Alicia Gallegos

Metrics used by the Centers for Medicare & Medicaid Services to determine penalties for heart failure hospital readmissions are not associated with quality of care or overall clinical outcomes, according to data presented at the annual scientific sessions of the American Heart Association.

Ambarish Pandey, MD, of the University of Texas Southwestern Medical Center in Dallas, and his colleagues analyzed data from centers participating in the American Heart Association’s Get With The Guidelines-Heart Failure (GWTG-HF) registry linked to Medicare claims from July 2008 to June 2011. Centers were stratified as having low risk-adjusted readmission rates and high risk-adjusted readmission rates based on publicly available data from 2013.

The study included 171 centers with 43,143 patients. Centers were almost evenly split between low- and high-risk–adjusted 30-day readmission rates, with just a few more (51%) falling in the low-risk–adjusted category.

Performance was nearly equal (95.7% for centers with a low risk-adjusted readmission rate vs. 96.5% for those with high risk-adjusted rate) for median adherence to all performance measures, as was the case for median percentage of defect-free care (90.0% vs. 91.1%, respectively) and composite 1-year outcome of death or all-cause readmission rates (median 62.9% vs. 65.3%, respectively). The higher readmission group had higher 1-year all-cause readmission rates (median, 59.1% vs. 54.7%), Dr. Pandey and his colleagues reported in the study that was published simultaneously in JACC: Heart Failure (2016 Nov 15. doi. org/10.1016/j.jchf.2016). One-year mortality rates were lower in the higher readmission group with a trend toward statistical significance (median, 28.2% vs. 31.7%; P = 0.07).

Taken together, the findings suggest the 30-day readmission metrics currently used by CMS to determine readmission penalties are not associated with quality of care or overall clinical outcomes, Dr. Pandey and his colleagues wrote. Results showing higher 30-day readmissions do not necessarily reflect poor quality of care and may be related to other factors.

“These findings question the usefulness of the [hospital readmission reduction program] metric in identifying and penalizing hospitals with low quality of care,” Dr. Pandey wrote, adding that the findings were consistent with previous studies that have demonstrated a lack of association between in-hospital quality of care and 30-day readmission rates.

CMS implemented the federal Hospital Readmissions Reduction Program (HRRP) in 2012 to provide financial incentives for hospitals to reduce readmissions. Under the program, CMS uses claims data to determine whether readmission rates for heart failure, acute myocardial infarction, and pneumonia at eligible hospitals are higher than would be predicted by CMS models. Centers with higher than expected readmission rates face up to a 3% reimbursement penalty.

[email protected]

On Twitter @legal_med

Metrics used by the Centers for Medicare & Medicaid Services to determine penalties for heart failure hospital readmissions are not associated with quality of care or overall clinical outcomes, according to data presented at the annual scientific sessions of the American Heart Association.

Ambarish Pandey, MD, of the University of Texas Southwestern Medical Center in Dallas, and his colleagues analyzed data from centers participating in the American Heart Association’s Get With The Guidelines-Heart Failure (GWTG-HF) registry linked to Medicare claims from July 2008 to June 2011. Centers were stratified as having low risk-adjusted readmission rates and high risk-adjusted readmission rates based on publicly available data from 2013.

The study included 171 centers with 43,143 patients. Centers were almost evenly split between low- and high-risk–adjusted 30-day readmission rates, with just a few more (51%) falling in the low-risk–adjusted category.

Performance was nearly equal (95.7% for centers with a low risk-adjusted readmission rate vs. 96.5% for those with high risk-adjusted rate) for median adherence to all performance measures, as was the case for median percentage of defect-free care (90.0% vs. 91.1%, respectively) and composite 1-year outcome of death or all-cause readmission rates (median 62.9% vs. 65.3%, respectively). The higher readmission group had higher 1-year all-cause readmission rates (median, 59.1% vs. 54.7%), Dr. Pandey and his colleagues reported in the study that was published simultaneously in JACC: Heart Failure (2016 Nov 15. doi. org/10.1016/j.jchf.2016). One-year mortality rates were lower in the higher readmission group with a trend toward statistical significance (median, 28.2% vs. 31.7%; P = 0.07).

Taken together, the findings suggest the 30-day readmission metrics currently used by CMS to determine readmission penalties are not associated with quality of care or overall clinical outcomes, Dr. Pandey and his colleagues wrote. Results showing higher 30-day readmissions do not necessarily reflect poor quality of care and may be related to other factors.

“These findings question the usefulness of the [hospital readmission reduction program] metric in identifying and penalizing hospitals with low quality of care,” Dr. Pandey wrote, adding that the findings were consistent with previous studies that have demonstrated a lack of association between in-hospital quality of care and 30-day readmission rates.

CMS implemented the federal Hospital Readmissions Reduction Program (HRRP) in 2012 to provide financial incentives for hospitals to reduce readmissions. Under the program, CMS uses claims data to determine whether readmission rates for heart failure, acute myocardial infarction, and pneumonia at eligible hospitals are higher than would be predicted by CMS models. Centers with higher than expected readmission rates face up to a 3% reimbursement penalty.

[email protected]

On Twitter @legal_med

Metrics used by the Centers for Medicare & Medicaid Services to determine penalties for heart failure hospital readmissions are not associated with quality of care or overall clinical outcomes, according to data presented at the annual scientific sessions of the American Heart Association.

Ambarish Pandey, MD, of the University of Texas Southwestern Medical Center in Dallas, and his colleagues analyzed data from centers participating in the American Heart Association’s Get With The Guidelines-Heart Failure (GWTG-HF) registry linked to Medicare claims from July 2008 to June 2011. Centers were stratified as having low risk-adjusted readmission rates and high risk-adjusted readmission rates based on publicly available data from 2013.

The study included 171 centers with 43,143 patients. Centers were almost evenly split between low- and high-risk–adjusted 30-day readmission rates, with just a few more (51%) falling in the low-risk–adjusted category.

Performance was nearly equal (95.7% for centers with a low risk-adjusted readmission rate vs. 96.5% for those with high risk-adjusted rate) for median adherence to all performance measures, as was the case for median percentage of defect-free care (90.0% vs. 91.1%, respectively) and composite 1-year outcome of death or all-cause readmission rates (median 62.9% vs. 65.3%, respectively). The higher readmission group had higher 1-year all-cause readmission rates (median, 59.1% vs. 54.7%), Dr. Pandey and his colleagues reported in the study that was published simultaneously in JACC: Heart Failure (2016 Nov 15. doi. org/10.1016/j.jchf.2016). One-year mortality rates were lower in the higher readmission group with a trend toward statistical significance (median, 28.2% vs. 31.7%; P = 0.07).

Taken together, the findings suggest the 30-day readmission metrics currently used by CMS to determine readmission penalties are not associated with quality of care or overall clinical outcomes, Dr. Pandey and his colleagues wrote. Results showing higher 30-day readmissions do not necessarily reflect poor quality of care and may be related to other factors.

