudocyesis. It is a story true but not to be believed. The North Carolina Medical Board finally disciplined the attending for not confirming the findings prior to the Section which occurred in 2008.
The US Senate has again given a month delay to the Medicare 21% decrease. The House refuses to pass a bill that allows the increase plus the continuation of jobs benefits and balances the budget with something else. A Senator has proposed an amendment to increase the time to June 1 since May 1 is only two weeks away.
There are new CMS standards for hospitals that accept Medicare or Medicaid patients. The standards affect anesthesia, what it is and who may do it. Only those trained in anesthesia may perform it. Deep sedation is anesthesia. Hospital bylaws may determine who besides an anesthesiologist may do sedation or anesthesia. Some anesthesia assistants must have supervision depending on the state. Supervision means an anesthesiologist must be immediately available. A pre anesthesia evaluation must be done within 48 hours of surgery and documented. This can be done by whatever licensed person the bylaws specifies but must include what should be documented. There are also specifics which must be in the intraoperative record. Top
California has fined seven hospitals for poor patient care. This includes the first $100,000 fine in the history of the program. Southwest Healthcare System of Murietta was fined a total of $225,000 for allowing three C-Sections to be done in low humidity operating rooms using electric cautery which may have sparked a fire. They have now been fined six times and are appealing them all. I don't want to be there as a patient. Also fined were St. Joseph in Orange after a patient left with an empty oxygen tank and died. Kaiser Hospital in Fontana got two fines for leaving a sponge in a patient post Section and for improper sterilization which caused a patient to get third degree burns. St. Bernadine in San Bernardino got $50,000 for failure to remove all of a breathing tube from a patient post surgery. She coughed it up after she went home. Sutter CPMC in San Francisco was fined for allowing surgery on the wrong knee. Sutter Davis was fined $25,000 for injecting iodine into someone with an allergy to it and not having any protocols or physicians present during the exam.
The JC has reinstated anti-discrimination requirements for hospitals. They are in the Medical Staff chapter and do not allow discrimination in gender, race or national origin for privileges or memberships on the medical staff. Top
Nebraska loves to send cases to the Supreme Court. This time the state has passed a bill to ban abortions after 20 weeks since the fetus can feel at that time. The new law has exceptions for the woman's imminent death or a serious risk of substantial and irreversible physical impairment of a major bodily function. This means mental health is not covered under the exemption. There is a separate bill requiring providers to screen women seeking abortion for possible physician or mental risks. 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.