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Showing 10 posts from 2011.

The Doctor’s Doctor: Professional Courtesy in an Age of Healthcare Regulation

For over 200 years, professional courtesy has been a hallmark of physician practice, a symbol of collegiality among doctors.  Historians describe its 18th century beginnings as physicians providing charity care for the families of their deceased colleagues—an early form of health insurance for doctors’ widows and children.  Over the years, the concept of collegial care also became the preferred alternative to physicians treating themselves or their own family members.  In fact, the American Medical Association’s (“AMA”) first code of medical ethics created an obligation among doctors to reciprocate medical care and to extend the courtesy to physician family members as well. Today, the AMA recognizes professional courtesy as a “long-standing tradition” but not an ethical requirement.[1]  The federal government’s commentary about “the provision of free or discounted health care items or services to a physician or his or her immediate family members or office staff,” however, is far more cautious than nostalgic. [2]   The Department of Health and Human Services Office of Inspector General’s advice that physicians “consult with an attorney” before extending professional courtesy warns that certain arrangements for free or discounted medical care run afoul of fraud and abuse laws.[3] More >

Electronic Prescribing: A Medicare Cut is Looming for all Physicians in 2012 and 2013

Posted In Health Care Law

Technology is wonderful! It seems like everyday our lives become easier and more convenient due to the ever changing world of IT. We can do almost anything over the Internet…order tickets, shop, chat, and now…even obtain prescription medications. More >

Accountable Care Organizations Regulations Passed This Week

Posted In Health Care Law

The final rule for accountable care organizations (“ACO”s) released by the Obama Administration this week addresses many of the criticisms received by the proposed rule, which was published this spring.  ACOs have been touted as one of the more promising initiatives of the Affordable Care Act because they aim to reduce the costs of caring for Medicare beneficiaries while improving quality of care by allowing provider partnerships to coordinate care, share medical records, and minimize duplicative tests and medical errors. More >


Posted In Health Care Law

As more nurses, pharmacists, physical therapists, chiropractors and other allied health professionals obtain advanced degrees that confer the ability to use the title “doctor,” physicians should be concerned that losing control over the term “doctor,” a word that has identified physicians for centuries, will create confusion for consumers and lead to a loss of control over the practice of medicine. With a shortage of physicians nationally as well as in Kentucky, mid-level practitioners are becoming the gatekeepers for health care.  Mid-level practitioners now make important medical decisions about diagnosis and access to care.  In Kentucky, the Kentucky Board of Medical Licensure (“KBML”) has taken an active role regulating the practice of certain allied health professions.  Professions that have their own licensing authority, however, have the ability to broaden the scope of practice of their profession and determine what title may be used.  The tensions between the professions may culminate in who gets to use the term “doctor.” More >


Posted In Health Care Law

With an economy in recession and health care costs that continue to rise, attorneys are bound to represent physicians, hospitals, nursing homes, physical therapists, chiropractors, nurse practitioners and many other types of health care providers as well as their patients at some time.  The current complexity and uncertainty of health law and its regulations are recipes for confusion for all lawyers even those that practice in the health law area on a daily basis.   The following represents a potpourri of health law topics that are important areas for attorneys to know about regardless of practice area.  More >

Physicians and Nursing Facilities: Never-Ending Liability?

Posted In Health Care Law

As commercials soliciting nursing home patients with claims for poor care play in Kentucky homes and Kentucky juries award large monetary verdicts against nursing homes, we can expect to see a growing number of lawsuits to be filed against nursing homes.  These lawsuits can be easy for the plaintiffs bar to prove when deficient care is found by state regulators and documented in statements of deficiencies issued to nursing homes by state regulators. Plans of corrections filed by nursing homes to bring their facilities into regulatory compliance may pit the treating physician of a nursing home resident against the nursing home and its staff. As lawsuits increase against nursing homes, physicians can be sure that their involvement as witnesses and even defendants will increase too.  Physicians need to be vigilant about their treatment of nursing home patients and aware of the importance of their role as well as the ever changing regulatory landscape. Pain medication, never events and increased transparency may all factor into increasing liability for physicians who care for nursing facility patients. More >

ACO’s: An Alternative to Employment by a Hospital?

Posted In Health Care Law

With a backdrop of rising health care costs, 50 million uninsured Americans, and a health care system that spends more per person but has lower quality than 37 other developed countries, Congress passed a comprehensive health care reform law with the vision of doctors and hospitals joining forces, coordinating care to hold down costs for the prospect of earning government bonuses for controlling cots.1 While no one can foresee exactly how all the provisions of the new law will mesh with the current system, four of Kentucky’s largest hospital systems are negotiating mergers and many of the smaller systems are buying up other providers or seeking to enter into controlling systems, physicians and their groups are increasingly looking to hospitals as employers. It is a buyers market for hospitals with the financial reserves to buy physician practices, butnot every physician practice can be bought by a hospital nor does every physician want to be employed by a hospital. While this activity is being driven by decreases in reimbursement, it is also a product of the new health reform law, which encourages providers to create integrated health care delivery systems that can improve the quality of health care services and lower health care costs. Accountable Care Organizations (“ACO”) are the vehicles through which shared savings are to be passed along when certain quality performance standards are met. Hospitals and physicians must find ways other than employment relationships to align themselves as ACO’s. More >


Posted In Health Care Law

The peer review process is an important and necessary function of health care organizations, and the benefits it yields are unquestionable. Mandated by the Medicare's Conditions of Participation and the Joint Commission, peer review helps health care providers ensure that their patients receive safe care. Each of the fifty states, including Kentucky, have recognized the importance of the peer review process and passed statutes granting privileged status to information gathered during the peer review process. Kentucky's statute, however, has been rendered ineffective by a line of court cases. Though the language of Kentucky's statute states unambiguously that all materials generated during the peer review process "shall be confidential and privileged and shall not be subject to discover, subpoena, or introduction into evidence, in any civil action in any court,"1 Sisters of Charity Health Systems, Inc. v. Raikes, the Supreme Court of Kentucky held that this protection does not apply in medical malpractice suits.2 Kentucky healthcare providers may be able to reclaim at least some confidentiality and privilege for the type of information typically compiled during peer review through a Patient Safety Organization. More >


Posted In Health Care Law
One of the most important changes created by the Health Care Reform Act is the establishment of an explicit duty to refund Medicare and Medicaid overpayments within 60 days of identification.  While this “60 day rule” sounds simple, it is anything but, as all providers and suppliers struggle to determine both how and when this rule applies without regulatory guidance from the Centers for Medicare & Medicaid.  Physicians and provider groups should pay particular attention to the 60 day rule as billing responsibilities are generally delegated to staff. In the normal course of business, a physician may not even be aware that his or her office staff has received and deposited an overpayment due to a simple mistake in billing.  Failure to refund an overpayment within 60 days now constitutes an “obligation” under the Federal False Claims Act, which means that the overpayment may be considered to be a false claim.  False claims, of course, can be the subject of qui tam lawsuits, government investigations, MAC/RAC audits, among others, and, if liability is found, then damages can be assessed at three times the amount of the claim and civil monetary penalties. 
More >


Posted In Health Care Law

Medical school teaches physicians how to treat patients when they show up, but does not address how to treat patients when they do not.  No-shows are money losers and a frequent problem for physician offices.  Not only do missed appointments disrupt patient flow, but no-shows also equate to lost revenue.  Further, when a patient misses an appointment, the overhead related to that no-show remains on the books because the costs of office space, equipment, staff and supplies accumulate regardless of whether or not a patient is seen and treated.  Fortunately, there are ways to limit the loss caused by missed appointments. More >

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