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http://www.csmonitor.com/Money/Mises-Economics-Blog/2010/0531/Justice-Department-declares-war-on-doctors
ObamaCare
Legal profession still lags in response to torture advisers
Financial Information Is Not Private In The USA
http://www.modernphysician.com/section/mppeoty#
modernhealthcare.com/section/toc
Doctors tack on fees for patients
The Doctor Payment Follies
Just As The FDIC Does Not Identify Problem Banks, CMS Does Not Identify Problem Hospitals...In The Land of The Free.
Why Bankruptcy Wont Rid You of Student Loans
Dartmouth Study Misapplied
Unreliable Medicare
Time Spent on Clinical Documentation A Survey of Internal Medicine Residents and Program Directors
Analysis of ObamaCare
AAPS vs. Sebelius
Complexity of ObamaCare
medlawblog.com/archives/legal-news-medicare-physician-payment-cuts-delayed-again.html
WSJ on ObamaCare
Medicare Under ObamaCare
Major General Butler: War Is A Racket
America: The Grim Truth
The Virtual Visit
| Pennsylvania: Navy ignores |
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| alleged fraud. |
Alleged fraud by Navy doctor is ignored by Navy at Main Line Health, Bryn Mawr, Pennsylvania near Philadelphia.
A Free-Market Guide To Fixing Health Care
Mythbusters
Market also discourages doctors from picking primary care
Myths
Myth 12. The uninsured cause overcrowding in emergency rooms, and increase costs for the rest of us through cost-shifting.
Will the lack of primary care doctors make universal coverage useless?
U.S. Moves to Rescind Healthcare "Conscience" Rule
Land of The Free
Choose A Safe Congress
Patriots
Unique Malpractice Risks of Ambulatory Surgery Centers
Brian S. Kern, Esq.
Posted: 11/20/2009
| Physician Rating: |
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( 10 Votes ) |
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Introduction
More and more physicians have been investing in ambulatory surgery centers (ASCs), especially as reimbursement rates continue
to decline. Although ASCs can be excellent sources of revenue, they can put you at increased risk for a lawsuit.
The unique malpractice risks for ASCs involve: policy manuals, liability for independent contractors, interactions with
the ASC's management company, and potential conflict with managed care companies.
Policy Manuals
Hospitals develop sophisticated policies to help insulate them from liability. However, it is not uncommon for doctors
setting up an ASC to be inadvertently more lax about policies and procedures. In some cases, the physician owners fail to
even develop policies; in other cases, the policies are too general and are not vigorously implemented.
Without specific and detailed procedures, ASCs can be more vulnerable to committing common errors that can lead to lawsuits.
These errors could include such everyday activities as failure to sterilize equipment, discharging a patient too early, failing
to obtain proper informed consent, and failing to provide sufficient supervision, oversight, or controls for staff members,
among others.
ASC owners need to develop a policy and procedure manual that will be at the heart of any risk prevention program.
The manual should carefully address all aspects of operations, such as the importance of maintaining safe and sterile equipment.
Although there are times that manufacturers and retailers assume some liability for equipment, facilities are ultimately responsible
for making sure that the equipment used in surgery is properly maintained and does not harm patients.
For example, you can take steps to avoid liability by making sure that the battery on a portable defibrillator is replaced
regularly. If you need to reach for the defibrillator, and it does not have a charge, you have a real problem. You should
create a schedule for checking or changing batteries, and note that in your manual.
However, ironically, a manual with too rigorous procedural goals can create problems. If an ASC does not conduct itself
as set out in its manuals, it is exposing itself to liability beyond what it might otherwise encounter. Plaintiff attorneys
could claim that you knew the proper procedures -- in fact, you put them in your manual -- but then did not bother to live
up to your own standard of care.
You need to craft these manuals carefully to reflect what actually happens in the ASC. The manuals should not be an aspiration;
they must be practical.
Still, having policies and procedures does not help much unless you implement and follow those policies. Too often, someone
sticks the procedure manuals in a filing cabinet and never opens them until legal issues occur. Then it is too late.
