Friday, July 31, 2009

Update: FTC Delays Implementation of Red Flag Rule Until November 1, 2009

The Federal Trade Commission (FTC) has delayed implementation of the "red flag" rule until November 1, 2009. The FTC's announcement does not mention whether or not the rule will be amended to exclude hospitals and other medical facilities from the list of "creditors" who are subject to the rule.

The FTC's announcement and guidance on the red flag rule can be found here:

Source: Federal Trade Commission

Thursday, July 30, 2009

Closed Residency Programs Records Are Available

A service from the Federation of State Medical Boards (FSMB) offers to permanently store the records of residency programs that have closed. The FSMB also offers to house medical staff files from closed hospitals. Upon request, the FSMB will verify a physician’s training or medical staff affiliation from one of these programs.

According to the Joint Commission (TJC), National Committee for Quality Assurance (NCQA), and URAC, verification of a physician’s credentials from one of these closed programs by the FSMB meets the primary source verification requirements of each of those organizations. To date, nearly 50 closed programs have sent their records to the FSMB.

The FSMB provides a centralized, uniform process for health care entities to obtain a verified, primary source record of physicians and physician assistants’ core medical credentials. For more information, please go to or contact Nicole Lloyd at or (817) 868-5084.

Wednesday, July 29, 2009

FTC Red Flag Rules May Be Delayed Again

The implementation of "red flag" rules requiring creditors and financial institutions to implement security programs and policies to deter identity theft may be delayed once more. Entities are currently required to be in compliance by August 1.

The American Medical Association, American Bar Association, and the National Retail Federation have filed complaints to the Federal Trade Commission (FTC), claiming that the red flag rules are meant for financial institutions such as banks and credit companies. The groups argue that the broad language of the rule has unintentionally placed other institutions under the policy. For example, hospitals would be considered creditors under the rule since they provide services and then defer payment until a patient pays a bill out of pocket, or insurance reimbursement is received.

The organizations have contacted the FTC and Congress to try and get a deadline extension, which would provide time to amend the policy to apply to only the intended institutions. If an extension is not granted, the American Bar Association intends to file a lawsuit against the FTC.

Source: BNA

Friday, July 24, 2009

Senate Delays Health Reform Vote Until September

The Senate has decided to hold off voting on a health reform package until September. President Obama's original desire was for both the House and the Senate to pass their reform bills prior to adjourning for the August recess.

Instead, Senate Majority Leader Harry Reid (D-NV) said that the Finance Committee will markup the Health, Education, Labor, and Pension (HELP) Committee's proposed plan prior to the recess, with a floor vote expected in September.

President Obama, Senate Republicans, and Senate Democrats are all in agreement over the delay, saying that it will allow senators more time to read the reform package and discuss it with their constituents during the August recess.

Source: CQ

Thursday, July 23, 2009

AMA Considers White Coat Ban

On June 16, the American Medical Association (AMA) voted to have a committee further consider a recommendation banning the use of white coats by doctors in hospitals.

The proposed recommendation comes after the British National Health System imposed a "bare below the elbow" system banning certain clothing items, including white coats. The movement toward eliminating the coats and items such as neckties has risen in response to the growing number of hospital-acquired infections. Although there has been no study directly linking white coats and business dress to the rise in hospital-acquired infections, it is believed that these items may be more likely to carry the germs that cause infections than short-sleeve scrubs.

The white coat has long been a symbol of physician responsibility and care. Now it seems that it may become a thing of the past in the pursuit to improve patient safety.

Source: The Chicago Tribune,0,1802810.story

President Obama Pitches His Health Plan to the Nation

As Congress is starting to face the fact that passage of a health reform bill is unlikely before the scheduled August recess, President Obama held a news conference last night to address concerns that have voiced by Americans.

Obama stated that changes in the delivery of care must be made in order to save money, which will in turn, be used to fund health coverage for the uninsured. His proposals included better communication between hospitals and doctors so patients aren't receiving repetitive tests, use of less expensive drugs, and higher Medicare reimbursement rates for healthcare providers who spend more time with their patients. The bottom line of the President's plan is to ensure that all Americans have health coverage and receive quality, cost-effective care.

