Thursday, December 21, 2017

Rigging the rules?

There are over sixty trauma centers and emergency rooms in Mississippi but if the Mississippi Board of Medical Licensure has its way, only two will be able to offer telemergency medicine. The Board wants to limit the practice of such medicine only to hospitals that have emergency rooms and provide air ambulance service.  Only two hospitals in Mississippi, UMMC and North Mississippi Medical Center in Tupelo, meet this new definition.*

 The Board filed a notice of an amendment to its telemedicine regulations with the Secretary of State on December 11.  The notice is posted below.  The notice states there will be no oral proceeding for the proposed amendment and that it will take effect after thirty days. 

Regulation 2635 of the Board's Administrative Code governs the practice of telemedicine in Mississippi.  Telemergency medicine is a form of telemedicine and is governed by the Board as well.  The Board defines it as

a unique combination of telemedicine and the collaborative/consultative role of a physician board certified in emergency medicine, and  an appropriate skilled health professional (nurse practitioner or physician assistant).

The Board didn't change the definition but instead threw in an amendment that stated where telemergency medicine could be practiced:

Rule 5.7 Collaborative/Consultative Physician Limited. No physician practicing telemergency medicine shall be authorized to function in a collaborative/consultative role as outlined in Part 2630, Chapter 1 unless his or her practice location is a Level One Hospital Trauma Center that is able to provide continuous twenty-four hour coverage and has an existing air ambulance system in  place.  Coverage  will  be  authorized  only  for  those  emergency  departments  of  licensed hospitals who have an average daily census of thirty (30) or fewer acute care/medical surgical occupied beds as defined by their Medicare Cost Report.
Regulation 2630 governs the supervision of nurse practitioners and physician's assistants.  Thus rural hospitals or physicians that lack the expertise that may be required in emergency situations will be forced to use only two hospitals for telemergency medicine.

The proposed rule bars hospitals that operate trauma centers such as St. Dominic or Baptist Hospital from providing telemergency services.  Keep in mind that those two hospitals received A and B ratings for patient safety this year while UMMC received a D.  There are over sixty hospital emergency rooms in Mississippi although many of them are classified as tier 3 or tier 4.  However, most of them will be prevented from providing telemergency medicine if this rule is enacted. 

Kingfish note: JJ reported in 2016 that the Board tried to make UMMC's telemedicine model the only one that could exist in Mississippi but that effort failed.  The Board adopted regulations last week for opioid prescriptions that also included a provision that would severely restrict the practice of telemedicine in Mississippi.  The Board apparently intends to rush this new regulation into law without giving those affected by it the chance to speak up for themselves.  If a hospital runs an emergency room and has the capabilities of working with other trauma-designated hospitals, why can’t it provide telemergency services? The Board’s restrictive stance and push for UMMC ensures most of them will be prevented from participating in telemergency medicine if this amendment becomes law. This amendment should be called the "UMMC Protection Regulation."

*The Mississippi State Department of Health said these were the only two hospitals that offer air ambulance service although there are private air ambulance companies that operate in Mississippi.


Anonymous said...

So much for conservative being synonymous with small government and free markets. For a bunch of MDs you would think an iota of business development potential and desire to keep up with technological advances in the workplace would have slipped through. Guess what state is not going to be ground zero for telemedicine development in spite of low business start up costs and a plethora of rural low income patients that would benefit.

Anonymous said...

Why can’t every hospital with an ER provide telemergency? This is Russia.

Anonymous said...

Hahahahahahahahahahahah. How much in kickbacks are these doctors serving on the board gettiing to make these restrictive rules?

Anonymous said...

This is a great tragedy. In order to cut outrageous Medicaid and Medicare costs, GubMint should be pushing as much telemedicine as possible.

Computer connections to, for example, low cost Indian pathologists, oncologists, and other specialists could greatly reduce the burden to the taxpayer.

Here is is a great example." BLANK is an android app that provides free online consults from General Physicians from India 24x7. Anyone around the world can talk to the Doctor.

We want to ensure that you have a doctor to talk to anytime you feel you want an opinion, no matter how minor / major the issue may be. Our health is too important for us to neglect.

Doctors are meticulously selected through a rigorous process to ensure that you get the right opinion." The taxpayers of Mississippi are already greatly overburdened and deserve better.

Let's start with all Medicare patients, so we clear out the waiting rooms. This "innovation" will greatly cut the burden posed by the elderly, while allowing them the convenience of meeting, "face to face," with that Indian doctor online, instead of the burden of providing transport, waiting in a crowded room where they might be exposed to other illnesses, and still provides managed, high quality, low cost medical services! A great ROI for our taxes!

