The bill sponsored by Congressman Campbell to allow physicians to be exempt from antitrust laws passed the House by an overwhelming vote (276-136). It then went to the Senate where it is essentially dead. Campbell can get no Republican or Democratic Senator to sponsor the bill. Why is that, you may ask. The Democrats do not want to help since Campbell was running against Diane Feinstein for the California Senate. The Senate Republican leader, Senator Lott, believes that the passage of the bill would lead to more law suits and more labor unions. The Republicans are also not happy with the AMA for their stand in favor of the Democratic Patient’s Bill of Rights. The Allied Health Practitioners are also against it. They believe they will be left out of any bargaining demands. The good news is that many state legislatures are considering proposal to allow some joint bargaining. California, thanks to the CMA, is one that is still considering it, but not very strongly.

JCAHO has stated in its recent newsletter that HR standards do not apply to volunteers but do apply to contract personnel. The institution may both review and adopt that contractor's policies or have their own and require the contractee to conform to theirs. The verified information required, depending on the relevancy, is education, licensure, evidence of one’s knowledge, experience and competence, evaluation, health, criminal background checks, and references. The contracted organization or individual or an audit of information may supply verification by the contracted organization. Audits must include an attestation of the accuracy of the information. When a JCAHO institution contracts for staff they must also define the requirements and review the practices of the contracted organization for compliance with the requirements. If the contractors are not doing the necessary things the organization can do their own checks.

Documentation authentication time is up to the individual institutions or state law. Whatever the institution decides must be complied with. If the timeframe is in hours the signature and date must include the time of the signature to ensure compliance.

Operative reports summaries must be written immediately post operative and prior to the patient going to the next level of care, the post anesthesia care unit.

The top ten hospital accreditation problems are HR.5, competence assessment; TX.3.5, Care; IM.7.7, Patient Data; PE.1.7.1, Assessment; HR.4.3, Staff Education; IM.7.3.2.2, Patient Data; PE.1.7, Assessment; IC.4, Infection Control; LD.1.3.4.2, Leadership, and PE.1.3 Assessment.

No credentialing nor privileging are required for organ harvest teams coming to a hospital if the Organ Procurement Organizations (OPO) and the hospital have a memo of understanding that the OPO will only send qualified, trained individuals.

Happy news. The JCAHO will begin conducting surveys during the evening, night and weekend shifts for full surveys. Those organizations surveyed about this were overwhelming in favor.

The survey for compliance of restraint and seclusion standards for one hour face to face meetings by physicians or other licensed independent practitioner with the proper authority in the medical and surgical floors for behavioral problems or in behavioral health floors or institutions began September 1, 2000. One needs evidence of performance via medical records, restraint logs, policies and procedures, staff interviews and patient interviews. This includes side rails and gerichairs when they restrict a patient’s movement. One must consider and document what may happen if the restrain is used versus what may happen if it is not used and is it the least restrictive means.

As mentioned in my July and October 2000 newsletters, JCAHO has changed some of their criteria. The ones that affect the medical staff the most are (1) what needs to be the policy if a patient undergoing conscious sedation inadvertently slips deeper into moderate or deep sedation; (2) Fair hearing procedures for AHPs; (3) When a physician only covers the institution by telemedicine you do not need full credentialing, but do need a policy; (4) Reappointment information must contain specific Performance Improvement information about each specific practitioner as compared to peer data and (5) how to have effective peer review policy. Please go to the JCAHO web site for detail on these standards, www.JCAHO.org.

Another national consulting firm has just come out with a new impaired physician policy. The policy preamble states that (1) the impaired physician is not entitled to a fair hearing and (2) the hospital CEO plays a significant part of the process with the medical staff leadership. "This is because an impaired physician is a hospital concern, not merely a medical staff problem." This consultant, who works for hospitals, believes the CEO should be the point person. I agree that both the hospital and medical staff need to be involved but I believe that the Chief of Staff should be the lead and give reports to the CEO. A different way, but one that keeps control in the hands of physicians and not administrators. For my views please see the article on disruptive physicians at
www.medspectrum.com.

Physicians who wish to copy information such as licenses from their own files should be allowed to do so except for those items such as confidential letters of reference. Each hospital medical staff should have a policy stating their copying policy. The physician should be allowed access to all information in their files except for the letters of reference and be allowed to place rebuttal statements in the file.