June 17, 2010 — In a last-minute shock to physicians, the Senate voted today against postponing a scheduled 21.3%
reduction in Medicare reimbursement to physicians and other health providers.
A compromise proposed by Sen. Max Baucus (D-MT) was defeated largely along party lines, with no Republican support. The
compromise was put forward after the Senate had rejected a $140 billion finance package yesterday that would have delayed
the cut in Medicare payments to physicians until 2012, along with measures to extend unemployment benefits and provide $24
billion to states to cope with their Medicaid programs.
The lower-spending compromise bill, dropping the total cost to $118 billion and the overall deficit impact from $79 billion
to $55 billion, would have delayed the planned Medicare cuts and provided a 2.2% raise for physicians through November 30,
rather than for the 19 months mandated by the earlier bill.
It still was not enough, however, to win over the 60 senators needed to end debate on the issue under Senate rules. Fifty-six
senators voted in favor, with 40 opposed. Opponents argued that the overall measure was not offset by spending cuts and added
too much to the deficit.
The pay cut for physicians took effect June 1, but the Center for Medicare and Medicaid Services (CMS) had held up June
claims through today, anticipating that Congress would stop the reduction retroactively.
Because the "doc fix" was defeated, CMS is ready to authorize its contractors to begin paying physicians at the lower rate.
"Senate Fiddles as Medicare Burns"
The American Medical Association (AMA) warned that unless Congress restores the cuts, physicians will limit the number
of Medicare patients they treat. A survey of 9000 members revealed that 17% of physicians — and 31% of those in primary
care — would take such action because Medicare rates are too low.
Just before the vote, when the 6-month fix was still seen as viable, the AMA condemned it, saying that Congress has broken
its promise to America's seniors and military families. In a news release titled, "Senate Fiddles as Medicare Burns," AMA
President Cecil B. Wilson, MD, noted that Congress has been arguing about the "doc fix" for months.
"Delaying the problem is not a solution," Dr. Wilson said in the statement. "Continued short-term actions are creating
severe instability that harms seniors as physicians make decisions to protect their practices from Medicare's volatility.
Continuing down this path just slaps a Band-Aid on a problem that needs urgent surgery."
Costs of Health Care Administration in the United States
and Canada
| To the Editor: There is little doubt that per capita health care administrative
costs are lower in Canada than in the United States, as Woolhandler et al. report (Aug. 21 issue),1 even though the precise magnitude of the gap is open to debate, a point that Aaron makes in his accompanying
editorial.2 However, the Canadian single-payer system results in chronic shortages of medical services because
of underfunding. The underfunding problem is usually considered to be a separate issue from the single-payer
system itself,2 but the very structure of the single-payer system may cause the problem.
In the United States, persons who wish to spend more on health care than the norm have a simple way of doing
so: they can purchase premium private medical insurance. Notwithstanding the Medicare prescription-drug
plans currently being discussed, it is generally not an option in the United States to increase medical expenditures
through the taxation system, given contemporary political and fiscal constraints. In Canada, however, increases
in medical expenditures are possible largely only through the taxation system. And even if, as some
surveys suggest, most Canadians are willing to spend more on health care,3 taxpayers cannot be sure that any given tax increase will actually go to health care expenditures.
Therefore, Canadian taxpayers generally resist tax increases, and underfunding and chronic shortages result.
Jasjeet S. Sekhon, Ph.D.
Harvard University
Cambridge, MA 02138
jasjeet_sekhon@harvard.edu
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Quality of Death
Good News for Bad References How to Fight Back
Health Coalition On Liability and Access
Dr. Berwick Bigger Than Kagan
HEALTH INDUSTRYJULY 13, 2010.Medicaid Stalemate Tests Cash-Strapped States
Federation of State Physician Health Programs
Many docs don't blow whistle on colleagues
Welcome To Hospital California
Racial, Gender Quotas in the Financial Bill?
