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New Mexico's new law of medical marijuana does not allow the individual to grow the medicine. It requires the State to directly go against federal policy and grow all the medical marijuana itself. The Department of Health must license the growers. The Department has asked the state attorney general for an opinion regarding the liability of the individuals in the Department.
The state of Washington is to decide what constitutes a two month supply of medical marijuana. The actual amount has never been decided even though the law has been on the books for a decade. The truth is that the amount will vary from patient to patient and will vary over time. Any amount chosen by the pols will be arbitrary and will not be scientific. Top
BC Life and Health, a California Blue Cross company, revoked 1880 individual health insurance policies in 2004 and 2005. To date, the Department of Insurance has reviewed 83 cases and issued citations against the insurer in 49 cases stating there were 67 violations of fair claims handling. The fines for the BC errors can be up to $10,000 per violation. The BC spokesperson sounds like she intentionally misspoke when she stated that the citations were for technical violations and that "in nearly every case, the DOI concluded that the recession was appropriate." In fact, there were 32 cases of failing to pay claims where liability was clear (no recessions were due), 27 cases of not having standards for investigation of claims (some recessions should be reversed) and 4 cases of lying to consumers about policy provisions. This is different from the $1 million fine Blue Cross already received from the state for its cancellations of individual HMO contracts.
In the People's Republic of Massachusetts, the Blues are now allowing small employers to purchase medical health policies for their employees if they are only going to pay 1/3. Until this month and the new state health plan all the employers had to pay at least 1/2 of the premium to get the insurance. The stupid legislators put the 1/3 into the law when it was passed last year. Now they are waking up to what is happening. Top
CMS has issued regs that tighten some of the Stark laws. An entity now includes an individual physician or any legal form thereof. If compensation is set in advance it applies to the revenue from physician personally performed work. If a billed designated health service is denied due to being a prohibited referral, the burden will be on the billing entity to show that the service was not prohibited.
CMS has continued on its path of having less physicians be a part of its Medicare network and more problems of access for seniors. They have decided that the payments to physicians will be reduced by bout 10% but then will add payments for their quality measures under the Tax Reform and Health Care Act of 2006 (TRHCA). The new recommendations, if approved, will begin January 1, 2008.
A new reg regarding purchased tests from the CMS states that physicians may not bill more than the supplier's net charge or the physician's actual charge or the fee schedule amount for either the technical or the professional amount.
CMS has given warning to Christus Santa Rosa in San Antonio, Texas; Abbott Northwestern Hosp. in Minneapolis and Vincent Hospital in Indianapolis, Indiana to shape up their transplant programs or they will lose funding. They perform less than the required amount of transplants per year to keep proficient. Top
It finally looks like its going to happen. The worst hospital in the US (for those that saw Sicko, is not a private hospital but a government one) is on the verge of closing. California has outlined their case for closing Martin Luther King Harbor Hospital. In a 32 page document they outline all the problems of the hospital and its injuries to patients.
The Governor of Rhode Island vetoed two bills recently. The first would have forbidden hospitals to mandate nurses working overtime and the second would have required payors to help the hospitals who are not getting paid their co-pays or deductibles. The legislature hopes to override the vetoes. Top
I know many of you do not follow, unless you need to, the foibles of the JC. They have just put out their 2009 Leadership Chapter. The introduction states that all leaders including the medical staff have the opportunity to participate in discussions but it is the Board that has the final decision on how leaders work together. It behooves all physicians to read this carefully. Most are common sense but some have changed dramatically. I will point to some of the Standards.
LD 1.30 The governing body will have a representative of the medical staff and that representative will be picked by the staff not the Board.
MS 1.10 has moved to LD 1.50
LD 2.20 states that conflicts of interest will be addressed by all three parts of the hospital, Board, administration and medical staff. The conflicts of interest may relate to business interests including actual or potential conflicts. However, these conflicts only apply to those who are on the leadership group and not the rank and file.
LD 3.30 states that leaders create and maintain a culture of safety and quality throughout the hospital. This includes setting a code of behavior including disruptive behavior for all in the hospital. This includes anything that threatens the morale of the staff or increases turnover which in turn harms care. However, the standard goes on to say that open discussion of issues of safety and quality should happen.
LD 4.30 states that organizational programs, services, sites or departments are effectively managed. Under the elements of performance it is stated that departments do not have to under a physician but any qualified professional. It does not define who would be a qualified professional. This is a major error as a psychiatry department may be led by a non physician psychologist.
LD 4.100 This standard is about conflicts of interest, including services. It states there will be disclosures of potential conflicts as defined by the hospital.
LD 4.130 defines the ongoing treatment by the needs of the patients not the ability to pay.
There are several standards regarding contracted services such as telemedicine.
The JC also made final the contentious MS1.20 Standard. This will make some hospitals very angry but will put the power of the bylaws back where it should be with the medical staff, not a small group that may be controlled by the administration. All the important aspects of the credentialing, privileging, hearings and elections must be in the bylaws. Also the medical staff can intercede if they believe the MEC is not acting in the entire medical staff interests. The new standard goes into effect in two years. It will be interesting to see the moaning and groaning about the hard work (not) that will be required. The MS Standard also potentially contradictory to LD 4.30 since it states the Department Chair will be certified by the an appropriate board or other competence as deemed appropriate by the medical staff not the hospital. Looks like the power is going back to the med staff and away from the administration. Top
Tennessee has passed a law that goes into effect on January 1 restricting physician movements. The law that exempts radiologists and emergency room physicians allows the physician's employer to restrict the physician that leaves the employer from practicing in either the county or a ten mile radius, whichever is greater and for up to two years. The Tennessee Supreme Court has already disallowed non-compete clauses. Part of the new law allows physicians to pay their groups a sum of money to be released from the non-compete agreements. This law will be challenged and the result will be interesting. The states are mixed in their laws on this subject with some saying a non-compete with an employee is against public policy and some allow it for all. 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.