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California's Department of Managed Care has issued an edict that HMO enrollees must be treated by a physician within 10 days of requesting an appointment for primary care and 15 days for specialists. Patients seeking urgent care that does not require prior authorization must be seen within 48 hours. All telephone calls to physician offices must be returned within 30 minutes and physicians must be available 24/7. This is supposed to reduce the ED visits. The rules will be phased in over two years. The HMOs will not be able to accomplish this unless they markedly increase the numbers of patients each physician sees or hire many more physicians, an unlikely scenario. Apparently there is a usual loophole that the physician may delay the appointment if they decide the delay will not have a detrimental impact on the health of the patient. HMOs who do not follow the rules may be fined per incident. Top As all know the election of a Republican in the People's Republic of Massachusetts was a repudiation of Obama policies, especially those on healthcare. This occurred after Obama went to the state to attempt to get the Democrat elected. The light is now coming on in Washington with Pelosi stating that the votes are not enough to pass the Senate version of healthcare. This means it is or should be dead and should be revived as a bipartisan measure. The other alternative is for the House to pass the Senate bill and send it to Obama. The worse alternative is to have the House and Senate agree on a compromise, have the House pass it and then have the Senate use the reconciliation process. This would kill the Democratic party. Speaking of the People's Republic, Governor Patrick is calling for an additional $75 million for their flawed health plan. This is to pay for the healthcare of legal immigrants. Florida's Governor has suspended the normal rules for hiring traveling nurses while the usual nurses are in Haiti causing a shortage of nurses in the state. Top The Joint Commission has added a new sentinel event. This one is for the pregnant woman. Hospitals are to educate physicians about hypertension, diabetes and obesity in pregnancy. The hospitals are to have specific protocols for treating pregnant women who have changes in their vital signs. Emergency room physicians are to consider whether each female patient is pregnant or was recently pregnant as this may affect response to treatment. If women have been identified as high risk they should be transferred to providers that specialize in the treatment of high risk pregnant women. All women at risk for pulmonary embolism should have compression stockings during C-Sections. There are now three organizations to accredit radiation facilities. The one already in place was the American College of Radiology. Joining them will be the Joint Commission and the Intersocietal Accreditation Commission. Starting January 1, 2012 all imaging providers must be accredited to receive Medicare money. Top California has fined 13 hospitals up to $100,000 for patient safety problems. The fines start at $25,000 for San Francisco General for leaving a sponge in a patient. Kaiser Oakland got a $50,000 fine for giving a 90 year old medication meant for another. This caused a myocardial infarction. JFK Hospital in Indio received the highest fine of $100,000 for four incidents of failing to monitor patients and medication in 2008. Top National Practitioners Data Bank The Bank will on March 1 have in its database all licensed healthcare providers including Podiatrists, Nurses, Chiropractors and Psychologists. Prior they only had physicians and dentists. 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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