PRIMARY CARE 2012 - mutualgravity.com · Internet CME limited to 30% per cycle I. Licensure & CME Category 1-B Credits: Participation in Publications, Inspections, Examinations &

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Jeffrey E. MyersJeffrey E. Myers Richard E. FerrettiRichard E. Ferretti

Associate General Counsel, LECOMAssociate General Counsel, LECOM General Counsel, LECOMGeneral Counsel, LECOM

[email protected]@lecom.edu [email protected]@lecom.edu

PRIMARY CARE 2012PRIMARY CARE 2012

Maintaining Your Professional Maintaining Your Professional

License License –– What Every What Every

Physician Should Know!Physician Should Know!

I. Licensure & CMEI. Licensure & CME

AOA members: 123 credits w/in 3 years

30 Category 1-A

90 Category 1-A, 1-B, 2-A, or 2-B

Certain Specialty and Sub-Specialty allowances for ACCME Category 1 credits thru 2015 – Still must total 30 for Category 1-A

CME Reporting forms: www.do-online.org

mailto:[email protected]

mailto:[email protected]

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Category 1-A Credits: Formal educational programs, sponsored by AOA, include:

Formal Osteopathic CME

Osteopathic Teaching – lectures and clinical

Federal Aviation

Presenting to Active Duty/Uniformed Service

Grand Rounds – Series of Three

Faculty Development

Judging Case and Poster Presentations

Internet CME limited to 30% per cycle


Category 1-B Credits: Participation in Publications, Inspections, Examinations &

Committee Meetings

Osteopathic Preceptoring

Recertification Examination credits

Non-AOA accredited institutional work

Non-Osteopathic CME w/ permission

Journal Reading

Test Construction

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Category 2-A Credits:

Formal programs that are ACCME accredited AAFP approved

Internationally known sponsors

AOA-sponsored Category 1 CME sponsors that do not meet 1-A faculty/hour requirements


Category 2-B Credits:

Scientific Exhibits

Home study;

Non-Osteopathic Audio Tapes

Quality Assessment Programs

Courses in medical economics

Risk Management

ABMS Recertification

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Other CME Opportunities

Risk Management Programs

Managed Care Programs

Standardized Life Support Courses

Bioterrorism (8 per cycle)


Activities that earn no credit:

Volunteer work

Post Graduate Studies

Medical Facility Tours

Board Certified/Eligible Physicians

Must earn a minimum of fifty CME credits in their primary specialty per cycle

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I. Licensure & CMEI. Licensure & CME CME Credits

per Cycle Length of

Cycle Mandatory Category 1

Credits

State-Mandated Content

F.L. 40 2 years 20 A0A 1-A HIV/Aids, Medical Errors,

Domestic Violence, Risk M,

Controlled Subst., State Law

& Rules

N.Y. None Infection Control & Child Abuse

O.H. 100 2 years 40 AOA 1-A or B

CME must be OOA-certified

P.A. 100 2years 20 AOA 1-A Risk M & Patient Safety – 12

credits

II. Licensure & ReregistrationII. Licensure & Reregistration

State-Specific Registrations

PA State Board of Osteopathic Medicine

State Medical Board of Ohio [Combined]

Florida Board of Osteopathic Medicine

New York State Board of Medicine [Combined]

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II. Licensure & ReregistrationII. Licensure & Reregistration

Online Capability

Ohio $335 +

Florida $431 +

Dispensing & Pain Management Fees if applicable

Via Mail – Begin process 3-4 months early

Pennsylvania $440 +

New York $735 +

II. Licensure II. Licensure -- Done RightDone Right

1.1. Mail the application to the correct addressMail the application to the correct address

2.2. Send in the right feesSend in the right fees

3.3. Identify all variations to your name ever usedIdentify all variations to your name ever used

4.4. Get the application form in quickly so supplemental Get the application form in quickly so supplemental documents will have a home filedocuments will have a home file

