San Francisco Sex Change
Only in San Francisco. Starting July 1, San Francisco will allow benefits
for a sex change operation. This includes the surgery and associated hormone
treatments and related medical needs. This is called a civil rights issue
and equal benefits for equal work. It also relates to a city medical fund
that is now flush with money. The cost for the surgery from male to female
is about $37,000 and about $77,000 for the reverse. The city is to cap their
expense at $50,000 for life. It also expects a co-pay of 15% if a city
affiliated physician does the surgery and a 50% co-pay if another physician
does the surgery. The potential patient would need to be on the payroll for
at least a year before becoming eligible for the benefit. This benefit will
add $1.70 per month to all employees in the Health System. Top
California Consumers ask for all
Documents in Health Care Arbitration Disputes
Two consumer groups have asked the Department of Managed Care to require
health plans to disclose all documents and information obtained during a
health care dispute resolution. The groups state this would give
"patients the edge" in negotiating with health plans over health
care disputes. This would unlevel the playing field and give rise to
significant privacy issues. One of the great benefits of arbitration is the
ability to have confidential settlements quickly. If this goes through, I
believe the plans will lengthen the process to protect their name. This will
add significantly to the costs of arbitration. Top
Medical Board of California Bureaucratic
Thinking
The San Diego Union-Tribune reports that the Medical Board of
California executive director, Ron Joseph believes that hospitals are hiding
bad doctors. He bases this on the theory that since patient complaints to
the Board have increased there should be an incremental increase in 805
reports from the hospitals to the MBC. In fact there has been a decrease in
805 reports in the past 10 years from 282 to about 100. He and Sen. Figueroa
feel hospitals are not reporting due to fear of bad publicity. These two
smart people want random audits of hospital peer review reports by the MBC.
They don’t take into account that many MBC complaints are trivial and
based on office communication problems, not involving hospitals.
Fortunately, the CMA testified that focusing on 805 reports make little
sense. There is no standard to judge how many reports should be generated in
any setting. If the MBC wants to focus on something, they should try
focusing on those managed care organizations (Permanente Medical Group) that
do not report physicians when during malpractice settlement the physician
names are dropped and only the organization remains as a party to the suit. Top
Medical Marijuana
In the continued swing toward state sponsored medical marijuana
initiatives, the New Mexico House Public Affairs Committee has passed 5-3 a
bill to allow medical marijuana in the use of certain diseases. The bill is
supported by the governor and would update New Mexico’s current policy for
marijuana use only for medical research. Top
Bush Delays HIPAA
Secretary of Health Thompson has delayed by 60 days the implementation of
HIPAA. This is to allow a new 30-day comment period. The new start date for
HIPAA is April 14, 2001, with compliance two years after. President Clinton
promulgated the orders under HHS since Congress failed to do so. However,
Clinton’s HHS forgot to send them to the GAO for their review, thus the
delay and possible changes. Top
FBI Wants More Money for Health Care
Fraud Investigations
The FBI wants to continue to prioritize health care fraud and the highest
white-collar crime. In order to do that they have asked for an increase in
their funding. In the past year the FBI has recovered $290 million in fines
and repayments plus the large HCA and Bayer Settlements. They have also
gotten 560 federal convictions. The FBI believes that about 10% of health
care spending is lost to fraud each year. This is about $100 billion. If
this is true, does anyone wonder where we can get more money for Medicare,
Medicaid and the uninsured? Top
JCAHO
The JCAHO in its new patient safety standards wants hospitals to focus at
least once a year to prospectively doing risk assessment. A new Sentinel
Event Alert allows hospitals to use a model to help them meet this standard.
The web site is
www.jcaho.org/edu_pub/sealert/sea16.html.
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Nursing Training
A new bill has been introduced into the California Senate that would
expand nurse training programs and create scholarships and loan forgiveness
programs for nurses that work in underserved areas. The author wants to
train an additional 4000 nurses each year. Currently about 5000 nurses
graduate each year from California nursing programs. The bill (SB317) would
allot $30 million to training programs in the first year and
"additional funds thereafter". Top
Institute of Medicine has New Report
The IOM has released its new report on the quality of medicine in the
United States. This report makes recommendations for increased quality and
communication improvement. It can be seen at
www.nationalacadenies.org/.
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