December 1, 2006  Legislation




New Requirements


The People's Republic of Massachusetts is finally joining the rest of the country in mandating that all patients with HIV be reported to the state to chart the HIV epidemic.  If the didn't report the feds would have withheld up to $15.1 million.

Gov. Romney of the Republic put in spending cuts for the Republic.  Part of those cuts are for education and notification regarding the new insurance mandate.  The governor used his emergency fiscal powers to cut $425 million.  Of that a mere $2.7 million was earmarked for healthcare education.

The cuts also have stopped all admissions at the Republic's mental hospitals.  It also means the letting go of about 37% of the people who do outpatient child and teen consulting.  After the mental hospitals have decreased their current patient load they could be reopened. In actuality the cuts were only 1.1% and the mental health folk are using methods to get the cuts restored.  

A story in the website tells about Humana talking patients into joining the HMO and not just the Medicare Part D plan.  After they sign up they find their physicians no longer will see them and some hospitals will not accept them.  CMS has had to intervene to get the people back on standard Medicare without penalty.  

The money in being a deeming authority is huge.  The JCAHO grossed about $106 million its accreditation and paid out about $100 million.  O'Leary was paid over $1.9 million in 2006, almost double over the prior year.  Fortunately for all concerned he is retiring in 2007.  The private side of the Joint took in an additional $40 million in publishing and consulting fess. This is also up about $7 million from the prior year.   

The FDA has fined the American Red Cross $5.7 million for violating blood safety laws.  This brings the total fines up to about $10 million for their blood practices.  Remember how the Red Cross gets its money.  From you and me.     Top


Florida is reviewing a death at Sarasota's Memorial Hospital that may have been caused by patient restraints and the hospital did not report to the state.  The incident happened August 3, 2006, and was eventually secretly reported by an unknown person to JCAHO.  That started the investigation and the eventual report to the state.  The hospital investigation turned up several other problems.  There were two other patients in which restraints were used without documentation as to the reason and a problem with the hospital's EHR system that does not allow all systems to be connected.  

The consulting group Ernst & Young has issued a report that states the IRS should accept a written report from hospitals on community benefit and not just have to answer a yes or no questionnaire.  The company was hired by the AHA.      

The GAO wants less payments from CMS to ambulatory surgery centers since they are done at a lower cost than the hospital.  The CMS has stated that they would pay about 62% of the outpatient hospital rate but the ASCs want 84%.          Top


Dr. Michael Wipf, a urologist, took out a 7 year old girl's ovaries unnecessarily.  He believed the child had a disease that affected the ovaries but the ovaries were normal on pathological inspection.  The state fine Dr. Wipf $2500 for his mistake.  The physician has also reached a med mal settlement with the family.  He was also ordered to consult with others in any other intersex cases and to complete extra courses in pediatric urology.        Top

New Requirements

Medicare (CMS) has published new requirements for completion of H&P, verbal orders, securing meds and completion of post anesthesia evals.  They are as follows:

    H&P  These can now be done on a different time frame and by more people.

    Verbal Orders  For the next five years they must be signed, dated and timed by either the primary physician or the person actually giving the order.  After that only the person actually giving the order can sign, date and time.  The order must be done within 48 hours unless there is a state law to the contrary.

    Maintaining Medications  The drugs must be kept in a secure location and locked if appropriate.

    Postanesthesia evaluation  The new rule allows any individual qualified to administer anesthesia and not just the person who actually did the anesthesia to write the note.   

CMS also released new rules for discharge.  Institutions must now tell admitted patients within two days about their discharge rights.  The signed initial form must be given to all patients two days prior to discharge if there has been two days between the original and the discharge.  If a patient wants a QIO review of the discharge, the hospital must give a detailed report to the patient.  This rule is effective 7/1/07.          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.