The Illinois Medical Practice Act is an essential state law that governs the practice of medicine in our state; without it, any person regardless of quali cation could practice medicine in Illinois without restriction or penalty. Because medicine is an ever-changing eld, the Act is set to expire on a regular basis, enabling the legislature to ensure that the law keeps pace with the current state of medical practice. Unfortunately, this regular expiration has also allowed politicians and interest groups to use this indispensable piece of legislation as a tool for exercising political in uence.
The Department of Healthcare and Family Services has recently proposed amendments regarding long term care and medical payment. This rulemaking will require long term care facilities to inform DHFS of any death or discharge of a resident on Medicaid within fifteen (15) calendar days. Changes in patient credit, third party liability, or requests for change in care rates—all information is to be submitted within forty-five (45) days. The information must be submitted via either of two electronic portals. The two portals are MEDI, Medical Electronic Data Intercharge, or EDI, the Electronic Data Intercharge Service Vendor. These amendements will add self-neglect to actions that are to be investigated by APS, Adult Protective Services. This will establish an APS registry which will record the names of caregivers who were found to have abused, neglected or exploited “adult” patients with disabilities ages 18 or older. The APS agency will review the victim’s case record and concur with a finding and recommend whether or not the said caregiver be placed on the registry or not concur and recommend against placement. Caregivers will be notified on the decision and soon as one has been made. Those who will be affected by this rulemaking include any agency which provide adult protective services, caregivers of older or disabled adults, agencies which hire or supervise caregivers and any and all law enforcement and fire protection agencies. This proposed amendements to the Medical Payment (89 IAC 140; 42 III Reg 9052) implements Public Act 100-449.
Messages and awareness campaigns regarding mental health and the extreme importance of a healthy work life balance inundate our culture. However ironically, doctors are rarely the focal point of these enterprises. This is the sad and unfortunate truth of our healthcare system. Doctors are afraid and reluctant to seek help for mental health, and those who do, are always nervous about losing their careers. According to a study done at the Mayo clinic, medical licensure questions inquiring physicians about their mental health or a prior diagnosis, discourages physicians’ from seeking the help they need. Doctors in some states are expected to answer questions likes these in order to renew their license and some of them are withholding information, and in some instances, failing to get the help they desperately need.
The report concluded that a staggering 40% of the physicians stated that they would be very hesitant to reach out and seek help, out of dread. Therefore, clearly there are many physicians masking their mental health problems out of fear of jeopardizing their careers, and they need all the support they can get to recover from physical and emotional burnout because of the intensity of their job descriptions.
The concern with asking doctors about their mental health on licensing applications is that the questions tend to be overly broad. Some state licensures ask about current mental conditions, previous mental health conditions and/or impairment from a mental health condition.
For most doctors, the overtaxing requirements of medical school mark the commencement of their mental health problems. A study carried out in 2016 highlighted that almost 30% of medical students were depressed or showed signs and symptoms of depression, but only 15% actually sought help for psychiatric care. These numbers increase during residency as it is a very tough and demanding period in their lives. This distress only worsens with time as the emotional burden keeps piling on.
Suicidal ideation is very high and prevalent amongst physicians, many physicians end up self-prescribing antidepressants and some may even reach out to their coworkers for a prescription as a favor.
Michael Meyers, a psychiatrist and a professor of clinical psychiatry at State University of New York-Downstate Medical Center, acknowledges that physicians under these circumstances often feel like they’re capable of handling their own treatment because they’re so knowledgeable in medicine. But Myers says, “Under no circumstances should doctors be treating themselves or their family members unless it is an emergency.”
There is a common myth and misconception that if a physician suffers from a mental health problem, they are unfit or incapable of taking care of the patients under their care. However the American Psychiatric Association says that there is absolutely no parallel and connection between this theory. This barrier that has been created in the mind of the general population regarding a physician seeking help for mental health and preforming their duties as a healthcare provider needs to explained and removed if we are to receive top notch medical help.
In fact a physician receiving mental health treatment helps both the doctor and the patient. The easier you make it for a symptomatic physician to go for a treatment that works, the better off the physician is and the better off his or her patients are.
Based on how the licensing questions are asked, they may actually be violating federal law. The Federation of State Medical Boards advises against asking physicians about their mental health treatment because doing so might infringe the Americans with Disabilities Act, yet almost two thirds of state medical boards ask physicians questions about their mental health.
As a result contrary to the common belief that there is a stigma attached to physicians and healthcare workers seeking help for mental health because there is a constant looming fear of losing their license, or being judged and questioned over their capabilities, it is in fact the lack of sought help and treatment that puts their careers, jobs and their patients at risk.
Illinois House passes a measure that requires hospitals to have Sexual Assault Nurse Examiners (SANEs). SANEs will be able to treat and examine victims of sexual assault. Currently, hospitals have nurses complete a ‘rape kit examination’. Sexual assault survivor, Lindsey Ross, completed a rape kit examination at a hospital outside of the city of Chicago. Ross believes the nurse who went through a rape kit examination with her was not fully trained to handle sexual assault cases. Ross explains that her experience would have been completely different had she been seen by a Sexual Assault Nurse Examiner.
As of now, sexual assault victims are treated the same regardless of age — SANEs will be able to recognize the difference in need between a child and an adult victim. The Illinois Health and Hospital Association supports this measure and the objectives it wishes to fulfill. After passing the House, this bill is to be considered by the Senate. This will be a monumental for sexual assault victims; allowing them to get the appropriate care for their traumatic experiences.
