Q I attended a workshop recently and heard about primary and secondary verification that must be used when checking on an applicant's license. I've looked at the license certificate and copied it. Isn't this all I have to do?

A Accrediting bodies require that organizations have a process in place to review, assess and validate an individual's qualifications, including education, training, experience, certification and licensure against the organization's established minimum requirements. It's not enough to copy or scan an applicant's license document. There's no assurance that the document or copy that you've visualized is genuine and not a forgery.

You can validate licensure by using primary or secondary verification.

• Primary source verification. This is when you inquire with the entity that originally issued the credential. Consult your state licensing board, as most states have this service available on the Web.
• Secondary verification. Also acceptable, this is when you inquire with a source that has already performed primary verification and has the information available for use. Examples of secondary sources are American Medical Association Physician Master Profile, American Osteopathic Association Master Profile, American Nurses Credentialing Center and specialty boards recognized by the American Board of Medical Specialties, American Dental Association and the American Podiatric Association.
  
  

Barbara Ann Harmer, RN, BSN, MHA
Senior consultant
Healthcare Consultants, Inc.
Celebration, Fla.
writeMail("[email protected]")

Do We Need an Emergency Power System?

Q Our ASC is on the eighth floor of a fully sprinkled building. We achieved AAAHC Medicare (deemed status) accreditation two years ago. We use a UPS (uninterruptible power supply, battery back-up) for emergency power because the building owners won't let us install a generator. The building's elevators aren't connected to emergency power. What's the regulation concerning the performance of cases under general anesthesia in our facility if the UPS will support all critical care electrical needs - and assuming we're not going to make any changes in the suite or its electrical or gas systems?

A If the facility was under construction on or before March 11, 2003, then you are OK with a type 3 EES (essential electrical system) emergency power system, which can be battery-based and only needs to serve things critical for patient safety, orderly cessation of procedures and exiting (evacuation) the facility. Considering that it's June 2004, that exception is probably now limited only to facilities already certified by CMS as ASCs.

All other facilities (those starting construction after March 11, 2003) that use general anesthesia must have type 1 emergency power systems that do indeed power the elevator, air filtration, heating and about everything else. While batteries are theoretically still permitted, I doubt they could ever have enough capacity to power all that for the four hours required (type 3 systems only need to last 90 minutes with the expected emergency loads).

William E. Lindeman, AIA
WEL Designs
Tuscon, Ariz.
writeMail("[email protected]")

Stark Law vs. Anti-kickback Statute

Q Are the Stark Law and the Anti-kickback Statute the same thing?

A They are not the same; here's how to differentiate.

The Anti-kickback Statute imposes criminal liability on violators and requires that the government demonstrate intention to violate the law. The law applies when any consideration is paid for the referral of "covered services" (Medicare or Medicaid services, for example).

Stark, on the other hand, imposes strict civil liability - violators can be fined or excluded from governmental programs regardless of intention - on physicians for prohibited referrals to entities with which they have a financial relationship. Stark only covers referrals of Medicare, Medicaid or other governmental program patients for certain designated health services (DHS), including radiology services (MRI, CT and ultrasound), radiation therapy services and supplies, durable medical equipment, prosthetics and orthotics, outpatient prescription drugs, and inpatient and outpatient hospital services.

You might be violating Stark if you have a direct or indirect financial relationship with an entity providing a DHS. You should know whether you (or an immediate family member) have a direct ownership or compensation arrangement with a facility. But you can also violate Stark if you refer to one entity and the referral implicates a relationship with another entity providing DHS. An indirect financial relationship such as this can exist even if part of the referral chain is protected by a Stark Law exception.

Note that for the Stark Law to be triggered, a referral must have occurred. The Phase I Stark regulations stated that no referral occurs when the physician actually performs the DHS. Phase I comments included requests that the exception be extended to services performed by others under the physician's supervision. Phase II confirms that a service performed by a referring physician won't constitute a referral that implicates the Stark Law. However, this exception doesn't apply to services performed by any other person (such as a nurse or technician), even if that person is supervised by the referring physician or is providing the services incident to the physician's professional services.

Lorin Patterson, Esq.
Shook, Hardy and Bacon, LLP
writeMail("[email protected]")