The Physician Payment Sunshine Provision

Under a proposed federal rule, the Physician Payment Sunshine Provision of the Affordable Care Act, drug companies, medical device and medical equipment manufacturers will have to disclose payments and gifts they make to physicians and hospitals. Under this rule, companies would have to report any gifts, food, educational or conference funding, charitable contribution and payments over $10 (or with a total annual amount exceeding $100) made to physicians and or hospitals. They will also be required to report stock ownership or investments in the companies by physicians. The purpose of the provision is to ensure transparency, prevent conflicts of interest and discourage any potential influence on clinical decision making.

If the companies do not comply with the provision they could face a $150,000 fine for failing to make the report and up to $ 1 million for failing to report transfers of value.  CMS anticipates beginning requiring data collection sometime in 2012, with reports due sometime in 2013.  The final rule is set to be published in a few months.

Physician Payments Sunshine Provisions in Health Care Reform, http://www.prescriptionproject.org/tools/sunshine_docs/files/Sunshine-fact-sheet-6.07.10.pdf

Why Small Gifts Matter, http://www.prescriptionproject.org/tools/sunshine_docs/files/WhySmallGifts_CB.pdf

Physician Held Liable for Negligent Infliction of Emotional Distress

A Pennsylvania court recently ruled that doctors can now be held liable for emotional distress even if they were not negligent.  In this particular case, the plaintiff had an ultrasound performed during her pregnancy and was told by the Radiologist that the ultrasound was normal, specifically that the baby was healthy and normal.  Four months later she delivered a child with partial arms and legs, hypoglossia, micrognathia and other congenital anomalies.  After the delivery she reported grief, rage, nightmares, anxiety, and insomnia, and continued to have these problems thereafter.

The plaintiff sued for negligent inflection of emotional distress, arguing that the doctor did not prepare her for the shock of the birth of a child with deformities.  In support of their decision, the court argued that it was reasonably foreseeable that the patient would suffer emotional distress during the birth of her child if not given the results of the ultrasound in advance.  They held that because doctors have a fiduciary duty to their patients, they have a legal and ethical responsibility to care for their patients’ wellbeing, including providing accurate information about test results when it is foreseeable that the test results may cause emotional distress.

Some argue that this precedent will cause and increase in emotional distress lawsuits against physicians.  We will have to wait and see if there will be a change in the litigation climate.

Toney v. Chester County Hospital, Pennsylvania Supreme Court, Middle Dist. 2011

Undocumented Immigrants will Remain Uninsured Under Health Care Reform

At the hospital where I work, a large portion of the patients we see and care for are undocumented immigrants.  Under the new health care reform laws set to take effect, many people who currently don't have health insurance will get coverage.  However, undocumented immigrants (estimated to be between 4 and 7 million) will  remain uninsured under health care reform.  Undocumented immigrants will remain ineligible for Medicaid and will also be prohibited from buying private health coverage in the exchanges.  These individuals will have to continue to receive health care from any available state programs, like the one available in our county.

New Law to Encourage Schools to have Epinephrine Available for Any Student with an Allergic Reaction

Six million children (one in twelve) in the United States suffer from some sort of food allergy.  However, parents are responsible for obtaining a prescription for Epinephrine (EpiPen) and having it available in school for them in case of emergency (for example if they have a life threatening anaphylactic reaction).  Children with unknown allergies or who may not have the medication available at school may be at danger if they do have an allergic reaction at school, because the medication is often not available.  However there is a new Act that may change this.  The School Access to Emergency Epinephrine Act, introduced in the U.S. Senate in November and the U.S. House of Representatives in December 2011, encourages states to allow schools to have epinephrine on hand for use in any student who is having a serious allergic reaction.

Update on Washington State Health Care Authority Denying Payment for Emergency Services of Medicaid Patients

Earlier this week I wrote about a new law in Washington State that would deny payment for all Emergency Department Visits that the Washington State Health Care Authority (HCA) deems "not medically necessary" in the ER.  The Washington Chapter of the American College of Emergency Physicians, the Washington State Medical Association, and the Washington State Hospital Association have joined forces and have created an online petition to stop this.  The petition can be found at http://www.thepetitionsite.com/3/stop-denying-payment-of-emergency-services-to-medicaid-patients/

In addition to the petition, they offer suggestions to save health care costs without denying Medicaid payments for Emergency Department visits.  Their suggestions include:

• Reducing ED visits for narcotic-seeking behavior.
• Increasing access to primary care and reducing ED visits by collaborative use of next-day or same-day visits to primary care.
• Creating a "Generics First" initiative spearheaded by physicians to voluntarily develop a statewide drug formulary.
• Instituting an extensive case management program to reduce ED utilization by frequent users.
• Tracking emergency room visits to reduce ED shopping.

The new rule is set to take effect on April 1st.  I will be watching closely for any updates.

Washington State Plans to Deny Medicaid Payments for All Medically Unnecessary Emergency Room Visits

A few months ago I wrote about Washington State limiting ER visits to 3 per year for Medicaid patients.  That rule was overturned in November, but things in Washington have changed drastically.  Under a new rule, Medicaid will no longer pay for any medically unnecessary emergency-room visits, even when patients or parents have reason to believe they're having an emergency. ER services not paid by Medicaid won’t be billed to the patient, but the doctor and the hospital will not receive payment for the services. They report that the point of the rule is to attempt to cut health care costs by deterring patients with non-emergency conditions from going to the ER and going to a primary care facility instead.

The new rule is set to take effect on April 1^st of this year.  If this rule takes effect, it will be the most restrictive ER Medicaid program in the country