“These findings question the usefulness of the [hospital readmission reduction program] metric in identifying and penalizing hospitals with low quality of care,” Dr. Pandey wrote, adding that the findings were consistent with previous studies that have demonstrated a lack of association between in-hospital quality of care and 30-day readmission rates.

CMS implemented the federal Hospital Readmissions Reduction Program (HRRP) in 2012 to provide financial incentives for hospitals to reduce readmissions. Under the program, CMS uses claims data to determine whether readmission rates for heart failure, acute myocardial infarction, and pneumonia at eligible hospitals are higher than would be predicted by CMS models. Centers with higher than expected readmission rates face up to a 3% reimbursement penalty.

[email protected]

On Twitter @legal_med

Physicians will have several options to choose from when it comes to advanced alternative payment models (APMs) in 2017.

In an Oct. 25 release, the Centers for Medicare & Medicaid Services announced seven models that will be considered advanced APMs in 2017, including the new Oncology Care Model with two-sided risk. Other advanced APM choices will include:

• Comprehensive Primary Care Plus (CPC+).
• Comprehensive ESRD Care Model (Large Dialysis Organization [LDO] arrangement).
• Comprehensive ESRD Care Model (non-LDO arrangement).
• Medicare Shared Savings Program Accountable Care Organizations (ACOs) – Track 2.
• Medicare Shared Savings Program ACOs – Track 3.
• Next Generation ACO Model.

• ACO – Track 1+.
• New voluntary bundled payment model.
• Comprehensive Care for Joint Replacement Payment Model (Certified Electronic Health Record Technology [CEHRT] track).
• Advancing Care Coordination through Episode Payment Models – Track 1 (CEHRT).

For performance years 2017 and 2018, participation requirements will apply only to Medicare payments and physicians who treat Medicare patients. Starting in 2019, clinicians may also meet an alternative standard for advanced APMs that will include non-Medicare payments and patients.

“With these new opportunities, CMS expects that by the 2018 performance period, 25% of clinicians in the Quality Payment Program will earn incentive payments by being a part of these advanced models,” Patrick Conway, MD, CMS deputy administrator said in a statement. “Thanks to MACRA and the Innovation Center, we’re striving to see more Medicare patients benefit from better care when they visit their doctor for a knee replacement, receive cancer treatment, or have a coordinated care team manage their complex conditions.”

CMS is accepting feedback from physicians on the Quality Payment Program final rule until Dec. 17. Doctors can submit their comments and suggestions electronically through the CMS e-Regulation website.

AGA supports physician-focused payment models (PFPMs) tailored to the practice and goals of GIs through the development of episodes of care. We appreciate that CMS has provided flexibility to allow more physicians to be eligible to participate in APMs and are hopeful that there will be new options in the future for gastroenterologists to demonstrate their value and maximize their earnings under APMs.

[email protected]
On Twitter @legal_med

AGA Resource
AGA is committed to preparing you for success in possible new reimbursement environments. Learn more about bundled and episode payment models at http://www.gastro.org/practice-management/quality/bundled-payment-options.

Physicians will have several options to choose from when it comes to advanced alternative payment models (APMs) in 2017.

In an Oct. 25 release, the Centers for Medicare & Medicaid Services announced seven models that will be considered advanced APMs in 2017, including the new Oncology Care Model with two-sided risk. Other advanced APM choices will include:

• Comprehensive Primary Care Plus (CPC+).
• Comprehensive ESRD Care Model (Large Dialysis Organization [LDO] arrangement).
• Comprehensive ESRD Care Model (non-LDO arrangement).
• Medicare Shared Savings Program Accountable Care Organizations (ACOs) – Track 2.
• Medicare Shared Savings Program ACOs – Track 3.
• Next Generation ACO Model.

• ACO – Track 1+.
• New voluntary bundled payment model.
• Comprehensive Care for Joint Replacement Payment Model (Certified Electronic Health Record Technology [CEHRT] track).
• Advancing Care Coordination through Episode Payment Models – Track 1 (CEHRT).

For performance years 2017 and 2018, participation requirements will apply only to Medicare payments and physicians who treat Medicare patients. Starting in 2019, clinicians may also meet an alternative standard for advanced APMs that will include non-Medicare payments and patients.

“With these new opportunities, CMS expects that by the 2018 performance period, 25% of clinicians in the Quality Payment Program will earn incentive payments by being a part of these advanced models,” Patrick Conway, MD, CMS deputy administrator said in a statement. “Thanks to MACRA and the Innovation Center, we’re striving to see more Medicare patients benefit from better care when they visit their doctor for a knee replacement, receive cancer treatment, or have a coordinated care team manage their complex conditions.”

CMS is accepting feedback from physicians on the Quality Payment Program final rule until Dec. 17. Doctors can submit their comments and suggestions electronically through the CMS e-Regulation website.

AGA supports physician-focused payment models (PFPMs) tailored to the practice and goals of GIs through the development of episodes of care. We appreciate that CMS has provided flexibility to allow more physicians to be eligible to participate in APMs and are hopeful that there will be new options in the future for gastroenterologists to demonstrate their value and maximize their earnings under APMs.

[email protected]
On Twitter @legal_med

AGA Resource
AGA is committed to preparing you for success in possible new reimbursement environments. Learn more about bundled and episode payment models at http://www.gastro.org/practice-management/quality/bundled-payment-options.

Physicians will have several options to choose from when it comes to advanced alternative payment models (APMs) in 2017.

In an Oct. 25 release, the Centers for Medicare & Medicaid Services announced seven models that will be considered advanced APMs in 2017, including the new Oncology Care Model with two-sided risk. Other advanced APM choices will include:

• Comprehensive Primary Care Plus (CPC+).
• Comprehensive ESRD Care Model (Large Dialysis Organization [LDO] arrangement).
• Comprehensive ESRD Care Model (non-LDO arrangement).
• Medicare Shared Savings Program Accountable Care Organizations (ACOs) – Track 2.
• Medicare Shared Savings Program ACOs – Track 3.
• Next Generation ACO Model.

• ACO – Track 1+.
• New voluntary bundled payment model.
• Comprehensive Care for Joint Replacement Payment Model (Certified Electronic Health Record Technology [CEHRT] track).
• Advancing Care Coordination through Episode Payment Models – Track 1 (CEHRT).

For performance years 2017 and 2018, participation requirements will apply only to Medicare payments and physicians who treat Medicare patients. Starting in 2019, clinicians may also meet an alternative standard for advanced APMs that will include non-Medicare payments and patients.