Even members of Obama's own party are skeptical about proposed plans. Moderate Blue Dog Democrats are countering Speaker Nancy Pelosi's (D-CA) claim that there are enough votes to pass the House's version of the bill. They claim that additional provisions need to be made to exempt small businesses from the requirement that all employers help pay for their employees' health coverage, and that there needs to be more language regarding offsets that will fund the government-run coverage option.

The Senate is also continuing negotiations on their version of the reform bill, with members of the Senate Finance Committee trying to figure out ways to raise revenue to fund the government health plan.

Sources: The Washington Post, CQ

Wednesday, July 22, 2009

Should Healthcare Be Rationed?

Peter Singer, Professor of Bioethics at Princeton University, proposes the rationing of healthcare as a solution to reducing costs. Singer suggests saving costly treatments for those who would benefit from them in the long-term, rather than to those who are expected to die within a few months to a year.

Although the idea of depriving someone of treatment sounds unethical, Singer argues that rationing already occurs in the current system, where those with private insurance can only access to the coverage they and their employers can afford, while those covered under Medicare and Medicaid are limited to those services with affordable copayment.

Singer urges the United States to consider a system used in other countries where public health coverage is provided at no cost, with the option to purchase additional private coverage. He believes that this, along with a system that rations healthcare expenses only to services that can provide years of quality living, is the best way for the United States to achieve the goal of healthcare reform, which is to provide coverage to all Americans.

To read the full article, click here:

Source: The New York Times

Increase in Outpatient Services in Unregulated Facilities

Americans are increasingly turning to outpatient services offered in doctors' offices rather than in hospitals or accredited ambulatory surgery centers. The July 20 Wall Street Journal article, "Seeking a Safer Surgery" examines the potential risks faced by patients.

Outpatient surgery in a doctor's office is favorable because it often costs less and is more accessible than scheduling the procedure in a hospital or ambulatory surgery center. However, many offices are not accredited by a recognized agency or certified by CMS, which require strict standards for training and facility conditions. Doctors are accountable only to their licensing standards. They may choose to have their offices accredited by the American Association for Accreditation of Ambulatory Surgery Facilities, The Joint Commission, or the Accreditation Association for Ambulatory Health Care, but many do not want to face the cost of surveying.

Many states have started imposing regulation on doctor's offices that offer outpatient surgery to diminish the potential safety risk.

To read the full article, click here:

Source: The Wall Street Journal

Tuesday, July 21, 2009

NAMSS Supports Task Force Revision of MS.1.20 (now MS.01.01.01)

The Joint Commission released a final revision of MS.1.20 in 2007 to address conflict in hospitals where members of the Medical Staff felt that the Medical Executive Committee no longer represented their interests. In 2008, The Joint Commission formed the MS.1.20 Task Force to address field concerns regarding the rationale, implementation, and language of the standard. This year, Task Force completed a proposed revision of MS.1.20 (now MS.01.01.01).

NAMSS commends the work of the MS.1.20 Task Force convened by The Joint Commission to create a workable compromise to the original revision, balancing elements that increase the voice of the Medical Staff, while promoting efficient hospital administration and governance. Past President Carol Ostermann, CPMSM, CPCS, represented NAMSS on the Task Force. Other groups represented on the Task Force include the American Medical Association, American Dental Association, American Hospital Association, Federation of American Hospitals, American College of Surgeons, and the American College of Physicians.

While the latest revision may require some bylaws changes in a number of facilities, we believe that it is a large improvement over the previous version, which potentially required a burdensome amount of policies and procedures to be placed within the medical staff bylaws. Improvements to the new proposal include:

  • Details of policies and procedures can be included in separate documents, rather than in the Medical Staff bylaws
  • The Medical Staff can delegate approval of policies and procedures to the Medical Executive Committee

The Joint Commission has given the Task Force organizations the opportunity to conduct field reviews of the proposed revision among their members. Each organization has been asked to provide The Joint Commission with their membership response by October 15, 2009. Based on this feedback, The Joint Commission will determine whether or not the proposed revision will be released to the entire field for review.

NAMSS has requested that The Joint Commission consider all comments and concerns voiced through the process and is willing to assist with any further revision or clarification after all responses have been collected and evaluated. NAMSS also intends to provide educational resources to the membership to help you understand the revision and how to implement it in your facility.