5.5. Correctly identify all training programs with addressesCorrectly identify all training programs with addresses

6.6. Promptly get necessary backup documentsPromptly get necessary backup documents

7.7. Follow up with sources that are sending in documentsFollow up with sources that are sending in documents

8.8. Stay in touch with your reviewer; check for eStay in touch with your reviewer; check for e--mailsmails

9.9. Accurately respond to any requests for follow upAccurately respond to any requests for follow up

10.10. Answer all questions honestly and completelyAnswer all questions honestly and completely

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II. Licensure II. Licensure –– Done WrongDone Wrong

Avoid

Lying

Being Late – It is unlawful to practice osteopathic medicine w/out a valid license (may also void professional liability coverage)

Withholding pertinent information – i.e., actions taken against physician in other states

Submitting an incomplete answer/registration

III. The State BoardIII. The State Board

Primary Purpose is to protect the public

Responsibilities

All professional and public members of the State Boards and the Committee for Professional Assistance must be dedicated to public protection and quality professional preparation and conduct.

The Board accomplishes their function via their State-granted authority and their team of Prosecuting Attorneys.

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III. The State Board III. The State Board -- ComplaintsComplaints

Quality of careQuality of care

MisdiagnosisMisdiagnosis

Substance abuse/impairmentSubstance abuse/impairment

Advertising violationAdvertising violation

Inappropriate prescriptionsInappropriate prescriptions

III. The State Board III. The State Board -- ComplaintsComplaints

Sexual contactSexual contact

Insurance fraudInsurance fraud

Excessive tests/treatmentsExcessive tests/treatments

Failure to release recordsFailure to release records

Patient neglect/abandonmentsPatient neglect/abandonments

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III. The State BoardIII. The State Board

The Boards have the authority to:

Issue subpoenas in all matters relating to the investigation of alleged violations

Subpoena witnesses, administer oaths, examine witnesses

Compel the production of such book, records, papers and documents as it may deem necessary

The State or Commonwealth Courts of the jurisdiction will enforce the subpoenas

III. The State BoardIII. The State Board-- PAPA11

Summary of 2009 PA-DO PA-MD Board Size/Composition

11/6 DO 11/6 MD

Meeting Frequency Monthly * Monthly

Standard of Proof Preponderance Preponderance

Total Actions 2009 25 185

Loss of License 9 93

Restriction of License 5 29

Other Prejudicial 7 41

Total # Active Licenses

6,760 45,070

Total Prejudicial Index

3.11 3.62

1Fed. St. Med. Bds., 2009

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III. The State Board III. The State Board –– Statistics Statistics

Defined Defined

Standard of Proof

Preponderance of the Evidence:

Majority of Jurisdictions/Used in Civil Cases

The standard is met if the proposition is more likely to be true than not true. Effectively, the standard is satisfied if there is greater than 50 percent chance that the proposition is true.

Results in higher instances of disciplinary actions

PA, OH, NY


DefinedDefined

Standard of Proof

Clear & Convincing:

Minority of Jurisdictions/Used in Equity Cases (Paternity, Child Custody, Probate, Right to Die) & some Criminal

Clear and convincing evidence is a higher level of burden of persuasion than a "Preponderance of the Evidence". This standard is met if the evidence presented by a party is found to be highly and substantially more probable to be true than not and the trier of fact must have a firm belief or conviction in its factuality.

Tend to have lower instances of disciplinary actions*

FL, MS, AL, IL, KS, WA, W.V. (MD), W.Y.

http://en.wikipedia.org/wiki/Probability

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DefinedDefined

Prejudicial Board Actions: Includes revocation, suspension, surrender or

mandatory retirement of license;

Includes probation, limitation, or restriction of license, or licensed privileges; and,

Modifications of a physician’s license, or the privileges granted by that license, that results in a penalty or reprimand, etc., to the physician


DefinedDefined

Total Prejudicial Index: A board’s total number of prejudicial actions is divided

by the total number of physicians licensed by the state, whether they practice in the state or not.

Assists state medical boards in monitoring their disciplinary activity over time.

It is not designed to be used in comparing boards to one another as States operate with different financial resources, levels of autonomy, legal constraints and staffing levels, etc.