The URAC, which credentials managed care organizations, has gone to a three-year cycle and removed the requirement for primary verification of hospital privileges. They have also gone on some standards from "must" to "should." Sounds like they want the business.

The People’s Republic of Massachusetts suffered a setback when the voters went against Question 5 that would have mandated a 17-person committee implement a system to guarantee comprehensive health coverage for all residents by July 2002. It also mandated that HMO’s administrative costs and executive salaries not exceed 10% of the revenues. Lastly, it would have banned the entry into the state by for profit health care plans. I have no idea what is meant by comprehensive health coverage nor how this was to be financed. I also do not believe that any business can be mandated into what their overhead may be.

California passed Proposition 36 that allows first and second time drug users to be placed in rehabilitation instead of or in conjunction with jail time. This will cost the State an additional $120M per year and was opposed by law enforcement officials, the governor and many drug court judges.

In California we have Proposition 215 that allows marijuana use with physician recommendation. Colorado voted to also allow patient use of marijuana use for certain diseases. These patients would be in a state database. As in California there was no provision for distribution. The Feds stated that they will continue to classify marijuana possession as a crime, but small amounts will probably not be prosecuted. Nevada has also gone with marijuana use for certain conditions by passing a state constitutional amendment by a 65-35%vote. Alaska went the other way by voting down a drug which would not only have legalized the drug but would have given amnesty to those previously convicted of marijuana crimes. In the most interesting election to me, the citizens of Mendocino County, California voted to allow county residents to grow 25 marijuana plants each. I have a feeling we have not heard the last from this county.

OSHA has had for the past 18 years a voluntary facility inspection where qualified institutions are removed from the routine scheduled inspection in exchange for approval of the facility. OSHA also agrees that if you voluntarily comply there will be no penalty levy for noncompliance. This is for institutions and companies that have comprehensive safety and health programs. Only three hospitals have taken advantage of this program. Blake Medical Center in Bradenton Florida just finished the voluntary inspection. Minor faults were found. No penalties were assessed. Blake had reduced their lost-time claim injuries by 65% and workers’ compensation costs were decreased by 50%. One national consulting company cautions about going into the program too quickly. They were concerned about the money it would cost to fix any violations. They state this could be up to tens of thousands of dollars. The consulting company does not balance that money against the savings mentioned above plus the fines that would be levied on an OSHA inspection. One would and should correct any problems that will decrease the hospital insurance and payout costs dramatically.

Here we go again. A CDC researcher in the November 10 Morbidity and Mortality Weekly Report states that we could save money and anxiety by not performing annual Pap smears, especially "if there is only low grade abnormalities which MIGHT have gone away if we’d left the women alone." She states " there are problems with annual screening that can result in potential harmful treatment and stress." ACOG suggests annual Pap tests. The ACS guidelines are for annual exams until there are three negative exams and then less frequently.

In a story in USA Today the new seismic standards for California hospitals to be in compliance by 2030 will be $20 billion. By 1/1/2001 hospitals must tell the state how vulnerable their buildings are to an earthquake. On 1/1/02 plans need to be turned into the state for repairing the hospitals. By 2008, all hospitals will need to be able to withstand a "large earthquake." By 2030, hospitals have to insure all facilities will be operational after an earthquake. The money necessary to get there is equal to all the money spent in California on capitol expenditures combined in the past decade.

Where is the money to come from? Many if not most of the hospitals will not be able to raise the money necessary via bonds. With healthcare at its present level, there can be no guarantee of paying the bonds off.

The University of California Irvine is expected to receive a $235 million grant to demolish its main hospital and reconstruct it to conform to the 2008 seismic regulations.

In another good use for the healthcare dollar the Department of Justice has collected a recordbreaking $1.5 billion in civil fraud recoveries with whistleblower suits leading the way with $1.2 billion. Be careful out there.

Besides Fraud and Abuse there is also EMTALA where hospitals and physicians may be fined. In May, June and July 2000 14 hospitals and one physician paid fines totaling $341,000. Included in these fines were $25,000 from Kaiser Richmond, $61,000 from Kaiser South Sacramento and Suburban Medical Center in Paramount. The one physician was from Fort Lauderdale Florida. He was fined $15,000 and was excluded from Medicare and Medicaid for one year. He admitted no wrongdoing in the settlement.

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.