“With these new opportunities, CMS expects that by the 2018 performance period, 25% of clinicians in the Quality Payment Program will earn incentive payments by being a part of these advanced models,” Patrick Conway, MD, CMS deputy administrator said in a statement. “Thanks to MACRA and the Innovation Center, we’re striving to see more Medicare patients benefit from better care when they visit their doctor for a knee replacement, receive cancer treatment, or have a coordinated care team manage their complex conditions.”

CMS is accepting feedback from physicians on the Quality Payment Program final rule until Dec. 17. Doctors can submit their comments and suggestions electronically through the CMS e-Regulation website.

AGA supports physician-focused payment models (PFPMs) tailored to the practice and goals of GIs through the development of episodes of care. We appreciate that CMS has provided flexibility to allow more physicians to be eligible to participate in APMs and are hopeful that there will be new options in the future for gastroenterologists to demonstrate their value and maximize their earnings under APMs.

[email protected]
On Twitter @legal_med

AGA Resource
AGA is committed to preparing you for success in possible new reimbursement environments. Learn more about bundled and episode payment models at http://www.gastro.org/practice-management/quality/bundled-payment-options.

Clear contracts with payers are critical as physicians enter into value-based care arrangements. During a recent webinar presented by the American Bar Association, legal experts provided guidance on how doctors can successfully draft pay-for-performance contracts and prevent disputes with payers.

1. Clearly define terms

Contract terms and definitions should be clearly outlined and understood by both parties before value-based agreements are signed, said Melissa J. Hulke, a director in the Berkeley Research Group, LLC health analytics practice.

2. Review payment calculations

Ensure that payment formulas are examined and agreed upon.

3. Monitor results

Actively monitor projected-to-actual financial performance under the contract. If performance is not being monitored and results are not being tested, it’s impossible to tell whether the contract is succeeding or failing, Ms. Hulke said.

It’s a good idea to monitor projected-to-actual financial performance monthly or at least quarterly, she advised.

“Tracking budget to actual performance and investigating successes and failures are important if the contracts are material to the provider’s business,” Ms. Hulke said.
 

4. Institute time frames for government methodologies

Be specific about when contracts are linked to Medicare reimbursement methodologies.

If commercial payers are tying payment rates to government programs, which often occurs, contracts should include whether the reimbursement is based on Medicare rates and methodologies as of a particular date and time, according to Ms. Hulke. For instance, the contract could specify that rates are tied to Medicare methodologies at the time the contract was executed. Alternatively, contracts could allow the physician payment rate to fluctuate depending on changes the government makes to Medicare rates and methodologies during the span of the contract.

“If this is not defined, when Medicare makes a change, the parties may have differing opinions on the appropriate rate of reimbursement that’s being paid,” she said.
 

5. Structure around state and federal laws

Conduct a regulatory analysis before inking any value based payment arrangement/transaction, and structure and document around potential legal constraints, Ms. Hanna said.

Know the laws in your state, she advised. Some states have requirements for provider incentive programs, while others may have rules for provider organizations or intermediaries that assume certain financial risk. When working with federal health care payers, review the Stark Law and Anti-Kickback regulations and ensure that if triggered by the arrangement, the venture falls within an exception of the statutes. Other legal considerations when drafting contracts include:

• HIPAA and state privacy laws.

• Antitrust laws.

• Telemedicine and telehealth laws.

• Medicare Advantage benefit guidelines for programs designed for specific Medicare Advantage populations.

• Scope of practice laws applicable to mid-level medical providers.

6. Design a dispute-resolution strategy

Include a thorough dispute-resolution strategy within the contract. The strategies help facilitate an orderly process for resolving disputes cost effectively, Ms. Hanna said. She suggested that policies start with an informal dispute-resolution process that sends unresolved matters to senior executives at each organization.

“This allows business leaders – and not the lawyers – to find a business solution to a thorny and potentially costly problem before each party gets entrenched in its own position and own sense of having been wronged,” she said in an interview. “The business solution may or may not rely on contract language but may be tailored to keep the relationship moving forward. However, if the informal process proves unsuccessful, then the process gets punted to the legal system – whether in a court proceeding or arbitration.”
 

7. Have an exit strategy

Include an exit strategy that ensures an end to the arrangement goes as smoothly and fairly as possible. The strategy will depend on the nature and structure of the payer-provider alignment and the value-based payment arrangement, Ms. Hanna said in an interview.

For example, in a true, corporate joint venture, the exit strategy may include buyout rights of the newly formed entity. In this case, it’s important to consider and negotiate the price of the buyout and what circumstances that will trigger the buyout. Termination rights should also be included in an exit strategy, Ms. Hanna said. One option is to allow termination “without case,” by either party.

“Clients often do not like this approach because the intention of the parties going in is to build a strong, long-term relationship where provider and payer benefit,” she said. “A ‘without cause’ termination rights gives the parties a safety valve if circumstances change or the relationship is just not successful.”

An alternative is to allow the relationship time to mature and grow before either party can exercise a without cause termination. A related approach is to develop triggering events that would give one or both parties the right to terminate the agreement, without the other party “having committed a bad act,” Ms. Hanna said in the interview.

“For instance, if the relationship does not meet certain financial or other benchmarks within an agreed-upon time frame, this may be a sufficient reason to terminate the relationship, abandon, or renegotiate the value-based purchasing payment formula or, perhaps, end an exclusive or other preferential relationship,” she said.
 

[email protected]

On Twitter @legal_med

Clear contracts with payers are critical as physicians enter into value-based care arrangements. During a recent webinar presented by the American Bar Association, legal experts provided guidance on how doctors can successfully draft pay-for-performance contracts and prevent disputes with payers.

1. Clearly define terms

Contract terms and definitions should be clearly outlined and understood by both parties before value-based agreements are signed, said Melissa J. Hulke, a director in the Berkeley Research Group, LLC health analytics practice.

2. Review payment calculations

Ensure that payment formulas are examined and agreed upon.

3. Monitor results

Actively monitor projected-to-actual financial performance under the contract. If performance is not being monitored and results are not being tested, it’s impossible to tell whether the contract is succeeding or failing, Ms. Hulke said.

It’s a good idea to monitor projected-to-actual financial performance monthly or at least quarterly, she advised.

“Tracking budget to actual performance and investigating successes and failures are important if the contracts are material to the provider’s business,” Ms. Hulke said.
 

4. Institute time frames for government methodologies

Be specific about when contracts are linked to Medicare reimbursement methodologies.

If commercial payers are tying payment rates to government programs, which often occurs, contracts should include whether the reimbursement is based on Medicare rates and methodologies as of a particular date and time, according to Ms. Hulke. For instance, the contract could specify that rates are tied to Medicare methodologies at the time the contract was executed. Alternatively, contracts could allow the physician payment rate to fluctuate depending on changes the government makes to Medicare rates and methodologies during the span of the contract.

“If this is not defined, when Medicare makes a change, the parties may have differing opinions on the appropriate rate of reimbursement that’s being paid,” she said.
 

