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As of January 1, JCAHO has begun to survey hospital-owned medical practices. This is whether or not the hospital wants to have the practices surveyed. Of course, as is typical for the organization, it will increase the cost of the survey and the preparation also will be significantly higher. The JCAHO definition of hospital owned is if the hospital includes the practice in their Medicare cost report, the hospital advertises the practice as part of the hospital. This includes the use of the name of the hospital on the group letterhead, yellow page listing or web site.
However, JCAHO got shut out in the race for surveying and
being the deeming organization for Medicare+Choice groups licensed as
HMOs. That went to NCQA who look more to outcomes and that has been
doing Medicare+C longer than JCAHO. The voluntary accreditation is in the
areas of quality assurance,
information on advance directives, antidiscrimination, access to services,
provider participation rules, and confidentiality and accuracy of enrollee
records.
The amoeba spreads. Effective July 1, 2002, new
credentialing requirements will go into effect for the Comprehensive
Accreditation Manual for Health Care Networks (CAMHCN), Comprehensive
Accreditation Manual for Managed Behavioral Health Care Organizations (CAMMBHC),
and Accreditation Manual for Preferred Provider Organizations (AMPPO). The
principle revision to the
credentialing requirements extends a network's recredentialing cycle from
2 to 3 years. This is good.
Also effective July 1, 2002, three components have been added to the scope of
the network survey process for managed care plans and integrated
delivery networks. Beginning July 1, unaccredited assisted living,
office-based surgery, and preferred provider organization components will
be sampled for survey at the time of survey of the managed care plan or
integrated delivery network. Three appendices to the CAMHCN containing
standards subsets for each of these components that commonly comprise a
health care network are now available on the website. Is it any wonder they
were bypassed for the Medicare+C deeming authority.
In another move, JCAHO has quit as a consultant to Leapfrog
and has become a full member. The first item is to identify ICU specific
measures. Look for these to be coming to a hospital near you.
The front page of the January 29, 2002, Wall Street Journal has a story about the Oryx. The real one not the fake JCAHO one. However, they do seem to be related. An Oryx is longhorned antelope from South Africa. They were imported with good intentions to New Mexico where they are currently a menace eating all that is good and scarce resources. While there has been attempts to rid New Mexico of them they continue to multiply. Even hunters can not shoot the critters fast enough. The biologist (hospital) admitted they have underestimated their reproductive potential. It is not warm and fuzzy. When threatened it fights and impales those that try to hurt it. I'm not sure which Oryx I'm talking about. Top
Governor Davis' nursing ratios for hospital patients, the first in the nation, set the benchmark at one nurse per six patients on a general medical-surgical floor and 1:4 on pediatrics. This will not make the nurse's union happy campers as they wanted the full service provision of 1:3. The California Hospital Association wanted a ridiculous 1:10 ratio. The ratios were set by the Department of Health Services. Earlier this year Kaiser decided that a 1:4 was the ratio they would seek. They will continue to attempt to reach their high ratio. There may be a higher ratio if LVNs are used to calculate the ratio. What happens now is a 45 day comment period followed by public hearings. In reality the ratios may not take effect until July, 2003. Of course, as all know, there are not enough nurses to make this happen. California is 49th in the RN per capita ratio. If there are not enough nurses, hospitals may have to cut back services to make the ratios work.
Gov. Davis has devised a plan to get more nurses. He has gone around the legislature and is using $60 million of federal funds obtained to assist disabled and unemployed workers. This is legal under the federal rules. The money will be divided into $24 million for more people to train nurses, $24 million to expand centers to train, $3 million to help LVN and RAs to become RNs, $1 million for nurse retain services and a state media blitz to recruit nurses. This is one of the best thing this Governor has done. Top
Virginia Wants to Un-cap Awards
The Virginia legislature wants to undo a cap on malpractice awards for birth-injury. The trial lawyers are trying for unlimited damages for malpractice if a physician or hospital is not participating in the birth-injury program. This 14 year old program provides lifetime benefits to injured children but removes the right to sue. The Democrat sponsoring the Trial Lawyer's bill wants to shift the control of the money away from the current administrative board to the Virginia Retirement System. The bill would also move the determination of what children are qualified from the Worker Comp system to the Circuit courts. The fund is currently maintained by fees from physicians, hospitals and insurers and are now at the highest level allowed by law. There is a similar fund in Florida. Top
There is unrest in the peoples republic of Massachusetts. The Governor has had the audacity to propose eliminating the entitlements of dental care for 500,000 poor adults and decreasing spending for cancer prevention. The proposed budget cuts $29 million from antismoking programs and $11 million for other preventative programs. The advocates have suggested that the programs can be saved by adding another 50 cent tax on cigarettes and delay the voter approved income tax roll-back. This latter move will assure the governor of a short term in the state house. In an interesting side-bar to this, the NIH has stated that mammograms may not save lives and that prior studies may have been faulty. They may change their recommendations for the use of the radiographs.
While in The People's Republic of Massachusetts, the medical board has warned the physicians who took care of the died after not getting prompt surgery at Children's Hospital. The father of the dead patient was not happy the physicians would not get fined or discipline. The problem was a systemic problem of how to communicate, or in this case, how not to communicate with each other. Top
This is a first for me. I have always thought of Medical Boards in the same was as I thought of the Gestapo. I must give congratulations to the Medical Board of California and to Bernard Alpert, MD, the President of the Board. In the January 2002 Action Report Dr. Alpert discusses his testimony before the state Legislature. Some of the questions and answers reported are as follows: "Q. Is the Board concerned with and how do account for the decline in disciplinary numbers over the past year as compared to previous ones? A. The Board has no disciplinary quotas; it responds to complaints. It remains vigilant as to license impropriety and at present we see no evidence of large numbers of such events going unaddressed. A spate of unlicensed activity has occurred recently, and this is being vigorously pursued, with measurable success. The concurrent number of malpractice claims does not lead to a conclusion that disciplinary cases are being missed. A low number of disciplinary actions might actually reflect an appropriate disciplinary posture in a high-quality practice environment. Conversely a high number of license actions would definitely indicate a problem, either that of a low medical quality or of an over-disciplinary environment." This is the first time I have ever heard of a medical board espousing the truth on this subject. Dr. Alpert goes on in his report to distinguish California and its malpractice environment under MICRA from the mess in West Virginia and Pennsylvania. The Action Report also is the best I have seen in 30 years with very helpful medical information to the licensees. I also see a trend in the disciplinary actions taken by the Board. They seem to be giving a lot more public reprimands for minor offenses and minor malpractice cases. Their severe punishments of license revocation with or without being stayed are appropriately for the more serious cases. 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.