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.
Friday, February 24, 2012
Sunday, February 12, 2012
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.
Friday, February 10, 2012
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.
Wednesday, February 8, 2012
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 1st of this year. If this rule takes effect, it will be the most restrictive ER Medicaid program in the country
Wednesday, December 28, 2011
Proposed Law Would Allow Patients to Get Direct Access to their Laboratory Results
In September the Department of Health and Human Services, Centers for Medicare and Medicaid Services, and the CDC, proposed a rule that would allow patients access to their test results directly from the laboratory, rather than having to go through their physician. There are pros and cons to this rule. It could improve safety by allowing patients to have direct access o information that sometimes gets overlooked by medical providers. It may help them make decisions about their medical care. On the other hand, the patient may receive abnormal test results prior to discussing them with a medical provider and this may cause them undue distress. They may misinterpret results. If the results are normal, it may discourage the patient from going back for follow-up care believing that since the results or normal, they have no medical issues.
More information can be found in the December 14th issue of JAMA.
Giardina, T., Should Patients Get Direct Access to their Laboratory Test Results?, JAMA, 306 (22): 2502-2503, December 14, 2011.
Tuesday, December 27, 2011
Appeal Filed to Block Law Prohibiting Physician Ownership of Hospitals
This is an update on a blog post I recently wrote about a provision in the Affordable Care Act that prohibits the creation of new physician owned hospitals. In March a Texas Federal Court ruled that the provision was constitutional. The plaintiffs, the Physician Hospitals of America and Texas Spine and Joint Hospital filed an appeal to the U.S. Court of Appeals, 5th Circuit and the Texas Medical Association and the Physicians Foundation filed amicus briefs to support the lawsuit. Of note, this is the only lawsuit out of 24 filed challenging provisions of the Affordable Care Act that the Texas Medical Association has gotten involved with.
I will be keeping a close eye on the developments with this lawsuit.
More information can be found in the December 2011 issue of Texas Medicine:
Conde, C. Doctor and Owner, Texas Medicine (December 2011).
Sunday, September 18, 2011
National Ban on Physician Ownership of Hospitals
One of my goals in life was to own a hospital. Thanks to a recent law passed by Congress, it doesn’t look like that is going to happen. A part of the Patient Protection and Affordable Care Act prohibits physician-owned hospitals from obtaining a Medicare provider number (meaning they cannot bill and receive payment from Medicare or Medicaid, which is a large proportion of hospital income). All existing physician-owned hospitals that were operating as of March 23, 2010 were grandfathered in (meaning the law won’t apply to them). Physician-owned hospitals that were under development at the time of the law passing were allowed to proceed with development as long as they obtained their Medicare provider numbers before the end of the year. After December 31, 2010, physician ownership and investment in hospitals was completely banned. The grandfathered hospitals will also be banned from increasing bed numbers, operating rooms or increasing the percentage of physician ownership.
According to a recent Texas Medical Association article, physician-owned hospitals are safer and have higher patient satisfaction ratings; “a 2005 Department of Health and Human Services study…found physician-owned hospitals have lower complication and mortality rates, as well as higher nurse-to-patient rations, than do general hospitals….CMS patient satisfaction ratings…show 85.1 percent of patients gave physician-owned hospitals a rating of nine or ten on a scale of ten, compared with a national hospital mean of only 64 percent.”
I believe physician are the right fit for owning and running a hospital, especially those with business and/or legal training and experience on top of their medical experience
More information on this issue can be found in the August 2010 edition of Texas Medicine. Ortolon, K., Quashing Ownership. Texas Medicine, 106:8; 29 (August 2010).
Sunday, December 25, 2011
The Synthetic Drug Control Act of 2011
Last Month I wrote about the DEA making it illegal to manufacture or use bath salts. Earlier this month, Congress passed the Synthetic Drug Control Act of 2011 which amends the Controlled Substances Act to place synthetic drugs (bath salts, synthetic marijuana, etc.) in Schedule 1. The DEA definition of schedule 1 drugs is drugs that “have a high potential for abuse, have no currently accepted medical use in treatment in the United States, and there is a lack of accepted safety for use of the drug or other substance under medical supervision.” The synthetic drugs join LSD, heroin, peyote, ecstasy and others that have been on the schedule 1 list for many years.
H.R. 1254: Synthetic Drug Control Act of 2011
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