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III. The State BoardIII. The State Board-- PAPA11


Summary of 2009 PA-DO PA-MD Board Size/Composition

11/6 DO 11/6 MD

Meeting Frequency Monthly * Monthly

Standard of Proof Preponderance Preponderance

Total Actions 2009 25 185





6,760 45,070

Total Prejud. Index 3.11 3.62

III. The State BoardIII. The State Board-- FLFL22

Summary of 2009 FL-DO FL-MD Board Size/Composition

7/5 DO 15/12 MD

Meeting Frequency Quarterly 7 Times per Annum

Standard of Proof Clear & Convincing Clear & Convincing

Total Prejudicial Actions

16 271





5,173 60,006

Total Prejud. Index 3.09 4.52


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III. The State BoardIII. The State Board-- OHOH33


Summary of 2009 OH-DO/MD Board Size/Composition 12/9 Physicians

Meeting Frequency Monthly

Standard of Proof Preponderance of Evidence

Total Prejudicial Actions 235*

Loss of License 103

Restriction of License 113

Other Prejudicial 18

Total # Active Licenses 42,022

Total Prejudicial Index 5.59

III. The State BoardIII. The State Board-- NYNY44

Summary of 2009 NY-DO/MD Board Size/Composition 20/2 All Physicians – 2 DO*

Meeting Frequency Monthly

Standard of Proof Preponderance of Evidence

Total Prejudicial Actions 322

Loss of License 161

Restriction of License 87

Other Prejudicial 74

Total # Active Licenses 85,370

Total Prejudicial Index 3.77


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IV. Medical Board PenaltiesIV. Medical Board Penalties

License Revocation/SuspensionLicense Revocation/Suspension Permanent Revocation/Suspension (OH)Permanent Revocation/Suspension (OH)

License LimitationLicense Limitation

RetrainingRetraining

Censure/ReprimandCensure/Reprimand

FinesFines

Community serviceCommunity service

Internet postingInternet posting

IV. Medical Board PenaltiesIV. Medical Board Penalties

State Boards consider the following factors for determining appropriate penalties5: Patient Harm

Opportunity (type of practice)

Severity of misconduct or inappropriate behavior

Context

Culpability of Licensee

Number of times misconduct occurred

Number of patients involved

Priors including disciplinary and malpractice history

Recommendations of assessing professionals (drugs and mental)

5Federation of State Medical Boards

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V. Prohibited ConductV. Prohibited Conduct Top Four Reasons for Top Four Reasons for

Disciplinary ActionsDisciplinary Actions

1. Impairment

2. Prescribing Issues

3. Actions by Other

State Boards

4. Criminal Actions

V. Prohibited ConductV. Prohibited Conduct

Thou shall notThou shall not

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Sex, Drugs and MoneySex, Drugs and Money

NOTE: This review follows PA law w/ any differences noted for other jurisdictions

The Board shall have authority to refuse, revoke or suspend the license of a physician for any of the following:

Conviction of a felony, a crime of moral turpitudemoral turpitude or a crime related to the practice of osteopathic medicine;

An act of baseness, vileness or depravity in the private and An act of baseness, vileness or depravity in the private and social duties which a man owes to his fellowmen, or to social duties which a man owes to his fellowmen, or to society in general, contrary to the accepted and customary society in general, contrary to the accepted and customary

rule of right and duty between man and manrule of right and duty between man and man


Felony (including moral turpitude) includes: Murder, Manslaughter, Assaults, Pedophilia

Rape, Prostitution, Bigamy, Illegal Pornography

Fraud, Perjury, Tax Evasion*, Theft, Blackmail, Embezzlement

Aiding and abetting or attempting to commit a crime involving moral turpitude

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Cause for Automatic Suspension of License: Certified copy of commitment to a mental health

facility

Conviction of a felony under the Controlled Substance, Drug, Device and Cosmetic Act

Cause for Temporary Suspension of License: Where there is an immediate and clear danger to the

public health and safety.

A prima facie case must be found or it is restored immediately.

