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Fee schedule includes expansion of Diabetes Prevention Program
An expansion of the Diabetes Prevention Program (DPP), announced July 7 in the proposed Medicare Physician Fee Schedule for 2017, would allow recognized suppliers to submit claims to the Centers for Medicare & Medicaid Services for payment beginning Jan. 1, 2018.
The proposed expansion would allow patients across the United States to access community-based intervention that curbs diabetes and keeps families healthy, according to Patrick Conway, MD, CMS chief medical officer.
“This is part of our efforts for better care, smarter spending, and healthier people,” Dr. Conway said in a statement. The “proposal is an exciting milestone for prevention and population health.”
The Diabetes Prevention Program started in 2011 as an Affordable Care Act pilot program awarded to the National Council of YMCAs of the United States of America (Y-USA). Medicare patients at high risk for diabetes attended 16 intensive educational sessions in a group-based, classroom-style setting and practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control.
The pilot resulted in savings of $2,650 per enrollee over 15 months, according to CMS, compared with costs associated with nonprogram beneficiaries – enough to cover the cost of the program. Program participants also were shown to lose an average of about 5% of their body weight.
In March 2016, the U.S. Health and Human Services Department announced that the CMS Office of the Actuary had certified the pilot Diabetes Prevention Program model as a cost savings program that reduced net Medicare spending. HHS determined that the program demonstrated the ability to improve the quality of patient care without limiting coverage or benefits.
In the fee schedule proposal, CMS is suggesting that each health care provider who offers services as part of a CDC-recognized organization delivering DPP services obtain a National Provider Identification number to provide Medicare DPP services, allowing supplier enrollment beginning as early as Jan. 1, 2017. In addition, CMS envisions a payment structure tying payment for Medicare DPP services to the number of sessions attended by patients and the achievement and maintenance of minimum weight loss. Claims for payment under the Medicare DPP would be submitted following the achievement of core session attendance and minimum weight loss, and following maintenance session attendance and maintenance of minimum weight loss, according to the proposal.
CMS has not decided whether the Medicare DPP should be expanded nationally in the first year of the program or whether it should be phased in.
The American College of Physicians expressed support for DPP expansion and said that organization leaders plan to provide comments on the basic framework.
“As a practicing primary care internist myself, I am greatly encouraged that CMS is proposing substantial improvements to help me and my colleagues provide coordinated, patient-centered, high-value, and team-based care to our patients,” ACP President Nitin S. Damle, MD, said in a statement. “We look forward to providing CMS with detailed comments to support these improvements while recommending other changes to strengthen primary care.”
Robert E. Ratner, MD, chief scientific and medical officer for the American Diabetes Association agreed.
“Providing people with prediabetes with effective tools to prevent diabetes is a win for all of us,” Dr. Ratner said in a statement. “We appreciate HHS’s continued commitment to improving the nation’s health and helping us reduce the incidence and burden of diabetes across the country.”
Wanda Filer, MD, president of the American Academy of Family Physicians, said her organization was still analyzing the proposal, but that the expansion sounds positive for health care.
“We think the expansion is a great idea for patients,” she said in an interview, adding that it’s essential that doctors are reimbursed for preventive services. “Frankly, if you do the work, you need to get paid.”
CMS will accept comments on the proposed rule until Sept. 6. The proposed rule will appear in the July 15 Federal Register.
On Twitter @legal_med
An expansion of the Diabetes Prevention Program (DPP), announced July 7 in the proposed Medicare Physician Fee Schedule for 2017, would allow recognized suppliers to submit claims to the Centers for Medicare & Medicaid Services for payment beginning Jan. 1, 2018.
The proposed expansion would allow patients across the United States to access community-based intervention that curbs diabetes and keeps families healthy, according to Patrick Conway, MD, CMS chief medical officer.
“This is part of our efforts for better care, smarter spending, and healthier people,” Dr. Conway said in a statement. The “proposal is an exciting milestone for prevention and population health.”
The Diabetes Prevention Program started in 2011 as an Affordable Care Act pilot program awarded to the National Council of YMCAs of the United States of America (Y-USA). Medicare patients at high risk for diabetes attended 16 intensive educational sessions in a group-based, classroom-style setting and practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control.
The pilot resulted in savings of $2,650 per enrollee over 15 months, according to CMS, compared with costs associated with nonprogram beneficiaries – enough to cover the cost of the program. Program participants also were shown to lose an average of about 5% of their body weight.
In March 2016, the U.S. Health and Human Services Department announced that the CMS Office of the Actuary had certified the pilot Diabetes Prevention Program model as a cost savings program that reduced net Medicare spending. HHS determined that the program demonstrated the ability to improve the quality of patient care without limiting coverage or benefits.
In the fee schedule proposal, CMS is suggesting that each health care provider who offers services as part of a CDC-recognized organization delivering DPP services obtain a National Provider Identification number to provide Medicare DPP services, allowing supplier enrollment beginning as early as Jan. 1, 2017. In addition, CMS envisions a payment structure tying payment for Medicare DPP services to the number of sessions attended by patients and the achievement and maintenance of minimum weight loss. Claims for payment under the Medicare DPP would be submitted following the achievement of core session attendance and minimum weight loss, and following maintenance session attendance and maintenance of minimum weight loss, according to the proposal.
CMS has not decided whether the Medicare DPP should be expanded nationally in the first year of the program or whether it should be phased in.
The American College of Physicians expressed support for DPP expansion and said that organization leaders plan to provide comments on the basic framework.
“As a practicing primary care internist myself, I am greatly encouraged that CMS is proposing substantial improvements to help me and my colleagues provide coordinated, patient-centered, high-value, and team-based care to our patients,” ACP President Nitin S. Damle, MD, said in a statement. “We look forward to providing CMS with detailed comments to support these improvements while recommending other changes to strengthen primary care.”
Robert E. Ratner, MD, chief scientific and medical officer for the American Diabetes Association agreed.
“Providing people with prediabetes with effective tools to prevent diabetes is a win for all of us,” Dr. Ratner said in a statement. “We appreciate HHS’s continued commitment to improving the nation’s health and helping us reduce the incidence and burden of diabetes across the country.”
Wanda Filer, MD, president of the American Academy of Family Physicians, said her organization was still analyzing the proposal, but that the expansion sounds positive for health care.
“We think the expansion is a great idea for patients,” she said in an interview, adding that it’s essential that doctors are reimbursed for preventive services. “Frankly, if you do the work, you need to get paid.”
CMS will accept comments on the proposed rule until Sept. 6. The proposed rule will appear in the July 15 Federal Register.
On Twitter @legal_med
An expansion of the Diabetes Prevention Program (DPP), announced July 7 in the proposed Medicare Physician Fee Schedule for 2017, would allow recognized suppliers to submit claims to the Centers for Medicare & Medicaid Services for payment beginning Jan. 1, 2018.
The proposed expansion would allow patients across the United States to access community-based intervention that curbs diabetes and keeps families healthy, according to Patrick Conway, MD, CMS chief medical officer.
“This is part of our efforts for better care, smarter spending, and healthier people,” Dr. Conway said in a statement. The “proposal is an exciting milestone for prevention and population health.”
The Diabetes Prevention Program started in 2011 as an Affordable Care Act pilot program awarded to the National Council of YMCAs of the United States of America (Y-USA). Medicare patients at high risk for diabetes attended 16 intensive educational sessions in a group-based, classroom-style setting and practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control.
The pilot resulted in savings of $2,650 per enrollee over 15 months, according to CMS, compared with costs associated with nonprogram beneficiaries – enough to cover the cost of the program. Program participants also were shown to lose an average of about 5% of their body weight.
In March 2016, the U.S. Health and Human Services Department announced that the CMS Office of the Actuary had certified the pilot Diabetes Prevention Program model as a cost savings program that reduced net Medicare spending. HHS determined that the program demonstrated the ability to improve the quality of patient care without limiting coverage or benefits.
In the fee schedule proposal, CMS is suggesting that each health care provider who offers services as part of a CDC-recognized organization delivering DPP services obtain a National Provider Identification number to provide Medicare DPP services, allowing supplier enrollment beginning as early as Jan. 1, 2017. In addition, CMS envisions a payment structure tying payment for Medicare DPP services to the number of sessions attended by patients and the achievement and maintenance of minimum weight loss. Claims for payment under the Medicare DPP would be submitted following the achievement of core session attendance and minimum weight loss, and following maintenance session attendance and maintenance of minimum weight loss, according to the proposal.
CMS has not decided whether the Medicare DPP should be expanded nationally in the first year of the program or whether it should be phased in.
The American College of Physicians expressed support for DPP expansion and said that organization leaders plan to provide comments on the basic framework.
“As a practicing primary care internist myself, I am greatly encouraged that CMS is proposing substantial improvements to help me and my colleagues provide coordinated, patient-centered, high-value, and team-based care to our patients,” ACP President Nitin S. Damle, MD, said in a statement. “We look forward to providing CMS with detailed comments to support these improvements while recommending other changes to strengthen primary care.”
Robert E. Ratner, MD, chief scientific and medical officer for the American Diabetes Association agreed.
“Providing people with prediabetes with effective tools to prevent diabetes is a win for all of us,” Dr. Ratner said in a statement. “We appreciate HHS’s continued commitment to improving the nation’s health and helping us reduce the incidence and burden of diabetes across the country.”
Wanda Filer, MD, president of the American Academy of Family Physicians, said her organization was still analyzing the proposal, but that the expansion sounds positive for health care.
“We think the expansion is a great idea for patients,” she said in an interview, adding that it’s essential that doctors are reimbursed for preventive services. “Frankly, if you do the work, you need to get paid.”
CMS will accept comments on the proposed rule until Sept. 6. The proposed rule will appear in the July 15 Federal Register.
On Twitter @legal_med
Feds Raise Buprenorphine Patient Loads
Qualified physicians soon will be allowed to provide medication-assisted treatment (MAT) with buprenorphine to nearly triple the number of patients under a new rule by the Substance Abuse and Mental Health Services Administration (SAMHSA).
The rule, announced by the Health & Human Services department on July 6, allows qualified practitioners to prescribe buprenorphine to up to 275 patients, up from the previous limit of 100. Raising the cap will mean treatment of 10,000-70,000 more patients within the first year, according to HHS. The rule takes effect Aug. 5.
In addition, HHS plans to eliminate pain management questions from the payment scoring calculation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The removal aims to relieve pressure on clinicians to overprescribe opioids since scores on the HCAHPS survey are tied to Medicare payments to hospitals. Hospitals would continue to use the questions to survey patients about their inpatient pain management experience, but the questions would not affect the level of payment that hospitals receive, HHS Secretary Sylvia M. Burwell said during a press conference. The changes are part of a number of steps announced by HHS to build on the agency’s Opioid Initiative.
“Together, these announcements will help us take additional steps forward,” Ms. Burwell said. “They increase access to help more people receive the evidence-based treatment they need. They help providers safely prescribe while helping their patients manage chronic pain, and they fill in the gaps of our understanding of this epidemic and how best to fight it.”
The agency also released a report on ongoing, federally funded opioid misuse and pain treatment research. The report is designed to help stakeholders and external funders of research in avoiding unnecessary duplication of research currently underway, according to HHS. The agency plans to launch more than a dozen new scientific studies on opioid misuse and pain treatment in the near future, Ms. Burwell said.
Another new rule mandates that Indian Health Service (IHS) clinicians and pharmacists check their state Prescription Drug Monitoring Program database prior to prescribing or dispensing any opioid for more than 7 days. The new policy is effective immediately for IHS clinicians authorized to prescribe opioids.
Amid the new steps, Secretary Burwell and others called on Congress to approve the President Obama’s proposed $1.1 billion in new funding to further address prescription opioid abuse and heroin use. Legislators are meeting July 6 to weigh final legislation aimed at the opioid epidemic, but have thus far, not fully supported the president’s proposed funding. In a July 5 letter, Democrats vowed to oppose the bill unless it included more money to treat addicted patients.
“If you want treatment for an opioid use disorder, you should be able to access it when you need it,” Michael Botticelli, director of National Drug Control Policy said during the press conference. “There is still time for Congress to do what’s right.”