5. Structure around state and federal laws

Conduct a regulatory analysis before inking any value based payment arrangement/transaction, and structure and document around potential legal constraints, Ms. Hanna said.

Know the laws in your state, she advised. Some states have requirements for provider incentive programs, while others may have rules for provider organizations or intermediaries that assume certain financial risk. When working with federal health care payers, review the Stark Law and Anti-Kickback regulations and ensure that if triggered by the arrangement, the venture falls within an exception of the statutes. Other legal considerations when drafting contracts include:

• HIPAA and state privacy laws.

• Antitrust laws.

• Telemedicine and telehealth laws.

• Medicare Advantage benefit guidelines for programs designed for specific Medicare Advantage populations.

• Scope of practice laws applicable to mid-level medical providers.

6. Design a dispute-resolution strategy

Include a thorough dispute-resolution strategy within the contract. The strategies help facilitate an orderly process for resolving disputes cost effectively, Ms. Hanna said. She suggested that policies start with an informal dispute-resolution process that sends unresolved matters to senior executives at each organization.

“This allows business leaders – and not the lawyers – to find a business solution to a thorny and potentially costly problem before each party gets entrenched in its own position and own sense of having been wronged,” she said in an interview. “The business solution may or may not rely on contract language but may be tailored to keep the relationship moving forward. However, if the informal process proves unsuccessful, then the process gets punted to the legal system – whether in a court proceeding or arbitration.”
 

7. Have an exit strategy

Include an exit strategy that ensures an end to the arrangement goes as smoothly and fairly as possible. The strategy will depend on the nature and structure of the payer-provider alignment and the value-based payment arrangement, Ms. Hanna said in an interview.

For example, in a true, corporate joint venture, the exit strategy may include buyout rights of the newly formed entity. In this case, it’s important to consider and negotiate the price of the buyout and what circumstances that will trigger the buyout. Termination rights should also be included in an exit strategy, Ms. Hanna said. One option is to allow termination “without case,” by either party.

“Clients often do not like this approach because the intention of the parties going in is to build a strong, long-term relationship where provider and payer benefit,” she said. “A ‘without cause’ termination rights gives the parties a safety valve if circumstances change or the relationship is just not successful.”

An alternative is to allow the relationship time to mature and grow before either party can exercise a without cause termination. A related approach is to develop triggering events that would give one or both parties the right to terminate the agreement, without the other party “having committed a bad act,” Ms. Hanna said in the interview.

“For instance, if the relationship does not meet certain financial or other benchmarks within an agreed-upon time frame, this may be a sufficient reason to terminate the relationship, abandon, or renegotiate the value-based purchasing payment formula or, perhaps, end an exclusive or other preferential relationship,” she said.
 

[email protected]

On Twitter @legal_med

Clear contracts with payers are critical as physicians enter into value-based care arrangements. During a recent webinar presented by the American Bar Association, legal experts provided guidance on how doctors can successfully draft pay-for-performance contracts and prevent disputes with payers.

1. Clearly define terms

Contract terms and definitions should be clearly outlined and understood by both parties before value-based agreements are signed, said Melissa J. Hulke, a director in the Berkeley Research Group, LLC health analytics practice.

2. Review payment calculations

Ensure that payment formulas are examined and agreed upon.

3. Monitor results

Actively monitor projected-to-actual financial performance under the contract. If performance is not being monitored and results are not being tested, it’s impossible to tell whether the contract is succeeding or failing, Ms. Hulke said.

It’s a good idea to monitor projected-to-actual financial performance monthly or at least quarterly, she advised.

“Tracking budget to actual performance and investigating successes and failures are important if the contracts are material to the provider’s business,” Ms. Hulke said.
 

4. Institute time frames for government methodologies

Be specific about when contracts are linked to Medicare reimbursement methodologies.

If commercial payers are tying payment rates to government programs, which often occurs, contracts should include whether the reimbursement is based on Medicare rates and methodologies as of a particular date and time, according to Ms. Hulke. For instance, the contract could specify that rates are tied to Medicare methodologies at the time the contract was executed. Alternatively, contracts could allow the physician payment rate to fluctuate depending on changes the government makes to Medicare rates and methodologies during the span of the contract.

“If this is not defined, when Medicare makes a change, the parties may have differing opinions on the appropriate rate of reimbursement that’s being paid,” she said.
 

5. Structure around state and federal laws

Conduct a regulatory analysis before inking any value based payment arrangement/transaction, and structure and document around potential legal constraints, Ms. Hanna said.

Know the laws in your state, she advised. Some states have requirements for provider incentive programs, while others may have rules for provider organizations or intermediaries that assume certain financial risk. When working with federal health care payers, review the Stark Law and Anti-Kickback regulations and ensure that if triggered by the arrangement, the venture falls within an exception of the statutes. Other legal considerations when drafting contracts include:

• HIPAA and state privacy laws.

• Antitrust laws.

• Telemedicine and telehealth laws.

• Medicare Advantage benefit guidelines for programs designed for specific Medicare Advantage populations.

• Scope of practice laws applicable to mid-level medical providers.

6. Design a dispute-resolution strategy

Include a thorough dispute-resolution strategy within the contract. The strategies help facilitate an orderly process for resolving disputes cost effectively, Ms. Hanna said. She suggested that policies start with an informal dispute-resolution process that sends unresolved matters to senior executives at each organization.

“This allows business leaders – and not the lawyers – to find a business solution to a thorny and potentially costly problem before each party gets entrenched in its own position and own sense of having been wronged,” she said in an interview. “The business solution may or may not rely on contract language but may be tailored to keep the relationship moving forward. However, if the informal process proves unsuccessful, then the process gets punted to the legal system – whether in a court proceeding or arbitration.”
 

7. Have an exit strategy

Include an exit strategy that ensures an end to the arrangement goes as smoothly and fairly as possible. The strategy will depend on the nature and structure of the payer-provider alignment and the value-based payment arrangement, Ms. Hanna said in an interview.

For example, in a true, corporate joint venture, the exit strategy may include buyout rights of the newly formed entity. In this case, it’s important to consider and negotiate the price of the buyout and what circumstances that will trigger the buyout. Termination rights should also be included in an exit strategy, Ms. Hanna said. One option is to allow termination “without case,” by either party.

“Clients often do not like this approach because the intention of the parties going in is to build a strong, long-term relationship where provider and payer benefit,” she said. “A ‘without cause’ termination rights gives the parties a safety valve if circumstances change or the relationship is just not successful.”

An alternative is to allow the relationship time to mature and grow before either party can exercise a without cause termination. A related approach is to develop triggering events that would give one or both parties the right to terminate the agreement, without the other party “having committed a bad act,” Ms. Hanna said in the interview.

