The Senate's slow-moving health bill is colliding with other legislative priorities on the economy, raising chances that Democrats won't meet their goal of pushing a healthcare overhaul through the chamber in December, the Wall Street Journal reports. Lawmakers hope to act this month to avert planned cuts in Medicare payments to doctors, scheduled to drop sharply in 2010. But action on the bill has slowed sharply, with the war in Afghanistan and the struggling economy moving to the forefront of lawmakers' concerns.
A report from the New Jersey Attorney General's office called for state agencies to create new rules that include barring doctors and their office staff from accepting food from drug companies and restrict the sale of "prescriber-identifiable" prescription data for commercial purposes. The rules would also require doctors who are renewing their licenses to disclose whether they accepted more than $200 worth of payments and/or gifts from industry during the preceding two years, and create a public database of the disclosures. Some of the recommendations could be enacted by the state's Board of Medical Examiners, while others would require the state to pass a new law.
Majority Leader Harry M. Reid has assumed full ownership of the healthcare overhaul that includes a 2,074-page bill that would cost $848 billion over 10 years and institute the most far-reaching changes to the system in generations, the Washington Post reports. Reid's goal is to the the bill backed by the 60 senators needed for final passage, something he hopes will come to pass as soon as late next week. Here, the Post offers his strategy to get it done.
Analysis of investigations and prosecutions by the New York State Office for Professional Medical Conduct (OPMC) and the New York State Office for Professional Discipline (OPD) reveals simple lessons that can reduce the risk that physicians and other licensed healthcare practitioners will become the subject of professional conduct investigation or prosecution.
Incorporating these lessons into your professional practice can also enhance the quality of care rendered to your patients and enhance your ability to defend against professional liability claims:
Document the patient's chief complaint(s) or reason for the visit clearly in the medical record. Unfortunately, it is very common to open a practitioner's medical record and to be unable to grasp the reason for the patient's visit from a review of the notes. Because the chief complaint or reason for the evaluation can vary from visit to visit, the documentation should be updated in the progress note for each visit. Documentation of the chief complaint or reason for the visit then becomes an organizing foundation for the evaluation of the patient and the corresponding medical record documentation including with respect to the appropriate history, physical examination, diagnostic tests, treatments, procedures and follow-up.
Request authorization from the patient to obtain copies of relevant medical records from the patient's other healthcare providers and maintain communication with these healthcare providers. Important information relevant to management of the patient can be obtained by adhering to this practice.
Document in a clear manner all medications prescribed by you including dosages, frequency, and mode of administration. Also document all medications prescribed by other healthcare providers as well as all non-prescription medications being taken by the patient. It is helpful for the medical record to distinguish which medications you prescribed so that you do not inadvertently make it appear that you have prescribed medications that have, in fact, been prescribed by other healthcare providers.
Licensing authorities and the third party payers expect you to be able to justify the medical necessity of the services you provide to patients. Document in the patient's medical record the clinical basis for all patient management decisions including diagnostic tests, treatments, and prescriptions you order. If you can't think of a reason, that should be a red flag to you.
Plans for patient follow-up should be clearly documented at the end of each note. If the patient has completed evaluation and treatment that should be documented. If a patient does not follow-up as recommended, you should reach out to the patient as appropriate by phone inquiries and letters. Be sure that all patient contacts respect the confidentiality of the patient as required by state and federal law (HIPAA). All attempts at patient contact should be clearly documented in the patient's medical record.
When ordering diagnostic tests, be sure to follow up on the results and to take action, as appropriate, with respect to any results of concern.
It is essential to document discussions with the patient, including those relating to informed consent. Obtain written informed consent when appropriate.
Be sure that you are able to document your current clinical competence with respect to all treatment rendered to patients. Avoid providing evaluation and treatment that you are not qualified to provide. Consider the use of consultants when appropriate and follow up on their reports.
Finally, please note that the list of issues that can cause practice risk management problems is exhaustive, continuously expanding and beyond the scope of this article. When you encounter a problem for which your peers can not provide a basic, time-tested and common sense solution, it may be appropriate to seek the guidance of experienced legal counsel.
Note: This article is written for educational purposes only and does not constitute legal advice. You should consult with your legal counsel prior to acting on any of the educational information provided herein.
Alan Lambert, MD, Esq. is an attorney whose practice is dedicated to healthcare law. Dr. Lambert is admitted to practice law in New York and he is of counsel to the law firm of Butzel, Long, a professional corporation. For more information call 212-905-1513 or visitwww.attorney-for-physicians.com.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
Payers have various rating, tiering, and ranking systems that attempt to assess a physician's performance against his or her peers. Some of these systems may be tied to reimbursement rates, but mostly they are used to steer patients to physicians in the higher-quality tier.
Often, say critics, the criteria on which the ratings are based are not disclosed to physicians in advance—when they could make changes to their practice. Moreover, many providers and consultants say the ratings are often incorrect, or at least imprecise. They also say the ratings may have more to do with cost than quality.
These rankings are an increasingly important part of marketing for health plans, so it's unlikely you will be able to opt out of them, says Jeffrey B. Milburn, Colorado Springs–based independent consultant at MGMA Health Care Con-sulting Group. But you can probably include provisions in your contract to help ensure accuracy. Milburn says such provisions should include:
The opportunity to review how the program operates. Ninety days would be ideal, but usually you can get 30–60 days notice, Milburn says.
Knowledge of the data being used. You want to be able to confirm that quality rankings are based on quality measures and not cost (efficiency) measures.
Knowledge of where data come from. You want something more detailed than someone saying, "It comes from claims."
Knowledge of the plan's methodology. How is the plan using the data?
Knowledge of the specific standards. Is the plan using a legitimate third-party organization?
Consideration of acuity. Too often, acuity isn't considered, Milburn says. You don't want the plan merely to acknowledge this; you want to see how it's factored in. Otherwise, you may be placed in a different tier because you have more severely ill patients.
An opportunity to appeal before the rankings are published. If you have concerns, you want them addressed before the rankings are made public.
If you think the data are incorrect, ask for a meeting. "I haven't had anyone turn me down. If the representative is reluctant to meet, appeal to the plan's medical director," says Milburn. If the plan is unwilling to give you that access, you may have a problem.
This article was adapted from one that originally appeared in the December 2009 issue ofThe Doctor's Office, a HealthLeaders Media publication.
Doctors in Europe have been warned not to respond to flirtatious approaches from patients on social networking sites like Facebook. The United Kingdom's Medical Defence Union said it was aware of a number of cases where patients have attempted to proposition doctors by sending them an unsolicited message on Facebook or similar sites. The medical body said it would be "wholly inappropriate" to respond to a patient making an advance in such a way. A legal adivsor for the Defence Union said the pitfalls posed to doctors using social networking sites and inadvertently breaching patient confidentiality had already been well documented, but the dangers of patients using the sites to approach doctors were less well publicized.