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For those of you who do not already know, the JCAHO is schizoid. They have a written policy in MS 2.1 that states that the medical staff bylaws can not be unilaterally amended. They also have an unwritten policy that states that the bylaws may state that the bylaws may be unilaterally amended. They would only enforce the policy if somebody actually did unilaterally amend the medical staff bylaws. I asked their attorney, Mr. Bressler, about this in the past and he stated that the interpretation was correct. This makes as much sense as some of their other proclamations and is just as deceiving. Unscrupulous hospitals can and do place the illegal wording in their medical staff bylaws and then point to it to show what they are doing is correct. Medical staff officers do not have the time to research the issues and of course are discouraged from doing the research by the hospital.
One hospital finally got it!! The Rocky Hill Veterans Home and Hospital dropped its JCAHO accreditation. The hospital rightly believed they were not getting the value for their money and is going to the state Department of Health for their accreditation. One state senator, who obviously knows nothing about the process, believes the decision is outrageous. She believes that the state agency that she funds is understaffed and would not find enough deficiencies. The senator doesn't realize the requirements call for only the compliance with Conditions of Participation, not the other stuff the JCAHO throws in that is only paper busy work. The cost for the inspection is $45,000 in hard costs and an additional $80,000 a year in soft costs. As everyone knows the Joint does not give value for the money. They make up their own rules and inspect on these plus the required conditions of participation. The Joint's rules usually have nothing to do with outcomes but only to increase their power. The hospital will be inspected by the State Department of Health, an agency that does not charge and also does the required 20% validation surveys. In the past seven years 17 Maine and New Hampshire institutions have also dropped the expensive Joint and have joined another agency, the AOA. They do the same thing but without the hassles and for a much lower price. It should be noted that in their last survey, Rocky Hill scored an 94.
The Joint now has allowed the behavior health institutions follow the acute care ones and allows mid level practitioners to do the face to face meeting and initiate restraint orders.
They also want special consideration from the HIPAA rules allowing hospitals to give them patient information without patient authorization.
Their medical staff standard committee is now looking into the intrusion of procedures performed in hospital owned physician offices and how the medical staff evaluates care outside of the hospital. Big Brother Lives! Top
The North Carolina governor has decided to place the new patient's assistance program under the Attorney General and not the Department of Insurance that the MCOs wanted. This program is to help patients with disputes against insurers. The new law of the state allows suit against insurers but only after an independent review. Good for the Governor.
New York State has enacted a law that will force all non-ERISA health insurance plans to cover some infertility treatments. This only applies to people between 21 and 44 and excludes vasectomy reversals and IVF. Medicaid patrons are excluded. If the plan pays for prescriptions, they must pay for infertility drugs. The bill excludes the payment for contraception, which had been a bone of contention in the past. In typical political fashion the bill was stuck in the middle of another bill dealing with the harvesting of quahogs and the registration of pet food brands. Everyone always states the two things one does want to see is the making of sausage and laws. Top
Long Term Care Hospital Reborn
Kindred Hospital in Minnesota was to have lost their Medicare and Medicaid funding. This long term care facility is a part of a large long term care organization has now been taken over (managed) by a non profit organization, Benedictine Health System. This is under an agreement brokered by the Minnesota Department of Health. Top
In case you missed it before, the CMS has released their proposed rule changing and clarifying EMTALA. The feds state again that the hospital must keep an on call roster but that physicians are not required to be on call at all times. They also stated that the screening and stabilization do not include inpatients, only those who come to the hospital. Their last one is that non-hospital owned physician practices located on hospital grounds are not subject to EMTALA, unless they are urgent care centers or a hospital department. These off campus sites would have to develop protocols regarding how they would react to an emergency. They are permitted to call 911 and the ambulance, even if owned by the hospital, can take the patient to the most appropriate facility. The proposed rules were silent on what being "on call" means. Top
The Pennsylvania legislature is about to take up the issue of joint and several liability. The businesses and the hospitals are against the concept and for the bill. The trial lawyers don't see it quite the same way. The doctrine of joint and several liability means that any defendant, no matter how little part he played in the case, can be hit with the lion's share of the verdict. This is the deep pocket theory. A trial lawyer stated that doing away with joint and several liability would punish the patients (read attorneys). The state legislators are finally getting it.
Nevada continues to attempt to stem the flow of physicians. The governor is now looking at how to decrease the costs of insurance for those high risk physicians in the state insurance program. This may include paying the tail coverage charged by the prior company, St. Paul. He is also looking at raising the co-pays that OBs may get per office visit. Top
The FDA has stated mad cow disease is a viable threat to the blood supply. However, so is the warning. The FDA has stated that on June 1 no donations will be accepted from person that have lived in France or more than five years, visited on lived in Great Britain for more than three months between 1980 and 1996 or received any blood transfusion in the UK since 1980. Starting November 1 all donations from military or dependents show were in northern Europe for six months or more are also barred. 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.