“For instance, if the relationship does not meet certain financial or other benchmarks within an agreed-upon time frame, this may be a sufficient reason to terminate the relationship, abandon, or renegotiate the value-based purchasing payment formula or, perhaps, end an exclusive or other preferential relationship,” she said.
 

[email protected]

On Twitter @legal_med

Physicians will have several options to choose from when it comes to advanced alternative payment models (APMs) in 2017.

In an Oct. 25 release, the Centers for Medicare & Medicaid Services announced seven models that will be considered advanced APMs in 2017, including the new Oncology Care Model with two-sided risk. Other advanced APM choices will include:

• Comprehensive Primary Care Plus (CPC+).

• Comprehensive ESRD Care Model (Large Dialysis Organization [LDO] arrangement).

• Comprehensive ESRD Care Model (non-LDO arrangement).

• Medicare Shared Savings Program Accountable Care Organizations (ACOs) – Track 2.

• Medicare Shared Savings Program ACOs – Track 3.

• Next Generation ACO Model.

• ACO – Track 1+.

• New voluntary bundled payment model.

• Comprehensive Care for Joint Replacement Payment Model (Certified Electronic Health Record Technology [CEHRT] track).

• Advancing Care Coordination through Episode Payment Models – Track 1 (CEHRT).

For performance years 2017 and 2018, participation requirements will apply only to Medicare payments and physicians who treat Medicare patients. Starting in 2019, clinicians may also meet an alternative standard for advanced APMs that will include non-Medicare payments and patients.

“With these new opportunities, CMS expects that by the 2018 performance period, 25% of clinicians in the Quality Payment Program will earn incentive payments by being a part of these advanced models,” Patrick Conway, MD, CMS deputy administrator said in a statement. “Thanks to MACRA and the Innovation Center, we’re striving to see more Medicare patients benefit from better care when they visit their doctor for a knee replacement, receive cancer treatment, or have a coordinated care team manage their complex conditions.”

CMS is accepting feedback from physicians on the Quality Payment Program final rule until Dec. 17. Doctors can submit their comments and suggestions electronically through the CMS e-Regulation website.

[email protected]

On Twitter @legal_med

Physicians will have several options to choose from when it comes to advanced alternative payment models (APMs) in 2017.

In an Oct. 25 release, the Centers for Medicare & Medicaid Services announced seven models that will be considered advanced APMs in 2017, including the new Oncology Care Model with two-sided risk. Other advanced APM choices will include:

• Comprehensive Primary Care Plus (CPC+).

• Comprehensive ESRD Care Model (Large Dialysis Organization [LDO] arrangement).

• Comprehensive ESRD Care Model (non-LDO arrangement).

• Medicare Shared Savings Program Accountable Care Organizations (ACOs) – Track 2.

• Medicare Shared Savings Program ACOs – Track 3.

• Next Generation ACO Model.

• ACO – Track 1+.

• New voluntary bundled payment model.

• Comprehensive Care for Joint Replacement Payment Model (Certified Electronic Health Record Technology [CEHRT] track).

• Advancing Care Coordination through Episode Payment Models – Track 1 (CEHRT).

For performance years 2017 and 2018, participation requirements will apply only to Medicare payments and physicians who treat Medicare patients. Starting in 2019, clinicians may also meet an alternative standard for advanced APMs that will include non-Medicare payments and patients.

“With these new opportunities, CMS expects that by the 2018 performance period, 25% of clinicians in the Quality Payment Program will earn incentive payments by being a part of these advanced models,” Patrick Conway, MD, CMS deputy administrator said in a statement. “Thanks to MACRA and the Innovation Center, we’re striving to see more Medicare patients benefit from better care when they visit their doctor for a knee replacement, receive cancer treatment, or have a coordinated care team manage their complex conditions.”

CMS is accepting feedback from physicians on the Quality Payment Program final rule until Dec. 17. Doctors can submit their comments and suggestions electronically through the CMS e-Regulation website.

[email protected]

On Twitter @legal_med

Physicians will have several options to choose from when it comes to advanced alternative payment models (APMs) in 2017.

In an Oct. 25 release, the Centers for Medicare & Medicaid Services announced seven models that will be considered advanced APMs in 2017, including the new Oncology Care Model with two-sided risk. Other advanced APM choices will include:

• Comprehensive Primary Care Plus (CPC+).

• Comprehensive ESRD Care Model (Large Dialysis Organization [LDO] arrangement).

• Comprehensive ESRD Care Model (non-LDO arrangement).

• Medicare Shared Savings Program Accountable Care Organizations (ACOs) – Track 2.

• Medicare Shared Savings Program ACOs – Track 3.

• Next Generation ACO Model.

• ACO – Track 1+.

• New voluntary bundled payment model.

• Comprehensive Care for Joint Replacement Payment Model (Certified Electronic Health Record Technology [CEHRT] track).

• Advancing Care Coordination through Episode Payment Models – Track 1 (CEHRT).

For performance years 2017 and 2018, participation requirements will apply only to Medicare payments and physicians who treat Medicare patients. Starting in 2019, clinicians may also meet an alternative standard for advanced APMs that will include non-Medicare payments and patients.

“With these new opportunities, CMS expects that by the 2018 performance period, 25% of clinicians in the Quality Payment Program will earn incentive payments by being a part of these advanced models,” Patrick Conway, MD, CMS deputy administrator said in a statement. “Thanks to MACRA and the Innovation Center, we’re striving to see more Medicare patients benefit from better care when they visit their doctor for a knee replacement, receive cancer treatment, or have a coordinated care team manage their complex conditions.”

CMS is accepting feedback from physicians on the Quality Payment Program final rule until Dec. 17. Doctors can submit their comments and suggestions electronically through the CMS e-Regulation website.

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The Texas Medical Board (TMB) has dropped an appeal that had challenged whether national telemedicine company Teladoc could sue over telemedicine restrictions enacted by the board. Both parties will now prepare to argue the merits behind the case in U.S. District Court in Austin, Texas.

TMB plans to vigorously defend its telemedicine rules in court, said Scott Freshour, interim executive director. He did not elaborate on the reasons behind the board’s Oct. 14 vote to withdraw its appeal in the case.

It’s likely that the board’s decision not to pursue the appeal was affected by the recent backing of Teladoc by the U.S. Department of Justice (DOJ) and the Federal Trade Commission (FTC) regarding the application of the state action doctrine, said Paul W. Pitts, a San Francisco health law attorney who has closely followed the case. The doctrine protects the deliberate policy choices of sovereign states to displace competition with regulation or monopoly public service.

In a brief to the 5th Circuit, the DOJ and the FTC urged the appeals court to dismiss the board’s appeal. The agencies called TMB’s telemedicine rules anticompetitive and said the board was not protected by the state action doctrine because requirements under the doctrine were not satisfied. However, the America Medical Association and the Texas Medical Association sided with the TMB, telling the court the entity should be immune from federal antitrust liability.