Qualified physicians soon will be allowed to provide medication-assisted treatment (MAT) with buprenorphine to nearly triple the number of patients under a new rule by the Substance Abuse and Mental Health Services Administration (SAMHSA).
The rule, announced by the Health & Human Services department on July 6, allows qualified practitioners to prescribe buprenorphine to up to 275 patients, up from the previous limit of 100. Raising the cap will mean treatment of 10,000-70,000 more patients within the first year, according to HHS. The rule takes effect Aug. 5.
In addition, HHS plans to eliminate pain management questions from the payment scoring calculation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The removal aims to relieve pressure on clinicians to overprescribe opioids since scores on the HCAHPS survey are tied to Medicare payments to hospitals. Hospitals would continue to use the questions to survey patients about their inpatient pain management experience, but the questions would not affect the level of payment that hospitals receive, HHS Secretary Sylvia M. Burwell said during a press conference. The changes are part of a number of steps announced by HHS to build on the agency’s Opioid Initiative.
“Together, these announcements will help us take additional steps forward,” Ms. Burwell said. “They increase access to help more people receive the evidence-based treatment they need. They help providers safely prescribe while helping their patients manage chronic pain, and they fill in the gaps of our understanding of this epidemic and how best to fight it.”
The agency also released a report on ongoing, federally funded opioid misuse and pain treatment research. The report is designed to help stakeholders and external funders of research in avoiding unnecessary duplication of research currently underway, according to HHS. The agency plans to launch more than a dozen new scientific studies on opioid misuse and pain treatment in the near future, Ms. Burwell said.
Another new rule mandates that Indian Health Service (IHS) clinicians and pharmacists check their state Prescription Drug Monitoring Program database prior to prescribing or dispensing any opioid for more than 7 days. The new policy is effective immediately for IHS clinicians authorized to prescribe opioids.
Amid the new steps, Secretary Burwell and others called on Congress to approve the President Obama’s proposed $1.1 billion in new funding to further address prescription opioid abuse and heroin use. Legislators are meeting July 6 to weigh final legislation aimed at the opioid epidemic, but have thus far, not fully supported the president’s proposed funding. In a July 5 letter, Democrats vowed to oppose the bill unless it included more money to treat addicted patients.
“If you want treatment for an opioid use disorder, you should be able to access it when you need it,” Michael Botticelli, director of National Drug Control Policy said during the press conference. “There is still time for Congress to do what’s right.”
Qualified physicians soon will be allowed to provide medication-assisted treatment (MAT) with buprenorphine to nearly triple the number of patients under a new rule by the Substance Abuse and Mental Health Services Administration (SAMHSA).
The rule, announced by the Health & Human Services department on July 6, allows qualified practitioners to prescribe buprenorphine to up to 275 patients, up from the previous limit of 100. Raising the cap will mean treatment of 10,000-70,000 more patients within the first year, according to HHS. The rule takes effect Aug. 5.
In addition, HHS plans to eliminate pain management questions from the payment scoring calculation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The removal aims to relieve pressure on clinicians to overprescribe opioids since scores on the HCAHPS survey are tied to Medicare payments to hospitals. Hospitals would continue to use the questions to survey patients about their inpatient pain management experience, but the questions would not affect the level of payment that hospitals receive, HHS Secretary Sylvia M. Burwell said during a press conference. The changes are part of a number of steps announced by HHS to build on the agency’s Opioid Initiative.
“Together, these announcements will help us take additional steps forward,” Ms. Burwell said. “They increase access to help more people receive the evidence-based treatment they need. They help providers safely prescribe while helping their patients manage chronic pain, and they fill in the gaps of our understanding of this epidemic and how best to fight it.”
The agency also released a report on ongoing, federally funded opioid misuse and pain treatment research. The report is designed to help stakeholders and external funders of research in avoiding unnecessary duplication of research currently underway, according to HHS. The agency plans to launch more than a dozen new scientific studies on opioid misuse and pain treatment in the near future, Ms. Burwell said.
Another new rule mandates that Indian Health Service (IHS) clinicians and pharmacists check their state Prescription Drug Monitoring Program database prior to prescribing or dispensing any opioid for more than 7 days. The new policy is effective immediately for IHS clinicians authorized to prescribe opioids.
Amid the new steps, Secretary Burwell and others called on Congress to approve the President Obama’s proposed $1.1 billion in new funding to further address prescription opioid abuse and heroin use. Legislators are meeting July 6 to weigh final legislation aimed at the opioid epidemic, but have thus far, not fully supported the president’s proposed funding. In a July 5 letter, Democrats vowed to oppose the bill unless it included more money to treat addicted patients.
“If you want treatment for an opioid use disorder, you should be able to access it when you need it,” Michael Botticelli, director of National Drug Control Policy said during the press conference. “There is still time for Congress to do what’s right.”
Feds raise buprenorphine patient loads
Qualified physicians soon will be allowed to provide medication-assisted treatment (MAT) with buprenorphine to nearly triple the number of patients under a new rule by the Substance Abuse and Mental Health Services Administration (SAMHSA).
The rule, announced by the Health & Human Services department on July 6, allows qualified practitioners to prescribe buprenorphine to up to 275 patients, up from the previous limit of 100. Raising the cap will mean treatment of 10,000-70,000 more patients within the first year, according to HHS. The rule takes effect Aug. 5.
In addition, HHS plans to eliminate pain management questions from the payment scoring calculation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The removal aims to relieve pressure on clinicians to overprescribe opioids since scores on the HCAHPS survey are tied to Medicare payments to hospitals. Hospitals would continue to use the questions to survey patients about their inpatient pain management experience, but the questions would not affect the level of payment that hospitals receive, HHS Secretary Sylvia M. Burwell said during a press conference. The changes are part of a number of steps announced by HHS to build on the agency’s Opioid Initiative.
“Together, these announcements will help us take additional steps forward,” Ms. Burwell said. “They increase access to help more people receive the evidence-based treatment they need. They help providers safely prescribe while helping their patients manage chronic pain, and they fill in the gaps of our understanding of this epidemic and how best to fight it.”
The agency also released a report on ongoing, federally funded opioid misuse and pain treatment research. The report is designed to help stakeholders and external funders of research in avoiding unnecessary duplication of research currently underway, according to HHS. The agency plans to launch more than a dozen new scientific studies on opioid misuse and pain treatment in the near future, Ms. Burwell said.
Another new rule mandates that Indian Health Service (IHS) clinicians and pharmacists check their state Prescription Drug Monitoring Program database prior to prescribing or dispensing any opioid for more than 7 days. The new policy is effective immediately for IHS clinicians authorized to prescribe opioids.
Amid the new steps, Secretary Burwell and others called on Congress to approve the President Obama’s proposed $1.1 billion in new funding to further address prescription opioid abuse and heroin use. Legislators are meeting July 6 to weigh final legislation aimed at the opioid epidemic, but have thus far, not fully supported the president’s proposed funding. In a July 5 letter, Democrats vowed to oppose the bill unless it included more money to treat addicted patients.
“If you want treatment for an opioid use disorder, you should be able to access it when you need it,” Michael Botticelli, director of National Drug Control Policy said during the press conference. “There is still time for Congress to do what’s right.”
On Twitter @legal_med
Qualified physicians soon will be allowed to provide medication-assisted treatment (MAT) with buprenorphine to nearly triple the number of patients under a new rule by the Substance Abuse and Mental Health Services Administration (SAMHSA).
The rule, announced by the Health & Human Services department on July 6, allows qualified practitioners to prescribe buprenorphine to up to 275 patients, up from the previous limit of 100. Raising the cap will mean treatment of 10,000-70,000 more patients within the first year, according to HHS. The rule takes effect Aug. 5.
In addition, HHS plans to eliminate pain management questions from the payment scoring calculation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The removal aims to relieve pressure on clinicians to overprescribe opioids since scores on the HCAHPS survey are tied to Medicare payments to hospitals. Hospitals would continue to use the questions to survey patients about their inpatient pain management experience, but the questions would not affect the level of payment that hospitals receive, HHS Secretary Sylvia M. Burwell said during a press conference. The changes are part of a number of steps announced by HHS to build on the agency’s Opioid Initiative.
“Together, these announcements will help us take additional steps forward,” Ms. Burwell said. “They increase access to help more people receive the evidence-based treatment they need. They help providers safely prescribe while helping their patients manage chronic pain, and they fill in the gaps of our understanding of this epidemic and how best to fight it.”
The agency also released a report on ongoing, federally funded opioid misuse and pain treatment research. The report is designed to help stakeholders and external funders of research in avoiding unnecessary duplication of research currently underway, according to HHS. The agency plans to launch more than a dozen new scientific studies on opioid misuse and pain treatment in the near future, Ms. Burwell said.
Another new rule mandates that Indian Health Service (IHS) clinicians and pharmacists check their state Prescription Drug Monitoring Program database prior to prescribing or dispensing any opioid for more than 7 days. The new policy is effective immediately for IHS clinicians authorized to prescribe opioids.
Amid the new steps, Secretary Burwell and others called on Congress to approve the President Obama’s proposed $1.1 billion in new funding to further address prescription opioid abuse and heroin use. Legislators are meeting July 6 to weigh final legislation aimed at the opioid epidemic, but have thus far, not fully supported the president’s proposed funding. In a July 5 letter, Democrats vowed to oppose the bill unless it included more money to treat addicted patients.
“If you want treatment for an opioid use disorder, you should be able to access it when you need it,” Michael Botticelli, director of National Drug Control Policy said during the press conference. “There is still time for Congress to do what’s right.”
On Twitter @legal_med
Qualified physicians soon will be allowed to provide medication-assisted treatment (MAT) with buprenorphine to nearly triple the number of patients under a new rule by the Substance Abuse and Mental Health Services Administration (SAMHSA).
The rule, announced by the Health & Human Services department on July 6, allows qualified practitioners to prescribe buprenorphine to up to 275 patients, up from the previous limit of 100. Raising the cap will mean treatment of 10,000-70,000 more patients within the first year, according to HHS. The rule takes effect Aug. 5.
In addition, HHS plans to eliminate pain management questions from the payment scoring calculation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The removal aims to relieve pressure on clinicians to overprescribe opioids since scores on the HCAHPS survey are tied to Medicare payments to hospitals. Hospitals would continue to use the questions to survey patients about their inpatient pain management experience, but the questions would not affect the level of payment that hospitals receive, HHS Secretary Sylvia M. Burwell said during a press conference. The changes are part of a number of steps announced by HHS to build on the agency’s Opioid Initiative.
“Together, these announcements will help us take additional steps forward,” Ms. Burwell said. “They increase access to help more people receive the evidence-based treatment they need. They help providers safely prescribe while helping their patients manage chronic pain, and they fill in the gaps of our understanding of this epidemic and how best to fight it.”
The agency also released a report on ongoing, federally funded opioid misuse and pain treatment research. The report is designed to help stakeholders and external funders of research in avoiding unnecessary duplication of research currently underway, according to HHS. The agency plans to launch more than a dozen new scientific studies on opioid misuse and pain treatment in the near future, Ms. Burwell said.
Another new rule mandates that Indian Health Service (IHS) clinicians and pharmacists check their state Prescription Drug Monitoring Program database prior to prescribing or dispensing any opioid for more than 7 days. The new policy is effective immediately for IHS clinicians authorized to prescribe opioids.
Amid the new steps, Secretary Burwell and others called on Congress to approve the President Obama’s proposed $1.1 billion in new funding to further address prescription opioid abuse and heroin use. Legislators are meeting July 6 to weigh final legislation aimed at the opioid epidemic, but have thus far, not fully supported the president’s proposed funding. In a July 5 letter, Democrats vowed to oppose the bill unless it included more money to treat addicted patients.
“If you want treatment for an opioid use disorder, you should be able to access it when you need it,” Michael Botticelli, director of National Drug Control Policy said during the press conference. “There is still time for Congress to do what’s right.”
On Twitter @legal_med
Supreme Court will not hear pharmacy religious liberty case
The U.S. Supreme Court has refused to decide whether pharmacists with strongly held religious beliefs can be forced to dispense emergency contraception to patients.
