Fall 2004
Health Watch-Patient Safety on the Way
Pennsylvania's medical facilities, including hospitals, ambulatory surgical centers, and birth centers, have begun reporting serious events, incidents and infrastructure failures in accordance with the new statewide incident reporting system implemented by the Patient Safety Authority under MCARE. The reporting obligations under MCARE extend beyond the medical facilities subject to the statute, to the physicians, RNs, LPNs and other licensed professionals working in the facilities. Medical facilities must report to the State incidents that were previously relegated to risk management. Failure of a facility to report constitutes a violation of law. Likewise, the failure of a licensee providing health care services in a regulated facility to report an incident within 24 hours in accordance with the facility's internal procedures may be reported to the appropriate licensing board (i.e., Board of Medicine, Board of Nursing).
This Summer, the Patient Safety Authority introduced the long-awaited reporting system to area medical facilities to standardize recording of incidents ranging from misdiagnosis, to falls and power outages. Certain types of serious events, including hospital rape, infant abduction and wrong site surgery, were previously reported to the Department of Health. However, there was no state-level accountability to licensed health workers individually for failure to report, and incidents were not tracked for potential remedial action.
State-wide large scale reporting of medical errors could be the first step toward a comprehensive program of risk management, and should benefit the patient population.
One thing is certain: the new standardized reporting system will keep medical facilities and licensed health care professionals on their toes and watchful of one another's missteps.
Health Care: Fraud and Abuse
According to some government estimates, over $100 billion dollars is lost each year to health care fraud and abuse. These estimates, if accurate, represent at least 10% of all health care expenditures in the U.S. Moreover, the baby boomers will soon reach retirement age in droves, thus exposing third-party payers such as Medicare to ever-increasing risks of the over-utilization of health care services.
Bottom line: the federal government has every intention of continuing, if not intensifying, the fight against health care fraud and abuse. Otherwise, the pressure on government and private health care plans could become crushing.
For health care providers or suppliers, this raises several areas or items of concern. Number one, inattention to the government's concerns - particularly the dogged determination of the U.S. Justice Department - could place at risk the fruits of your hard work. Number two, even the advice of consultants (including lawyers, accountants and reimbursement specialists) could place you in harm's way if the advisor plays fast and loose with the increasingly complex body of health care laws.
Providers and suppliers should not lose sight of the fact that, in the end, you will be held accountable by the government if violations of the federal and state health care fraud and abuse laws are uncovered. Therefore, all should exercise both caution and prudence when seeking an advisor on these important and complex issues.
Certificate of Need
As the current legislative session draws to a close, we should note that the Pennsylvania General Assembly is considering reinstituting the Certificate of Need (CON) program which - from 1979 until its demise in 1996 - was a controversial weapon in the Pa. Department of Health's arsenal in the war against skyrocketing medical costs.
The CON program was part of the Health Care Financing Act, a comprehensive state law adopted, in the words of the General Assembly, to "enhance and coordinate the orderly and economical distribution of health care resources to prevent needless duplication of services." Among other matters, the Department of Health attempted to curtail over utilization of services - which inevitably leads to higher health care costs - by requiring owners and operators of health care facilities to demonstrate a "need" for certain new clinically related health services (e.g., MRI and ambulatory surgical facilities) PRIOR TO development or construction.
During its 17 year life, CON was ridiculed by segments of the health care community - particularly doctors - as an unwarranted bureaucratic intrusion upon the business decisions of providers. While few believe that the CON program was a great success, some commentators do argue that CON enjoyed modest success in controlling the needless proliferation of some services, such as open heart surgery and the number of long-term care beds. Moreover, CON is thought to have improved the quality of care by, among other matters, requiring providers of unlicensed services (which was most clinically related health services) to meet nationally recognized quality standards.
Now, with the issues of health care affordability and availability again becoming a national concern, some members of the Pa. House and Senate have introduced bills calling for the reactivation of CON, with the full power of "needs" assessment to be given to the Department of Health.
These bills will die at the end of this month as the legislature adjourns. But, look for their reintroduction (and possible debate) in the next session. Health care reform remains a public policy issue of paramount importance. CON will be part of the debate.
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