Health-Care Overhaul Proposals
Skilled Healthcare Faces Over $671 Million in Damages
The Berwick Evasion
The Berwick Extension
The SGR for Physician Payment An Indispensable Abomination
Choose Your Care When Healthy: Patients Cannot Be Customers.
Why Pay-For-Performance in Medical Practice Wont Work
Rome
| "TITANIC will founder. It is a |
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| mathematical certainty." |
Everything from the morality of eating cookies to the solvency of Medicare.
As of this summer, unemployment insurance trust funds in 30 states were insolvent.
"If you like FEMA and TSA, then you'll love our national health care plan."
Why Is the Gulf Cleanup So Slow? There are obvious actions to speed things up, but the government oddly resists taking them.
VA Watchdog
Leaked Internal Memo Shows How VA Systematically Screws Over Wounded Vets to Maintain Performance Grades A newly surfaced
internal memo shows that VA health facilities get good grades by delaying and denying care.
Feds taking the weekend off in oil fight?
Health law risks turning away sick
| Net U.S. Debt: as % of GDP: |
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| Click to enlarge picture. |
ObamaCare Likely To Succeed
Executive salaries in non-profit hospitals
Health Spending vs. Results
Ghost Medicine
The WSJ Guide to ObamaCare
Let's Simplify
Unfunded Debt: Pensions in Illinois, New Jersey, Pennsylvania...
Language Matters
For Denied Claims, a Bit of Help
Obamacare and its Impact on Doctors
Physicians group accuses CIA of testing torture techniques on detainees
Justice Department Declares War On Doctors
Medical Loss-Ratio
IRS May Withhold Tax Refunds to Enforce Health-Care Law. Court case
pending.
Radiology As A Career-Lottery
When the Doctor Gets Sued
With Fewer U.S. Opportunities, Home Looks Appealing to Expats
Obesity
Why the United States Should Reject Socialized Medicine (a.k.a. Single Payer) and Restore Private Medicine
Myth 24. Medicare is the model of efficiency and fairness.
Blood Money
Reform & Due Process
Report Claims Hospitals Lax in Reporting Problem Doctors
To reach KevinMD, Please click here.
| 29% uninsured: One way to |
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| run a country. There are others. |
A Modest Proposal: Give All The Money To The Administrator
Why U.S. health care expenditure and ranking on health care indicators are so different from Canada's rankings.
May 14, 2009 — From President Obama, to members of Congress, to federal and private agencies concerned with the issue,
officials in Washington and beyond are pointing to the need for more physicians and other healthcare workers, especially in
primary care. The Association of American Medical Colleges, for its part, has called for a 30% increase in enrollment to meet
anticipated demands up through 2025 — demands that would rise dramatically if lawmakers managed to pass some form of
universal healthcare.
But as essential as it is, the push for more physicians and healthcare professionals will not by itself solve a related
workforce problem: the maldistribution of physicians and other healthcare professionals across the nation, a problem
that has left rural, frontier, and some inner-city communities especially vulnerable.
Nowhere are workforce shortages showing up more clearly in these areas than in community health centers (CHCs), the outpatient
clinics that receive federal and other money to provide treatment to people regardless of their income or insurance status.
Nationally, the current need for primary care providers, including physicians, nurse practitioners (NPs), physician assistants
(PAs), and certified nurse midwives, is roughly 1850, according to the National Association of Community Health Centers (NACHC)
in Bethesda, Maryland. An additional 1400 nursing slots also remain unfilled.
At a CHC in south central Washington State, for instance, Anita Monoian, chief executive officer and president of Yakima
Neighborhood Health Services, has struggled for some time now to fill 5 physician vacancies in her clinic, despite aggressive
recruiting. "For a couple of these vacancies, I've been recruiting for more than a year," Ms. Monoian, who is also chair-elect
of the board of directors of NACHC, told Medscape Medical News.
Ms. Monoian is fortunate in some ways, since Yakima, a city of about 85,000, is "not as rural as some places that have
1200 people." Still, recruiting for physicians and other health professionals remains a challenge — as it does, to varying
degrees, in CHCs across the country.