Since its inception a decade ago, the Medicare Fraud Strike Force has charged more than 3,500 people with ‘ripping off’ Medicare as of early 2017. These are nine teams (made up of agents, investigators, prosecutors, auditors, etc) based in fraud hot spots such as Miami, Los Angeles, Detroit, Southern Texas, New York City, Southern Louisiana, Chicago and Tampa.
Here are some examples of the type of cases that the Medicare Fraud Strike Force goes after:
1.) Using Fake Patients for Payment.
Miami based agents investigating Medicare Fraud heard of suspicious practices of a psychiatric medical facilities recruiting patients, and so they started investigating. Here is what they found: medical facilities were paying recruiters to scare patients. Many of those people were drug addicts who were not in need of psychiatric services, but were looking for case or substance-abuse treatment. They were coached to say that they were suicidal to generate bogus Medicare claims. The CEO of the facility was convicted and sentenced to serious jail time.
2.) False Billing by Healthcare Providers.
These health care companies were billing Medicare for bogus home health services. The task force carefully checked patient records and compared them for billing records and found instances where patients were not care for, but the health care providers were billing anyways. Some patients were given expensive treatments that they did not need, and Medicare was even billed for services that did not happen at all.
3.) The Opioid Medicare Connection.
Medicare numbers are worth more on the black market than credit card numbers, since Medicare numbers can be used to bogus opioid prescriptions. The pills are then sold on the street for big profit. Monitoring opioid prescriptions is difficult because they are so frequently given to patients in pain. One in three Medicare Part D beneficiaries received at least one opioid prescription in 2016. One case in Detroit involved a doctor who used recruiters to find patients whose Medicare numbers he could steal. He would then use those numbers to give patients painkillers for cash. This particular doctor was sentenced to 23 years in prison.
Women who have vaginal mesh implants to support their bladders often have discomfort. These women sometimes find themselves falling prey to a burgeoning industry that makes money by coaxing women into have surgery – sometimes unnecessarily — so that they are more lucrative plaintiffs in a lawsuit against medical device manufacturers. Court records suggest that perhaps thousands of women have been sucked into unnecessary surgeries, which may have horrendous complications.
The litigation surrounding mesh implants is lucrative. Millions of women, world wide, have received them,and many women do in fact complain that they cause bleeding and/or pain during sexual intercourse. But, surgery is not always, or even often, the answer.
The Illinois Department of Financial and Professional Regulation will prosecute doctors for performing unnecessary procedures, and rightfully so, as it is a violation of state and federal criminal law to perform and bill for a procedure that is not medically necessary. Charges of Medicare and Medicaid fraud are also likely.
Doctors must be wary of arrangements with lawyers and or third parties who are arranging to find patients for them. It is illegal to pay a referral for patients.
“I’d rather see a female doctor.” In a male-dominated profession, this request is not common, unless we are speaking about gynecology. From 1970 to today, the percentage of women gynecologists jumped from 7 percent to 59 percent. Male physicians fear that due to the decline in number of male gynecologists, their gender may eventually be excluded from the speciality altogether. The Chicago Tribune article, Male OB-GYNs are in the decline by Soumya Karlamangla mentions an instance of this gender preference. Brooke Hamel, a 19 year old girl from Virginia, recently went to the gynecologist to get a intrauterine device inserted. “He touched me and I immediately lost it… As soon as I had to spread my legs, I was in a really vulnerable place, and I did not want to be in that position with a male.” Outside of this speciality, fewer than a third of physicians are females. Men are now less likely than ever to try and become an OB-GYN due to this controversy. If the drop in number of male gynecologists continues, this could weaken the field overall. In terms of care, male and female OB-GYNs have the same education and practice. Preference in gender is only a matter of what the patient feels most comfortable with. On the other hand, there are women who prefer male OB-GYNs stating they are more gentle and better listeners. Perhaps this is due to the need to overcome this uprising stereotype.
On March 12, 2018, Jonathan Reisman wrote an article for the Chicago Tribune called ‘Judgment calls: Who really needs a pain killer?’ Dr. Reisman is an emergency room physician at Schuylkill Medical Center in Pottsville, Pensilvania. Dr. Reisman explains how the presence of drug seekers has negatively impacted many physician’s practice.
Opioids have become quite the ‘hot’ topic in today’s society . When used properly they are a powerful blessing but when not properly used, they have an incredibly destructive potential. A popular question amongst doctors is whether or not to prescribe opioids. Patients have a tendency to exaggerate pain in order to receive painkillers. Some of the patients seek a buzz while others are trying to find a fix for opioid withdrawal, which is an painful and unpleasant condition. Due to this strong presence of drug-seekers, physicians have found prescribing opioids an incredibly difficult decision to make. This epidemic is spreading rapidly and tainting the way physician’s think and it is beginning to cast doubt over clinical instincts. Physicians enabled this epidemic and are now tasked with its salvation.
The Federal Drug Enforcement Administration brings physicians a great responsibility and minimal insight on discerning diseases from ‘drug-seekers’. The misuse of opioids is nuclear and brings about death and destruction. But, when used properly they have an unbridled power that almost immediately relieves patients of antagonizing pain. Opioids are a double edged sword that are extremely concerning and hard to ignore. Doctors are being faced with under treating pain or feeding an addictions; being pulled in opposite directions by a patient’s pain and a national crisis. In the 1990’s there was a horrifying under treatment of pain that angered the public. Physician’s have the power to alleviate pain but are withholding from it. In order to not re-live the past, a physician’s decision to prescribe or administer opioids tends to be influenced by this phenomenon that occurred in the 90’s. So, now what? Patient pain is a daily conundrum and the decision on whether or not to prescribe opioids has become an emotional tug for physicians.