Aside from the AMA and Texas Medical Association, the Texas board had few allies in the appeals dispute,” Mr. Pitts said in an interview.

“Many interested parties were lining up on the side of Teledoc by filing amici curiae arguing that the 5th Circuit lacked jurisdiction to hear this appeal and that the state action doctrine is not applicable,” he said. “As the market for telemedicine grows rapidly, there is an increasing number of parties with something at stake in this case.”

Now that the appeal has ended, the district court can get back to the primary issue at hand: whether the rule requiring a face-to-face exam can be justified or whether it’s just a means of protecting the traditional physician practice, Mr. Pitts said. The ultimate ruling in the case has broad implications for the practice of telemedicine in Texas and beyond.

“Medical boards in other states are revising their rules to be more accommodating of telemedicine as the use of this approach grows in acceptance around the country.” he said. “The Texas Medical Board is increasingly an outlier in this space. If Teledoc prevails, you can expect to see investors taking another look at the telemedicine space as the Texas market opens up and the role of the state medical board is diminished.”
 

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The Texas Medical Board (TMB) has dropped an appeal that had challenged whether national telemedicine company Teladoc could sue over telemedicine restrictions enacted by the board. Both parties will now prepare to argue the merits behind the case in U.S. District Court in Austin, Texas.

TMB plans to vigorously defend its telemedicine rules in court, said Scott Freshour, interim executive director. He did not elaborate on the reasons behind the board’s Oct. 14 vote to withdraw its appeal in the case.

It’s likely that the board’s decision not to pursue the appeal was affected by the recent backing of Teladoc by the U.S. Department of Justice (DOJ) and the Federal Trade Commission (FTC) regarding the application of the state action doctrine, said Paul W. Pitts, a San Francisco health law attorney who has closely followed the case. The doctrine protects the deliberate policy choices of sovereign states to displace competition with regulation or monopoly public service.

In a brief to the 5th Circuit, the DOJ and the FTC urged the appeals court to dismiss the board’s appeal. The agencies called TMB’s telemedicine rules anticompetitive and said the board was not protected by the state action doctrine because requirements under the doctrine were not satisfied. However, the America Medical Association and the Texas Medical Association sided with the TMB, telling the court the entity should be immune from federal antitrust liability.

Aside from the AMA and Texas Medical Association, the Texas board had few allies in the appeals dispute,” Mr. Pitts said in an interview.

“Many interested parties were lining up on the side of Teledoc by filing amici curiae arguing that the 5th Circuit lacked jurisdiction to hear this appeal and that the state action doctrine is not applicable,” he said. “As the market for telemedicine grows rapidly, there is an increasing number of parties with something at stake in this case.”

Now that the appeal has ended, the district court can get back to the primary issue at hand: whether the rule requiring a face-to-face exam can be justified or whether it’s just a means of protecting the traditional physician practice, Mr. Pitts said. The ultimate ruling in the case has broad implications for the practice of telemedicine in Texas and beyond.

“Medical boards in other states are revising their rules to be more accommodating of telemedicine as the use of this approach grows in acceptance around the country.” he said. “The Texas Medical Board is increasingly an outlier in this space. If Teledoc prevails, you can expect to see investors taking another look at the telemedicine space as the Texas market opens up and the role of the state medical board is diminished.”
 

[email protected]

On Twitter @legal_med

The Texas Medical Board (TMB) has dropped an appeal that had challenged whether national telemedicine company Teladoc could sue over telemedicine restrictions enacted by the board. Both parties will now prepare to argue the merits behind the case in U.S. District Court in Austin, Texas.

TMB plans to vigorously defend its telemedicine rules in court, said Scott Freshour, interim executive director. He did not elaborate on the reasons behind the board’s Oct. 14 vote to withdraw its appeal in the case.

It’s likely that the board’s decision not to pursue the appeal was affected by the recent backing of Teladoc by the U.S. Department of Justice (DOJ) and the Federal Trade Commission (FTC) regarding the application of the state action doctrine, said Paul W. Pitts, a San Francisco health law attorney who has closely followed the case. The doctrine protects the deliberate policy choices of sovereign states to displace competition with regulation or monopoly public service.

In a brief to the 5th Circuit, the DOJ and the FTC urged the appeals court to dismiss the board’s appeal. The agencies called TMB’s telemedicine rules anticompetitive and said the board was not protected by the state action doctrine because requirements under the doctrine were not satisfied. However, the America Medical Association and the Texas Medical Association sided with the TMB, telling the court the entity should be immune from federal antitrust liability.

Aside from the AMA and Texas Medical Association, the Texas board had few allies in the appeals dispute,” Mr. Pitts said in an interview.

“Many interested parties were lining up on the side of Teledoc by filing amici curiae arguing that the 5th Circuit lacked jurisdiction to hear this appeal and that the state action doctrine is not applicable,” he said. “As the market for telemedicine grows rapidly, there is an increasing number of parties with something at stake in this case.”

Now that the appeal has ended, the district court can get back to the primary issue at hand: whether the rule requiring a face-to-face exam can be justified or whether it’s just a means of protecting the traditional physician practice, Mr. Pitts said. The ultimate ruling in the case has broad implications for the practice of telemedicine in Texas and beyond.

“Medical boards in other states are revising their rules to be more accommodating of telemedicine as the use of this approach grows in acceptance around the country.” he said. “The Texas Medical Board is increasingly an outlier in this space. If Teledoc prevails, you can expect to see investors taking another look at the telemedicine space as the Texas market opens up and the role of the state medical board is diminished.”
 

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On Twitter @legal_med

Adult patients who avoid vaccines cost the health care system $7 billion in preventable illness in 2015, according to a meta-analysis.

Sachiko Ozawa, PhD., of the University of North Carolina at Chapel Hill and her colleagues estimated the annual economic burden of diseases associated with 10 adult vaccines recommended by the Centers for Disease Control and Prevention that protect against 14 pathogens by looking at studies with U.S. cost data for adult age groups and using cost-of-illness modeling (Health Affairs 2016 Oct. doi:10.1377/hlthaff.2016.0462).

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Adult patients who avoid vaccines cost the health care system $7 billion in preventable illness in 2015, according to a meta-analysis.

Sachiko Ozawa, PhD., of the University of North Carolina at Chapel Hill and her colleagues estimated the annual economic burden of diseases associated with 10 adult vaccines recommended by the Centers for Disease Control and Prevention that protect against 14 pathogens by looking at studies with U.S. cost data for adult age groups and using cost-of-illness modeling (Health Affairs 2016 Oct. doi:10.1377/hlthaff.2016.0462).

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On Twitter @legal_med

Adult patients who avoid vaccines cost the health care system $7 billion in preventable illness in 2015, according to a meta-analysis.

