WVHCA: Proposed Amendment to West Virginia CON Law Defintion of "Private Office Practice"

On June 15, 2010, the West Virginia Health Care Authority filed a Notice of a Comment Period on a Proposed Rule with the West Virginia Secretary of State amending West Virginia CSR 65-7, Certificate of Need Rule.


According to the Summary and Statement of Circumstances filed with the Proposed Rule the "amendment clarifies the definition of "private office practice" for purposes of administering the Certificate of Need Program. Those entities meeting this criteria may be eligible for an exemption from Certificate of Need review pursuant to West Virginia Code 16-2D-R(a)."


Written comments on the Proposed Rule are due on or before July 16, 2010.

WVBOM: Policy Statement - Guidelines for Physicians in Collaborative Relationships with Advanced Nurse Practitioners

On May 10, 2010, the West Virginia Board of Medicine has issued a new Policy Statement - Guidelines for Physicians in Collaborative Relationships with Advanced Nurse Practitioners or Certified Nurse Midwives; Standard of Practice.


The new Policy Statement provide West Virginia physicians with guidance on the role and responsibility they play in the collaborative relationship with advanced nurse practitioners and certified nurse-midwifes. In summary, the guidance provides:


A. The physician must be permanently and fully licensed in West Virginia without restriction or limitation.


B. There should be a written collaborative agreement should should include certain specific provisions as outlined in the Policy Statement.


C. Other considerations that are outlined in the Policy Statement


The Policy Statement indicates that the failure by a physician to adhere to these minimum requirements and guidelines may result in discipline by the Board of Medicine.

Credentialing and Privileging Telemedicine Physician and Practitioner

Last week the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule revising the conditions of participation (CoPs) for hospitals and critical access hospitals allowing for a new credentialing and privileging process for physicians and practitioners who provide telemedicine services. The proposed rule should make it easier on smaller hospital (especially critical access hospitals) who don't have the in-house medical staff to adequately evaluate and privilege a wide range of specialty physicians who provide services through telemedicine.


The proposed rule was published in the Federal Register on May 26, 2010, and titled, Credentialing and Privileging of Telemedicine Physicians and Practitioners, 75 Fed Reg 29479 (May 26, 2010). Comments on the proposed rule must be submitted by July 26, 2010.


Traditionally the CoPs have required the governing body of the hospital to make all privileging decisions based on the recommendations of its medical staff using specific criteria. Hospitals often use third-party credentialing verification services to assist in compiling the voluminous documents needed to verify credentialing and then have the governing body of the hospital review and sign off on the privileging decision.


The proposed rule points out that there has been a Joint Commission standard policy that allows "privileging by proxy," which has been in direct conflict with CoPs. "Privileging by proxy" allows Joint Commission accredited hospitals to utilize a different methodology to privilege"distant-site" physicians and practitioners. Basically, allowing one Joint Commissioned accredited hospital to accept the privileging decisions of another Joint Commissioned accredited hospital. In the past, hospitals were deemed (deemed status) to meet the CoPs if they were accredited by the Joint Commission. However, changes in the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) will halt (effective July 15, 2010) the statutory recognition of the Joint Commission's hospital accreditation program and now requires the Joint Commission to meet CMS standards in order to confer Medicare deemed status.


CMS has decided that requiring each hospital to independently privilege providers is a duplicative and burdensome process, especially for small hospitals who often use telemedicine services from larger academic medical centers and hospitals to provide access to needed specialty services. Thus, CMS is proposing in the rule to revise the hospital credentialing and privileging requirements to allow a hospital who obtains telemedicine services by agreement with another hospital that the agreement can specify that the hospital providing the telemedicine services is responsible for credentialing the telemedicine provider and can provide this information to the medical staff of the hospital receiving the telemedicine services who can then rely upon the credentialing and privileging decisions of the hospital providing the telemedicine services.


