"Health & Medical News"

Advanced-practice nurses are the focus of a new wave of scope-of-practice bills that are making their way to state lawmakers.

At least 24 states are already considering bills or are expecting measures to be introduced this year. Measures address issues such as independent practice, doctor supervision of nurses, prescribing authority, or extended prescribing, including of controlled substances.

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One physician’s faxed order to discontinue hydrocodone, marketed as Anexsia, was misread by the pharmacist as an order to discontinue Arixtra, an anticoagulant. Another doctor intended to electronically order clonidine, an antihypertensive, but accidentally ordered the sedative clonazepam because both appeared as “CLON” on the computer screen.

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Washington — Higher-than-expected costs and enrollment in Massachusetts’ health reform program are translating into higher premiums and co-payments for enrollees and a concern physicians will face pay cuts.

The Connector Authority, the board overseeing the state’s comprehensive health system reform program, unanimously agreed on March 20 to raise monthly premiums by 10% for its subsidized health plans starting July 1, the beginning of the state’s 2009 fiscal year.

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An integral part of some state and local health system reform efforts has hit a major stumbling block. The business community has taken employer mandates to court.

These state and local laws require businesses to spend a certain amount on workers’ health care coverage or put that money into a fund to provide access for the uninsured. U.S. courts in Maryland, New York and California have sided with the business community and ruled that the federal Employee Retirement Income Security Act trumps these efforts.

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Colorado’s noneconomic damage cap in medical liability cases is under fire. Physicians say legislation — approved by the state Senate in late February — threatens to unhinge the state’s stable medical liability climate.

The bill, backed by trial lawyers, would raise the current $300,000 cap by roughly 50%, to more than $460,000, largely to track inflation. More problematic, doctors say, is that injuries classified as physical impairment or disfigurement no longer would be subject to the limit on pain and suffering awards.

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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 — To treat or not to treat has long been a puzzle in prostate cancer, with studies lending support to both options. Now comes a new, large study of older men with early-stage cancer that points to “watchful waiting” rather than treatment as the better option for this population.

The study, presented Feb. 14 at the 2008 Genitourinary Cancers Symposium in San Francisco, found that a conservative approach that included monitoring for increasing levels of prostate-specific antigen and other signs of the cancer’s growth was a successful strategy for the majority of the older men studied who had stage I or stage II prostate cancer.

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Washington — Many states enacted modest health coverage expansions in 2007, but gloomy budget forecasts will continue to make it tough for them to adopt more expensive, comprehensive health reforms.

Three major state reform trends continued or developed in 2007, said Susan Laudicina, one of the authors of a recent BlueCross BlueShield Assn. report on health legislation. States continue to adopt bills expanding access to public health programs and legislation making private insurance more affordable or flexible. Ten states also adopted transparency bills, most of which required hospitals to disclose medical errors and infection rates.

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A legal dispute in Washington state has doctors worried that their ability to employ other licensed medical professionals — and ultimately compete in health care — may be compromised.

The owner of a physical therapy group is suing an orthopedic practice, saying the doctors are profiting illegally from referrals they make to physical therapists who work for them. Columbia Physical Therapy also claims that state law prohibits Benton Franklin Orthopedic Associates in Kennewick, Wash., from hiring physical therapists at all. Both sides are asking the Washington Court of Appeals to clarify the issue. Judges have yet to decide whether to accept the case.

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Washington — President Bush used his last State of the Union speech to restate his existing health care proposals, including tax deductions for health insurance spending, health insurance pools for businesses, medical liability reform and wider use of health information technology. Bush also challenged Congress to address the long-term solvency of entitlement programs, such as Medicare.

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