Citizens Coalition For Responsible Healthcare, Inc.

Proposals to Healthcare Providers For Responsible Healthcare Policy

1. Written Agreement For Referrals

That the Carilion Clinic, the Virginia Medical Society and the Roanoke Academy of Medicine forthwith jointly develop a written referral policy and a written agreement for referrals among healthcare providers, including but not limited to Carilion Clinic and non-Carilion healthcare providers, together with a standardized referral form for use by consumers and healthcare providers respectively, in requesting and in making such referrals.

2. Second Opinions

That Virginia law be modified to require that healthcare providers and the insurers of Virginia residents be provided with a "Second Opinion" of medical diagnoses and treatment plans, at the request of such resident, insured and/or their provider, and that such second opinion shall be obtained from and rendered by healthcare provider(s) who are not employed by the organization, hospital, clinic, or entity that is or employs the person rendering the initial opinion.

3. Itemized Statements

That healthcare providers in Virginia shall, upon request of the patient-consumer or his designee, provide within 30 days, an itemized statement of the services rendered and goods and products charged for to the patient-consumer, including: (1) a detailed billing (2) The Form UB-04 (for charges in 2008 and later) and UB-92 (for charges prior to 2008) and (3) the Coding Abstract (sometimes known as the "screen shot").

4. Master Charge Price Lists

That healthcare providers in Virginia, upon request of the patient-consumer or his designee, provide within 30 days, a master list of the charges for DRG's, and healthcare and medical services, products and goods charged by the healthcare provider, showing the retail or "list price" for each such charge, and that such list be annually updated and be filed by the healthcare provider with the local public library for public inspection where the services are offered and provided.

5. Conflict Of Interest Policies

That healthcare providers adopt and implement conflict of interest policies for their governance and administration, with provisions similar to those adopted by the Citizens Coalition for Responsible Healthcare, Inc.

6. Healthcare Injury And Death Reporting And Investigation

That federal and state law be amended to provide for creation of a federal agency with jurisdiction, responsibilities and authority in the healthcare services industry that are analogous to those that the NTSB and FAA have in the aviation industry; that a federal pool of funds identified and block granted to the various states for administration by the Workers Compensation systems of the states for injuries and/or death from errors and omissions of healthcare entities and providers; that such healthcare providers, without liability for such reporting, be required to report to the agency errors and omissions occurring in healthcare diagnosis and treatment resulting in injury and/or death; that citizen-patient remedies for errors and omissions be limited to the provisions of worker's compensation laws, jurisdiction, procedures and financial "caps" to be developed by the various states. And that the revisions to law shall be reviewed through a sunset provision in the amended law after ten years.

7. Standard Of Care

That law governing the standard of care by which the acts of healthcare providers are to be judged shall be modified to provide that the standard of care under Code of Virginia Section 8.01-581.20 in a locality where a medically integrated clinic using the model of Carilion Clinic is operating shall be the statewide standard of care for healthcare providers practitioners who are not employed by or practicing at such medically integrated clinic.

Code of Virginia

Code of Virginia Section 8.01-581.20. Standard of care in proceeding before medical malpractice review panel; expert testimony; determination of standard in action for damages.

A. In any proceeding before a medical malpractice review panel or in any action against a physician, clinical psychologist, podiatrist, dentist, nurse, hospital or other health care provider to recover damages alleged to have been caused by medical malpractice where the acts or omissions so complained of are alleged to have occurred in this Commonwealth, the standard of care by which the acts or omissions are to be judged shall be that degree of skill and diligence practiced by a reasonably prudent practitioner in the field of practice or specialty in this Commonwealth and the testimony of an expert witness, otherwise qualified, as to such standard of care, shall be admitted; provided, however, that the standard of care in the locality or in similar localities in which the alleged act or omission occurred shall be applied if any party shall prove by a preponderance of the evidence that the health care services and health care facilities available in the locality and the customary practices in such locality or similar localities give rise to a standard of care which is more appropriate than a statewide standard. Any physician or nurse who is licensed to practice in Virginia shall be presumed to know the statewide standard of care in the specialty or field of medicine in which he is qualified and certified. This presumption shall also apply to any physician who is licensed in some other state of the United States and meets the educational and examination requirements for licensure in Virginia. This presumption shall also apply to any nurse licensed by a state participating in the Nurse Licensure Compact. An expert witness who is familiar with the statewide standard of care shall not have his testimony excluded on the ground that he does not practice in this Commonwealth. A witness shall be qualified to testify as an expert on the standard of care if he demonstrates expert knowledge of the standards of the defendant's specialty and of what conduct conforms or fails to conform to those standards and if he has had active clinical practice in either the defendant's specialty or a related field of medicine within one year of the date of the alleged act or omission forming the basis of the action.