Justices did not explain their June 28 denial of Stormans, Inc. vs. Wiesman, but the decision was made over the objection of Chief Justice John G. Roberts Jr., Associate Justice Samuel Alito Jr., and Associate Justice Clarence Thomas. In his dissent, Associate Justice Alito wrote the court should have heard the case to ensure that novel and concededly “unnecessary burden on religious objectors” does not trample fundamental rights.
“If this is a sign of how religious liberty claims will be treated in the years ahead, those who value religious freedom have cause for great concern,” he wrote in his dissent.
At issue in the case is a 2007 rule by Washington state that a family-owned pharmacy in Olympia must provide Plan B contraception to patients. The “delivery rule” creates “a duty for pharmacists to deliver lawfully prescribed drugs or devices in a timely manner and does not allow for conscience-based decisions not to dispense the drug. The Stormans family, who own Ralph’s Thriftway, sued the state over the regulation, alleging violations of the free exercise, equal protection, and due process clauses of the Constitution. The business owners equate emergency contraception to abortion, and they argue that dispensing the medication violates their religious beliefs.
The 9th U.S. Circuit Court of Appeals sided with the state, calling the regulations “neutral and generally applicable.” The plaintiffs appealed to the Supreme Court. The denial by the high court allows the 9th Circuit decision to stand.
Nearly 20 court briefs were issued to the Supreme Court in the case, including briefs by the American Association of Pro-Life Obstetricians and Gynecologists and 4,609 individual health care professionals in support of the pharmacy.
“By effectively prohibiting exemptions for religious reasons, the state of Washington’s regulations depart radically from widely established norms within the health care industry protecting the individual conscience rights of health care professionals,” the health care professionals wrote in their brief. “Such norms favoring the freedom of conscience are particularly well established where, as here, the practitioner’s right to decline care applies to particular treatments, not to individual patients or classes of persons; and where, as here, declining treatment for reasons of religious conscience has no practical impact on quality or availability of care.”
On Twitter @legal_med
The U.S. Supreme Court has refused to decide whether pharmacists with strongly held religious beliefs can be forced to dispense emergency contraception to patients.
Justices did not explain their June 28 denial of Stormans, Inc. vs. Wiesman, but the decision was made over the objection of Chief Justice John G. Roberts Jr., Associate Justice Samuel Alito Jr., and Associate Justice Clarence Thomas. In his dissent, Associate Justice Alito wrote the court should have heard the case to ensure that novel and concededly “unnecessary burden on religious objectors” does not trample fundamental rights.
“If this is a sign of how religious liberty claims will be treated in the years ahead, those who value religious freedom have cause for great concern,” he wrote in his dissent.
At issue in the case is a 2007 rule by Washington state that a family-owned pharmacy in Olympia must provide Plan B contraception to patients. The “delivery rule” creates “a duty for pharmacists to deliver lawfully prescribed drugs or devices in a timely manner and does not allow for conscience-based decisions not to dispense the drug. The Stormans family, who own Ralph’s Thriftway, sued the state over the regulation, alleging violations of the free exercise, equal protection, and due process clauses of the Constitution. The business owners equate emergency contraception to abortion, and they argue that dispensing the medication violates their religious beliefs.
The 9th U.S. Circuit Court of Appeals sided with the state, calling the regulations “neutral and generally applicable.” The plaintiffs appealed to the Supreme Court. The denial by the high court allows the 9th Circuit decision to stand.
Nearly 20 court briefs were issued to the Supreme Court in the case, including briefs by the American Association of Pro-Life Obstetricians and Gynecologists and 4,609 individual health care professionals in support of the pharmacy.
“By effectively prohibiting exemptions for religious reasons, the state of Washington’s regulations depart radically from widely established norms within the health care industry protecting the individual conscience rights of health care professionals,” the health care professionals wrote in their brief. “Such norms favoring the freedom of conscience are particularly well established where, as here, the practitioner’s right to decline care applies to particular treatments, not to individual patients or classes of persons; and where, as here, declining treatment for reasons of religious conscience has no practical impact on quality or availability of care.”
On Twitter @legal_med
The U.S. Supreme Court has refused to decide whether pharmacists with strongly held religious beliefs can be forced to dispense emergency contraception to patients.
Justices did not explain their June 28 denial of Stormans, Inc. vs. Wiesman, but the decision was made over the objection of Chief Justice John G. Roberts Jr., Associate Justice Samuel Alito Jr., and Associate Justice Clarence Thomas. In his dissent, Associate Justice Alito wrote the court should have heard the case to ensure that novel and concededly “unnecessary burden on religious objectors” does not trample fundamental rights.
“If this is a sign of how religious liberty claims will be treated in the years ahead, those who value religious freedom have cause for great concern,” he wrote in his dissent.
At issue in the case is a 2007 rule by Washington state that a family-owned pharmacy in Olympia must provide Plan B contraception to patients. The “delivery rule” creates “a duty for pharmacists to deliver lawfully prescribed drugs or devices in a timely manner and does not allow for conscience-based decisions not to dispense the drug. The Stormans family, who own Ralph’s Thriftway, sued the state over the regulation, alleging violations of the free exercise, equal protection, and due process clauses of the Constitution. The business owners equate emergency contraception to abortion, and they argue that dispensing the medication violates their religious beliefs.
The 9th U.S. Circuit Court of Appeals sided with the state, calling the regulations “neutral and generally applicable.” The plaintiffs appealed to the Supreme Court. The denial by the high court allows the 9th Circuit decision to stand.
Nearly 20 court briefs were issued to the Supreme Court in the case, including briefs by the American Association of Pro-Life Obstetricians and Gynecologists and 4,609 individual health care professionals in support of the pharmacy.
“By effectively prohibiting exemptions for religious reasons, the state of Washington’s regulations depart radically from widely established norms within the health care industry protecting the individual conscience rights of health care professionals,” the health care professionals wrote in their brief. “Such norms favoring the freedom of conscience are particularly well established where, as here, the practitioner’s right to decline care applies to particular treatments, not to individual patients or classes of persons; and where, as here, declining treatment for reasons of religious conscience has no practical impact on quality or availability of care.”
On Twitter @legal_med
Initiative aims to improve transition from pediatric to adult care
Gregg Michael Talente, MD, remembers well a young patient who nearly fell through the gap between pediatric an adult health care.
The woman was treated for lupus by her pediatrician until age 19 when the doctor moved out of town. When she landed in front of Dr. Talente, it was clear the patient lacked the knowledge and skills to self-manage her condition, he recalled. Dr. Talente and his team, including pharmacists, helped the young woman understand how to administer her medications, provided refill reminders, and counseled her about reproductive health and how other medications could interact with lupus treatment.
“I look at her as a near-miss case,” said Dr. Talente, director of the internal medicine resident clinic at the University of South Carolina, Columbia, who specializes in pediatric-adolescent medicine. “A lot of bad things could have happened to her because her transition was delayed, and she wasn’t prepared. Fortunately, she landed in a place with more resources than a typical adult clinic so we were able to catch up.”
A new national initiative is designed to aid patients such as this during the move from pediatric to adult health care. The Pediatric to Adult Care Transitions Initiative is a collaborative effort by various specialty groups to facilitate more effective transition and transfer of young adults, while providing a framework for pediatricians and adult care providers. The project is under the direction of the American College of Physicians’ (ACP) Council of Subspecialty Societies in conjunction with the Got Transition (GT)/Center for Health Care Transition Improvement, the Society of General Internal Medicine (SGIM), and the Society for Adolescent Health and Medicine. Got Transition is a cooperative project by the Maternal and Child Health Bureau and The National Alliance to Advance Adolescent Health to improve pediatric-to-adult-care transitions through innovative strategies.
Since the Pediatric to Adult Care Transitions Initiative launched in spring 2015, project leaders have designed a series of disease-specific tools to enable smoother transition of patients. The downloadable tools include a transition readiness assessment, a medical summary/transfer record tool, and a self-care assessment. The guides were adapted from Got Transition’s six core elements of health care transition, developed from joint clinical recommendations by the ACP, the American Academy of Pediatrics, and the American Academy of Family Physicians.
The disease-specific tools are just the beginning, said Carol Greenlee, MD, chair of the Pediatric to Adult Care Transitions Initiative and chair of the ACP’s Council of Subspecialty Societies.
“We don’t want to just have tools on a website, we want to improve the whole process,” she said. “One of our goals is education and implementation. Part of implementation has to include collaboration because you don’t care-coordinate in isolation. You have to care-coordinate not just with the patient and family, but the pediatric and adult care providers need to collaborate.”
A need for better transition
Data show that knowledge and resources are lacking on both the pediatric and adult care side when it comes to transitioning patients from one realm to the other. A 2009 survey by the AAP found that most pediatric practices neither initiate transition planning early in adolescence nor offer transition-support service (AAP News 2009 Nov. Vol. 30). Another study in the Journal of General Internal Medicine found that many adult providers feel unprepared to care for young adults with complex chronic conditions and that in some cases, there is no identified adult primary care or specialty provider to whom care can be transitioned (J Gen Intern Med. 2008 Oct;23[10]:1621-7). Lack of time, inadequate payment, and poor training also have been cited as barriers to successful transition (Pediatrics. 2001 Jul 1. doi: 10.1542/peds.2011-0969).
Poor transitions often lead to negative health outcomes for young adults, said Dr. Patience White, codirector of Got Transition and professor of medicine and pediatrics at George Washington University, Washington. She has co-led the Pediatric to Adult Care Transitions Initiative.
“The quality of care goes down; many [patients] are lost from their care, and they don’t get the kind of care they need,” Dr. White said. “Therefore, they have poor outcomes, and then of course, the cost goes up because they are utilizing emergency rooms or tests are repeated. You’re looking at poor patient experience, poor quality, and increased cost.”
Enter the Pediatric to Adult Care Transitions Initiative. The project was designed with the busy practices of pediatricians and adult care providers in mind, said Dr. Talente, who is past chair of the SGIM Adults with Complex Conditions Originating in Childhood Task Force.
“Everyone is busy, and asking each individual practitioner to develop the systems they need to do this right is not really practical,” he said. “That’s where this project is really helpful, in the sense that it’s attempting to deliver tools and systems to providers that they can use and just adapt, without doing all the work themselves when they’re trying to run their busy practices.”
The initiative’s readiness assessment is a first step toward improving early transition planning, Dr. Greenlee said. The tool allows pediatricians to measure the knowledge and skill level of patients in the years leading to transition age, and enables doctors to fill any gaps before the transfer occurs.
The tool helps physicians gauge “what this young adult needs to know before they go out into the adult world and take on self-management,” she said. “Making sure they know how to fill a prescription, how to take their medications, know signs and symptoms of a crisis – that sort of thing.”
To enable better communication between providers, initiative leaders created the transfer summary, a hand-off outline that includes critical items the receiving clinician should know about the patients, such as information about their conditions, personal interests, or special needs. The third tool launched by the initiative – a self-management assessment – is a resource for adult care providers to measure the patients’ skills and knowledge once they begin adult care.
Overcoming obstacles to transition
The path to smoother patient transitions is not without bumps in the road. Adding time and new tools to physicians’ already heavy workloads can be challenging, Dr. Greenlee said.
“One of the biggest challenges is the time it takes on both sides,” she said. “Here we’re saying, ‘Here’s more to do.’ As a pediatrician, you’re gong to be preparing and educating [patients] in self-management and trying to get the parents engaged. There’s extra work.”
But helping pediatricians understand the bigger picture results – better outcomes, improved quality, lower health care costs – is key to acceptance, according to initiative leaders.
Strengthening communication between pediatric and adult practices also is critical to making the transition tools effective, added Dr. White. Pediatric practices cannot make successful transfers alone.
“The challenges are to find the partnerships that you need to start it, and the next big challenge is the buy-in,” she said. “You’ve got to get your leadership and senior physicians in a practice to agree that this is something they’re going to do. What’s frustrating for families is when different physicians use different modes of this whole process.”
Reimbursement for transition-related care is an ongoing climb, added Dr. Talente. In the past, physicians have struggled to receive payment for certain nonvisit time needed for transitions, he said.
However, Got Transition recently made headway toward improved payment, Dr. White said. Code 99420 now can be used to bill for transition readiness assessments conducted with youth and self-care assessments conducted with young adults. Got Transition and several physician specialty organizations also have developed a payment work group to address transition care codes. Got Transition offers a coding and reimbursement tip sheet to aid doctors in billing for pediatric to adult transitions.
