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JCAHO & Unilateral Amendments Is the Hospital a Friend? To all those medical staffs who believe the hospital is your friend, I am enclosing a part of a letter put out by the California Hospital Association supporting the ability of hospitals to unilaterally change medical staff bylaws. Let us hope their side will not prevail with the JCAHO, but they do pay alot of money to the organization. This is dated 8/5/03: Background Kentucky has allowed one malpractice carrier a 29% raise in premiums for the coming year. The insurer wanted 157% raise in insurance for hospitals. Approval is required for any raise over 25%. The Insurance Commissioner also denied a 57% increase to another company, which then reduced the increase to 40%, which was approved. Florida has postponed the August 5 third special session of the legislature to deal with the malpractice crisis in the state. He believes that more time will allow the negotiators to come up with a better bill prior to having the legislature meet. Top The embattled Washington DC hospital, Greater Southwest Community, that is in the middle of a political battle between the politics of DC and the JCAHO, has stated it will satisfy the city requirements within 60 days or close. This gives the city, not JCAHO, the power to shut them down if they do not walk the walk. This is the second ultimatum to the hospital. It ignored the one in March and so did the city. Washington DC is to give a list of things that must be done at the hospital within 60 days or the license will be lifted. This included hiring a new permanent director of the ED, shoring up their medical records and equipment maintenance. The hospital has agreed to the terms set out by the city to remain licensed. There must be at least two ED physicians at all times. There must be ED core nursing staff and provide triage within 30 minutes of arrival. They also have to improve equipment and maintenance along with their record keeping. As I have said before, there is no way the city or the politically motivated JCAHO will allow this hospital to close. Top The Washington State Office of Insurance has declared that boutique medicine is dead. The Commissioner believes that it is illegal under the Washington State law. This includes both retainer fees and monthly fees for quick access. The only way the physician can charge the retainer fees is if they have no insurance contracts with the patient's insurers, if the fees do not cover any medical services and if the patients are uninsured. The commissioner believes these are insurance fees and therefore he can regulate them. This will probably challenged in the courts. Top CMS has decided to markedly decrease the money they are paying for the few medications they pay for. This mainly involves oncologists. The current standard is for the oncologist to administer the cancer fighting dugs either in the hospital outpatient setting or his/her office. If done in the outpatient hospital setting the oncologist does not make any money except for a visit but has no expenses either. In the office the oncologist has the medication delivered by his nurse and the payment is for the drug and some small amount for the administering of the drug. Under the new way the amount paid for the drug will be significantly reduced and the payment for the administration will be somewhat increased. This means a continued overhead for the physician with less income. The only way to halt the free fall is to transfer care back to the hospital setting and get rid of now unneeded salaries. If the physician has the patient pick up the medicine at the pharmacy they will still have the office overhead for the nurse. They will only be punishing the patient and not acting like a prudent business person. Top A physician has quit the Massachusetts Medical Board to publicize the faulty nature of the Board. There are over 400 cases of unexpected deaths and other potential problems that are backlogged and not even read to prioritize or triage. This is the second physician to quit for the same reason. The first was the medical board's chair and this one is a former editor of the New England Journal of Medicine. The problem stems from lack of money for staff to reviewing the reports from hospitals as well as internal politics. They accuse the Executive Director of putting too much money into the taking of licenses and not enough into the nonpunative safety program. Top California Legislation to be Signed Potentially lame duck Governor not only is naming judges as fast as he can but is finally getting around to signing legislation. Some of the health related measures that should be signed very soon are the requirement that schools teach age appropriate sex education, uniform guidelines for emergency contraception, the limitation of what a pharmacist may ask or charge for emergency contraception and the requirement that insurers can not increase premiums for abortion clinics because of claims for hate crimes. It also increases the definition of hate crimes against abortion centers. 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.
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