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The Oklahoma State Board of health has given permission for United States Pharmacopoeia (USP) to be a liability free reporting ground for Oklahoma hospitals to use to report medical errors. This type of thinking is what is needed by the other states that wish to utilize voluntary reporting. Top
The California Department of Health Services is holding public hearings regarding a proposal to report HIV using a code. The code would include the date of birth and the last four numerals of the social security number. The reporting would only be from confidential centers and not from anonymous testing sites. One of the concerns is in the immigrant population. The State needs to track HIV by 2002 under CDC Guidelines and by 2005 in order to receive its share of Ryan White Funds. Top
As of May 1, 2001 California IPAs will have to report their solvency status. They will need to report claims and available cash with other reports later. The problem is the State can not force the IPAs to comply and can only publish the names of those that do not comply. The East County Medical Group has just finished converting all primary care physicians to capitation and stated they will pay the back money owed over four years. Yes, there are some physicians who agreed! Some physicians have reported the organization to the Department of Managed Care for special audit. Top
HHS Secretary Thompson has delayed a Clinton regulation allowing nurse anesthetists to provide anesthesia services to Medicare recipients without supervision. The regulation has been delayed another sixty days and been reopened for public comment. The current rule would allow governors to decide whether or not nurse anesthetists could give anesthesia without supervision. HHS is proposing that the governors get the approval of state boards of medicine and nursing. Top
The California Medical Association is not giving up. They are again pushing a bill to allow physicians to come together to negotiate with health plans. This time they are attempting to characterize it as a dispute resolution plan between physicians and health plans. Assembly Bill 1600 is to use binding arbitration as the mode of settlement. For some reason the California Association of Health Plans do not want the "ridiculous, unwarranted" bill to pass. Top
Although no bills have passed as yet, there are signs of activity at various statehouses on the economic credentialing issue. Please see my piece in the May 15 News section and the May 1 Legal section of Medicalaw.net. An article in the May 2001 Modern Physician states that Illinois, Arkansas, South Dakota, and Tennessee have had bills limiting the use of this terrible criteria introduced in their legislature. To date all have been defeated but that was the battle, not the war. Top
On May 21, 2001 JCAHO announced a six month delay in the required collection of core ORYX data. the new start to collect date is July 1, 2002. This data is to begin to be reported on January 1, 2003 for the first quarter. I was the JCAHO Chair of my hospital when ORYX was started and I would advise all hospitals to begin now researching what data is needed and how the data can be collected expeditiously. If your computer systems are not set correctly you will not be able to easily collect the data and many man-hours will be wasted with this ongoing project.
JCAHO has issued a clarification on granting temporary privileges. They state that temporary privileges would be acceptable in two instances. The first is to fulfill an important patient need such as when a physician becomes ill and an LIP would need to take over the practice until the return or someone has a particular skill which is not otherwise available. In this one would need to verify the current licensure and current competence and be a recommendation to the CEO by the medical staff. The second circumstance for a temporary privilege is for a new applicant waiting for review by MEC and Board. This can not exceed 120 days. Here there needs to be verification of licensure, relevant training or experience, current competence, the ability to perform the requested privileges and any other criteria required by the bylaws. Also the NPDB needs to have been queried and the application is complete and without red flags. Top
Maine Prescription Legislation
Maine passed a law stating that control prescription drug prices. A new program called MaineRx would negotiate with drug companies to receive low prices for drugs for the uninsured. If MaineRx can not get "significant price concessions" by 2003 Maine will establish mandatory price controls on all prescription drugs. This sounds illegal and was challenged in court. There was an injunction placed on the program and the 1st Circuit Court of Appeal dissolved the injunction, a most controversial decision. The Court ruled that no federal commerce clause rules are broken since it only is confined to its own state. This goes against many past commerce clause rulings by the US Supreme Court. Top
Maxicare Goes Under Again
Maxicare, the first HMO to go under in the 1980s, has done it again. The State of California Department of Managed Care has taken over the financially insolvent HMO. The Department cited poor finances, poor quality preventive care and handling of patient grievances. Maxicare has filed for bankruptcy but the Department thinks the filing is illegitimate. Top
The United States Supreme Court in the usual 5-4 decision stated in NLRB v Kentucky River Community Care that if nurses use independent judgment in directing employees such as aides or LPNs, they are supervisors. As supervisors they can not unionize. 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.