HHS/CMS announce ePrescribing regulations. The Department of Health and Human Services and CMS issued a final rule for ePrescribing standards. The final rules were published in the Federal Register under November 7, 2005 at 70 FR 67568.
Highmark announces the Highmark E Health Collaborative. The Highmark E Health Collaborative is a joint project between Highmark and the Pittsburgh Foundation to foster the adoption and utilization of electronic prescription systems. The Collaborative will provide funding to eligible physicians who wish to acquire and use electronic technology. Highmark will contribute $26.5 million , $18.5 million of which will go to physician funding and $8 million of which will go to support eHealth technology at UPMC. The maximum grant per physician is $7,000. In order to determine if you are eligible for this program, visit the Highmark E Health Collaborative Web site at www.highmarkehealth.org.
JCAHO has posted a field review notice regarding hospital Medical Staff credentialing in privileging standards. The proposed standards would establish additional evidence based processes for the determining the competence of practitioners. See the JCAHO website link for the field review.
The centers for Medicaid and Medicaid Services (CMS) reported today that quality of care has improved significantly in hospitals participating in the premier hospital quality incentive demonstration project, a groundbreaking Medicare pay for performance demonstration project. The press release was posted on the CMS website on
November 14, 2005.
The Pennsylvania Insurance Department announced on October 31, 2005 that the 2006 MCARE assessment will be 29% of the primary prevailing premium. Earlier in the week, Pennsylvania Governor Ed Rendell promised extending the MCARE abatement program for 2 more years.
Several hundred medical malpractice cases settled or adjudicated by the Department of Health and Human Services between 1997 and 2004 were not reported to a national repository of provider data, the HHS Office of Inspector General said in report released Oct. 19.
Continue Reading...The final rule from the Medicare Physician Fee Schedule revises the Stark definition of designated health services (DHS) to include diagnostic and therapeutic nuclear medicine services. Since this change will impact existing relationships, this portion of the rule has a delayed effect date, i.e. January 1, 2007.
Fee Schedule: Nuclear Medicine: DHS (CMS's discussion on page 676)
Physicians often ignore crucial early warning signs in the credentialing process. Physicians also sometimes ignore the fact that the credentialing process is a structured legal process which can trap the unwary and penalize the careless. Here are 10 mistakes physicians make during the process, along with advice on how to prevent them.
Continue Reading...The OSHA regulations applicable to the offices of medical professionals are aimed at creating a safe and healthy practice. Compliance creates a positive work environment and minimizes employee complaints. There are six OSHA general standards that apply to physician offices of all sizes and a seventh requirement that applies only to offices that offer X-ray services. We will discuss each in this article.
Continue Reading...President Bush signed the Patient Safety and Quality Improvement Act of 2005 on July 29, 2005, describing the legislation as "a critical step towards our goals insuring top quality, patient-driven healthcare for all Americans."
Continue Reading...P4P is the newest healthcare reform theory. Many believe the theory developed wide-spread acceptance following the landmark report, To Err is Human, published by the Institute of Medicine (IOM) in 2000, followed by the IOM report, Crossing the Quality Chasm: A New Health System For the Twenty-First Century, issued in 2001. There is almost unanimous agreement that P4P, if implemented correctly, has great potential to improve patient care. The basic premise is to (1) define quality by some measurable standard, (2) provide reimbursement incentives which compensate improved quality and (3) assess performance and pay accordingly.
Continue Reading...In the December 2004 PRN, Highmark stated that concierge medical practices are "not compatible" with its network requirements. Highmark stated that Blue Cross Blue Shield will initiate termination of impacted provider contracts or a without cause basis upon learning of conversion to concierge practice models.
As of Monday, July 25, Medicare will only pay for physical therapy services provided in physician offices "incident to" the physician's services if the physical therapy services are provided by "qualified personnel" as defined in a June 24 transmittal to Medicare contractors.
Continue Reading...Highmark will pay for care by more than one physician for treatment of hospital or skilled nursing facility in patients when the physicians are treating two or more separate conditions or the severity of the single condition requires the services of two or more physicians. The medical records should:
- Document the primary physician's request for the consult(s)
- Document the seriousness of the medical condition
In MurfreesboroMedical Clinic vs. Udom, the Tennessee Supreme Court ruled that restrictive covenants are not enforceable against physicians, unless specifically prescribed by law. In handing down this decision, the Court overturned an appellate court decision enforcing the restrictive covenant. Although restrictive covenants are otherwise enforceable in Tennessee, the Court found that interfering with patient freedom of choice was sufficient justification to reject enforcement.
While CMS was announcing its EHR beta test, the Secretary of Health and Human Services, Michael Leavitt, announced the composition of the American Health Information Community. Access the HHS Press Release here. The purpose of the Community is to advance President Bush's HER project. Modern Healthcare reported in its September 19, 2005 edition that many healthcare information specialists see the panel as too politicized with insufficient real-world experience.
A headline in the Wall Street Journal recently read: "High Court Rules IRAs Untouchable." This headline was prompted by a recent U.S. Supreme Court case (Rousey v Jacoway) which held that creditors may not execute on individual retirement accounts (IRAs) in a bankruptcy proceeding. This decision has been hailed as a huge victory for IRA owners.
Continue Reading...The DHHS had issued guidance entitled "Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons." Several individual physicians and professional associations sought to enjoin the Guidance, but a federal district court ruled that the Guidance had not cause sufficient damage or injury nor threatened future damage or injury sufficient to make the case ripe for decision. The mere fact that the Guidance Document is not aligned with the organizations advocacy an litigation goals does not constitute a concrete and particularized injury or create a Article III case here. View the guidance on the DHHS Web site.
Colwell v. HHS, S.D. Cal. No. 04CV1748, 3/7/05.
CMS Issues Stark Advisory Opinion Stating That Stock Interest In Non-Profit Practice Organization Is Not A Stark Financial Interest
CMS has determined that stock held by physician shareholders in a 700 physician non-profit group medical practice does not constitute a financial interest for purposes of Stark, so that it would not prohibit referrals by the physicians to that group.
Continue Reading...In WellSpan Health v. Bayliss, the WellSpan Health System, the primary components of which are York Hospital and Gettysburg Hospital, attempted to enforce a restrictive covenant against a physician in all counties listed in the non-compete section of an employment contract, despite the fact that WellSpan had no physical presence in three of the counties. The trial court enforced the restrictive covenant by enjoining Dr. Bayliss from practicing in York and Adams counties, but not Lancaster County. The Superior Court affirmed the trial court, affirmed that restrictive covenants are enforceable when reasonably designed to protect identifiable interests, but also acknowledged the necessity to balance the public interest involved.
Med Law Blog is published by Michael Cassidy
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