Dr. Greenlee said she hopes that more pediatricians will start using the tools developed by the initiative, and she recommends reviewing the Got Transition website (www.gottransition.org) and considering how to incorporate transition efforts into practices.
“Start with a policy,” she said. “Start thinking about your approach and then make that approach intentional. My advice ... is to just start with one step at a time.”
On Twitter @legal_med
Gregg Michael Talente, MD, remembers well a young patient who nearly fell through the gap between pediatric an adult health care.
The woman was treated for lupus by her pediatrician until age 19 when the doctor moved out of town. When she landed in front of Dr. Talente, it was clear the patient lacked the knowledge and skills to self-manage her condition, he recalled. Dr. Talente and his team, including pharmacists, helped the young woman understand how to administer her medications, provided refill reminders, and counseled her about reproductive health and how other medications could interact with lupus treatment.
“I look at her as a near-miss case,” said Dr. Talente, director of the internal medicine resident clinic at the University of South Carolina, Columbia, who specializes in pediatric-adolescent medicine. “A lot of bad things could have happened to her because her transition was delayed, and she wasn’t prepared. Fortunately, she landed in a place with more resources than a typical adult clinic so we were able to catch up.”
A new national initiative is designed to aid patients such as this during the move from pediatric to adult health care. The Pediatric to Adult Care Transitions Initiative is a collaborative effort by various specialty groups to facilitate more effective transition and transfer of young adults, while providing a framework for pediatricians and adult care providers. The project is under the direction of the American College of Physicians’ (ACP) Council of Subspecialty Societies in conjunction with the Got Transition (GT)/Center for Health Care Transition Improvement, the Society of General Internal Medicine (SGIM), and the Society for Adolescent Health and Medicine. Got Transition is a cooperative project by the Maternal and Child Health Bureau and The National Alliance to Advance Adolescent Health to improve pediatric-to-adult-care transitions through innovative strategies.
Since the Pediatric to Adult Care Transitions Initiative launched in spring 2015, project leaders have designed a series of disease-specific tools to enable smoother transition of patients. The downloadable tools include a transition readiness assessment, a medical summary/transfer record tool, and a self-care assessment. The guides were adapted from Got Transition’s six core elements of health care transition, developed from joint clinical recommendations by the ACP, the American Academy of Pediatrics, and the American Academy of Family Physicians.
The disease-specific tools are just the beginning, said Carol Greenlee, MD, chair of the Pediatric to Adult Care Transitions Initiative and chair of the ACP’s Council of Subspecialty Societies.
“We don’t want to just have tools on a website, we want to improve the whole process,” she said. “One of our goals is education and implementation. Part of implementation has to include collaboration because you don’t care-coordinate in isolation. You have to care-coordinate not just with the patient and family, but the pediatric and adult care providers need to collaborate.”
A need for better transition
Data show that knowledge and resources are lacking on both the pediatric and adult care side when it comes to transitioning patients from one realm to the other. A 2009 survey by the AAP found that most pediatric practices neither initiate transition planning early in adolescence nor offer transition-support service (AAP News 2009 Nov. Vol. 30). Another study in the Journal of General Internal Medicine found that many adult providers feel unprepared to care for young adults with complex chronic conditions and that in some cases, there is no identified adult primary care or specialty provider to whom care can be transitioned (J Gen Intern Med. 2008 Oct;23[10]:1621-7). Lack of time, inadequate payment, and poor training also have been cited as barriers to successful transition (Pediatrics. 2001 Jul 1. doi: 10.1542/peds.2011-0969).
Poor transitions often lead to negative health outcomes for young adults, said Dr. Patience White, codirector of Got Transition and professor of medicine and pediatrics at George Washington University, Washington. She has co-led the Pediatric to Adult Care Transitions Initiative.
“The quality of care goes down; many [patients] are lost from their care, and they don’t get the kind of care they need,” Dr. White said. “Therefore, they have poor outcomes, and then of course, the cost goes up because they are utilizing emergency rooms or tests are repeated. You’re looking at poor patient experience, poor quality, and increased cost.”
Enter the Pediatric to Adult Care Transitions Initiative. The project was designed with the busy practices of pediatricians and adult care providers in mind, said Dr. Talente, who is past chair of the SGIM Adults with Complex Conditions Originating in Childhood Task Force.
“Everyone is busy, and asking each individual practitioner to develop the systems they need to do this right is not really practical,” he said. “That’s where this project is really helpful, in the sense that it’s attempting to deliver tools and systems to providers that they can use and just adapt, without doing all the work themselves when they’re trying to run their busy practices.”
The initiative’s readiness assessment is a first step toward improving early transition planning, Dr. Greenlee said. The tool allows pediatricians to measure the knowledge and skill level of patients in the years leading to transition age, and enables doctors to fill any gaps before the transfer occurs.
The tool helps physicians gauge “what this young adult needs to know before they go out into the adult world and take on self-management,” she said. “Making sure they know how to fill a prescription, how to take their medications, know signs and symptoms of a crisis – that sort of thing.”
To enable better communication between providers, initiative leaders created the transfer summary, a hand-off outline that includes critical items the receiving clinician should know about the patients, such as information about their conditions, personal interests, or special needs. The third tool launched by the initiative – a self-management assessment – is a resource for adult care providers to measure the patients’ skills and knowledge once they begin adult care.
Overcoming obstacles to transition
The path to smoother patient transitions is not without bumps in the road. Adding time and new tools to physicians’ already heavy workloads can be challenging, Dr. Greenlee said.
“One of the biggest challenges is the time it takes on both sides,” she said. “Here we’re saying, ‘Here’s more to do.’ As a pediatrician, you’re gong to be preparing and educating [patients] in self-management and trying to get the parents engaged. There’s extra work.”
But helping pediatricians understand the bigger picture results – better outcomes, improved quality, lower health care costs – is key to acceptance, according to initiative leaders.
Strengthening communication between pediatric and adult practices also is critical to making the transition tools effective, added Dr. White. Pediatric practices cannot make successful transfers alone.
“The challenges are to find the partnerships that you need to start it, and the next big challenge is the buy-in,” she said. “You’ve got to get your leadership and senior physicians in a practice to agree that this is something they’re going to do. What’s frustrating for families is when different physicians use different modes of this whole process.”
Reimbursement for transition-related care is an ongoing climb, added Dr. Talente. In the past, physicians have struggled to receive payment for certain nonvisit time needed for transitions, he said.
However, Got Transition recently made headway toward improved payment, Dr. White said. Code 99420 now can be used to bill for transition readiness assessments conducted with youth and self-care assessments conducted with young adults. Got Transition and several physician specialty organizations also have developed a payment work group to address transition care codes. Got Transition offers a coding and reimbursement tip sheet to aid doctors in billing for pediatric to adult transitions.
Dr. Greenlee said she hopes that more pediatricians will start using the tools developed by the initiative, and she recommends reviewing the Got Transition website (www.gottransition.org) and considering how to incorporate transition efforts into practices.
“Start with a policy,” she said. “Start thinking about your approach and then make that approach intentional. My advice ... is to just start with one step at a time.”
On Twitter @legal_med
Gregg Michael Talente, MD, remembers well a young patient who nearly fell through the gap between pediatric an adult health care.
The woman was treated for lupus by her pediatrician until age 19 when the doctor moved out of town. When she landed in front of Dr. Talente, it was clear the patient lacked the knowledge and skills to self-manage her condition, he recalled. Dr. Talente and his team, including pharmacists, helped the young woman understand how to administer her medications, provided refill reminders, and counseled her about reproductive health and how other medications could interact with lupus treatment.
“I look at her as a near-miss case,” said Dr. Talente, director of the internal medicine resident clinic at the University of South Carolina, Columbia, who specializes in pediatric-adolescent medicine. “A lot of bad things could have happened to her because her transition was delayed, and she wasn’t prepared. Fortunately, she landed in a place with more resources than a typical adult clinic so we were able to catch up.”
A new national initiative is designed to aid patients such as this during the move from pediatric to adult health care. The Pediatric to Adult Care Transitions Initiative is a collaborative effort by various specialty groups to facilitate more effective transition and transfer of young adults, while providing a framework for pediatricians and adult care providers. The project is under the direction of the American College of Physicians’ (ACP) Council of Subspecialty Societies in conjunction with the Got Transition (GT)/Center for Health Care Transition Improvement, the Society of General Internal Medicine (SGIM), and the Society for Adolescent Health and Medicine. Got Transition is a cooperative project by the Maternal and Child Health Bureau and The National Alliance to Advance Adolescent Health to improve pediatric-to-adult-care transitions through innovative strategies.
Since the Pediatric to Adult Care Transitions Initiative launched in spring 2015, project leaders have designed a series of disease-specific tools to enable smoother transition of patients. The downloadable tools include a transition readiness assessment, a medical summary/transfer record tool, and a self-care assessment. The guides were adapted from Got Transition’s six core elements of health care transition, developed from joint clinical recommendations by the ACP, the American Academy of Pediatrics, and the American Academy of Family Physicians.
The disease-specific tools are just the beginning, said Carol Greenlee, MD, chair of the Pediatric to Adult Care Transitions Initiative and chair of the ACP’s Council of Subspecialty Societies.
“We don’t want to just have tools on a website, we want to improve the whole process,” she said. “One of our goals is education and implementation. Part of implementation has to include collaboration because you don’t care-coordinate in isolation. You have to care-coordinate not just with the patient and family, but the pediatric and adult care providers need to collaborate.”
A need for better transition
Data show that knowledge and resources are lacking on both the pediatric and adult care side when it comes to transitioning patients from one realm to the other. A 2009 survey by the AAP found that most pediatric practices neither initiate transition planning early in adolescence nor offer transition-support service (AAP News 2009 Nov. Vol. 30). Another study in the Journal of General Internal Medicine found that many adult providers feel unprepared to care for young adults with complex chronic conditions and that in some cases, there is no identified adult primary care or specialty provider to whom care can be transitioned (J Gen Intern Med. 2008 Oct;23[10]:1621-7). Lack of time, inadequate payment, and poor training also have been cited as barriers to successful transition (Pediatrics. 2001 Jul 1. doi: 10.1542/peds.2011-0969).
Poor transitions often lead to negative health outcomes for young adults, said Dr. Patience White, codirector of Got Transition and professor of medicine and pediatrics at George Washington University, Washington. She has co-led the Pediatric to Adult Care Transitions Initiative.
“The quality of care goes down; many [patients] are lost from their care, and they don’t get the kind of care they need,” Dr. White said. “Therefore, they have poor outcomes, and then of course, the cost goes up because they are utilizing emergency rooms or tests are repeated. You’re looking at poor patient experience, poor quality, and increased cost.”
Enter the Pediatric to Adult Care Transitions Initiative. The project was designed with the busy practices of pediatricians and adult care providers in mind, said Dr. Talente, who is past chair of the SGIM Adults with Complex Conditions Originating in Childhood Task Force.
“Everyone is busy, and asking each individual practitioner to develop the systems they need to do this right is not really practical,” he said. “That’s where this project is really helpful, in the sense that it’s attempting to deliver tools and systems to providers that they can use and just adapt, without doing all the work themselves when they’re trying to run their busy practices.”
The initiative’s readiness assessment is a first step toward improving early transition planning, Dr. Greenlee said. The tool allows pediatricians to measure the knowledge and skill level of patients in the years leading to transition age, and enables doctors to fill any gaps before the transfer occurs.
The tool helps physicians gauge “what this young adult needs to know before they go out into the adult world and take on self-management,” she said. “Making sure they know how to fill a prescription, how to take their medications, know signs and symptoms of a crisis – that sort of thing.”
To enable better communication between providers, initiative leaders created the transfer summary, a hand-off outline that includes critical items the receiving clinician should know about the patients, such as information about their conditions, personal interests, or special needs. The third tool launched by the initiative – a self-management assessment – is a resource for adult care providers to measure the patients’ skills and knowledge once they begin adult care.
Overcoming obstacles to transition
The path to smoother patient transitions is not without bumps in the road. Adding time and new tools to physicians’ already heavy workloads can be challenging, Dr. Greenlee said.