Sachiko Ozawa, PhD., of the University of North Carolina at Chapel Hill and her colleagues estimated the annual economic burden of diseases associated with 10 adult vaccines recommended by the Centers for Disease Control and Prevention that protect against 14 pathogens by looking at studies with U.S. cost data for adult age groups and using cost-of-illness modeling (Health Affairs 2016 Oct. doi:10.1377/hlthaff.2016.0462).

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On Twitter @legal_med

Officials at the Centers for Medicare & Medicaid Services are launching a new initiative aimed at reducing administrative burdens for physicians who participate in certain value-based payment models.

Under an 18-month pilot, providers practicing within certain Advanced Alternative Payment Models (Advanced APMs) will be relieved of additional documentation scrutiny under Medicare medical review programs, according to an Oct. 13 CMS announcement. As part of the effort, the agency will direct Medicare Administrative Contractors and Recovery Audit Contractors to consider doctors participating in Advanced APMs as a low-priority for postpayment claim reviews.

Courtesy American College of Physicians

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On Twitter @legal_med

Officials at the Centers for Medicare & Medicaid Services are launching a new initiative aimed at reducing administrative burdens for physicians who participate in certain value-based payment models.

Under an 18-month pilot, providers practicing within certain Advanced Alternative Payment Models (Advanced APMs) will be relieved of additional documentation scrutiny under Medicare medical review programs, according to an Oct. 13 CMS announcement. As part of the effort, the agency will direct Medicare Administrative Contractors and Recovery Audit Contractors to consider doctors participating in Advanced APMs as a low-priority for postpayment claim reviews.

Courtesy American College of Physicians

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On Twitter @legal_med

Officials at the Centers for Medicare & Medicaid Services are launching a new initiative aimed at reducing administrative burdens for physicians who participate in certain value-based payment models.

Under an 18-month pilot, providers practicing within certain Advanced Alternative Payment Models (Advanced APMs) will be relieved of additional documentation scrutiny under Medicare medical review programs, according to an Oct. 13 CMS announcement. As part of the effort, the agency will direct Medicare Administrative Contractors and Recovery Audit Contractors to consider doctors participating in Advanced APMs as a low-priority for postpayment claim reviews.

Courtesy American College of Physicians

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On Twitter @legal_med

About half of all doctors who participate in the Physician Quality Reporting System (PQRS) soon will learn that their Medicare pay will be cut by up to 2% in 2017.

The Centers for Medicare & Medicaid Services has completed its assessments for reporting year 2015 and has begun notifying physicians that a 2.0% negative payment adjustment is forthcoming for those who did not satisfactorily report PQRS quality measures or who failed to satisfactorily participate in a qualified clinical data registry.

Doctors have just 2 months to challenge findings that they believe were made in error to spare themselves the 2017 cut, according to a CMS announcement.

If doctors believe their 2017 PQRS pay cut is erroneous, they can submit an informal review request by 11:59 p.m. EST on Nov. 30. CMS will investigate the merits of all review requests and issue a decision within 90 days. All requests for informal review must be submitted via a Web-based tool on the quality reporting communication support page. There are no hardship exemptions for the PQRS pay cuts.

In addition, some 2015 PQRS performance scores will be publicly reported on the Physician Compare website. CMS is hosting two sessions in October to provide further information about such public reporting.

In 2015, approximately 1.15 million professionals were eligible and able to participate in PQRS; just over half (624,077 or 54%) of eligible professionals successfully submitted data. The rest – about 528,000, or 46% – will see a pay cut in 2017, according to CMS.

Last year, slightly more health providers – 558,885 eligible professionals – were subject to the 2016 PQRS pay cut based on their 2014 reporting experience.

Walter J. Gorski, director of regulatory affairs for the American College of Physicians, said the college will be monitoring the notifications as they go out to physicians to assess impacts at the individual practice level and overall.

“In past years, the PQRS experience reports have shown a low level of participation in the program and, thus, a large number of physicians being subject to these negative adjustments,” Mr. Gorski said in an interview. “This low level of overall participation has long been a concern of ours and something we have recommended that CMS work to mitigate by simplifying reporting – something that we are pushing strongly for as the program is rolled into the new MIPS pathway [Merit-Based Incentive Payment System] within the [Quality Payment Program].”

The new Quality Payment Program will replace both PQRS and the Value Modifier program, as well as the separate payment adjustments under the Medicare EHR Incentive Program. The streamlined program will have reduced quality reporting requirements and a flexible design that allows eligible clinicians to pick the pace of participation during the first year, according to CMS.

“The newly announced ‘pick your pace’ approach for the first year of MIPS reporting will give physicians an opportunity to get their feet wet with quality reporting in a way that will protect them from future negative adjustments,” Mr. Gorski said.
 

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On Twitter @legal_med

About half of all doctors who participate in the Physician Quality Reporting System (PQRS) soon will learn that their Medicare pay will be cut by up to 2% in 2017.

The Centers for Medicare & Medicaid Services has completed its assessments for reporting year 2015 and has begun notifying physicians that a 2.0% negative payment adjustment is forthcoming for those who did not satisfactorily report PQRS quality measures or who failed to satisfactorily participate in a qualified clinical data registry.

Doctors have just 2 months to challenge findings that they believe were made in error to spare themselves the 2017 cut, according to a CMS announcement.

If doctors believe their 2017 PQRS pay cut is erroneous, they can submit an informal review request by 11:59 p.m. EST on Nov. 30. CMS will investigate the merits of all review requests and issue a decision within 90 days. All requests for informal review must be submitted via a Web-based tool on the quality reporting communication support page. There are no hardship exemptions for the PQRS pay cuts.

In addition, some 2015 PQRS performance scores will be publicly reported on the Physician Compare website. CMS is hosting two sessions in October to provide further information about such public reporting.

In 2015, approximately 1.15 million professionals were eligible and able to participate in PQRS; just over half (624,077 or 54%) of eligible professionals successfully submitted data. The rest – about 528,000, or 46% – will see a pay cut in 2017, according to CMS.

Last year, slightly more health providers – 558,885 eligible professionals – were subject to the 2016 PQRS pay cut based on their 2014 reporting experience.

Walter J. Gorski, director of regulatory affairs for the American College of Physicians, said the college will be monitoring the notifications as they go out to physicians to assess impacts at the individual practice level and overall.

“In past years, the PQRS experience reports have shown a low level of participation in the program and, thus, a large number of physicians being subject to these negative adjustments,” Mr. Gorski said in an interview. “This low level of overall participation has long been a concern of ours and something we have recommended that CMS work to mitigate by simplifying reporting – something that we are pushing strongly for as the program is rolled into the new MIPS pathway [Merit-Based Incentive Payment System] within the [Quality Payment Program].”