For a more detailed discussion and understanding of the proposed revisions read the proposed rule in the May 26, 2010, Federal Register.

2010 AHLA Hospitals and Health Systems Law Institute: Hot 2010 Health Law Legal Topics

Although it is cold today in West Virginia - I'm hoping it will be hot in Florida in February.

I thought I would take a moment on this cold wintry day to write about the hot health topics that will be discussed at the American Health Lawyers Association (AHLA) Hospitals and Health Systems Law Institute scheduled for February 25-26, 2010 at the Doral Golf Resort & Spa in Miami, Florida (Conference Brochure PDF).

I will be speaking at the Hospitals Law Institute along with my colleague, Jody Joiner, Assistant Operations Counsel at Sisters of Charity of Leavenworth Health System. Our topic scheduled for Friday, February 26 is Hospital’s Friend or Foe: The Age of Social Media and Health 2.0 where we plan to cover:

• The social media technology tools used by health care providers and hospitals
• Pros/cons and legal implications of social media and health 2.0 services such as blogs, wikis, social networking, podcasting, video sharing, etc.
• Best practices and development of policies and procedures which address staff and employees using social media

In addition to our session there will be variety of "hot" health law legal topic covered at the conference that will interest hospital administrators and their legal counsel, including sessions on government data mining to identify hospital compliance, understanding the recent ARRA HITECH developments impacting HIPAA and EHR, hospital/physician collaboration and relationships, best practices in hospital practitioner credentialing, peer review and privileging, voluntary disclosure strategies, hospital clinical research issues, and much more.

The AHLA Hospital and Health System Law Institute overlaps with the AHLA Physicians and Physician Organizations Law Insitute which will be held on February 24-25.The Physician Law Insitute will include "hot" physician topics on on call payments, Accountability Care Organizations, HITECH, disruptive physician behavior intervention, Stark issues for physicians, hospital/physician mergers, FMV for physician compensation and much more.

You can register for one or both. As an AHLA Member I regularly attend the Physician/Hospital Law Institutes every year or so because of quality and breadth of health law related materials for those who work in the health care industry. More information, along with how to register, can be found at the AHLA website:
Hospitals and Health Systems Law Institute
Physicians and Physician Organizations Law Insitute

A 1930 Medical Record

I was recently in my hometown of New Martinsville visiting my dad, a retired family physician. When I arrived he had waiting for me a copy of one of my grandfather's medical records from the 1930s. My grandfather, Dr. Albert Coffield, practiced rural medicine in Wetzel County, West Virginia from 1911 until his death in 1936.

My dad told me the following story about the medical record.

My dad was a doctor who practiced out of his house on Coffield Ridge in Wetzel County. After my dad died in 1936 our mother sold the household furnishing and his office equipment. I was 12 years old when he died and my older brother was a first year student at West Virginia University. Since my mother wasn't employed she decided to move us to Morgantown where the University was so that my older brother could continue his college education. As a way to continue the family income she rented rooms to college students - many who came to the University from Wetzel County.

Included in the sale of the household and office furnishing was a wooden credenza with metal alphabetized slides. Behind some of the slides were some old medical records that were left in the credenza.

Thirty years later a lady who was a patient of mine brought the wooden credenza to me and told me that she had bought the credenza at the auction of my family's household items in 1936. She told me that she thought I would appreciate having it.

Here are photos of the medical record of a patient from 1934. The medical record format is simple yet complete. It contains all the important demographic and clinical information - including the patient statement, habits, family history, past history, physician examination and diagnosis. On the back is additional space for notes and a drawing of the internal organs that I suspect was meant to be used with the patient for education and instruction. It even has a built in billing record section that even the change:healthcare crowd would love.

What can these photos tell us about the current health care reform debate. Compare these photos of a medical record from 1934 to those that cost .73 cents today. Could today's physician and his or her patient get "meaningful use" out of this record?

A close up of the billing section for the change:healthcare gang.