Follow-up and Future Issues
January 3, 2002
In addition to bioterrorism legislation, several issues are expected to gain attention next year:
Medicare+Choice plans: As of Dec. 31, many insurers will stop Medicare+Choice coverage, leaving many Medicare beneficiaries searching for supplemental plans. Those plans, if available, are usually pricey. Traditional Medicare coverage remains available, but the need for so-called Medigap coverage will be a strain on many elderly who live on fixed incomes.
Economic stimulus bill with insurance provisions: Both Houses of Congress have passed stimulus bills, which ultimately did not include subsidies for COBRA programs for the newly unemployed. (COBRA allows laid-off employees to participate in their former employer's health insurance plan for a period of time.) The stimulus package debate split on partisan lines, with Republicans supporting a bill with tax cuts and Democrats wanting to extend unemployment benefits. With the economy still tenuous, the need to subsidize health benefits will continue to be an issue.
Health Insurance
Portability and Accountability Act reforms: Few people are happy
complying with the sections of HIPAA regulations, which take effect
in 2002. Although HIPAA seems to have survived Bush administration
scrutiny (after the act was passed in the waning months of the Clinton
administration), adjustments are expected. (The act, which attempts
to protect patients' privacy of their health records, has huge documentation,
privacy and compliance implications.)
HIPAA reform
efforts will focus on:
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Medical research: In its present form, HIPAA regulations have a chilling effect on medical research because they limit the researchers' ability to gather and use patient information.
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Prior consent: The timing and nature of patient consent needs clarification. Present regulations allow providers to use patient information for "treatment, payment and health care operations" without obtaining consent first.
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Oral communications: Present regulations prohibit verbal communications between providers and patients that are "necessary for treatment."
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"Minimum necessary" provision: At present, the act prohibits providers from using any personal medical information beyond the minimum amount necessary to accomplish a given purpose.
"The intent of the [HIPAA] law was very good, but there is a huge, unwieldy and costly effort to make facilities compliant," Hegge said. "There are efforts to streamline the regulations, but my experience is that when federal lawmakers try to streamline, regulations just become more difficult to follow."
Patient safety legislation: This legislative package of bills attempts to address the risk of medication errors and unsafe health care practices. One bill allows whistle-blower protection if a health care worker reports unsafe conditions. "If patient safety legislation is not acted on this year, the problem won't go away. These bills will resurface," Wakefield said.
Licensure: The National Council of State Boards of Nursing Inc., the American Nurses Association, specialty organizations and state legislatures will be looking at interstate nursing licensure because of the rapid growth of telehealth/telemedicine, expansion of multistate health care systems and increased mobility of registered nurses. (The present licensure model requires nurses to be licensed in each state in which they practice.) According to international health care consultant Patricia Cholewka, Ed.D., MPA, RN, more states will consider multistate licensure, a system that allows a nurse to practice in multiple states.
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