“One of the biggest challenges is the time it takes on both sides,” she said. “Here we’re saying, ‘Here’s more to do.’ As a pediatrician, you’re gong to be preparing and educating [patients] in self-management and trying to get the parents engaged. There’s extra work.”
But helping pediatricians understand the bigger picture results – better outcomes, improved quality, lower health care costs – is key to acceptance, according to initiative leaders.
Strengthening communication between pediatric and adult practices also is critical to making the transition tools effective, added Dr. White. Pediatric practices cannot make successful transfers alone.
“The challenges are to find the partnerships that you need to start it, and the next big challenge is the buy-in,” she said. “You’ve got to get your leadership and senior physicians in a practice to agree that this is something they’re going to do. What’s frustrating for families is when different physicians use different modes of this whole process.”
Reimbursement for transition-related care is an ongoing climb, added Dr. Talente. In the past, physicians have struggled to receive payment for certain nonvisit time needed for transitions, he said.
However, Got Transition recently made headway toward improved payment, Dr. White said. Code 99420 now can be used to bill for transition readiness assessments conducted with youth and self-care assessments conducted with young adults. Got Transition and several physician specialty organizations also have developed a payment work group to address transition care codes. Got Transition offers a coding and reimbursement tip sheet to aid doctors in billing for pediatric to adult transitions.
Dr. Greenlee said she hopes that more pediatricians will start using the tools developed by the initiative, and she recommends reviewing the Got Transition website (www.gottransition.org) and considering how to incorporate transition efforts into practices.
“Start with a policy,” she said. “Start thinking about your approach and then make that approach intentional. My advice ... is to just start with one step at a time.”
On Twitter @legal_med
Justices issue ruling on Texas abortion restrictions
The U.S. Supreme Court has ruled that two Texas abortion restrictions are unconstitutional and place a substantial obstacle in the path of women seeking abortions. In a 5-to-3 vote, justices ruled that both provisions of HB 2 create an “undue burden” on abortion access. The court struck down both requirements, reversing a decision by the 5th Circuit.
The majority justices found the requirements – mandating that abortion providers have admitting privileges at a hospital within 30 miles of an abortion clinic in order to provide the service, and that all abortion clinics meet the same requirements as ambulatory surgical centers (ASCs) – are unnecessary and offer little medical advantage to patients.
“The surgical-center requirement provides few, if any, health benefits for women, poses a substantial obstacle to women seeking abortions, and constitutes an ‘undue burden’ on their constitutional right to do so,” wrote Associate Justice Stephen B. Breyer. “Before this requirement was enacted, Texas law required abortion facilities to meet a host of health and safety requirements that were policed by inspections and enforced through administrative, civil, and criminal penalties. Record evidence shows that the new provision imposes a number of additional requirements that are generally unnecessary in the abortion clinic context.”
The majority court added that common sense also suggests that a “physical facility that satisfies a certain physical demand will generally be unable to meet five times that demand without expanding physically or incurring significant costs.” Texas did not provide evidence that such expansions were possible, justices said.
Chief Justice John G. Roberts dissented, along with Associate Justice Samuel Alito Jr. and Associate Justice Clarence Thomas, calling the decision a departure from the court’s obligation to find fairly.
“[The] decision exemplifies the court’s troubling tendency to bend the rules when any effort to limit abortion, or even to speak in opposition to abortion, is at issue,” Associate Justice Thomas wrote in his dissent. “As Justice Alito observes … today’s decision creates an abortion exception to ordinary rules of res judicata, ignores compelling evidence that Texas’ law imposes no unconstitutional burden, and disregards basic principles of the severability doctrine.”
Whole Woman’s Health v. Hellerstedt centered on whether two Texas abortion regulations unconstitutionally restrict women’s access to the procedure. One rule requires abortion providers to have admitting privileges at a hospital within 30 miles and another rule requires abortion clinics to meet the same standards as those of ambulatory surgical centers. The plaintiffs, who are clinics and doctors, argued that both restrictions are unnecessary and limit access to abortion services. The Texas Department of State Health Services argued that the restrictions are reasonable and effective measures that raise the standard of care for abortion patients and ensure health and safety. The 5th U.S. Circuit Court of Appeals sided with the state; the clinics and physicians appealed.
The plaintiffs also asked the Supreme Court to reaffirm prior rulings that outline when a new abortion law imposes an “undue burden” on a patient’s right to end a pregnancy. The standard results from a 1992 Supreme Court decision, Planned Parenthood of Southeastern Pennsylvania v. Casey, in which the justices affirmed abortion rights established in Roe v. Wade.
The plaintiffs also wanted the Supreme Court to instruct lower courts to weigh whether new state restrictions on abortions really serve to protect patient health. The 5th U.S. Circuit Court of Appeals refused to answer this question when it ruled in favor of Texas in 2015, stating that courts must accept that new laws brought before them would serve the public interest.
More than 70 groups and organizations issued friend-of-the-court briefs to the Supreme Court in the case, including 45 briefs in support of the plaintiffs. In its Jan. 4 brief to the Supreme Court, the American College of Obstetricians and Gynecologists argued that the Texas restrictions are inconsistent with accepted medical practice and provide no benefit to patient care.
On Twitter @legal_med
The U.S. Supreme Court has ruled that two Texas abortion restrictions are unconstitutional and place a substantial obstacle in the path of women seeking abortions. In a 5-to-3 vote, justices ruled that both provisions of HB 2 create an “undue burden” on abortion access. The court struck down both requirements, reversing a decision by the 5th Circuit.
The majority justices found the requirements – mandating that abortion providers have admitting privileges at a hospital within 30 miles of an abortion clinic in order to provide the service, and that all abortion clinics meet the same requirements as ambulatory surgical centers (ASCs) – are unnecessary and offer little medical advantage to patients.
“The surgical-center requirement provides few, if any, health benefits for women, poses a substantial obstacle to women seeking abortions, and constitutes an ‘undue burden’ on their constitutional right to do so,” wrote Associate Justice Stephen B. Breyer. “Before this requirement was enacted, Texas law required abortion facilities to meet a host of health and safety requirements that were policed by inspections and enforced through administrative, civil, and criminal penalties. Record evidence shows that the new provision imposes a number of additional requirements that are generally unnecessary in the abortion clinic context.”
The majority court added that common sense also suggests that a “physical facility that satisfies a certain physical demand will generally be unable to meet five times that demand without expanding physically or incurring significant costs.” Texas did not provide evidence that such expansions were possible, justices said.
Chief Justice John G. Roberts dissented, along with Associate Justice Samuel Alito Jr. and Associate Justice Clarence Thomas, calling the decision a departure from the court’s obligation to find fairly.
“[The] decision exemplifies the court’s troubling tendency to bend the rules when any effort to limit abortion, or even to speak in opposition to abortion, is at issue,” Associate Justice Thomas wrote in his dissent. “As Justice Alito observes … today’s decision creates an abortion exception to ordinary rules of res judicata, ignores compelling evidence that Texas’ law imposes no unconstitutional burden, and disregards basic principles of the severability doctrine.”
Whole Woman’s Health v. Hellerstedt centered on whether two Texas abortion regulations unconstitutionally restrict women’s access to the procedure. One rule requires abortion providers to have admitting privileges at a hospital within 30 miles and another rule requires abortion clinics to meet the same standards as those of ambulatory surgical centers. The plaintiffs, who are clinics and doctors, argued that both restrictions are unnecessary and limit access to abortion services. The Texas Department of State Health Services argued that the restrictions are reasonable and effective measures that raise the standard of care for abortion patients and ensure health and safety. The 5th U.S. Circuit Court of Appeals sided with the state; the clinics and physicians appealed.
The plaintiffs also asked the Supreme Court to reaffirm prior rulings that outline when a new abortion law imposes an “undue burden” on a patient’s right to end a pregnancy. The standard results from a 1992 Supreme Court decision, Planned Parenthood of Southeastern Pennsylvania v. Casey, in which the justices affirmed abortion rights established in Roe v. Wade.
The plaintiffs also wanted the Supreme Court to instruct lower courts to weigh whether new state restrictions on abortions really serve to protect patient health. The 5th U.S. Circuit Court of Appeals refused to answer this question when it ruled in favor of Texas in 2015, stating that courts must accept that new laws brought before them would serve the public interest.
More than 70 groups and organizations issued friend-of-the-court briefs to the Supreme Court in the case, including 45 briefs in support of the plaintiffs. In its Jan. 4 brief to the Supreme Court, the American College of Obstetricians and Gynecologists argued that the Texas restrictions are inconsistent with accepted medical practice and provide no benefit to patient care.
On Twitter @legal_med
The U.S. Supreme Court has ruled that two Texas abortion restrictions are unconstitutional and place a substantial obstacle in the path of women seeking abortions. In a 5-to-3 vote, justices ruled that both provisions of HB 2 create an “undue burden” on abortion access. The court struck down both requirements, reversing a decision by the 5th Circuit.
The majority justices found the requirements – mandating that abortion providers have admitting privileges at a hospital within 30 miles of an abortion clinic in order to provide the service, and that all abortion clinics meet the same requirements as ambulatory surgical centers (ASCs) – are unnecessary and offer little medical advantage to patients.
“The surgical-center requirement provides few, if any, health benefits for women, poses a substantial obstacle to women seeking abortions, and constitutes an ‘undue burden’ on their constitutional right to do so,” wrote Associate Justice Stephen B. Breyer. “Before this requirement was enacted, Texas law required abortion facilities to meet a host of health and safety requirements that were policed by inspections and enforced through administrative, civil, and criminal penalties. Record evidence shows that the new provision imposes a number of additional requirements that are generally unnecessary in the abortion clinic context.”
The majority court added that common sense also suggests that a “physical facility that satisfies a certain physical demand will generally be unable to meet five times that demand without expanding physically or incurring significant costs.” Texas did not provide evidence that such expansions were possible, justices said.
Chief Justice John G. Roberts dissented, along with Associate Justice Samuel Alito Jr. and Associate Justice Clarence Thomas, calling the decision a departure from the court’s obligation to find fairly.
“[The] decision exemplifies the court’s troubling tendency to bend the rules when any effort to limit abortion, or even to speak in opposition to abortion, is at issue,” Associate Justice Thomas wrote in his dissent. “As Justice Alito observes … today’s decision creates an abortion exception to ordinary rules of res judicata, ignores compelling evidence that Texas’ law imposes no unconstitutional burden, and disregards basic principles of the severability doctrine.”
Whole Woman’s Health v. Hellerstedt centered on whether two Texas abortion regulations unconstitutionally restrict women’s access to the procedure. One rule requires abortion providers to have admitting privileges at a hospital within 30 miles and another rule requires abortion clinics to meet the same standards as those of ambulatory surgical centers. The plaintiffs, who are clinics and doctors, argued that both restrictions are unnecessary and limit access to abortion services. The Texas Department of State Health Services argued that the restrictions are reasonable and effective measures that raise the standard of care for abortion patients and ensure health and safety. The 5th U.S. Circuit Court of Appeals sided with the state; the clinics and physicians appealed.
The plaintiffs also asked the Supreme Court to reaffirm prior rulings that outline when a new abortion law imposes an “undue burden” on a patient’s right to end a pregnancy. The standard results from a 1992 Supreme Court decision, Planned Parenthood of Southeastern Pennsylvania v. Casey, in which the justices affirmed abortion rights established in Roe v. Wade.
The plaintiffs also wanted the Supreme Court to instruct lower courts to weigh whether new state restrictions on abortions really serve to protect patient health. The 5th U.S. Circuit Court of Appeals refused to answer this question when it ruled in favor of Texas in 2015, stating that courts must accept that new laws brought before them would serve the public interest.
More than 70 groups and organizations issued friend-of-the-court briefs to the Supreme Court in the case, including 45 briefs in support of the plaintiffs. In its Jan. 4 brief to the Supreme Court, the American College of Obstetricians and Gynecologists argued that the Texas restrictions are inconsistent with accepted medical practice and provide no benefit to patient care.
On Twitter @legal_med
Supreme Court deadlocks on immigration policy case
Supreme Court justices have deadlocked on whether protections for undocumented immigrants can be expanded under an executive order by the President.
