Tuesday, September 28, 2010

Whistleblower Physician Awarded $1 in Damages after Hospital Took Retaliatory Action

The US District Court for the District of Maine awarded Dr. Kristine Thayer $1 in damages, plus recovery of attorney's fees and court costs after a jury found that Eastern Maine Medical Center (EMMC) took retaliatory action against her in violation of Maine's Whistleblower Protection Act (Thayer v. Eastern Maine Medical Center).

Thayer, a pediatric surgeon, told her supervisor that pediatric gastroenterologist Dr. Mohammed Tabbah was providing substandard patient care. Following the report, the hospital began an investigation of Dr. Thayer as a disruptive physician and the medical staff executive committee recommended that she attend anger management counseling, with the threat of disciplinary action for further disruptive behavior. Thayer voluntarily chose to leave EMMC.

At trial, the jury found that the supervisor's initiation of peer review was retaliation for Dr. Thayer's actions and a violation of the Whistleblower Protection Act; however, they believe that that she suffered no injury that would entitle her to damages. Thayer filed an amended complaint for damages as well as the cost of court and attorneys' fees.

The district court ruled that Thayer was entitled to court and attorneys' fees. However, they limited her damages to $1, stating that the reinstatement of her professional reputation and the negative reputation cast on EMMC was an appropriate remedy that did not need to be supplemented by a further award of monetary damages.

Source: BNA

Friday, September 24, 2010

TJC Releases 2010 Report on Hospital Quality and Safety

The Joint Commission (TJC) has released their 2010 Annual Report on Quality and Safety. For the first time, the report focuses on accountability and performance and how they have a positive impact on patient care.

To read the full report, click here:

Source: The Joint Commission

Are Train Station Bathrooms Cleaner than Hospital Bathrooms?

A survey performed by MicrobeWorld, an educational branch of the American Society for Microbiology, shows that bathroom users in large public places such as Grand Central Station in New York City and Turner Field in Atlanta, may be more likely to wash their hands than those working in hospitals.

Turner Field scored the lowest out of all the public locations, with 65 percent of men washing their hands after using the bathroom. This is high compared to a study performed by McGuckin Methods International, which found that less than 50 percent of bathroom visitors in ICU and non-ICU units complied with baseline hand washing guidelines.

Organizations such as The Joint Commission have set hand hygiene goals for hospitals and have reported success in increasing compliance. Hospitals need to emphasize the importance of proper hand washing. This simple practice can help drastically cut the number of hospital-acquired infections, which are on the rise in facilities across the country.

Source: thehealthcareblog.com

Thursday, September 23, 2010

Six Major Health Reform Provisions Effective Today

Today, six of the major provisions of the Affordable Care Act go into effect. They are:

  • Extended coverage for young adults under their parents' plan
  • Plans must offer free preventative care services
  • Insurance companies are prohibited from rescinding coverage if a person becomes sick
  • The ability for Americans to select between two appeal processes when challenging an insurance decision
  • Elimination of lifetime caps on coverage
  • Regulation of insurers' ability to set dollar limits on coverage

To read more details about these provisions, click here:

Curious about when the other provisions of the Affordable Care Act will go into effect? Click here to see a full timeline of changes that will occur:

Sources: healthreform.gov, EmblemHealth

Wednesday, September 22, 2010

OIG Report Shows CMS' Failure to Report Adverse Actions to HIPDB

A report from the Department of Health and Human Services Office of the Inspector General (OIG) shows that although the Centers for Medicare & Medicaid Services (CMS) took adverse actions against providers, it failed to report all of these actions to the Healthcare Integrity and Protection Data Bank (HIPDB).

The HIPDB is a repository of "all final adverse actions against health care practitioners, providers, and suppliers." The purpose of the HIPDB is to provide states, federal agencies, and health plans with a resource to help them prevent dealings with practitioners, providers, and suppliers with a history of fraud and abuse.

The report, titled "CMS Reporting to the Healthcare Integrity and Protection Data Bank," revealed that CMS failed to properly report actions taken against laboratories, DME suppliers, and nursing homes. These adverse actions either went unreported even when final action was taken, or were reported outside of the required reporting timeframe, which is about 30 days from the date action was taken, or the date that the reporting entity discovered the action.

The OIG recommended that CMS resolve the problem by providing staff and contractors with better education on reporting requirements. CMS agreed with the findings and pledged to work with the Health Resources and Services Administration (HRSA) to determine what actions are reportable.

This report reminds us that MSPs must be diligent when performing credentialing functions. The data we rely upon is only as good as the reporting source. You cannot evaluate data pulled from one source with a "vacuum mindset." When pulling reports, compare the information you collect along with other reports as well as the provider's history. This investigative step may help you to disclose adverse actions that may not be found in database reports.