Thank you for coming to the meeting!  It appears you see merit in proposals 1,3,4,5.  GREAT!  What did you think of the speakers, testamonials, and open forum?  Regarding your following statements:

Proposal #2 "This just seems to me to be a way for the non-Carilion doctors to increase their business." 

Why would you have a problem with good non-Carilion doctors increasing their business?  Why won't Carilion allow their Drs. to refer patients to a non-Carilion physician, without repercussions?  Why does my (excellent non-Carilion) Dr. have to fight to get timely reports and results from Carilion radiology and special procedure departments. I don't have the same problem with my now Carilion physicians, who have printed out results for me to take to my non-Carilion Drs.  I can't give their names, as they were just recently cquired" (and none too happy about it).  

Proposal #6, now here is a proposal only doctors, lawyers, and those interested in big government could love. 

I'm not as sure, as you seem to be, that Carilion leadership will love this. 

Proposal #7 "This proposal wants to LOWER the standard of care for the area to that of non-Carilion providers." 

Sounds like you've already made up you mind that the only good healthcare in this area is what Carilion's leadership choose it to be.  Try listening to some of the patient care Carilion staff.

First I wouldn’t say I saw merit in proposals 1, 3, 4 and 5.  I am afraid I don’t know that much about them to comment.  They might be good ideas or they might not be.  I will wait for more informed people to respond to those proposals.

Concerning proposal #2, I don’t have a problem with non-Carilion doctors increasing their business and never said I did.  Those were your words – don’t ascribe your words to me.  I don’t know about repercussions as I don’t work for Carilion, but I do know I see a Carilion family physician and have been referred many times to non-Carilion specialists.  So, if there is a problem within Carilion, I guess my PCP is going to be in BIG trouble.  As far as obtaining reports, films, etc., I don’t have a problem at all – I just ask and I get them, usually that day.  I am sorry but I can’t say the same for Lewis-Gale Physicians or Lewis-Gale Medical Center.

My problem with proposal #2 was exactly as I stated, you are recommending that I be REQUIRED to obtain a second opinion from a non-Carilion doctor if the orignial opinion was from a Carilion doctor.  I sure don’t want you limiting my choice in the name of responsible healthcare.  You are now doing exactly what you accuse Carilion of doing – limiting my choices only you are attempting to use the law to do it.

Regarding your response to proposal #6 – Carilion leadership loving it - my comments about your proposal being loved was sarcasm.  I don’t see anyone loving a huge new federal agency.  I don’t know of a single physician, nurse, hospital, clinic or other healthcare provider that would be in favor of this proposal.  Most would be spending a large portion of each day answering investigator’s questions.

Finally, in response to your comment on proposal #7 about my having already made up my mind, it wasn’t me that made up my mind, it was the Coalition that seems to have made up their mind that their care is not going to be on a par with Carilion.  Otherwise there would be no need in attempting to change the standard, now would there?  On listening to Carilion staff – sure, on average in any large company, there are generally a certain percent of the employees that at any given time are unhappy – that’s life.  I am sure you can find unhappy staff at Lewis-Gale if you really wanted to look.

Just a personal comment here.  Unfortunately, I have to see many different doctors in the valley – Carilion, Lewis-Gale, independents.  Many are fine doctors providing good service.  However, it isn’t just Carilion that has problems, so doctors, before throwing stones you might just want to look around your own glass houses and do a little house cleaning.  I am talking about independents not wanting to refer to Carilion unless pushed.  I am talking about the difficulty of obtaining records from Lewis-Gale Physicians and some independents.  I am talking about Lewis-Gale medical personnel making errors that cause injury and death.  In other words, all the problems you seem to have with Carilion.  Including Lewis-Gale Medical Center trying to collect a bill that was over 5 years old and was paid 5 years ago – fortunately, I keep my records.

I do look forward to attending your next meeting.