In a June 23 decision, justices were equally divided on the constitutionality of two of President Obama’s immigration policies: the Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) and an expanded version of the Deferred Action for Childhood Arrivals (DACA). The former protects undocumented immigrants who are parents of U.S. citizens from deportation, if they meet certain criteria. The second extends work authorization under the original DACA program from 2 years to 3 years and broadens age requirements.
The 4-to-4 split decision in Texas v. United States mean the policies remain blocked by the lower court, and the expanded programs will not go forward anytime soon. The decision does not affect original DACA, which protects from deportation undocumented immigrants brought to the United States as children and offers access to work authorization.
President Obama expressed disappointment at the lack of agreement, saying the tie vote underscores the need for nine justices on the court.
“As disappointing as it was to be challenged for taking the kind of action that other administrations have taken, the country was looking to the Supreme Court to resolve the important legal questions raised in this case,” President Obama said during a June 23 press conference. “Today, the Supreme Court was unable to reach a decision ... it means the expanded set of common sense deferred action policies that I announced 2 years ago cannot go forward at this stage until there is a ninth justice on the court to break the tie.”
Texas Attorney General Ken Paxton was satisfied with the decision, calling it a victory for the state plaintiffs.
“Today’s decision keeps in place what we have maintained from the very start: one person, even a president, cannot unilaterally change the law,” Mr. Paxton said in a statement. “This is a major setback to President Obama’s attempts to expand executive power, and a victory for those who believe in the separation of powers and the rule of law.”
Texas was 1 of 26 states that sued over DAPA and expanded DACA. The states argued the president does not have the authority to issue the new immigration policies, and that the programs violate the Constitution as well as the Administrative Procedure Act for notice-and-comment rule making. Justices heard oral arguments April 18.
Immigration advocates were worried that if expanded DACA were struck down, a similar fate would follow for the original DACA policy. As it stands, undocumented immigrants who benefit from deportation protection and work authorization under original DACA, including undocumented medical students, will not be affected by the Supreme Court decision.
Marielena Hincapié, executive director for the National Immigration Law Center, vowed to continue fighting for the policies to take effect.
“Immigrants and allies fought for and won these significant policy victories, which would have brought much-needed emotional and economic stability to millions of our community members, and we will not sit back,” she said in a statement. “We urge the Department of Justice to seek a rehearing for when a ninth justice is confirmed for the Supreme Court.”
Federation for American Immigration Reform President Dan Stein said the split decision upholds the rule of law and helps preserve the balance of power in the United States.
“By ruling in favor of the federal court’s injunction, half of the nation’s Supreme Court Justices have shown that they have deep concerns about this president’s attempt at a power grab by his efforts to amend federal laws from the Oval Office,” Mr. Stein said in a statement.
Texas v. United States will be sent back to U.S. District Court Judge Andrew Hanen in Texas who will hear the case on its merits. The case could wind its way back to the U.S. Supreme Court for a rehearing after a ninth justice is confirmed.
On Twitter @legal_med
Supreme Court justices have deadlocked on whether protections for undocumented immigrants can be expanded under an executive order by the President.
In a June 23 decision, justices were equally divided on the constitutionality of two of President Obama’s immigration policies: the Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) and an expanded version of the Deferred Action for Childhood Arrivals (DACA). The former protects undocumented immigrants who are parents of U.S. citizens from deportation, if they meet certain criteria. The second extends work authorization under the original DACA program from 2 years to 3 years and broadens age requirements.
The 4-to-4 split decision in Texas v. United States mean the policies remain blocked by the lower court, and the expanded programs will not go forward anytime soon. The decision does not affect original DACA, which protects from deportation undocumented immigrants brought to the United States as children and offers access to work authorization.
President Obama expressed disappointment at the lack of agreement, saying the tie vote underscores the need for nine justices on the court.
“As disappointing as it was to be challenged for taking the kind of action that other administrations have taken, the country was looking to the Supreme Court to resolve the important legal questions raised in this case,” President Obama said during a June 23 press conference. “Today, the Supreme Court was unable to reach a decision ... it means the expanded set of common sense deferred action policies that I announced 2 years ago cannot go forward at this stage until there is a ninth justice on the court to break the tie.”
Texas Attorney General Ken Paxton was satisfied with the decision, calling it a victory for the state plaintiffs.
“Today’s decision keeps in place what we have maintained from the very start: one person, even a president, cannot unilaterally change the law,” Mr. Paxton said in a statement. “This is a major setback to President Obama’s attempts to expand executive power, and a victory for those who believe in the separation of powers and the rule of law.”
Texas was 1 of 26 states that sued over DAPA and expanded DACA. The states argued the president does not have the authority to issue the new immigration policies, and that the programs violate the Constitution as well as the Administrative Procedure Act for notice-and-comment rule making. Justices heard oral arguments April 18.
Immigration advocates were worried that if expanded DACA were struck down, a similar fate would follow for the original DACA policy. As it stands, undocumented immigrants who benefit from deportation protection and work authorization under original DACA, including undocumented medical students, will not be affected by the Supreme Court decision.
Marielena Hincapié, executive director for the National Immigration Law Center, vowed to continue fighting for the policies to take effect.
“Immigrants and allies fought for and won these significant policy victories, which would have brought much-needed emotional and economic stability to millions of our community members, and we will not sit back,” she said in a statement. “We urge the Department of Justice to seek a rehearing for when a ninth justice is confirmed for the Supreme Court.”
Federation for American Immigration Reform President Dan Stein said the split decision upholds the rule of law and helps preserve the balance of power in the United States.
“By ruling in favor of the federal court’s injunction, half of the nation’s Supreme Court Justices have shown that they have deep concerns about this president’s attempt at a power grab by his efforts to amend federal laws from the Oval Office,” Mr. Stein said in a statement.
Texas v. United States will be sent back to U.S. District Court Judge Andrew Hanen in Texas who will hear the case on its merits. The case could wind its way back to the U.S. Supreme Court for a rehearing after a ninth justice is confirmed.
On Twitter @legal_med
Supreme Court justices have deadlocked on whether protections for undocumented immigrants can be expanded under an executive order by the President.
In a June 23 decision, justices were equally divided on the constitutionality of two of President Obama’s immigration policies: the Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) and an expanded version of the Deferred Action for Childhood Arrivals (DACA). The former protects undocumented immigrants who are parents of U.S. citizens from deportation, if they meet certain criteria. The second extends work authorization under the original DACA program from 2 years to 3 years and broadens age requirements.
The 4-to-4 split decision in Texas v. United States mean the policies remain blocked by the lower court, and the expanded programs will not go forward anytime soon. The decision does not affect original DACA, which protects from deportation undocumented immigrants brought to the United States as children and offers access to work authorization.
President Obama expressed disappointment at the lack of agreement, saying the tie vote underscores the need for nine justices on the court.
“As disappointing as it was to be challenged for taking the kind of action that other administrations have taken, the country was looking to the Supreme Court to resolve the important legal questions raised in this case,” President Obama said during a June 23 press conference. “Today, the Supreme Court was unable to reach a decision ... it means the expanded set of common sense deferred action policies that I announced 2 years ago cannot go forward at this stage until there is a ninth justice on the court to break the tie.”
Texas Attorney General Ken Paxton was satisfied with the decision, calling it a victory for the state plaintiffs.
“Today’s decision keeps in place what we have maintained from the very start: one person, even a president, cannot unilaterally change the law,” Mr. Paxton said in a statement. “This is a major setback to President Obama’s attempts to expand executive power, and a victory for those who believe in the separation of powers and the rule of law.”
Texas was 1 of 26 states that sued over DAPA and expanded DACA. The states argued the president does not have the authority to issue the new immigration policies, and that the programs violate the Constitution as well as the Administrative Procedure Act for notice-and-comment rule making. Justices heard oral arguments April 18.
Immigration advocates were worried that if expanded DACA were struck down, a similar fate would follow for the original DACA policy. As it stands, undocumented immigrants who benefit from deportation protection and work authorization under original DACA, including undocumented medical students, will not be affected by the Supreme Court decision.
Marielena Hincapié, executive director for the National Immigration Law Center, vowed to continue fighting for the policies to take effect.
“Immigrants and allies fought for and won these significant policy victories, which would have brought much-needed emotional and economic stability to millions of our community members, and we will not sit back,” she said in a statement. “We urge the Department of Justice to seek a rehearing for when a ninth justice is confirmed for the Supreme Court.”
Federation for American Immigration Reform President Dan Stein said the split decision upholds the rule of law and helps preserve the balance of power in the United States.
“By ruling in favor of the federal court’s injunction, half of the nation’s Supreme Court Justices have shown that they have deep concerns about this president’s attempt at a power grab by his efforts to amend federal laws from the Oval Office,” Mr. Stein said in a statement.
Texas v. United States will be sent back to U.S. District Court Judge Andrew Hanen in Texas who will hear the case on its merits. The case could wind its way back to the U.S. Supreme Court for a rehearing after a ninth justice is confirmed.
On Twitter @legal_med
Dos and don’ts of dealing with disruptive behavior
CHICAGO – Dealing with disruptive behavior by staff and colleagues isn’t just about knowing what to do – it’s also about knowing what not to do.
Often, mishandling disruptive behavior can make matters worse and lead to further conflict among physicians and employees, health law experts warn. At a conference held by the American Bar Association, attorneys offered guidance on the dos and don’ts of disruptive behavior management.
Don’t discipline for the wrong reasons
Know what disruptive behavior is not, advised Margo S. Struthers, a Minneapolis-based health law attorney. Criticism offered in good faith with the aim of improving patient care should not be considered disruptive, she said.
“This is a problem that comes up a lot because, often, there is some element of criticism that is offered by the supposed disruptive physician, which may or may not be justified, may or may have been done in good faith, and may or may not have been in a respectful manner.”
An isolated incident of behavior that is not reflective of a pattern of inappropriate, deep-seated, and habitual behavior should not be construed as disruptive, Ms. Struthers added. In addition, disruptive behavior is not respectful disagreement with leadership, presentation of controversial ideas, or the respectful complaining about processes that endanger patient care.
Do address behavior that is truly disruptive
According to the American Medical Association, disruptive behavior is defined as personal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care, including conduct that interferes the ability to work with members of the health care team. Such behavior can be passive, such as ignoring calls or frequently missing meetings; passive-aggressive, such as excessive sarcasm or veiled threats; or aggressive, such as yelling or bullying.
Don’t focus solely on the behavior
Most disruptive behavior has a root cause, and efforts should be made to get to the bottom of the conduct, according to Sidney Welch, an Atlanta-based health law attorney.
“Often, there’s an underlying frustration in terms of clinical care or what they’re being told to do or the systems and processes [in play],” she said “Where is the sources of the tension that is creating the behavior?”
Do identify contributing factors
Personality characteristics that could lead to hostile behavior include self-centeredness, immaturity, resentfulness, or a need for power and control. Systemic factors could include increased productivity demands, cost-containment requirements, embedded hierarchies, fear of litigation, ineffective or absent conflict-resolution processes, competition between hospitals and medical staff, new care settings, and marketplace demands. Shortages of staff and high work burdens also could fuel disruptive behavior, Ms. Welch said.
“There are situations where there [is] a psychiatric disorder or a personality disorder that’s the root cause of the disruption,” she said. But “sometimes it’s just a stressful situation. A lot of these cases [in which] the physician is the disruption, we’re seeing them in high stakes emergency departments or situations where decisions have to be made very quickly, or fatigue and external stresses may be the source.”
Don’t apply corrective actions inconsistently
Make expectations clear by having a code of conduct supported by policies that apply to every employee, Ms. Welch noted. A lack of fairness among employees can create greater tension and generate increased conflict during a disruptive situation. Ensure that physicians are not be treated differently than nurses or administrators when addressing complaints, she said.
Do implement a graduated set of responses
A tiered response system (informal, formal, disciplinary, regulatory) helps manage disruptive situations based on the extent of conduct, Ms. Welch said.
“The process and disciplinary process [should] to be multileveled so that people know the rules of the road, and the parameters and the bumpers so to speak, are defined.”
Don’t necessarily involve HR
Be cautious of allowing human resource (HR) departments to direct potential disruptive physician issues, Ms. Struthers said.
