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Past and Present
JCAHO Sentinel Event Update At its July 17-18 meeting, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Board of Commissioners approved a new procedure which will allow the JCAHO to review an organization's response to a sentinel event through a verbal interview process. The new procedure does not require JCAHO to see or inquire about an organization's root cause analysis--the organization's comprehensive look at how and why a specific event occurred. The Joint Commission's policy for reporting sentinel events remains the same--reporting and submitting a root cause analysis and action plan is voluntary. The accrediting organization defines a sentinel event as: unanticipated deaths or major permanent loss of function; infant abduction or discharge of infant to the wrong family; rape by another patient or staff; hemolytic transfusion reactions; or surgery to the wrong patient or wrong body part. Many hospitals and health systems are concerned that sharing a root cause analysis with the JCAHO would present legal risk under some state laws, such as Arkansas'. Diane Mackey, Arkansas Hospital Association legal counsel, reports that Arkansas privilege laws do not seem to provide protection for the root cause analysis if it is sent to the JCAHO. However, she says it is absolutely essential that a hospital perform a serious inquiry into the root cause of a sentinel event, whether the JCAHO is involved or not. Ms. Mackey advises that, in the event of a sentinel event, hospitals should:
She suggests that if a hospital has trouble properly performing a root cause analysis, representatives should notify the JCAHO within five days of the event requesting help, again with legal counsel's assistance to achieve the best possible protection from discovery. Ms. Mackey also recommends that hospitals order two books, Conducting a Root Cause Analysis in Response to a Sentinel Event (1996) and Sentinel Events: Evaluating Cause and Planning Improvement (1998), from the JCAHO to help in preparing a root cause analysis.
New Rules for Telemedicine Medicare will pay for telemedicine consultations at 80% of the physician fee schedule but only when both practitioners are present at a video terminal, according to a set of proposed regulations released last summer. After a 60-day public comment period, the new rules are scheduled to take effect on January 1, 1999. Medicare coverage for telemedical consultations was mandated by last year's balanced-budget law. According to HCFA estimates, Medicare will spend about $270 million for telemedicine services from 1999-2003. Prior to that, Medicare didn't pay for most telemedicine services. Under the new rules, physicians would be reimbursed at 80% of the rate they would normally be paid under the Medicare physician fee schedule. The consulting physician would then be responsible for forwarding 25% of that amount to the referring physician. The consulting physician would be paid at a rate based on his or her location, not the location of the patient. However, the patient must be located in a rural area designated by HCFA as a "health professional shortage area." HCFA said that in general, a referral to a specialist could run afoul of the federal anti-kickback statutes, which bar any form of remuneration to induce Medicare or Medicaid patient referrals. However, a presenting physician in a telemedicine case would be considered a "conduit," and the case would not be considered a referral. "We do not believe this interpretation violates the purpose of the self-referral law," HCFA said. Under the new rules, not only physicians, but also physician assistants, nurse practitioners, and other non-physician practitioners would be eligible for reimbursement for telemedicine services.
Congress Logging On Members of Congress and their staffs have been logging on to http://fca.aha.org, the American Hospital Association's (AHA) web site that's designed to give Capitol Hill the latest information on the government's use of the False Claims Act to investigate Medicare billing disputes. The site has been in operation since May 25, and reports more than 12 hits a day. The goal: building Hill support for S. 2007 and H.R. 3523, the Health Care Claims Guidance Act, which would amend the False Claims Act to distinguish innocent Medicare billing mistakes from genuine fraud. This dynamic site features video clips, horror stories, and the latest list of cosponsors. For more information, contact Ken Becker, the AHA's national grassroots director, at (202) 626-2288.
Nursing Homes Under Fire by Feds More surprise inspections and faster financial penalties face nursing homes following a new enforcement policy announced by President Clinton. By the end of the year, the federal government plans to post on the Internet inspection reports for each of the nation's 16,700 nursing homes. Clinton also said he would send to Congress legislation to establish a national registry of nursing home workers who've been convicted of abuse and require nursing homes to run criminal background checks on job applicants. A similar bill introduced last year already has bipartisan backing. About 1.6 million people live in nursing homes, but that number will rise dramatically with the aging of the baby boom generation. By 2000, the United States will have more elderly people than children. Under Clinton's plan, the administration will:
Compliance Officers--Who are they? Of 43 health systems recently surveyed by the Hay Group, half have created a compliance officer's post, while another 22% plan to open such a job soon. "Our survey shows a growing concern about the regulatory scheme and staying in safe harbors," says Gordon Hawthorne, senior consultant in the Hay Group's healthcare practice and a former Arkansas hospital executive. "It also shows that the federal government's increasing emphasis on compliance is working." Although the Office of Inspector
General has issued general guidelines for compliance programs, there's
no cookie-cutter definition for the job. Generally, compliance officers
at smaller organizations have more duties than those at larger ones,
even though they make less money. Smaller systems often don't have
the resources to put someone on the job full time and may end up
combining compliance tasks with internal auditing or similar duties. Though compliance is all about obeying the law, the survey found that few health systems require a legal background. Most systems look for healthcare experience and a working knowledge of government policy, especially Medicare. An officer can turn over detailed legal questions to the hospital's counsel, but few non-healthcare lawyers can cram 33 years of Medicare policy overnight.
Fraud Investigation Results Reported According to a recent General Accounting Office (GAO) report, the Department of Health and Human Services and the Department of Justice together were responsible for restoring $130.7 million to the federal Medicare Hospital Insurance Trust Fund in fiscal year 1997. The report disclosed that sources of the deposits were primarily penalties and damages ($89 million) and criminal fines ($41 million) resulting from healthcare fraud audits, evaluations, investigations, and litigation initiated prior to implementation of the Health Care Fraud and Abuse Control (HCFAC) program which was established pursuant to the Health Insurance Portability and Accountability Act of 1996. The report cited $6.1 billion in cost savings to healthcare funds in 1997; $2.1 billion related to the Medicaid program, and the remaining $4 billion related to actions that could not be associated with expenditures for HCFAC.
Tougher "Samaritan" Laws Proposed The death last May of a 15-year-old boy outside a Chicago hospital when staffers, citing hospital policy, refused to go outside to bring him in, has helped spark a public debate about how--or if--Americans have a duty to help someone in need. Some policy experts say people do have such a duty and it should be legislated. Following the incident, the Chicago City Council introduced three ordinances to require hospital personnel to care for an injured person outside of the facility. The toughest of the measures would allow the city to revoke the business license of any hospital whose staffers fail to assist a victim within 150 feet of the hospital's doors. Following the Chicago incident, the AHA urged all hospitals to review their policies regarding whether emergency department staff can leave the facility to treat a patient. For the most part, America's legal system does not require people to render aid to a victim. Only seven states--Louisiana, Minnesota, Montana, Rhode Island, Utah, Vermont, and Wisconsin--have so-called "duty to render aid" laws, according to the National Conference of State Legislatures. And not all apply to healthcare workers. But nearly every state has "Good Samaritan" laws and most of the laws provide immunity from lawsuits for healthcare professionals who voluntarily provide aid to someone who is critically injured.
Arkansas Hospitals Quiz 1. Who is the new
administrator of DeQueen Regional Medical Center? Arkansas Hospitals Quiz Answers: 1. Rex Jones
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