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HHS Secretary Thompson has stated that HIPAA will be modified, but will become law on April 15. The law allows for changes by HHS for up to one year. The law will not take effect for two years. Changes that are already done are that primary care physicians may tell specialists about the patient and pharmacies may fill phone ordered prescriptions without prior consent. Also parents will have the right to inspect their minor children's health records, including abortion. This is the item that held the measure up in the Senate for several years allowing HHS to propagate their own rules.
In California, MediCal will need to be revised to conform to
less codes being used and possibly having less ability to track public health
data. The state has been criticized for not funding enough money for this
program. The reply is we do not know the final rules so let's wait.
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Medicare has expanded coverage to include intestinal transplants for beneficiaries with irreversible intestinal failure. The transplants would only be allowed at the U. of Pittsburgh, Jackson Memorial in Miami and Mt. Sinai in New York. Top
Massachusetts in trying to join Connecticut and New York as having long term care sold by a private public consortium. The bill would allow holders of these policies to qualify for Medicaid, regardless of their assets. If they buy policies while in their 60s their assets would be safe during life and after death. Normally Medicaid attaches assets after the death of the second spouse to pay for care provided during life. In Conn. if one buys $100,000 of long term insurance, the state will match the amount with Medicaid coverage. It is believed that this will save Conn. $95 million per year by 2016. In NY if one buys three years worth of coverage you qualify for Medicaid when your insurance runs out. Top
The commission is seeking responses to its draft standard for the effectiveness of staffing. They are not looking at nurse to patient ratios but want to incorporate evidence-based information that applies clinical and HR indicators.
JCAHO is now discussing if and how they should and would survey hospital owned physician practices.
JCAHO has also issued on it's web site www.jcaho.org a clarification regarding temporary privileges. I recommend this reading to you and your medical staff office personnel. Top
Since the legislature passed the regulation regarding nurse-patient ratios there has been considerable rancor over the "correct ratio." An April 3, 2001 LA Times article discusses the lack of any standards, including clinical data, to follow. Therefore any ratio eventually decided upon will be a political and not a clinical number. There is no debate as to the need for more nurses whose ranks were decimated by the HMO revolution and the emphasis on not hospitalizing patients. There will be a shortage of about 25,000 nurses in the next 4 years. One of the largest problems is the lack of available nurses, no matter what the ratio. Also, there is the nurse fight whether hospitals should restart their own nursing schools or the new nurses should be college trained.
The Assembly Health Committee passed AB1075 that sets nursing home nursing ratios. The bill states that caregivers should not take care of more than 5 patients during the day, 10 in the evening and 15 during the night. The bill does not offer any more money for the care legislated. Top
Alaska Senate passes Antitrust Relief
The state Senate passed legislation to allow physicians to collectively negotiate with insurance companies over fees and necessary care. California has been asked to pass similar legislation but to date has not. Top
The Texas Department of Insurance states insurance companies that are late payors will be under state oversight. If they do not mend their evil ways the state will essentially run the business with the threat of $1000 per day fine per late payment until the claims are paid in a timely fashion. Top
The Kentucky Medical Board is warning physicians about receiving gifts from pharmaceutical companies. Any gift should be educational and of benefit to the patient. Some physicians have accepted car washes and pedicures. Top
Stark Delayed
In another blow to the Clinton last minute regulations, the Stark Fraud and Abuse regulations have been delayed to at least June with a new open comment period. This may delay the implementation significantly. The Stark rules now join OSHA and until this week the HIPAA regs in administrative limbo. OSHA has already been killed by the Congress and new rules are being written. The administration is not permitted to simply revoke the rules but must to through a reasoned decision making process and must give the reasons for the changes. Top
The state Department of Health has blasted 143 bed Mesa General for their poor patient care. Many of the problems are traced to staff shortages. Some of the problems were medication errors in half of the patients and this was not found by the hospital QA program, vital signs were not monitored in patients receiving blood transfusions and poor record keeping by physicians and staff. The hospital has to April 23 to clean up it's act or potentially face the removal of Medicare funds. Top
Sen. H. Clinton has proposed a bill to double the annual funding for medical education to $17 billion. This provide special accounts for teaching hospitals and medical schools. She discussed the national nursing shortage but provided no funds for training more nurses. Top
Public citizen, a Ralph Nader group, published a list of the best and worst Medical Boards in the country. Their criteria was the same as the California Board, fuzzy math. The said that a state was good or bad if they disciplined more physicians per capita. The study does not take into account whether or not there are less physicians that require discipline nor what the norm should be. The harsher the discipline the better the state. This is stupid! In my opinion this is one study where I would want to be the worst.
In the People's Republic of Massachusetts the Medical Board has fined two Boston Medical Center neurosurgeons $10,000 each for professional misconduct. The charge was for doing a procedure called omental transposition. The omentum is stretched to the spinal cord in the hope for restoring nerves. The patients were paraplegic. This procedure is done in other parts of the world. No patient was harmed and some reported improvements. the problem was there was no control group nor adequate follow-up and therefore could not be considered a bona fide experimental procedure producing "scientifically or medically useful information". There was also an element of falsehood since a person posing as a physical therapist recruited patients for the study so she could collect rehab fees for her center. The surgery has been done on 26 patients and so far 12 have sued the Boston Medical Center. The Center has settled nine to date. 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.