The “Good” Stuff The “Good” Stuff -- PrescriptionsPrescriptions

Register with DEA Register with DEA http://www.deadiversion.usdoj.http://www.deadiversion.usdoj.

gov/Registration.htmlgov/Registration.html

Know limits of the five federal schedules 21 USC Know limits of the five federal schedules 21 USC section 801section 801

oo Medical indicationsMedical indications

oo Degree of potential dependence/abuseDegree of potential dependence/abuse

Must be in good faithMust be in good faith

Must be part of practiceMust be part of practice

Keep in mind record keeping and Keep in mind record keeping and reportingreporting obligationsobligations

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Check your state’s laws:

OHIO: http://codes.ohio.gov/oac/4731-11

FLORIDA: Chapter 893.03 Chapter 893.03

New York: http://www.health.ny.gov/professionals/narcotic/lawshttp://www.health.ny.gov/professionals/narcotic/laws_and_regulations.htm_and_regulations.htm

Pennsylvania: https://ecapps.health.state.pa.us/DDC/MainMhttps://ecapps.health.state.pa.us/DDC/MainMenu.aspenu.asp


Prescriptions for controlled substances shall be written in indelible ink, indelible pencil or typewriter and shall include the following information6: (1) The date of issue. (2) The name and address of the patient, (3) Directions for administration. (4) The name, address and Federal Drug Enforcement

Administration registration number of the prescribing practitioner.

(5) The signature of the prescribing practitioner in the manner described in subsection (b) (brand medically necessary, etc.).

6Title 28 PA Code, § 25.53. Prescription orders.

Controlled Substances, Drugs, Devices & Cosmetics.

http://codes.ohio.gov/oac/4731-11



http://www.health.ny.gov/professionals/narcotic/laws_and_regulations.htm

http://www.health.ny.gov/professionals/narcotic/laws_and_regulations.htm

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(e) The Physician’s Federal Drug Enforcement Administration registration number cannot be preprinted on the prescription form.

6Title 28 PA Code, § 25.53. Prescription orders.

Controlled Substances, Drugs, Devices & Cosmetics.


Revoked (con’t): Being unable to practice osteopathic medicine and surgery w/

reasonable skill safety to patients by reason of:

Illness

Drunkenness

Excessive drug, narcotics, chemicals or other type of material

Or as a result of any mental or physical condition

Upon probable cause, the Board may compel the physician to submit to a mental or physical examination by physicians designated by the Board.

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The “Bad” Stuff The “Bad” Stuff –– AddictionsAddictions

Professional Health Monitoring ProgramsProfessional Health Monitoring Programs

2 Options for PA’s Impaired 2 Options for PA’s Impaired Practitioner/ProfessionalPractitioner/Professional::

1.Voluntary Recovery Program (VRP)

Agree to be assessed by a VRP-approved assessor;

Comply with all of the terms and conditions for VRP participation;

Enter into an agreement stipulating that disciplinary action, including suspension or revocation, will be deferred so long as the licensee adheres to the agreement.

The “Bad” Stuff The “Bad” Stuff –– AddictionsAddictions Professional Health Monitoring ProgramsProfessional Health Monitoring Programs

But, licensee is ineligible for VRP if: Convicted of, or pleading guilty, or no contest to a

felony or misdemeanor under the Controlled Substance, Drug, Device and Cosmetic Act.

Licensees with a history of practice problems clearly involving significant patient harm;

Licensees who have been involved in the diversion of controlled substances for the primary purpose of sale or distribution;

Licensees who have committed sexual boundary violations; or,

Licensees who have failed to successfully complete a similar program in another jurisdiction.

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The “Bad” Stuff The “Bad” Stuff –– AddictionsAddictions Professional Health Monitoring ProgramsProfessional Health Monitoring Programs

2. Disciplinary Monitoring Unit (DMU)

A mandatory program for licensees who have had formal disciplinary action by the Bureau’s licensing

boards.

Provides appropriate treatment and structured monitoring to ensure that participants remain capable of safely practicing their licensed profession.

These licensees will, at best, have a permanent disciplinary record on their license profile.