NAMSS appreciated the opportunity to work with The Joint Commission and the members of the Task Force in a participatory process to ensure that MS.01.01.01 works toward the goal of providing safe, quality patient care. We hope to continue working with The Joint Commission and other organizations to ensure that the perspective of the medical services professional is included in the development of healthcare policies.

The Joint Commission’s official announcement can be found in the July 15 issue of Joint Commission Online and in the next issue of Perspectives.

A link to the proposed revision and survey was sent to the membership via e-mail and will be posted on the NAMSS website in the coming days.

If you have any questions or comments regarding MS.01.01.01, NAMSS’ position on the proposed standard, or did not receive the original eBlast announcement, contact Christine Perez at

Thursday, July 9, 2009

California Physician Assistant Convicted of Medicare Fraud and Identity Theft

Los Angeles physician assistant Ronald Luis Bradshaw, an employee of Glenmountain Medical Group, was convicted of four counts of healthcare fraud, conspiracy to commit healthcare fraud, and aggravated identity theft on June 30 for stealing a doctor’s identity to collect $7.7 million in Medicare payments (United States v. Bradshaw).

A report by the Department of Justice states that from April 2005 to April 2008, Bradshaw ordered tests and prescribed durable medical equipment to Medicare beneficiaries under the apparent supervision of a doctor.

The doctor testified that he had never worked at the Glenmountain facility and that Bradshaw had written the prescriptions using his UPIN without his knowledge.

The Department of Justice and the Department of Health and Human Services have formed the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to combat fraudulent healthcare claims such as this one. HEAT currently has teams in Los Angeles, Detroit, South Florida, and Houston.

MSPs have the ability to help in the battle against healthcare fraud. When credentialing Allied Health Professionals, ask yourself, “Did I remember to confirm the AHP’s supervising physician?” Also, examine current practices at your facility. Do you have best practices and procedures in place for ensuring that UPINs are kept confidential?

Healthcare fraud is costing the system millions of dollars. By asking yourself the two questions above, you can not only ensure that you have verified the identity of an AHP, but you can also prevent the types of fraud illustrated in this case, which drain funding from the beneficiaries who truly rely on Medicare and Medicaid coverage.

Source: BNA

CMS Renews TJC's Deeming Authority for Critical Access Hospitals

The Centers for Medicare and Medicaid Services (CMS) has renewed The Joint Commission's (TJC) deeming authority for the accreditation of critical access hospitals through November 21, 2011.

“Critical access hospitals are an important safety net, providing Medicare beneficiaries living in rural areas with the care that they need,” says Mark Pelletier, R.N., M.S., executive director, Accreditation and Certification Services, The Joint Commission. “The Joint Commission is pleased to collaborate with CMS to provide quality oversight for these important providers of rural health care.”

Critical access hospitals serve rural areas, and usually located over 35 miles from another hospital. They receive cost-based reimbursement from Medicare. There are currently over 1,000 critical access hospitals nationwide.

Tuesday, July 7, 2009

Hospitals Agree to Contribute $155 Billion to Cover the Uninsured

The Washington Post reports that the American Hospital Association, the Federation of American Hospitals, and the Catholic Health Association have agreed to contribute $155 billion over the next ten years to help provide coverage for the uninsured.

By agreeing to the plan, which involved discussions with members of the Obama Administration and Senate Finance Committee, the hospital associations recognized that they will receive lower payments for services under Medicare and Medicaid and for services provided to the uninsured.

The agreement follows a similar revenue reduction agreement reached with pharmaceutical companies made two weeks ago.

To read the full article, click here:

Source: The Washington Post

Monday, July 6, 2009

CMS Proposes 21.5% Physician Pay Cut and Other Measures for 2010

The proposed Medicare Physician Fee Schedule (PFS) projects a 21.5% cut in physician payments for 2010. CMS expects that the cut will be offset by proposals in President Obama's plans for health reform, which will reduce future cuts and will increase payments for primary care physicians.

CMS' proposal also includes the following:
  • Reallocating a higher proportion of professional liability insurance costs to physicians with the highest malpractice costs;

  • Reducing payments for imaging services to provide increased payments for services such as primary care;

  • And encouraging participation in the Electronic Prescribing Incentive Program and the Physician Quality Reporting Initiative.

The proposed rule can be found in the Federal Register. It is open for public comment until August 31, with the final rule going into effect on November 1.

To read the proposed rule, click here: