Legislation
HEW institutes reimbursement for second opinion The US Department of Health, Education, and Welfare (HEW) has announced a program for reimbursement for second opinions on surgery for Medicare patients in spite of differences on how to best organize such a program. HEW has also requested states to institute similar programs under Medicaid and will encourage all Americans, including those not covered under Medicare and Medicaid, to seek second opinions. In the matter of “unnecessary” surgery, HEW believes it must rely on the Professional Standards Review Organization (PSRO) program to effectively eliminate these procedures and has suggested a seven-point program to strengthen the PSROs. Among the points are the following: 0 The National PSRO Council will develop criteria for the ten most common surgical procedures. 0 Final regulations will be issued requiring review of nonemergency surgical procedures prior to the procedure when high surgical rates or other “inappropriate” practices are found. 0 PSROs will search for areas of “unusual variations” in the rate of surgery and take whatever steps are necessary, including preadmission review, to lower rates. W Answering a suggestion by Dan Rostenkowski (D-Ill)to develop a programto “restrain cost increases on a voluntary basis” before the Second Session of the 95th Congress con-
154
3
venes in January, the American Medical Association, American Hospital Association, and Federation of American Hospitals announced organization of a national steering committee to develop a voluntary program for cost containment. The three organizations stated they believe “voluntary restraint by hospitals and physicians is the most equitable method. . . consistent with sound medical practice and with least disruption to patient care.” W What form the Administration’s National Health Insurance Bill expected next session of Congress will take is still unpredictable. President Carter has only indicated it will be comprehensive and implemented in stages. One possibility is it will be based on a plan submittedto Joseph Califano, HEW secretary, by Alain C Enthoven, economics professor at Stanford (Calif) University. Called the Consumer Choice Health Plan, it would give federal subsidies through tax credits or vouchers for the purchase of private health insurance. Enthoven believes this plan would redistribute enough income so everyone could buy into a good health plan and would correct many of the cost-increasing incentives present today. He calls it the “approach to national health insurance based on regulated competition in the private sector.” According to the plan, the federal government would help people enroll in and pay for a private health benefits plan with tax credits or vouchers whose amounts are based on actuarial category and financial need for the poor and which are usable only for premiums for qualified health plans. To be qualified, the plan must implement physician fee and hospital cost controls.
W A 1977 California law providesthat until Jan
AORN Journal, January 1978, V o l 2 7 , N o 1
1, 1983, the California Department of Health may approve pilot projects permitting registered nurses, physician’s assistants, or pharmacists to prescribe,dispense, and administer drugs under the general supervision of a licensed physician and surgeon. No more than five projects may involve RNs; three, physician‘s assistants; and two, pharmacists. During the pilot projects, participants acting within these guidelines are exempt from the Healing Arts Practices Act. Among the projects’ goals are evaluation of “the new health skills taught or the extent to which existing skills have been reallocated” and the “implication of the project for existing licensure laws. . . health services curricula,
and the health care delivery systems.” In Washington, the State Board of Medical Examiners has authorized physician’s assistants to issue prescriptions for patients of the physician responsible for the supervision of the assistant. Also, if a physician’s assistant is employed or extended privileges by a hospital or health care institution permitting it, the physician’sassistant may write medical orders for inpatients under the care of the physician responsible for his supervision. Both of these permissions do not extend to Schedule II drugs.
Sudden infant death risk factors identified
In a study done in 1973, Carpenter and Emery tested the validity of these risk factors by attempting to predict which infants would die of sudden infant death syndrome. They studied 6,000 newborns and scored them according to the risk factors. ”Babies with the highest scores tended to die at a rate six times as high as that of babies with lower scores.” To determine if some type of medical intervention could decrease the death rate of the high-risk group, they again studied a group of newborns (1 1,000) and divided the high-risk group into two subgroups-those who would receive additional medical intervention and follow-up and those who would not receive special care. Medical intervention included clinical review, home visits from a primary health care nurse, hospitalization if the infant was apparently not doing well, and help from the nurse on preparing correct formula. The results of this last study showed that the subgroup receiving medical attention had a rate of death only twice as high as the low-risk group, whereas the subgroup receiving no additional medical attention had a death rate nine times as high as the low-risk group. Carpenter and Emery conclude that not only can these infants be identified at birth, but that their likelihood of dying from sudden infant death syndrome can be greatly reduced by increased medical intervention.
Two English scientists have shown that there are risk factors connected with sudden infant death syndrome and that these factors can be used to predict which infants may be stricken. R G Carpenter, now of the London School of Hygiene and Tropical Medicine, and J L Emery of Children’s Hospital, Sheffield, England, have reported in Nature that not only can these risk factors be used to determine the high-risk group, but that medical surveillance can substantially reduce the incidence of death. In 1972, Carpenter and Emery determined 40 risk factors for the group of infants that died of sudden infant death syndrome. In their recent report, they have narrowed this to eight factors or variables, which now constitute their scoring system. A single factor does not indicate high risk, but rather all factors are considered together. According to their article (in Nature), the variables in the system include age and blood group of mother, urinary tract infection or polyhydramnios during pregnancy, length of second stage of labor, place in birth order, prematurity, and feeding method (whether breast or bottle fed). Carpenter and Emery did associate low risk with breast feeding, if mother’s blood group was A, and increasing age of the mother.