The difficulty of getting providers to practice in rural, frontier, and even some inner-city communities is not new. "This
isn't something that has come up in the last 1 or 2 years," said Tom Morris, associate administrator in the Office of Rural
Health Policy, Health Resources Services Administration (HRSA), US Department of Health and Human Services. "It's a longstanding
challenge."
And yet there are at least anecdotal signs that the gap between supply and demand in some areas is widening. "There was
a time when it would take a community health center 2 to 3 months to recruit physicians and other providers," said Jim Macrae,
who as HRSA associate administrator for primary care manages a budget that goes in part to support CHCs across the country.
"At worst, it would take 6 months. Now 6 months is the average — and in some cases it's 12 months before they can find
someone."
Several factors seem to be driving this trend — a workforce that is aging and needs to be replaced; a shallower pool
of international students from which to draw; the extra strain placed on clinics by the recession and worker layoffs; and
a new generation of physician recruits who are smart, tech-savvy, and not inclined to settle. "They've set a standard for
the quality of life they want, and they're not going to compromise that standard," explained Ms. Monoian, who added that applicants
often end up interviewing her.
Simply having more doctors, nurses, and others looking for a job, of course, would mitigate these problems. But
even the AAMC has acknowledged that "increasing the number of physicians alone will not improve distribution," since providers
would still tend to favor some locations at the expense of others. Beyond the necessary but insufficient step of boosting
supply, AAMC makes clear, "effective policies for improving access must be continued and enhanced."
Getting Clinicians Where They're Needed
The economic stimulus measure, signed into law by President Obama in February, will address some of these concerns, especially
as they affect CHCs.
Besides $1.5 billion for CHC infrastructure improvements and another $500 million for CHC service enhancements, the stimulus
package directs $500 million to deal with distribution-related problems. Of this $500 million, $300 million will go to the
National Health Services Corps to place 4100 new primary care physicians, NPs, PAs, dentists, and other healthcare professionals
in underserved areas across the country.
As part of this process, NHSC participants are eligible to have their medical school tuition and fees reduced or paid for
through, respectively, an NHSC loan repayment or scholarship program. An additional $200 million in stimulus money is slated
for the HRSA Title VII Health Professions and Title VIII Nurse Training programs. "This is basically to create the next cadre
of providers to serve in rural, frontier, and inner-city communities," the HRSA's Jim Macrae told Medscape Medical News.
Beyond targeting stimulus money, policymakers, say experts, also need to think about workforce distribution, and workforce
planning generally, in a more coordinated way. "Many countries have workforce planning that's more formal," said Mark Doescher,
MD, MSPH, an associate professor in the Department of Family Medicine, University of Washington School of Medicine, Seattle,
and director of the WWAMI Rural Health Research Center. "We really don't have that here."
How might a more coordinated approach work? Dr. Doescher starts by envisioning a continuum, which stretches from the time
a student enters secondary school to the time he or she begins their career. By exerting the right influence at key "leverage
points" along the way, Dr. Doescher told Medscape Medical News, educators and other "stakeholders" can increase the
odds that a student will not only choose primary care but elect to practice their profession in an underserved area.
In secondary school and college, that means enhancing science and mathematics instruction; at the medical school admissions
level, it means doing more to recruit applicants from rural communities, who are more likely to return to their communities
to practice; and within medical school, it means, among other things, giving students "longitudinal rural experiences," which
a number of even urban-based medical schools are doing.
Residency, noted Dr. Doescher, presents a whole different set of leverage points, because students may now be carrying
debt, may be training in urban hospitals, and may have crucial family and lifestyle decisions to make. Still, he said, it
is possible to exert the kind of influence — like loan forgiveness or providing Medicare financing for community-based
rural residencies — that might not only bring providers to underserved communities for 3 or 4 years but help them put
down roots.
As Tom Morris of HRSA's Office of Rural Health Policy says: "No one thing will solve the problem. It's a lot of individual
activities pointing in the right direction that will make a difference."
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