Good Sam law; capitation fight
Texas doctors no longer have to prove they didn't expect to be paid to qualify as Good Samaritans. That's the result of a recent Texas Supreme Court ruling in a case in which a physician voluntarily responded to a hospital's "Dr. Stork" page and was later sued for malpractice when the baby suffered permanent neurological damage.
The decision reverses an appellate court ruling that the state's Good Samaritan law protects doctors only if they can prove that they hadn't acted in expectation of payment for services. Although the physician testified that he wouldn't have billed the patient, the appeals court refused to accept his testimony as proof.
The state Supreme Court declared that the appellate decision would put physicians who act as Good Samaritans in the impracticable position of having to disprove every possible theory by which they might be entitled to compensation. The Texas court's position contrasts with that of the New Jersey Supreme Court, which ruled last year that the state's Good Samaritan law isn't intended to protect physicians who care for patients in fully staffed hospitals.
For more on the Texas case, see "Do Good Samaritan laws protect you in the hospital?" (May 10, 2002).
Physicians, nurses, and patients view quality of care and patient satisfaction differently, according to a study published in the Journal of Nursing Scholarship. Doctors rated quality higher (83.6 on a 100 point scale) than nurses (73.9) and slightly higher than patients (81.7). They also tended to somewhat overestimate patient's satisfaction with inpatient care. While nurses' rating of satisfaction approximated that of patients (81.4 vs 81.3), physicians scored it 86.2.
In a case that's likely to decide the fate of most of the nation's medical marijuana laws, the US Solicitor General has petitioned the Supreme Court to review whether a physician's recommendation to use marijuana is analogous to a "prescription." Last year, the Court of Appeals for the Ninth Circuit held that the government couldn't investigate a physician or revoke his DEA registration merely because he recommends medical marijuana to a patient.
The appeals court also held that the revocation of a physician's DEA registration would be inconsistent with the First Amendment, since professional speech should be protected. The government contends that the practice of medicine is subject to regulation, even where that practice involves speech.
The California Department of Managed Health Care has proposed regulations that will require health plans to make capitation payments to providers from the date of patient enrollmentretroactively, if necessary. That "will help to reduce the financial instability of some physician groups and their contracting physicians," says CMA President Ronald Bangasser.
Initially, the DMHC had proposed allowing health plans to delay assigning new enrollees to a provider for as long as 45 days after enrollment. In addition, health plans would have been allowed to defer making capitated payments for another 45 days. The California Medical Association argued that the initial proposal would not only put physicians at financial risk, but would allow health plans to profit unfairly by retaining the premiums collected from those patients.
For the past two years, states have struggled to deal with the downturn in the nation's economy. Because Medicaid is the second largest expenditure in state budgets, services once thought to be sacred are now on the chopping block, according to the Health Policy Tracking Service. Despite a one-time infusion of $20 billion in federal assistance, legislatures in at least 36 states have been forced to alter Medicaid eligibility, benefits, and reimbursement rates for fiscal year 2004. For example, they've increased copayments for prescription drugs and medical services (11 states), eliminated or reduced benefits (12), toughened eligibility requirements (11), and cut reimbursement rates for all or some providers (18).
Joan Rose. UPDATE: Focus on practice.
Sep. 5, 2003;80:13.