The new Quality Payment Program will replace both PQRS and the Value Modifier program, as well as the separate payment adjustments under the Medicare EHR Incentive Program. The streamlined program will have reduced quality reporting requirements and a flexible design that allows eligible clinicians to pick the pace of participation during the first year, according to CMS.

“The newly announced ‘pick your pace’ approach for the first year of MIPS reporting will give physicians an opportunity to get their feet wet with quality reporting in a way that will protect them from future negative adjustments,” Mr. Gorski said.
 

[email protected]

On Twitter @legal_med

About half of all doctors who participate in the Physician Quality Reporting System (PQRS) soon will learn that their Medicare pay will be cut by up to 2% in 2017.

The Centers for Medicare & Medicaid Services has completed its assessments for reporting year 2015 and has begun notifying physicians that a 2.0% negative payment adjustment is forthcoming for those who did not satisfactorily report PQRS quality measures or who failed to satisfactorily participate in a qualified clinical data registry.

Doctors have just 2 months to challenge findings that they believe were made in error to spare themselves the 2017 cut, according to a CMS announcement.

If doctors believe their 2017 PQRS pay cut is erroneous, they can submit an informal review request by 11:59 p.m. EST on Nov. 30. CMS will investigate the merits of all review requests and issue a decision within 90 days. All requests for informal review must be submitted via a Web-based tool on the quality reporting communication support page. There are no hardship exemptions for the PQRS pay cuts.

In addition, some 2015 PQRS performance scores will be publicly reported on the Physician Compare website. CMS is hosting two sessions in October to provide further information about such public reporting.

In 2015, approximately 1.15 million professionals were eligible and able to participate in PQRS; just over half (624,077 or 54%) of eligible professionals successfully submitted data. The rest – about 528,000, or 46% – will see a pay cut in 2017, according to CMS.

Last year, slightly more health providers – 558,885 eligible professionals – were subject to the 2016 PQRS pay cut based on their 2014 reporting experience.

Walter J. Gorski, director of regulatory affairs for the American College of Physicians, said the college will be monitoring the notifications as they go out to physicians to assess impacts at the individual practice level and overall.

“In past years, the PQRS experience reports have shown a low level of participation in the program and, thus, a large number of physicians being subject to these negative adjustments,” Mr. Gorski said in an interview. “This low level of overall participation has long been a concern of ours and something we have recommended that CMS work to mitigate by simplifying reporting – something that we are pushing strongly for as the program is rolled into the new MIPS pathway [Merit-Based Incentive Payment System] within the [Quality Payment Program].”

The new Quality Payment Program will replace both PQRS and the Value Modifier program, as well as the separate payment adjustments under the Medicare EHR Incentive Program. The streamlined program will have reduced quality reporting requirements and a flexible design that allows eligible clinicians to pick the pace of participation during the first year, according to CMS.

“The newly announced ‘pick your pace’ approach for the first year of MIPS reporting will give physicians an opportunity to get their feet wet with quality reporting in a way that will protect them from future negative adjustments,” Mr. Gorski said.
 

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On Twitter @legal_med

The majority of lawsuits against internists stem from alleged diagnostics errors, results of a new study show.

Of 1,180 legal claims against internists, 39% were related to failed, delayed, or wrong diagnosis allegations, according to an analysis published by The Doctors Company, a nationwide medical malpractice insurer. Negligence associated with medical treatment accounted for 32% of the claims, while 19% were related to alleged medication errors.

The Doctors Company evaluated 1,180 claims from its database against internal medicine physicians that closed from 2007 to 2014. Of diagnostic-related cases, 56% alleged inadequate patient assessments, such as failure to order or delay in ordering diagnostic tests. The final diagnoses most commonly related to these allegations were myocardial infarction (6%), lung cancer (5%), and colorectal cancer (5%). More than 200 other diagnoses were seen in fewer than 2% of the claims, according to the study.

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On Twitter @legal_med

The majority of lawsuits against internists stem from alleged diagnostics errors, results of a new study show.

Of 1,180 legal claims against internists, 39% were related to failed, delayed, or wrong diagnosis allegations, according to an analysis published by The Doctors Company, a nationwide medical malpractice insurer. Negligence associated with medical treatment accounted for 32% of the claims, while 19% were related to alleged medication errors.

The Doctors Company evaluated 1,180 claims from its database against internal medicine physicians that closed from 2007 to 2014. Of diagnostic-related cases, 56% alleged inadequate patient assessments, such as failure to order or delay in ordering diagnostic tests. The final diagnoses most commonly related to these allegations were myocardial infarction (6%), lung cancer (5%), and colorectal cancer (5%). More than 200 other diagnoses were seen in fewer than 2% of the claims, according to the study.

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On Twitter @legal_med

The majority of lawsuits against internists stem from alleged diagnostics errors, results of a new study show.

Of 1,180 legal claims against internists, 39% were related to failed, delayed, or wrong diagnosis allegations, according to an analysis published by The Doctors Company, a nationwide medical malpractice insurer. Negligence associated with medical treatment accounted for 32% of the claims, while 19% were related to alleged medication errors.

The Doctors Company evaluated 1,180 claims from its database against internal medicine physicians that closed from 2007 to 2014. Of diagnostic-related cases, 56% alleged inadequate patient assessments, such as failure to order or delay in ordering diagnostic tests. The final diagnoses most commonly related to these allegations were myocardial infarction (6%), lung cancer (5%), and colorectal cancer (5%). More than 200 other diagnoses were seen in fewer than 2% of the claims, according to the study.

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On Twitter @legal_med

Federal health officials are wasting no time in putting to use long-awaited congressional funding aimed at strengthening Zika prevention and advancing research efforts.

The country’s health care agencies will split the $1.1 billion in funding approved by Congress on Sept. 28, dividing the money among Zika vaccine development, mosquito control, and response to virus outbreaks in the United States and globally, Sylvia Burwell, Health and Human Services secretary, said during an Oct. 3 press conference.

Courtesy HHS

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On Twitter @legal_med

Federal health officials are wasting no time in putting to use long-awaited congressional funding aimed at strengthening Zika prevention and advancing research efforts.

The country’s health care agencies will split the $1.1 billion in funding approved by Congress on Sept. 28, dividing the money among Zika vaccine development, mosquito control, and response to virus outbreaks in the United States and globally, Sylvia Burwell, Health and Human Services secretary, said during an Oct. 3 press conference.

Courtesy HHS

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On Twitter @legal_med

Federal health officials are wasting no time in putting to use long-awaited congressional funding aimed at strengthening Zika prevention and advancing research efforts.

The country’s health care agencies will split the $1.1 billion in funding approved by Congress on Sept. 28, dividing the money among Zika vaccine development, mosquito control, and response to virus outbreaks in the United States and globally, Sylvia Burwell, Health and Human Services secretary, said during an Oct. 3 press conference.

Courtesy HHS

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On Twitter @legal_med