To read the full OIG report, click here:

Source: Department of Health and Human Services, Office of the Inspector General

Tuesday, September 14, 2010

Study Shows Patients Are Provided with Insufficient Quality Physician Quality Data

Patients are encouraged to select physicians based on certain quality characteristics; however, a recent study reveals that patients don't have access to the information that should be used in order to make decisions on healthcare providers. This finding can be found in the September 13, 2010 issue of the American Medical Association's Archives of Internal Medicine.

The report states that the profile information given to the public to assist with the selection of a doctor does not strongly correlate with a doctor's ability to provide quality clinical care. For example, malpractice claims were found to be a weak indicator of performance. The study noted that there are three characteristics that are associated with higher performance --"female sex, board certification, and graduation from a domestic medical school;" however, even this data only indicated marginal differences in quality.

The report also notes the need for greater public access to physician quality data, so patients can make well-informed choices regarding their care. As MSPs know, one must search beyond the basic information on a physician's training to reveal the true level of quality that the physician can provide.

To view the report's abstract, click here (payment required for access to the full article): http://archinte.ama-assn.org/cgi/content/abstract/170/16/1442?view=short&fp=1442&vol=170&lookupType=volpage

Source: Archives of Internal Medicine

Tuesday, September 7, 2010

Report Encourages Disclosure of Large-Scale Medical Mistakes

The Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) recommends that large-scale adverse events and medical mistakes should be reported by facilities, even though they do not result in patient harm. This recommendation was noted in a study titled, "The Disclosure Dilemma -- Large Scale Adverse Events," which was published in the New England Journal of Medicine.

The AHRQ encouraged facilities to personally contact all patients that may be affected by a large-scale error such as the use of improperly sterilized medical tools and equipment malfunctions, even if the patients suffered no effect. Facilities are concerned that reporting these events will cause psychological distress on patients that would have had no worries had the event gone undisclosed. They are also concerned that reporting events will place a burden of negative press on facilities.

The AHRQ recommends that facilities have a policy in place that sets a structure for reporting errors and reaching out to all affected patients with follow-up care and compensation.

To read the full study, click here: http://www.nejm.org/doi/full/10.1056/NEJMhle1003134

Source: BNA

Friday, September 3, 2010

Resident Suspected of Altering Performance Records

Dr. Eric George Batterson of the University of Michigan Health System is accused of accessing computers without authorization to alter his performance records.

Batterson allegedly used a program that tracks the typing of a computer's user. He used this information to obtain passwords for computers and e-mail accounts so he could alter his performance records and lower the performance records of his colleagues. Batterson's activities were discovered when employees realized that their computers and e-mails had been accessed without their permission.

A preliminary court hearing is scheduled for Sept. 29. Batterson is charged with "nine counts each of unauthorized access of computers and using computers to commit a crime, as well as one count of possessing a Taser."

Source: annarbor.com

Watch out for H.E.A.T.

The Obama Administration will be increasing the HEAT to help combat healthcare fraud. The US Attorney General and Secretary of Health of Human Services created the Healthcare Enforcement Action Team (HEAT) in 2009 to investigate cases of fraud. HEAT strike teams are currently present in seven cities. The increase will expand HEAT presence to twenty metropolitan areas.

The HEAT strike teams are responsible for targeting and investigating healthcare fraud cases, something that the FBI and Department of Justice have not been able to handle on their own. Billions of dollars are currently being wasted due to fraudulent claims. The Obama Administration hopes that the success of HEAT will help to prevent and recover these claims, so that money can be better spent on improving quality and controlling costs for Medicare beneficiaries.

Source: Lexology (log-in required)

Thursday, September 2, 2010

Former CEO of LA Hospital Sentenced for Role in Billing Scheme

On August 31, Rudra Sabaratnam, former CEO of the now-defunct City of Angels Medical Center in Los Angeles, CA was sentenced to two years in prison and ordered to pay $4.1 million in restitution for his role in a Medicare and Medi-Cal billing scheme (US v. Sabaratnam).

Sabaratnam, along with former board chairman Robert Bourseau, paid an employee of a homeless recruitment center in the "Skid Row" district of Los Angeles to refer homeless patients to the City of Angels Medical Center for unnecessary inpatient treatment so that the facility could bill Medicare and Medi-Cal. Bourseau was sentenced earlier this year for his role.

Often reports of fraudulent Medicare billing involve physicians and other providers. This case serves as a reminder that corruption and abuse of power can occur at all levels of healthcare delivery -- from the provider to the administrator.

Source: BNA