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The New Jersey Assembly passed a malpractice reform bill that had been previously passed by the senate. The bill provides no caps on non-economic damages. The statute of limitations for those injured at birth would drop to age 13 from age 20. The Good Samaritan Act would now include all providing emergency assistance outside their normal duties and require court-ordered mediation and settlement proceedings prior to court. There would also be a $3 per year tax imposed on all employers per employee and a $75 fee on each physician to fund a $75 million package to help physicians and hospitals pay their malpractice premium.
New Jersey also passed a law that allows for more open discussion of medical errors. This means reporting serious preventable mistakes of state and to patients. Confidential reporting to the state by all but physicians is possible and these can not be used in court. All health care facilities except physician offices will have to set up patient safety committees to analyze errors. The committee work will not be discoverable.
In Massachusetts, the Senate passed a bill that would drop from 12% to 3% interest rates on malpractice judgments along with the requirement of approval by the Division of Insurance of all raises in malpractice rates.
The Iowa Governor vetoed a bill with a $250,000 cap on non-economic damages stating it would not significantly reduce costs or increase availability of medical liability insurance. He was wrong! Top
The Federation of State Medical Boards has passed a model policy for the use of pain medication. The policy wants the state boards to discipline for undertreatment of pain as they do for overtreatment. The policy would provide a safe harbor for physicians. Physicians may now opt out of treating pain patients on a daily basis and refer more quickly than before. The new guidelines are about the same as the 1998 ones where physicians are to document the nature and intensity of the pain, the current and past treatments and the effect of pain on physical and psychological function. There needs to be a written treatment plan with objectives to determine success and this needs to be reviewed periodically.
The Wisconsin Medical Society has released their version of pain management guidelines. The guidelines recommend early intervention to prevent chronicity and to refer to pain centers when the pain of the physician matches those they treat. The guideline also places an onus on the patient to take responsibility for resolving pain by adherence to long term treatments such as physical therapy and counseling which may not be covered by insurance. Lots of luck! Top
The Joint is again succumbing to outside political pressure and going even more outside their original duty of a deeming organization. The newest is to see that anesthesiologists use bispectral brain monitor during surgery to prevent awareness during the procedure. The anesthesiologists are wary of the study that showed that people are aware during surgery since the study was financed by the company that makes the monitor.
The Joint also is going to start evaluating staffing agencies ability to provide competent staffing services. This is being done for more money and not for their mission.
It is interesting that the total amount of complaints received by JCAHO were 8500 in 2003. Of these, over 1/3 were from state licensing agencies, CMS or accredited organizations. Of the total 21% generated a request for a response and 20% received other more in-depth responses. That leaves 60% with no response at all. The organization in its May JCAHOnline struts its good overall satisfaction but does not mention any negative responses to its own survey.
JACHO also is now requiring the hospital privacy/compliance officer to complete a grid that will be checked for accuracy during a survey. If the officer ranks any area of the grid below a 1 or a 2, the hospital must set up an improvement plan that again will be checked during a survey. Since privacy officers do not do JCAHO speak well or at all and administrators do not do HIPAA speak well or at all, it should be interesting. All answers need to be backed up with data such as the exact percent of patients that received the notice of privacy practices and what happened to the rest. It has been recommended that hospitals only do very simple and easily documented tasks for this onerous requirement.
In Maryland the State Health secretary criticized the JCAHO for being to close to the organizations it is inspecting. This truism was brought on by the fiasco at Maryland Hospital, where the lab lied about the testing it did. The JCAHO inspections were called collegial and laid back. The lab had been inspected about a year prior to the whistleblower event and was performed by the College of American Pathologists at the behest of and as part of the usual JCAHO accreditation.
In another political move, the Joint gave Drew/King hospital in Los Angeles full accreditation. The State Department of health is closing many of its units but the Joint only said they needed to fix some 14 relatively minor problems that have little to do with the quality of care provided. The supervisor of the district, who doesn't know much about the accreditation process, states that once a hospital has been in the press they have to be better than the rest to become accredited. This is not true. Top
The new guidelines explain the on-call requirements for physicians. If the hospital is short on numbers of certain specialists and the physician will come to the ED to see only their own patients and not all ED patients, it is a potential violation. This may force a push-shove relationship between physicians and hospitals. The ED physician may not refer the patient to the physician's office for initial treatment unless the office is on the hospital grounds and shares the same Medicare provider number. The hospital policies should state in minutes the response time of the on-call physician. It does not say they need to show up but only respond. If a physician sends a lower license individual to see the patient and this is in line with state law it is okay but the physician is still responsible. Top
The Louisiana legislature passed and the Governor signed a controversial bill to allow psychologists to prescribe psychological drugs. The pro side was to increase access. The con side was educational and oversight. The legislation requires psychologists consult with the patient's physician prior to prescribing drugs. The psychologists would also have to take a postdoctoral course in psychopharmacy. The prescribing psychologists would also be licensed by the psychology board and not the medical board. Top
Medicare is ready to delay payments to those providers who don't meet the HIPAA electronic transaction standards. All electronic claims that are not in the proper format will be treated as paper claims and not paid for 28 days. Those claims that conform will continue to be paid in 14 days. The differential will begin on July 1. It is imperative for all physicians to check the readiness of their vendors. The vendors will not be penalized, the physicians will.
In Maryland, a new law closes a loophole caused by at least one managed care company. The law originally read the company had to pay a claim in 30 days. The company did but did not mail it for another 60 days. The law now reads that the payment must be made and mailed within 30 days. This bit of cheating was found by a psychotherapist who noted the checks received had a date of a several months earlier than the postmark. 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.