More “Bad” More “Bad” -- SelfSelf--Prescribing Prescribing

NarcoticsNarcotics

Prohibited in Ohio Prohibited in Ohio –– including familyincluding family

Prohibited in Florida Prohibited in Florida -- Prescribing or dispensing Prescribing or dispensing or administering any medicinal drug appearing or administering any medicinal drug appearing on on any schedule set forth in chapter 893 any schedule set forth in chapter 893 by the by the D.O. is forbidden.D.O. is forbidden.

Policy Statements against in P.A.Policy Statements against in P.A.

Policy Statements against in N.Y.Policy Statements against in N.Y.

AOA & AMA have policy statements against.AOA & AMA have policy statements against.

Emergency exceptions existEmergency exceptions exist

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Other Prohibited ConductOther Prohibited Conduct

Making misleading, deceptive, untrue or fraudulent representations in the practice of osteopathic medicine and surgery. Sensationalism, superiority, bonuses or inducements

(NY)

Claiming a secret method of treatment (NY)

Representing, with the purpose of obtaining compensation or other advantage as personal gain or for any other person, that an incurable disease or injury, or other incurable condition, can be permanently cured (OH)

Sexual Misconduct Sexual Misconduct -- PatientsPatients

Forbidden by all jurisdictions & consent is never a defense

Defined broadly: Neglecting to employ disrobing/draping policy

Propositioning for a date

Conversations of a sexual nature

Sexual contact – Kissing in a romantic manner

Intercourse – Including Intercourse in exchange for drugs

Includes the Patient, and patient’s guardian and/or relative

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Sexual Misconduct Sexual Misconduct -- PatientsPatients

Violation if sexual misconduct occurs PA: Sexual behavior which occurs prior to the 2-year

anniversary of the termination of the professional relationship constitutes unprofessional conduct (Statute)

OHIO: Within ninety days after the licensee-patient relationship was terminated (Statute)

FLORIDA: Must terminate patient/physician relationship otherwise misconduct (Statute)

NEW YORK: Board will not tolerate physician sexual misconduct and is committed to protecting the public from such misconduct (Policy Statement)

Penalties for Medicaid ViolationsPenalties for Medicaid Violations

Treble damages Under FFCATreble damages Under FFCA

Incarceration under State’s criminal codeIncarceration under State’s criminal code

FinesFines

RepaymentRepayment

Dissolution of practiceDissolution of practice

Revocation of licenseRevocation of license

Divestiture of propertyDivestiture of property

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Avoidance of Fraud and Abuse Avoidance of Fraud and Abuse

(DON’TS)(DON’TS) Submitting a bill you are not sure of or that does not Submitting a bill you are not sure of or that does not

conform to program rulesconform to program rules

Performing unnecessary servicesPerforming unnecessary services

Billing for Services Not RenderedBilling for Services Not Rendered

Misrepresentation of ServicesMisrepresentation of Services

Having unqualified people do workHaving unqualified people do work

Unbundling Supplies and/or ServicesUnbundling Supplies and/or Services

Paying for referrals to you and/or accepting “kickbacks”Paying for referrals to you and/or accepting “kickbacks”

Charging patients “access”, “administrative” or “fees”Charging patients “access”, “administrative” or “fees”

Selling samples and Drug DiversionSelling samples and Drug Diversion

PA Drug/Fraud Case 1PA Drug/Fraud Case 1 According to the grand jury, Rajendra Yande, D.O. (Clearfield County)

saw his patients in his living room, exercise room or kitchen of his home.

Dr. Yande allegedly did not require patients’ medical records prior to prescribing controlled substances and allegedly did not conduct physical exams on his patients.

The grand jury found that Dr. Yande did not accept any insurance for his pain management patients and had a sign posted in his waiting room area that had a price list based on the number of narcotic medications prescribed.