Anonymous said...

@7:54— kickbacks not needed when they are employed by the entity that is benefiting from these regs.

Anonymous said...

Another reason to take every bit of telehealth PR coming from our Congressional RINOs, like this garbage, er, example from
Empty Suit Harper
, and chuck it in your Spam folder.

Anonymous said...

Doesn't their amendment just add "Level II" to those hospitals that can offer telemergency services? The restriction on having an air ambulance service is existing regulation. They've expanded the definition to move beyond only UMMC being able to provide telemergency and now would include Forest General and NMHC which are level II trauma centers.

Scroll to the last page to see the addition.

Anonymous said...

OK - ALL hospitals will be able to do tele-ER WITH these hospitals if they choose. The "lead" or "resource" facility (for lack of better terminology) will offer treatment advice and send their air ambulance if its warranted
. And contrary to popular belief, no, the "big guys" don't steal the patients. They leave them at the local facility if it is medically reasonable for the patient.

Yes. I work in healthcare. Done it for 30+ years.

Anonymous said...


Anonymous said...

@8:48 - Please do not let details get in the way of a chance to take a shot at UMMC.


Anonymous said...

Did someone mention 'low cost Indian doctors'? Are we one day going to rely on diagnoses over the net from India like we do customer service provided by most large companies?

Anonymous said...

Regardless of when it was implemented, the air-ambulance requirement is ... interesting.

I would like to know what other states that allow telemedicine have such a requirement, vs. which do not.

Anonymous said...

8:48 & 8:49. Yall mus be new to JJ. You are suggesting facts and actual language to the discussion. Don't you know that one of the primary purpose of this site is to take a shot at UMMC any chance it can?

Anonymous said...

Then why are you here @11:34?

Anonymous said...

Well, while you people in Mississippi are passively sitting in your waiting rooms, telemedicine has become so common over here in Georgia and South Carolina that coverage benefit incentives have been added into our medical insurance coverage, both private and Medicare advantage plans. In addition, funding over here has gone into start-up telemedicine software and app developers such as Zeriscope and Reach Health. What kind of medical technology and software companies does UMMC have sitting across from it on Woodrow Wilson Avenue or North State Street? Instead, you people in Mississippi are using your tax dollars to do what -- fund companies that turn sawdust into wood pellets to burn for electricity? Is Mississippi a state or a plantation?

Kingfish said...

But I'm unfairly targeting UMMC. Perhaps I should release the emails showing the collaboration between the Medical Board and UMMC and other entities to define telemedicine so there isn't much competition.

.....I got a bad case of loving you said...

So this doesn't have to first go before the newly created Occupational Licensing Review Commission?

Anonymous said...

Having recently spent 9 hours in the ER of a Jackson hospital (not UMMC) for the 4th time in a month for the same issue without resolution, I don't think this hospital can handle what is going on in their ER, much less add telemedicine to the mix. Medicine has changed & not for the better.

Anonymous said...

It's an EMERGENCY ROOM,not a clinic. If you've had the same issue four times in one month, you have a chronic condition and need to be seen at a clinic or doctor's office instead of tying up the ER.

Anonymous said...

Umm...have you been to UMMC emergency room lately? I have - it IS a FREE CLINIC

Anonymous said...

December 21, 2017 at 8:22 PM

+ 1,000

ER four times in one month for the same problem? BS.

Anonymous said...

From both a nationally and globally healthcare point of view, rest assured Mississippi takes great pains to limit themselves in providing smart healthcare. Kingfish is spot on in his assessment of telehealth and UMMC's dogged determination at gaming the system for YEARS. They might actually succeed this time.

Kingfish said...

I want to make it clear, UMMC has a good telemedicine program. They gave me a tour of it once. Its needed in Mississippi and can help bring expertise to rural and underserved areas. Don't think any posts about this subject are knocks on the program itself and how it works.

Anonymous said...

Don't disagree, KF. They have an excellent telehealth program, which is nationally recognized. My point is that Mississippi continues to shoot itself in the foot time and time again over turf issues and state regulations that hinder, not help the residents of this state. UMMC is not alone in trying to secure what it deems to be in its own best interests. As a state we are completely disfunctional with healthcare delivery and access. It's simply astounding the gaps that exist with no real solutions in sight. We are a poor rural state. Not everyone lives in Jackson, Hattiesburg, Tupelo, Oxford or along the coast. Everyone should have access to quality care. Did not say free. Quality. If delivery of said care needs to be handled in a more creative way than "how we've always done it" or a monopoly needs to be broken up to make sure access to basic services are met - so be it.

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