"Health & Medical News"

From:
Treatment Research Institute
600 Public Ledger Building, 150 S. Independence Mall West
Philadelphia, PA 19106
Tel: (215) 399-0980
http://www.tresearch.org

Paying substance abuse treatment providers for results, not services, may lead to improved quality of care, according to the first published study of a novel performance-based contracting system implemented by the State of Delaware in 2002.

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Washington — Drug firms would have a more direct route to physicians when it comes to spreading the word about new research findings for off-label uses of drugs and devices, if a new Food and Drug Administration proposal is finalized.

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Washington — Federal regulators have proposed sweeping patient safety rules to give physicians and others a confidential, voluntary way to report medical errors and near mistakes. Several health care organizations applauded the release of the long-awaited regulations but want a closer look before making a final judgment.

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A California appeals court dealt another blow to health plans over their policy cancellation tactics.

The 4th District Court of Appeal unanimously said insurers have a responsibility to make sure patients’ policy applications are complete and accurate before issuing coverage — not after expensive claims come in the door. Judges said plans cannot revoke patients’ policies unless they fully investigate pre-enrollment forms up front or insurers show patients intentionally misled them.

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Georgia physicians and hospitals are wrangling over a rule change that paves the way for general surgeons to establish ambulatory surgery centers without going through the certificate-of-need process.

The state’s Dept. of Community Health in December 2007 unanimously approved a rule that reclassifies general surgery as a single specialty rather than a multispecialty. It amends related certificate-of-need requirements for physician-owned ambulatory surgery facilities. Georgia law exempts surgery centers focusing on a single specialty, such as orthopedics or obstetrics and gynecology, from demonstrating need.

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A California appeals court ruling may bode well for physicians and patients in their fight against alleged illegal policy cancellations by health insurance companies.

A three-judge panel of the 2nd District Court of Appeal unanimously ruled that the practice of reviewing individuals’ applications after they have submitted claims and then pulling the coverage based on alleged errors “is flatly prohibited” under state insurance laws. The Dec. 4, 2007, decision gave the green light to a patient’s class-action lawsuit alleging that Blue Shield of California tried to dodge claims by looking for supposed misstatements or omissions on patients’ policy forms after approving treatment.

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The New Mexico Department of Health would issue licenses to individuals and organizations to legally provide medical marijuana under draft rules unveiled last week, the Associated Press reported Dec. 4.

The license would allow patients, caregivers, state-run programs or private entities to legally manufacture and distribute marijuana for medical use. The draft rules will be open for public comment starting in late December, and a public hearing will be held in January.

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Physicians say a Colorado Supreme Court ruling recognizes the importance of protecting ongoing peer review from the threat of lawsuits. But they say the decision likely will make it difficult for doctors to get relief from the courts when they believe abuses are taking place during the proceedings.

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The House Committee on Education and Labor heard emotional testimony about abuses at so-called boot-camp programs for troubled youth, and members vowed to step up regulation of the programs, USA Today reported Oct. 11.

A Florida jury last week acquitted guards and a nurse of manslaughter charges over the death of a 14-year-old boot-camp resident, but Congress heard many other stories about children who died while enrolled in similar programs. “I can’t think of any testimony that we have heard in this committee that has caused a greater sense of anger and sorrow,” said committee chairman Rep. George Miller (D-Calif.).

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Physicians fear that a recent Minnesota Supreme Court decision could compromise statutory peer review protections and taint physicians in medical liability cases that are tied to negligent credentialing claims.

For the first time, the high court recognized that patients can sue hospitals for allegedly granting privileges to doctors with questionable credentials. The unanimous decision adds Minnesota to a list of at least 25 other states that recognize negligent credentialing claims.

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