“I have some concerns about HR getting involved for a couple of reasons,” she said. “If you get nonphysicians involved, it seems to exacerbate the level of tension.”
In addition, if a hospital has a significant number of both employed and independent physicians, HR can sometimes apply different standards and varied courses of action depending on employment status, she said. Of course, if the alleged disrupter is a nonphysician, HR is generally the only route for remedy within a hospital setting, Ms. Welch noted.
Do address the issue through internal processes
Every medical staff should develop and adopt bylaw provisions or policies for intervening in situations in which a physician’s behavior is identified as disruptive, according to AMA policy. Medical staff bylaw provisions or policies should contain procedural safeguards that protect due process.
For doctors in groups or small practices, employment policies and procedures should address protocols when disruption matters arise, Ms. Struthers said.
“The dynamics in a small clinic is that some doctors may more have power than others, so it may be harder in some contexts to treat everyone the same,” she said in an interview. “But that’s a really important thing to do. Any well-advised clinics would have a code of conduct or conduct policy, really to protect the clinic from employee lawsuits.”
Don’t let policies collect dust
“As we all know, you can write the policies, you can put them on the shelf, but if people aren’t reading them and understanding them and aren’t educated on them, then it really does no good,” Ms. Welch said.
Do ensure everyone knows how disruptive behavior is handled
Make certain that all staff review disruptive behavior policies and are adequately trained in how the process works, Ms. Welch added. Employees should know where to seek help if experiencing a disruption matter. Consider having staff members sign or acknowledge a code of conduct upon credentialing or hiring.
“Obviously, disruptive behavior can impact patient care, and it can come from a lot of differ directions; It’s not just physicians,” Ms. Struthers said. “Hospitals [and practices] like other places of business, need to have comprehensive polices and procedures, and they need to follow them.”
On Twitter @legal_med
CHICAGO – Dealing with disruptive behavior by staff and colleagues isn’t just about knowing what to do – it’s also about knowing what not to do.
Often, mishandling disruptive behavior can make matters worse and lead to further conflict among physicians and employees, health law experts warn. At a conference held by the American Bar Association, attorneys offered guidance on the dos and don’ts of disruptive behavior management.
Don’t discipline for the wrong reasons
Know what disruptive behavior is not, advised Margo S. Struthers, a Minneapolis-based health law attorney. Criticism offered in good faith with the aim of improving patient care should not be considered disruptive, she said.
“This is a problem that comes up a lot because, often, there is some element of criticism that is offered by the supposed disruptive physician, which may or may not be justified, may or may have been done in good faith, and may or may not have been in a respectful manner.”
An isolated incident of behavior that is not reflective of a pattern of inappropriate, deep-seated, and habitual behavior should not be construed as disruptive, Ms. Struthers added. In addition, disruptive behavior is not respectful disagreement with leadership, presentation of controversial ideas, or the respectful complaining about processes that endanger patient care.
Do address behavior that is truly disruptive
According to the American Medical Association, disruptive behavior is defined as personal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care, including conduct that interferes the ability to work with members of the health care team. Such behavior can be passive, such as ignoring calls or frequently missing meetings; passive-aggressive, such as excessive sarcasm or veiled threats; or aggressive, such as yelling or bullying.
Don’t focus solely on the behavior
Most disruptive behavior has a root cause, and efforts should be made to get to the bottom of the conduct, according to Sidney Welch, an Atlanta-based health law attorney.
“Often, there’s an underlying frustration in terms of clinical care or what they’re being told to do or the systems and processes [in play],” she said “Where is the sources of the tension that is creating the behavior?”
Do identify contributing factors
Personality characteristics that could lead to hostile behavior include self-centeredness, immaturity, resentfulness, or a need for power and control. Systemic factors could include increased productivity demands, cost-containment requirements, embedded hierarchies, fear of litigation, ineffective or absent conflict-resolution processes, competition between hospitals and medical staff, new care settings, and marketplace demands. Shortages of staff and high work burdens also could fuel disruptive behavior, Ms. Welch said.
“There are situations where there [is] a psychiatric disorder or a personality disorder that’s the root cause of the disruption,” she said. But “sometimes it’s just a stressful situation. A lot of these cases [in which] the physician is the disruption, we’re seeing them in high stakes emergency departments or situations where decisions have to be made very quickly, or fatigue and external stresses may be the source.”
Don’t apply corrective actions inconsistently
Make expectations clear by having a code of conduct supported by policies that apply to every employee, Ms. Welch noted. A lack of fairness among employees can create greater tension and generate increased conflict during a disruptive situation. Ensure that physicians are not be treated differently than nurses or administrators when addressing complaints, she said.
Do implement a graduated set of responses
A tiered response system (informal, formal, disciplinary, regulatory) helps manage disruptive situations based on the extent of conduct, Ms. Welch said.
“The process and disciplinary process [should] to be multileveled so that people know the rules of the road, and the parameters and the bumpers so to speak, are defined.”
Don’t necessarily involve HR
Be cautious of allowing human resource (HR) departments to direct potential disruptive physician issues, Ms. Struthers said.
“I have some concerns about HR getting involved for a couple of reasons,” she said. “If you get nonphysicians involved, it seems to exacerbate the level of tension.”
In addition, if a hospital has a significant number of both employed and independent physicians, HR can sometimes apply different standards and varied courses of action depending on employment status, she said. Of course, if the alleged disrupter is a nonphysician, HR is generally the only route for remedy within a hospital setting, Ms. Welch noted.
Do address the issue through internal processes
Every medical staff should develop and adopt bylaw provisions or policies for intervening in situations in which a physician’s behavior is identified as disruptive, according to AMA policy. Medical staff bylaw provisions or policies should contain procedural safeguards that protect due process.
For doctors in groups or small practices, employment policies and procedures should address protocols when disruption matters arise, Ms. Struthers said.
“The dynamics in a small clinic is that some doctors may more have power than others, so it may be harder in some contexts to treat everyone the same,” she said in an interview. “But that’s a really important thing to do. Any well-advised clinics would have a code of conduct or conduct policy, really to protect the clinic from employee lawsuits.”
Don’t let policies collect dust
“As we all know, you can write the policies, you can put them on the shelf, but if people aren’t reading them and understanding them and aren’t educated on them, then it really does no good,” Ms. Welch said.
Do ensure everyone knows how disruptive behavior is handled
Make certain that all staff review disruptive behavior policies and are adequately trained in how the process works, Ms. Welch added. Employees should know where to seek help if experiencing a disruption matter. Consider having staff members sign or acknowledge a code of conduct upon credentialing or hiring.
“Obviously, disruptive behavior can impact patient care, and it can come from a lot of differ directions; It’s not just physicians,” Ms. Struthers said. “Hospitals [and practices] like other places of business, need to have comprehensive polices and procedures, and they need to follow them.”
On Twitter @legal_med
CHICAGO – Dealing with disruptive behavior by staff and colleagues isn’t just about knowing what to do – it’s also about knowing what not to do.
Often, mishandling disruptive behavior can make matters worse and lead to further conflict among physicians and employees, health law experts warn. At a conference held by the American Bar Association, attorneys offered guidance on the dos and don’ts of disruptive behavior management.
Don’t discipline for the wrong reasons
Know what disruptive behavior is not, advised Margo S. Struthers, a Minneapolis-based health law attorney. Criticism offered in good faith with the aim of improving patient care should not be considered disruptive, she said.
“This is a problem that comes up a lot because, often, there is some element of criticism that is offered by the supposed disruptive physician, which may or may not be justified, may or may have been done in good faith, and may or may not have been in a respectful manner.”
An isolated incident of behavior that is not reflective of a pattern of inappropriate, deep-seated, and habitual behavior should not be construed as disruptive, Ms. Struthers added. In addition, disruptive behavior is not respectful disagreement with leadership, presentation of controversial ideas, or the respectful complaining about processes that endanger patient care.
Do address behavior that is truly disruptive
According to the American Medical Association, disruptive behavior is defined as personal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care, including conduct that interferes the ability to work with members of the health care team. Such behavior can be passive, such as ignoring calls or frequently missing meetings; passive-aggressive, such as excessive sarcasm or veiled threats; or aggressive, such as yelling or bullying.
Don’t focus solely on the behavior
Most disruptive behavior has a root cause, and efforts should be made to get to the bottom of the conduct, according to Sidney Welch, an Atlanta-based health law attorney.
“Often, there’s an underlying frustration in terms of clinical care or what they’re being told to do or the systems and processes [in play],” she said “Where is the sources of the tension that is creating the behavior?”
Do identify contributing factors
Personality characteristics that could lead to hostile behavior include self-centeredness, immaturity, resentfulness, or a need for power and control. Systemic factors could include increased productivity demands, cost-containment requirements, embedded hierarchies, fear of litigation, ineffective or absent conflict-resolution processes, competition between hospitals and medical staff, new care settings, and marketplace demands. Shortages of staff and high work burdens also could fuel disruptive behavior, Ms. Welch said.
“There are situations where there [is] a psychiatric disorder or a personality disorder that’s the root cause of the disruption,” she said. But “sometimes it’s just a stressful situation. A lot of these cases [in which] the physician is the disruption, we’re seeing them in high stakes emergency departments or situations where decisions have to be made very quickly, or fatigue and external stresses may be the source.”
Don’t apply corrective actions inconsistently
Make expectations clear by having a code of conduct supported by policies that apply to every employee, Ms. Welch noted. A lack of fairness among employees can create greater tension and generate increased conflict during a disruptive situation. Ensure that physicians are not be treated differently than nurses or administrators when addressing complaints, she said.
Do implement a graduated set of responses
A tiered response system (informal, formal, disciplinary, regulatory) helps manage disruptive situations based on the extent of conduct, Ms. Welch said.
“The process and disciplinary process [should] to be multileveled so that people know the rules of the road, and the parameters and the bumpers so to speak, are defined.”
Don’t necessarily involve HR
Be cautious of allowing human resource (HR) departments to direct potential disruptive physician issues, Ms. Struthers said.
“I have some concerns about HR getting involved for a couple of reasons,” she said. “If you get nonphysicians involved, it seems to exacerbate the level of tension.”
In addition, if a hospital has a significant number of both employed and independent physicians, HR can sometimes apply different standards and varied courses of action depending on employment status, she said. Of course, if the alleged disrupter is a nonphysician, HR is generally the only route for remedy within a hospital setting, Ms. Welch noted.
Do address the issue through internal processes
Every medical staff should develop and adopt bylaw provisions or policies for intervening in situations in which a physician’s behavior is identified as disruptive, according to AMA policy. Medical staff bylaw provisions or policies should contain procedural safeguards that protect due process.
For doctors in groups or small practices, employment policies and procedures should address protocols when disruption matters arise, Ms. Struthers said.
“The dynamics in a small clinic is that some doctors may more have power than others, so it may be harder in some contexts to treat everyone the same,” she said in an interview. “But that’s a really important thing to do. Any well-advised clinics would have a code of conduct or conduct policy, really to protect the clinic from employee lawsuits.”
Don’t let policies collect dust
“As we all know, you can write the policies, you can put them on the shelf, but if people aren’t reading them and understanding them and aren’t educated on them, then it really does no good,” Ms. Welch said.
Do ensure everyone knows how disruptive behavior is handled
Make certain that all staff review disruptive behavior policies and are adequately trained in how the process works, Ms. Welch added. Employees should know where to seek help if experiencing a disruption matter. Consider having staff members sign or acknowledge a code of conduct upon credentialing or hiring.
“Obviously, disruptive behavior can impact patient care, and it can come from a lot of differ directions; It’s not just physicians,” Ms. Struthers said. “Hospitals [and practices] like other places of business, need to have comprehensive polices and procedures, and they need to follow them.”
On Twitter @legal_med
AT THE PHYSICIANS LEGAL ISSUES CONFERENCE
8 steps to avoid legal risks from your practice website
CHICAGO – An inadequately designed medical practice website can pose serious legal dangers, said Michael J. Sacopulos, a medical malpractice defense attorney based in Terre Haute, Ind.
Here is a list of website to-dos that can reduce your legal risks:
• Post emergency information on the website contact page. Unlike the practice’s phone system, the website may fail to include a disclaimer that the patient should call 911 if experiencing a medical emergency.
