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OSHA inspected physicians offices for compliance with the standards and especially the blood borne ones. The cited 156 offices for infractions and fined a total of $51,000. During the same time frame there were 118 citation given to hospitals and nursing care facilities received 344. I remember when I was in solo practice, I would constantly bug Medicare regarding their erroneous claims denials. I won all I contested. Following that my office was singled out for an OSHA inspection. This is right after the blood borne regs came in. I was cited since one of my tags was the wrong color. No fine. They missed the bottle of liquor in the refrig with the culture supplies. Top
HHS Sec. Mike Leavitt said that physicians should be forced to switch to electronic records if they want to avoid the 10% cut in pay for 2008. The Senate will possibly require the use of e-prescribing for the overturn of the pay cut. Mr. Leavitt also stated that tying the physician pay cut reversal to a cut in benefits or payments to Medicare Advantage would be vetoed. There is expected to be another bill offered in the Senate to mandate e-prescribing by 2011 with some short term waivers for hardship. The problem will be the DEA has to date forbidden the use of e-prescribing for Scheduled drugs. Top
The latest blurb in the misnamed Medical Staff Briefing done by an organization that doesn't care about physicians, only hospitals that pay, states that hospitals should be careful on how much they spend on physicians. They can not get into the mode of wanting money back from the physicians at the end of the calendar year. It also states that Stark now allows professional courtesy for medical staff members. Stark made FMV easier by allowing one to use any of the four major benchmarket companies. The other changes also made easier CME and physician recruitment.
In a Stark problem in West Virginia, the state Health Care Authority ruled that physician may put CT scanner is their offices. The Governor has put that on hold until he can be assured that Medicaid patients will also have access to these scanners. The hospitals are pressuring the Governor not to allow the scanners in the office in their typical turf battles. The hospitals cry wolf regarding their having to treat all comers but the physicians of the state give the most uncompensated care. Top
Oklahoma is not happy with Humana, not that anyone is. They found the insurer was taking Medicare Advantage business from unlicensed agents. This is deceptive. The State fine Humana the maximum it could, $500,000. The Feds, whose job it is to regulate the Medicare Advantage plans, has issued a total of $600,000 in fines in total. Much of the problem with Humana's deceptive practices stem from its contract to sell its policies at Wal Mart and the confusion between selling the limited Part D and the expensive HMO product.
CMS has decided to only allow $16,000 for each radioinnunotherapy treatment. It sounds like alot but it costs $30,000. This may stop this therapy for all patients since if hospitals don't offer it for Medicare patients they can not offer it to others. It is used for non-Hodgkins Lymphoma where other therapies have not worked.
A study in the Annals of Emergency Medicine has shown that patients between 65 and 74 years of age in the ED have increased by 34% in ten years. It will increase even more in the future with Medicare scaling back payments to physicians who will stop taking new Medicare patients.
CMS has new rules for EMTALA. Prior hospitals with EDs in an emergency area would not be sanctioned for inappropriate transfers. The new rules narrow the original. There is now a waiver of sanctions if the patient was in the emergency and was not stabilized prior to transfer and it is now okay to triage someone away from the ED. The emergency must be declared by the President and a public health emergency declared by the Secretary of HHS.
The Pennsylvania Senate voted to extend a med mal subsidy for the next year but rejected a Democratic ploy to take money from the med mal fund to pay for adult health insurance. Those physicians that accept the money may not move out of state for at least one year. The House and the Democratic Governor may not go along with the plan.
California has added another insurer to the list of claims finagling. Blue Shield has been accused of 1262 violations of laws and regs by retroactively denying coverage to over 200 people after they filed claims. The problems were also not paying interest, poor claims handling and not paying claims promptly. The proposed fine is a mere $12.6 million. Blue Shield is planning to fight the fine. These violations do not include the insurer's HMO business. This is part of an additional investigation. Blue Cross already had a $1 million fine for their actions in illegally canceling the policies of 90 people. Kaiser was fined $322,000 for the same thing. Investigations into other insurers are proceeding as well.
In Maryland, the physician owned Medical Mutual Liability Insurance Society was going to declare a $68.6 million dividend. The state then stepped in and since the state raised the money to stabilize the med mal premiums by subsidy they want the company to return $84 million it received in the subsidy. The company agreed and also agreed to decrease the $68 million dividend to $13 million. The state was made whole before the physicians got any money. This is fair. Top
Greater Southeast Hospital of Washington, DC has taken the role of the worst hospital in the country from the now defunct King Hospital of LA. They have so many problems that they just got there accreditation remove. They also lost their accreditation in 2003 while under a different owner.
Some hospital administrators are there because they are too dumb to get a job anywhere else. The administrators of a state mental hospital in Morganton, North Carolina, didn't report deaths at the institution as required under state law. I'm sure it was just an oversight since at least one patient died from suffocation while being held down by the staff.
California has nurse patient ratios in acute care hospitals. A recent law suit to enforce the ratios in nursing homes was dismissed by a judge stating the state has never adopted regs to enforce the requirements. The 1999 law requires nursing homes provide at least 3.2 hours per patient day. In 2001 a law was passed to change to a fixed ratio. That law can not be done since it requires an additional $208 million in Medicaid funding in a broke and deeply in debt state.
California had a rule that all hospitals needed to be earthquake safe. Now the rules have changed. They still need to be earthquake safe just not as quickly. The Governor has given up to 20 extra years to become earthquake safe if you show that the ground the hospital is on is stable. It has nothing to do with how financially stable the hospital is, only the ground. Say good-bye to the small not doing so well hospitals. The original law states that retrofitting was to begin next month. To date, less than 25% of the hospitals are in compliance. The hospitals are spending a significant amount of money not on the safety but on amenities to attract patients and on money to politicians.
Georgia is still one of the backwards states that requires CONs. There is now a fight between the House and the Dept. of Community Health over the rules governing ambulatory surgery centers. Georgia already has a decreased number of general surgeons. The Dept. want to allow general surgeons to open ASCs. To no one's surprise the hospitals are fighting it by lobbying (paying) the legislators to not allow this to occur. The Governor wants changes in the rules.
All know that there is no love lost between the American Hospital Association and the specialty hospitals. The Physician Community Hospitals of America recently sent a letter to the presidential candidates. The AHA found out and then did the yada yada yada bit. They pulled out the trite they are making it hard for us to do our community service bit. A tired horse since they do so little community service. They are good at hounding patients for the unreal full cost of care and charging for care due to their own malpractice. I will say the both of the latter are on the wane due to the bad publicity, law suits and legislative regulation, not to the hospitals initiative. It should also be noted that in the latest figures, 2005, hospitals were paid 7% more than in the year prior. This is based on the charges and not the amounts actually paid. That certainly did not happen to the providers of care. 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.