Dr. Yande is charged with 11 counts of drug device and cosmetic act violations, four counts of dealing in proceeds of unlawful activity, and

one count of provider prohibited acts. Reported July 11, 2011, PA Office of Attorney General

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PA Drug/Fraud Case 1PA Drug/Fraud Case 1

Results: Loss of License

Type: Osteopathic Physician and Surgeon

Type: Number: OS013788

Profession: Osteopathic Medicine

Status: Voluntary Surrender – Disciplinary

Issue Date:8/4/2006

Expires:10/31/2012

Last Renewed:10/16/2010


Dr. Ralph W. Crawford, Jr., 65, Altoona. The criminal charges state that between January 2003 and April 2005, Dr. Crawford provided prescriptions for powerful and potentially addictive pain medications such as Oxycontin, Fentanyl, Percocet and Vicodin to several Altoona area women in exchange for sexual favors.

Dr. Crawford was charged with 11 counts of prescribing a controlled substance beyond accepted professional practice; two counts of prostitution (patronizing prostitutes); two counts of criminal conspiracy; and one count each of Medicaid fraud, hindering apprehension or prosecution and prescribing a controlled substance to a known drug dependant person.

Dr. Crawford passed away on September 10, 2010

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Results: Loss of License

Type: Medical Physician and Surgeon

Type: Number:MD008718E

Profession: Medicine

Status: Voluntary Surrender – Disciplinary

Issue Date: 7/1/1966

Expires: 12/31/2006

Last Renewed: 10/12/2004


Practicing fraud or deceit in obtaining a license False credentials, aliases, prior criminal record(s)

Making a false or deceptive biennial registration with the Board

Never, ever lie on your registration

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Having a license to practice osteopathic medicine and surgery revoked or suspended or having other disciplinary action taken, or an application refused, revoked or suspended by the proper licensing authority of another state, territory or country. Physicians w/ multiple licenses must notify each and

every authority of any disciplinary actions.


Violating a regulation promulgated by the Board or an order of the Board previously entered in a disciplinary proceeding.

Knowingly maintaining a professional association w/ a person in violation of these regulations or knowingly aiding, assisting, procuring or advising an unlicensed person to practice osteopathic medicine and surgery. Help your fellow physiciansHelp your fellow physicians

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Prohibited Conduct Prohibited Conduct –– Catchall Catchall

Malpractice Provisions Malpractice Provisions

Being guilty of any other immoral or unprofessional conduct not specifically defined herein. Such unprofessional conduct shall include any departure from, or the failure to conform to, the standards of acceptable and prevailing osteopathic medical practice.

Injury to patient need not be established. (OH & PA)

The State Boards mandate the reporting of Malpractice lawsuits w/in 60 days of notice.

Practicing the profession w/ negligence on more than one occasion (NY).


Malpractice ProvisionsMalpractice Provisions New York’s code lists: Practicing with gross

incompetence, Practicing with incompetence, Practicing with gross incompetence (NY)

New York will automatically commence an investigation using the following criteria:

Six or more malpractice payouts over the past five years

Cancellation or non-renewal of coverage by the insurer due to concern about quality of care

Addition of a surcharge of 75% or more to physician’s policy

A single payout amount higher than a specialty –and geography – specific 75th percentile amount.

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Malpractice ProvisionsMalpractice Provisions

PA’s MCARE Act of 2002: Mandatory self-reporting obligation for physicians

Must self-report to the Board within 60 days of the occurrence of any of the following:

Notice of civil malpractice lawsuit

Notice of any disciplinary action by another jurisdiction

Any controlled substance violation

Any arrests for criminal offenses including homicide, assault, sexual offenses

Also obligates the Board to review allegations of single acts of simple negligence



Florida: Grounds for Emergency Suspension, : Grounds for Emergency Suspension, Under Section 456.074, include:Under Section 456.074, include:

Medicaid fraudMedicaid fraud

Controlled substance violationsControlled substance violations

Repeated malpractice (3X)Repeated malpractice (3X) A Constitutional AmendmentA Constitutional Amendment

Failed drug testFailed drug test

Default on student loansDefault on student loans

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OHIO - 4731-15-03 Malpractice reporting requirement: Any insurer providing professional liability insurance or any other entity that seeks to indemnify the professional liability of any person holding a valid certificate issued pursuant to Chapter 4730., 4731., 4760. or 4762. of the Revised Code shall notify the board within thirty days after the final disposition of any written claim for damages where such disposition results in a payment which exceeds twenty-five

thousand dollars.



