Sands, MD All publication rights reserved by author Information is essential to the proper care of patients, and computerized medical records allow health care providers to gain access to current patient medical information more rapidly and more efficiently than the paper record. The immense benefits that this computerized information provides must be weighed against the right of the patient to expect that his or her records remain confidential. Institutions that have mature hospital information systems, such as The Center for Clinical Computing CCC at Boston's Beth Israel Hospital, have grappled with these issues in the effort to balance system useability with patient privacy.
The mind set of most physicians is that peer review proceedings resulting in disciplinary action is something that happens to "the other guy. This article will hopefully put you on the road to understanding.
The Present Day Nature of Disciplinary Proceedings Outside of the context of licensing board matters, disciplinary proceedings most frequently arise at health facilities, primarily hospitals.
The initial catalyst may or may not appear trivial, however, it is imperative that physicians understand the potential and likelihood for a "snowball effect. Unfortunately, the advent of managed care has opened up a new and growing area of exposure.
Few physicians can practice nowadays without contracts with insurers and other payers of healthcare services. These entities are increasingly scrutinizing physicians pursuant to the same triggers as hospitals. There are obvious and not so obvious implications from disciplinary proceedings.
They also frequently serve as the impetus for licensing actions by the Medical Board of California. Physicians today find themselves under the microscope as in no time in the past.
As such, it is important to understand and know how to cope in this new environment. Disciplinary Actions in the Payer Contracting Arena The advents of managed care now requires physicians to apply to become paneled providers for health insurance companies, HMOs, and the like.
Without them, most physicians cannot survive in practice today. Utilizing the same information that a hospital uses, an insurance carrier decides whether the applicant will be made a member of the provider panel.
It will consider education, training, experience, claims history, hospital affiliations, and the existence of hospital and licensing board actions. Like the lb.
Physicians have greater protection once accepted as a panel provider, however these rights are more limited than in the medical staff setting. The issues of summary suspension of hospital privileges and probationary license status warrant special mention.
The foregoing occurs after the physician has exercised, or at least had the opportunity to exercise, a full menu of procedural due process rights. Yet, summary suspension is different. Under California law, a summary suspension can be imposed at a hospital when a physician poses an eminent danger to the health and safety of patients, is disruptive to hospital operations, or has engaged in unethical or unprofessional behavior.
The agreements that physicians sign with payers obligates the physician to immediately advise the payer when a summary suspension has been imposed. Plans vary on whether or not probationary license status results in automatic delisting.
You need to consult your provider agreements for details in this regard. However, many plans require that the physicians at all times maintain an "unrestricted" license to practice medicine. A license revocation action initiated by the Medical Board of California called an Accusation can conclude, either by settlement or administrative ruling, with the physician still having a license to practice medicine; but with a license that is subject to very specific terms and conditions of probation.
Under many plans this will result in automatic delisting with little recourse. Still in others, the payer will decide on the delisting with the physician having limited rights to challenge the decision.
Whatever rights exist, are set out in the plan and have already been agreed to by the physician. The payer will investigate all complaints, but the nature and extent of the investigation varies depending upon the complaint itself.The Basics: What Every Physician Needs to Know About Medical Staff and Other Types of Disciplinary Proceedings.
by Thomas R. Bradford, Esq. OBM Geriatrics ; 1(2), doi: /leslutinsduphoenix.com Page 2/34 modifying telomerase activity, or even, as suggested recently, in combination with techniques that .
The patient should have a right of access to his/her medical records and be allowed to provide identifiable additional comments or corrections. The right of access is not absolute. With over , users downloading 3 million documents per month, the WBDG is the only web-based portal providing government and industry practitioners with one-stop access to current information on a wide range of building-related guidance, criteria and technology from a 'whole buildings' perspective.
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