• Provide disclaimers about doctor-patient relationship. In addition, it’s important that the website includes a warning that communications through the website do not constitute a doctor-patient relationship, Mr. Sacopulos said during an American Bar Association conference. “Most [websites] have a box where you can leave comments. [People need to be told] that it does not create a physician-patient relationship when they describe their medical condition, sometimes even posting photographs.”
• Advise regarding comment security. Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, medical information sent through electronic channels must be encrypted unless a patient consents otherwise. If information can be transmitted through a website’s comment box, patients should be advised that the transmission is not secure before they send their information, Mr. Sacopulos said.
• Secure any online appointment scheduling. Make sure that patients’ names and personal information are not visible to other patients when they schedule appointments, he said. A cardiology practice in Phoenix learned this the hard way when it had to pay the U.S. Department of Health & Human Services $100,000 for lack of HIPAA safeguards online. An investigation by the Office for Civil Rights found the practice was posting clinical and surgical appointments for patients on an Internet-based calendar that was publicly accessible.
• Ensure patient anonymity. The accidental release of private medical information occurred on the website of a St. Louis physician who obtained consent from her patients to include their before and after photos. No names were posted with the photos, but the computer file names of the photos included the patients’ names, and when a person scrolled over a photo with a cursor, the file name popped up. This allowed the public to view the patient name associated with each photo and caused serious problems for the practice, including litigation, he noted.
• Be aware of state board requirements that pertain to physician practice websites. Several state boards do not allow testimonials to be posted on websites. States also differ on the inclusion of before and after photos. New Jersey, for example, allows before and after photos on websites, while New York does not. Some state boards allow doctors to cite that they are board certified on a website without specifics, while states such as Louisiana require that physicians announce the specific certifying board.
“These are ethical and affirmative duties on behalf of physicians that oftentimes come up in websites,” he said.
• Adhere to the Americans With Disabilities Act (ADA). A website is considered real estate for purposes of the ADA, meaning it must include an accessible format to patients with disabilities, Mr. Sacupulos said. Problems arise when certain website features make sites difficult or incompatible with assistance devices that disabled patients require, such as a screen reader or voice interactive software. The National Federation for the Blind has been active in this area and has filed multiple class action lawsuits against companies that did not have compliant websites, he said. An ADA tool kit for best website practices can be found online.
• Hire an experienced Web designer to create the practice’s website. Too often, practices use a family member or friend to set up the company’s page, Mr. Sacupulos said. In one such instance, a young designer became angry at his doctor employer and set up a false website in his name, alleging abuses against patients. “Work with someone credible,” he advised. “Make sure you own your own domain. Many of these Web designers will purchase the domain name and build a site around it, which is great until you want to move to the next Web designer, and then you have to buy your domain back.”
On Twitter @legal_med
CHICAGO – An inadequately designed medical practice website can pose serious legal dangers, said Michael J. Sacopulos, a medical malpractice defense attorney based in Terre Haute, Ind.
Here is a list of website to-dos that can reduce your legal risks:
• Post emergency information on the website contact page. Unlike the practice’s phone system, the website may fail to include a disclaimer that the patient should call 911 if experiencing a medical emergency.
• Provide disclaimers about doctor-patient relationship. In addition, it’s important that the website includes a warning that communications through the website do not constitute a doctor-patient relationship, Mr. Sacopulos said during an American Bar Association conference. “Most [websites] have a box where you can leave comments. [People need to be told] that it does not create a physician-patient relationship when they describe their medical condition, sometimes even posting photographs.”
• Advise regarding comment security. Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, medical information sent through electronic channels must be encrypted unless a patient consents otherwise. If information can be transmitted through a website’s comment box, patients should be advised that the transmission is not secure before they send their information, Mr. Sacopulos said.
• Secure any online appointment scheduling. Make sure that patients’ names and personal information are not visible to other patients when they schedule appointments, he said. A cardiology practice in Phoenix learned this the hard way when it had to pay the U.S. Department of Health & Human Services $100,000 for lack of HIPAA safeguards online. An investigation by the Office for Civil Rights found the practice was posting clinical and surgical appointments for patients on an Internet-based calendar that was publicly accessible.
• Ensure patient anonymity. The accidental release of private medical information occurred on the website of a St. Louis physician who obtained consent from her patients to include their before and after photos. No names were posted with the photos, but the computer file names of the photos included the patients’ names, and when a person scrolled over a photo with a cursor, the file name popped up. This allowed the public to view the patient name associated with each photo and caused serious problems for the practice, including litigation, he noted.
• Be aware of state board requirements that pertain to physician practice websites. Several state boards do not allow testimonials to be posted on websites. States also differ on the inclusion of before and after photos. New Jersey, for example, allows before and after photos on websites, while New York does not. Some state boards allow doctors to cite that they are board certified on a website without specifics, while states such as Louisiana require that physicians announce the specific certifying board.
“These are ethical and affirmative duties on behalf of physicians that oftentimes come up in websites,” he said.
• Adhere to the Americans With Disabilities Act (ADA). A website is considered real estate for purposes of the ADA, meaning it must include an accessible format to patients with disabilities, Mr. Sacupulos said. Problems arise when certain website features make sites difficult or incompatible with assistance devices that disabled patients require, such as a screen reader or voice interactive software. The National Federation for the Blind has been active in this area and has filed multiple class action lawsuits against companies that did not have compliant websites, he said. An ADA tool kit for best website practices can be found online.
• Hire an experienced Web designer to create the practice’s website. Too often, practices use a family member or friend to set up the company’s page, Mr. Sacupulos said. In one such instance, a young designer became angry at his doctor employer and set up a false website in his name, alleging abuses against patients. “Work with someone credible,” he advised. “Make sure you own your own domain. Many of these Web designers will purchase the domain name and build a site around it, which is great until you want to move to the next Web designer, and then you have to buy your domain back.”
On Twitter @legal_med
CHICAGO – An inadequately designed medical practice website can pose serious legal dangers, said Michael J. Sacopulos, a medical malpractice defense attorney based in Terre Haute, Ind.
Here is a list of website to-dos that can reduce your legal risks:
• Post emergency information on the website contact page. Unlike the practice’s phone system, the website may fail to include a disclaimer that the patient should call 911 if experiencing a medical emergency.
• Provide disclaimers about doctor-patient relationship. In addition, it’s important that the website includes a warning that communications through the website do not constitute a doctor-patient relationship, Mr. Sacopulos said during an American Bar Association conference. “Most [websites] have a box where you can leave comments. [People need to be told] that it does not create a physician-patient relationship when they describe their medical condition, sometimes even posting photographs.”
• Advise regarding comment security. Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, medical information sent through electronic channels must be encrypted unless a patient consents otherwise. If information can be transmitted through a website’s comment box, patients should be advised that the transmission is not secure before they send their information, Mr. Sacopulos said.
• Secure any online appointment scheduling. Make sure that patients’ names and personal information are not visible to other patients when they schedule appointments, he said. A cardiology practice in Phoenix learned this the hard way when it had to pay the U.S. Department of Health & Human Services $100,000 for lack of HIPAA safeguards online. An investigation by the Office for Civil Rights found the practice was posting clinical and surgical appointments for patients on an Internet-based calendar that was publicly accessible.
• Ensure patient anonymity. The accidental release of private medical information occurred on the website of a St. Louis physician who obtained consent from her patients to include their before and after photos. No names were posted with the photos, but the computer file names of the photos included the patients’ names, and when a person scrolled over a photo with a cursor, the file name popped up. This allowed the public to view the patient name associated with each photo and caused serious problems for the practice, including litigation, he noted.
• Be aware of state board requirements that pertain to physician practice websites. Several state boards do not allow testimonials to be posted on websites. States also differ on the inclusion of before and after photos. New Jersey, for example, allows before and after photos on websites, while New York does not. Some state boards allow doctors to cite that they are board certified on a website without specifics, while states such as Louisiana require that physicians announce the specific certifying board.
“These are ethical and affirmative duties on behalf of physicians that oftentimes come up in websites,” he said.
• Adhere to the Americans With Disabilities Act (ADA). A website is considered real estate for purposes of the ADA, meaning it must include an accessible format to patients with disabilities, Mr. Sacupulos said. Problems arise when certain website features make sites difficult or incompatible with assistance devices that disabled patients require, such as a screen reader or voice interactive software. The National Federation for the Blind has been active in this area and has filed multiple class action lawsuits against companies that did not have compliant websites, he said. An ADA tool kit for best website practices can be found online.
• Hire an experienced Web designer to create the practice’s website. Too often, practices use a family member or friend to set up the company’s page, Mr. Sacupulos said. In one such instance, a young designer became angry at his doctor employer and set up a false website in his name, alleging abuses against patients. “Work with someone credible,” he advised. “Make sure you own your own domain. Many of these Web designers will purchase the domain name and build a site around it, which is great until you want to move to the next Web designer, and then you have to buy your domain back.”
On Twitter @legal_med
EXPERT ANALYSIS FROM THE PHYSICIANS LEGAL ISSUES CONFERENCE
VIDEO: Telehealth program provides weight management support to rural clinics
MINNEAPOLIS – Can telehealth help obese patients lose weight?
Weight management experts at the Medical University of South Carolina, Charleston, sought to find out through a unique program to provide practice support to rural health care providers.
The telehealth program gives health clinics in rural South Carolina access to teams of weight management experts and support through mHealth applications linking providers and clinical faculty.
The project includes biweekly group patient sessions led by a psychologist, registered dietitian, and exercise physiologist. The program uses videoconferencing systems and a provider-focused mobile app that captures weight and blood pressure data from wireless peripherals, while allowing for manual input of data.
In a video interview at the American Telemedicine Association annual conference, Ragan Aleise DuBose-Morris, Ph.D., director of telehealth education for the Medical University of South Carolina, and Joshua Brown, Ph.D., director of clinical services at the university’s Weight Management Center, discussed the weight management initiative and its effectiveness. Dr. DuBose-Morris and Dr. Brown also explained how the initiative was designed, and how the effort has impacted the weight of obese patients in the state.
[email protected] On Twitter @legal_med
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MINNEAPOLIS – Can telehealth help obese patients lose weight?
Weight management experts at the Medical University of South Carolina, Charleston, sought to find out through a unique program to provide practice support to rural health care providers.
The telehealth program gives health clinics in rural South Carolina access to teams of weight management experts and support through mHealth applications linking providers and clinical faculty.
The project includes biweekly group patient sessions led by a psychologist, registered dietitian, and exercise physiologist. The program uses videoconferencing systems and a provider-focused mobile app that captures weight and blood pressure data from wireless peripherals, while allowing for manual input of data.
In a video interview at the American Telemedicine Association annual conference, Ragan Aleise DuBose-Morris, Ph.D., director of telehealth education for the Medical University of South Carolina, and Joshua Brown, Ph.D., director of clinical services at the university’s Weight Management Center, discussed the weight management initiative and its effectiveness. Dr. DuBose-Morris and Dr. Brown also explained how the initiative was designed, and how the effort has impacted the weight of obese patients in the state.
[email protected] On Twitter @legal_med
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
MINNEAPOLIS – Can telehealth help obese patients lose weight?
Weight management experts at the Medical University of South Carolina, Charleston, sought to find out through a unique program to provide practice support to rural health care providers.
The telehealth program gives health clinics in rural South Carolina access to teams of weight management experts and support through mHealth applications linking providers and clinical faculty.
The project includes biweekly group patient sessions led by a psychologist, registered dietitian, and exercise physiologist. The program uses videoconferencing systems and a provider-focused mobile app that captures weight and blood pressure data from wireless peripherals, while allowing for manual input of data.
In a video interview at the American Telemedicine Association annual conference, Ragan Aleise DuBose-Morris, Ph.D., director of telehealth education for the Medical University of South Carolina, and Joshua Brown, Ph.D., director of clinical services at the university’s Weight Management Center, discussed the weight management initiative and its effectiveness. Dr. DuBose-Morris and Dr. Brown also explained how the initiative was designed, and how the effort has impacted the weight of obese patients in the state.
[email protected] On Twitter @legal_med
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
EXPERT ANALYSIS FROM ATA 2016