A 2011 study in the New England Journal of Medicine reported that:

75% of physicians in "low-risk" specialties and virtually 100% of physicians in "high-risk" specialties could expect to face a malpractice claim during their careers.

However, the authors also noted that the vast majority of malpractice claims did not lead to any indemnity payments.

Jena AB, Seabury S, Lakdawalla D, Chandra A (August 2011). "Malpractice risk according to physician specialty". N. Engl. J. Med. 365

http://en.wikipedia.org/wiki/New_England_Journal_of_Medicine

http://en.wikipedia.org/wiki/New_England_Journal_of_Medicine

http://dx.doi.org/10.1056/NEJMsa1012370

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Mandated Professional Liability Mandated Professional Liability

InsuranceInsurance

13 States Mandate Liability Insurance at various limits.

Florida: Generally required (100k/300k) or 100k escrow funds available. With Hospital Privileges (250k/750k) or 250K escrow.

New York: Not mandatory, but basic coverage of 1.3M/3.9M required for participation in excess pool.


InsuranceInsurance

Pennsylvania: Mandatory, amounts dependent on policy issuance year* but currently at 500K/1.5M. 1M/3M Future?

Ohio: Not mandatory. Must notify patients prior to providing non-emergency services & get signature.

Regardless of State Law, usually necessary for staff privileges and to participate in health plans.

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InsuranceInsurance

PA’s MCARE Law (The Saga Continues)

Adopted in 2002, Replaced the CAT Fund

Eventually retired in two steps – still no plan

Litigation continues on State misappropriation of funds and unfunded future liabilities ($1.7B)

State failed to transfer sufficient monies – 2003-2007 - from HCPRA to MCARE to cover the full cost of the abated physician-assessments.


InsuranceInsurance

PA’s MCARE Law Key Points:

Excess Coverage Fund

Patient Safety Authority – Reportable Events

Informed Consent Requirement

Punitive Damages – Willful or Reckless

Collateral Source Rule on Past Medical and Past Lost Earnings damages (offset by insurance)

Preservation & Accuracy of Patient Records

Expert Witness Qualifications

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Receiving a Board NoticeReceiving a Board Notice

The PA Board handles approximately 150 cases annually w/ >20% resulting in a disciplinary action.

What Should YOU Do If They Request A Response From You?

Get a Lawyer! – or at least consult with one - to handle all requisite correspondence and evidentiary submissions. (WHY?)

Be responsive, timely and professional

Board CommunicationBoard Communication

With counsel’s input actively participate in the whole process – (get the chart in order)

Reply, Clarification, Explanation, Patient Files, etc.

If a disciplinary case is initiated: During any depositions, interviews, and

interrogatories with the Board (or Board Counsel), always display an attitude of optimism and

confidence.

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Board CommunicationBoard Communication

This is essentially a trial and clearly an

adversarial forum

But, Avoid overt expressions (especially via verbal or written statements) of anger, hostility or arrogance which may cause the Board (the JUDGE & JURY) to have negative feelings toward you and your character.

Key Duties: Patient RecordsKey Duties: Patient Records

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Key Duties Key Duties –– Patient RecordsPatient Records

Maintain records in confidenceMaintain records in confidence

Furnish copies upon requestFurnish copies upon request

oo Not conditioned upon payment of feesNot conditioned upon payment of fees

Give treatment report in lieu of recordsGive treatment report in lieu of records

Psychiatrist records direct to next psychiatristPsychiatrist records direct to next psychiatrist

Keep record of disclosureKeep record of disclosure

Give notice of termination of practiceGive notice of termination of practice

State Law mandated copy charges State Law mandated copy charges

Patient RecordsPatient Records

P.A.

Patient's medical records must be kept for at least 7 years from the date of the last medical service for which a medical record entry is required.

The medical record for a minor patient must be retained until 1 year after the minor patient reaches the majority, even if this means that the physician retains the record for a period of more than 7 years

N.Y.

All patient records must be retained for at least six years. Obstetrical records and records of minor patients must be retained for at least six years, and until one year after the minor

patient reaches the age of 21 years

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Patient RecordsPatient Records

F.L.