156
Dora B D’Amico Associate editor
AORN Journal, January 1978, Vol27, No 1
HEW institutes reimbursement for second opinion The US Department of Health, Education, and Welfare (HEW) has announced a program for reimbursement for second opinions on surgery for Medicare patients in spite of differences on how to best organize such a program. HEW has also requested states to institute similar programs under Medicaid and will encourage all Americans, including those not covered under Medicare and Medicaid, to seek second opinions. In the matter of “unnecessary” surgery, HEW believes it must rely on the Professional Standards Review Organization (PSRO) program to effectively eliminate these procedures and has suggested a seven-point program to strengthen the PSROs. Among the points are the following: 0 The National PSRO Council will develop criteria for the ten most common surgical procedures. 0 Final regulations will be issued requiring review of nonemergency surgical procedures prior to the procedure when high surgical rates or other “inappropriate” practices are found. 0 PSROs will search for areas of “unusual variations” in the rate of surgery and take whatever steps are necessary, including preadmission review, to lower rates. W Answering a suggestion by Dan Rostenkowski (D-Ill)to develop a programto “restrain cost increases on a voluntary basis” before the Second Session of the 95th Congress con-
154
3
venes in January, the American Medical Association, American Hospital Association, and Federation of American Hospitals announced organization of a national steering committee to develop a voluntary program for cost containment. The three organizations stated they believe “voluntary restraint by hospitals and physicians is the most equitable method. . . consistent with sound medical practice and with least disruption to patient care.” W What form the Administration’s National Health Insurance Bill expected next session of Congress will take is still unpredictable. President Carter has only indicated it will be comprehensive and implemented in stages. One possibility is it will be based on a plan submittedto Joseph Califano, HEW secretary, by Alain C Enthoven, economics professor at Stanford (Calif) University. Called the Consumer Choice Health Plan, it would give federal subsidies through tax credits or vouchers for the purchase of private health insurance. Enthoven believes this plan would redistribute enough income so everyone could buy into a good health plan and would correct many of the cost-increasing incentives present today. He calls it the “approach to national health insurance based on regulated competition in the private sector.” According to the plan, the federal government would help people enroll in and pay for a private health benefits plan with tax credits or vouchers whose amounts are based on actuarial category and financial need for the poor and which are usable only for premiums for qualified health plans. To be qualified, the plan must implement physician fee and hospital cost controls.
W A 1977 California law providesthat until Jan
AORN Journal, January 1978, V o l 2 7 , N o 1
1, 1983, the California Department of Health may approve pilot projects permitting registered nurses, physician’s assistants, or pharmacists to prescribe,dispense, and administer drugs under the general supervision of a licensed physician and surgeon. No more than five projects may involve RNs; three, physician‘s assistants; and two, pharmacists. During the pilot projects, participants acting within these guidelines are exempt from the Healing Arts Practices Act. Among the projects’ goals are evaluation of “the new health skills taught or the extent to which existing skills have been reallocated” and the “implication of the project for existing licensure laws. . . health services curricula,
and the health care delivery systems.” In Washington, the State Board of Medical Examiners has authorized physician’s assistants to issue prescriptions for patients of the physician responsible for the supervision of the assistant. Also, if a physician’s assistant is employed or extended privileges by a hospital or health care institution permitting it, the physician’sassistant may write medical orders for inpatients under the care of the physician responsible for his supervision. Both of these permissions do not extend to Schedule II drugs.
Sudden infant death risk factors identified
In a study done in 1973, Carpenter and Emery tested the validity of these risk factors by attempting to predict which infants would die of sudden infant death syndrome. They studied 6,000 newborns and scored them according to the risk factors. ”Babies with the highest scores tended to die at a rate six times as high as that of babies with lower scores.” To determine if some type of medical intervention could decrease the death rate of the high-risk group, they again studied a group of newborns (1 1,000) and divided the high-risk group into two subgroups-those who would receive additional medical intervention and follow-up and those who would not receive special care. Medical intervention included clinical review, home visits from a primary health care nurse, hospitalization if the infant was apparently not doing well, and help from the nurse on preparing correct formula. The results of this last study showed that the subgroup receiving medical attention had a rate of death only twice as high as the low-risk group, whereas the subgroup receiving no additional medical attention had a death rate nine times as high as the low-risk group. Carpenter and Emery conclude that not only can these infants be identified at birth, but that their likelihood of dying from sudden infant death syndrome can be greatly reduced by increased medical intervention.
Two English scientists have shown that there are risk factors connected with sudden infant death syndrome and that these factors can be used to predict which infants may be stricken. R G Carpenter, now of the London School of Hygiene and Tropical Medicine, and J L Emery of Children’s Hospital, Sheffield, England, have reported in Nature that not only can these risk factors be used to determine the high-risk group, but that medical surveillance can substantially reduce the incidence of death. In 1972, Carpenter and Emery determined 40 risk factors for the group of infants that died of sudden infant death syndrome. In their recent report, they have narrowed this to eight factors or variables, which now constitute their scoring system. A single factor does not indicate high risk, but rather all factors are considered together. According to their article (in Nature), the variables in the system include age and blood group of mother, urinary tract infection or polyhydramnios during pregnancy, length of second stage of labor, place in birth order, prematurity, and feeding method (whether breast or bottle fed). Carpenter and Emery did associate low risk with breast feeding, if mother’s blood group was A, and increasing age of the mother.
156
Dora B D’Amico Associate editor
AORN Journal, January 1978, Vol27, No 1
