December 1&15, 2004 Legislation
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The Center for Medicare and Medicaid Services (CMS) has issued a letter to its state survey agency directors on what to look for in credentialing hospitals. They state that the medical staff must insure that the practitioner has the ability to do all the procedures granted to him/her. This means that core privileges should not be given to all members of a Department. They should be tailored to the individual physician. Anything above the tailored core privileges must be specifically given to the physician. The Board has the final say on all privileges. The surveyors are to look at the process and determine if it complies with the Conditions of Participation. The privileging process must be in the medical staff bylaws. The process must state criteria for determining the privileges that may be given to practitioners and a procedure for applying the criteria to the individual practitioners. The letter goes on to say that if core privileges are used that the ability of the practitioner to perform the entire roster must be assessed. It also states board certification is not a recognized basis to bestow privileges. This is to be in force immediately and should be disseminated within thirty days and training given to the inspectors.
The Joint has doubled back. After sever weeks ago giving Harbor General in Los Angeles a conditional accreditation, it now states that it is fully accredited. This came after the hospital challenged the Joint's findings.
The Joint continue to put its nose where it doesn't belong. It has now inserted itself in the pay for performance programs. It has set up a group of guidelines for the use of pay for performance, including the measurements of metrics. This is usually a harbinger of their attempting to make money out of their guidelines. Top
In Massachusetts a physician who left a sponge in a patient received a reprimand. The physician had been warned that there was a sponge missing and he closed anyway. The licensing board also gave five years probation to a physical medicine physician for sexually abusing his office manager and patient. The Board revoked the license of a psychiatrist for Medicaid fraud and writing a prescription for an addict. He had prior convictions for the same thing. Top
Pennsylvania has continued to subsidize about 30,000 providers who pay into a state run catastrophic medical mal insurance. Some rural high risk specialists would pay nothing into the fund. Most of the others would pay about half of the usual amount.
The Maryland Senate has stepped back slightly from the precipice and agreed with the Governor to create a fund to subsidize four years of med mal premiums. The Senate also agreed to lower the proposed caps on non-economic damages from $1.6 million to $975,000. The Governor and the physicians wanted a cap of $650,000. The Senate committee voted to raise the money for the med mal premium help by a 2% tax on HMOs. This would raise about $80 million per year and could also help increase the Medicaid payments to the physicians. The Senate panel also endorsed forced mediation between the parties prior to the trial, freezing the existing cap on non-economic damages at its current $650,000 for the next four years instead of the $15,000 per annum increase, allowing physicians to apologize and not have that used in court against the physician, bar attorneys from filing malpractice suits if they bring three frivolous suits in a five year period.
The Governor wants to use state surplus money to help fund the 33% malpractice increases of the physicians. This will probably never get through the legislature. Top
California has passed a law the would require ALL companies with 50 or more employees to train their managers to handle sexual harassment. This must be done every two years by instructors with knowledge and expertise in the prevention of on the job harassment, retaliation and discrimination. If they don't do this, there is no penalty but if it is found out they don't then the state could look at other business practices. Top
The DEA has listed a new set of rules (guidelines) on their website. They have gone back on their previous statements that they removed when they realized they may be used against them in a case in Virginia. The new ones are more harsh and do not comport with the recommendations made by their consultant pain physicians. The new guidelines will force physicians and patients back to the dark ages in pain relief. The DEA now states that the number of patients in a practice receiving pain meds, the number of tablets prescribed and how long the therapy lasts are all potential indicia of problems. The DEA also stated that giving patients prescriptions dated later to allow the patient from having to have another office visit is illegal. The DEA position will keep physicians fro practicing good medicine and will lead to unnecessary patient suffering. Top
The Bush administration has voiced strong support for medical technology innovation, including the electronic medical record. That support did not get to the Congress as the recent budget did not include a $50 million request for the support of health information demonstration projects. 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.