Maintain the written record of a patient for a period of at least five (5) years from the date the patient was last examined or treated by the osteopathic physician

O.H.

No specific statute – But, should be kept for at least as long as the length of time of the statute of limitations (1 year in O.H.) for medical malpractice claims.

Maternity patient 2 years

Medicare patient 6 years

Medicaid patient 5 years

Duties with Records Duties with Records (CONT.)(CONT.)

Must keep Must keep legible legible medical records that medical records that justify the course of treatment of the justify the course of treatment of the patient:patient:

Patient historiesPatient histories

Examination resultsExamination results

Test resultsTest results

Drugs prescribedDrugs prescribed

ConsultationsConsultations

HospitalizationsHospitalizations

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Transparency with the BoardTransparency with the Board

Online Profiles & C.V.’s Online Profiles & C.V.’s -- contentcontent

1.1. All medical education, including graduate All medical education, including graduate education;education;

2.2. Any hospitals at which the physician has Any hospitals at which the physician has privileges;privileges;

3.3. The primary practice address;The primary practice address;

4.4. Any certifications;Any certifications;

5.5. The year that the physician began practicing The year that the physician began practicing medicine;medicine;

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Transparency Transparency (CONT.)(CONT.)

Profiles Profiles –– content content (CONT.)(CONT.)

6.6. Any faculty appointments;Any faculty appointments;

7.7. Any criminal offense for which guilt has been Any criminal offense for which guilt has been found and any appeals thereof;found and any appeals thereof;

8.8. Any final disciplinary action within the previous Any final disciplinary action within the previous 10 years;10 years;

9.9. Any relevant professional qualifications; andAny relevant professional qualifications; and

10.10. Any malpractice or negligence claims.Any malpractice or negligence claims.

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Transparency Transparency (CONT.)(CONT.)

Profiles Profiles –– other dutiesother duties

Update the profile within the jurisdictionUpdate the profile within the jurisdiction--specified time period of material changesspecified time period of material changes

Notify the Board prior to moving to a new Notify the Board prior to moving to a new practicepractice

Notify patients of relocationsNotify patients of relocations

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Full Disclosure to Patients & PublicFull Disclosure to Patients & Public

False* advertisingFalse* advertising

You must always identify yourself as a D.O.You must always identify yourself as a D.O.

State Law often mandates that you wear a State Law often mandates that you wear a badge or name plaque while working badge or name plaque while working identifying your name and degree.identifying your name and degree.

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Impairment Risk SummaryImpairment Risk Summary AFCSAFCS

Be awareBe aware oo SelfSelf

oo PlacePlace

oo RulesRules

oo ConsequencesConsequences

Watch the slippery slopeWatch the slippery slope

If you think you might have a problem, you If you think you might have a problem, you probably doprobably do

Family and friendsFamily and friends

Use resourcesUse resources

If you see it, report itIf you see it, report it 77

Conclusion on Physician ConductConclusion on Physician Conduct Ten Golden RulesTen Golden Rules

1.1. Tell the truth 24/7Tell the truth 24/7

2.2. Treat patients and their families with respect Treat patients and their families with respect (ApologizeApologize)

3.3. Do not divert/misuse drugsDo not divert/misuse drugs

4.4. Keep accurate and detailed recordsKeep accurate and detailed records

5.5. Must be scrupulous in dealing with Medicaid and Must be scrupulous in dealing with Medicaid and Medicare; check with CMSMedicare; check with CMS

6.6. Seek help if you become impairedSeek help if you become impaired

7.7. Help colleaguesHelp colleagues

8.8. Maintain financial obligationsMaintain financial obligations

9.9. Only examine those anatomical parts requiredOnly examine those anatomical parts required

10.10. Never, ever become sexually involved with a patientNever, ever become sexually involved with a patient

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QuestionsQuestions

Documents

PRIMARY CARE 2012 - mutualgravity.com · Internet CME limited to 30% per cycle I. Licensure & CME Category 1-B Credits: Participation in Publications, Inspections, Examinations &