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 14^th issue of JAMA.

Giardina, T., Should Patients Get Direct Access to their Laboratory Test Results?, JAMA, 306 (22): 2502-2503, December 14, 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, 5^th 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).

Original  Blog Post:

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).

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

http://thomas.loc.gov/cgi-bin/query/z?c112:h1254:&_cldee=Y2FtZXJvbmRlY2tlckBnbWFpbC5jb20%3d&_cldee=cmI0QGJjbS5lZHU%3d

DEA, Controlled Substances Schedules, Definition of Controlled Substances, http://www.deadiversion.usdoj.gov/schedules/

Potential Solutions to the Drug Shortage Problem

Currently there are over 180 prescription drugs that are in a dangerously short supply.  These drugs include many important and lifesaving antibiotics, chemotherapy and cardiovascular drugs.

There are a few things the government is doing to try to tackle the problem. The Preserving Access to Life-Saving Medications Act of 2011 is a bill that is currently active that would require drug manufacturers to notify the FDA six months in advance of potential drug manufacturing interruptions. 

An additional problem with the drug shortage situation is that those manufacturers that do have the drugs are charging higher than normal prices for their drugs.  Evidence has been discovered that shows that five drug companies have charged seven to eighty times the regular prices of shortage drugs.  Since the discovery of this information, President Obama has issued an executive order that seeks to reduce this price gouging problem by asking the Department of Justice to examine price increases for shortage drugs to see if the increases violate the law.

I will continue to watch for developments on this issue.

Trapp, D., Obama Targets Prices of Shortage Drugs, American Medical News, November 21, 2011.

Current Drug Shortages, FDA, November 23, 2011, http://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm050792.htm

Drug Shortages, FDA, November 21, 2011, http://www.fda.gov/drugs/drugsafety/drugshortages/default.htm

Update on Judge Directed Negotiation in Medical Liability Lawsuits in New York

       A few months ago I wrote about a new pilot program in effect in New York in which judges lead negotiation in medical liability cases as opposed to having them go through the traditional litigation process.  Over 1,000 cases have gone through the program and so far the results have been positive. 

        Since implementation of the program medical liability payments and settlements have decreased,  and the expenses spent in defending medical liability cases has declined.  The average time cases are completed has declined from three years to nine months.  Doctors that are found to have no responsibility in the cases are weeded out within the first six months of the program (in traditional liability cases these doctors cannot be removed from lawsuits until after the discovery process which can be more than a year after the case is filed).

        It seems that this may be another solution to dealing with the medical liability crisis.  I will be keeping a close eye on the progress of this program.

Gallegos, A., Cutting Costs From the Bench, American Medical News (November 7, 2011).

Stanford University Program Offers Apology and Financial Compensation to Patients Affected by Adverse Events-Since then Liability Premiums and Numbers of Claims Have Dropped

       Stanford University has developed a new way to deal with high liability payments by creating a more transparent and patient centered approach to dealing with adverse events.  In this new program, they identify adverse events that have been reported by physicians or patients within 90 days of its occurrence.  Investigations are made, and if the event is determined to have been avoidable, the patient and or family is contacted with the results, an apology is made and compensation is discussed. 

       According to Stanford, liability claim frequency has dropped 36% since implementation of the program in 2007 and they estimate that they have saved $3.2 million in annual premiums since the program has been established.  It seems like this may be a good thing to identify adverse events early, holding physicians accountable, apologizing and rectifying the situation when possible.

O’Reilly, K., Stanford Cuts Liability Premiums with Cash Offers After Errors.  American Medical News (November 7, 2011).

Washington State Lifts Limits on Medicaid Patient ER Visits

      A few months ago I wrote a blog post about Washington State implementing a law starting October 1, 2011 that limited the amount of ER visits for Medicaid patients to three visits a year.    Many physicians, including myself felt it was extremely dangerous to place these limits on patients.  The  Washington State chapter of the American College of Emergency Physicians, Seattle Children's Hospital, Washington State Medical Association, and the Washington State Hospital Association filed a lawsuit challenging this.  Yesterday the Court lifted the limit on the ER visits.

      Of note,  when they looked closer at the numbers they discovered that 97 percent of Washington's Medicaid clients did't even exceed three ER visits a year. "They blamed a "small, but expensive group" of patients for running up large numbers of visits.  Some of those patients have more than 100 visits a year, often for chronic conditions and a need for painkillers, officials said."

Read more:

State lifts three-visit ER limit for poor patients
 http://www.seattlepi.com/local/article/State-lifts-three-visit-ER-limit-for-poor-patients-2263234.php#ixzz1dRdxibdJ