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OIG: States provide incomplete picture of Medicaid managed care
Federal auditors are calling on the Medicaid program to withhold money from states that don’t provide complete information on managed care companies.
The recommendation from the Department of Health and Human Service’s Office of the Inspector General (OIG) comes after an audit found that at least 26 states had committed reporting errors when submitting managed care treatment data to the Centers for Medicare & Medicaid Services. The errors included incomplete information, missing identifiers, and missed deadlines.
“The high proportion of beneficiaries enrolled in managed care makes accurate encounter data essential for the oversight of Medicaid as well as prevention of fraud, waste, and abuse,” OIG auditors said in a July 6 report.
OIG auditors reviewed claim files from fiscal year 2011 in the Medicaid Statistical Information System (MSIS), a national database in which states must submit managed care encounter data. Medicaid managed care programs deliver health services through contracted arrangements between state Medicaid agencies and managed care entities. In 2013, 70% of the 55 million Medicaid patients nationwide were enrolled in managed care programs, according to the report.
The OIG examined encounter information from 38 states. Auditors found eight of the states did not report encounter data from any managed care entities by the required deadline. Eleven states did not report encounter data for all managed care entities. An additional seven states submitted information with missing fields and invalid identifiers that precluded the OIG from verifying the status of encounter data. Past OIG audits have also raised concerns about the completeness, timeliness, and accuracy of national Medicaid data. In a 2009 report, OIG found that 15 states did not report encounter data to the MSIS.
OIG recommended that CMS withhold federal funds from states that fail to submit encounter data to the MSIS until the data is reported. CMS should also monitor encounter data to ensure information is reported for all managed care entities, OIG recommended.
The Affordable Care Act gives CMS the authority to withhold federal Medicaid matching funds from states that fail to provide proper encounter data to the national database. However, rules for implementing the ACA provision have not been finalized, and as a result, CMS has not exercised its authority to withhold funds. In June, CMS issued a “notice of proposed rule-making” that would authorize the withholding of federal funds.
CMS agreed with both OIG recommendations, according to the OIG’s report. The agency stated that it will continue to work with states to ensure that managed care programs submit timely encounter data to states, that data is complete, and that information includes valid fields.
On Twitter @legal_med
Federal auditors are calling on the Medicaid program to withhold money from states that don’t provide complete information on managed care companies.
The recommendation from the Department of Health and Human Service’s Office of the Inspector General (OIG) comes after an audit found that at least 26 states had committed reporting errors when submitting managed care treatment data to the Centers for Medicare & Medicaid Services. The errors included incomplete information, missing identifiers, and missed deadlines.
“The high proportion of beneficiaries enrolled in managed care makes accurate encounter data essential for the oversight of Medicaid as well as prevention of fraud, waste, and abuse,” OIG auditors said in a July 6 report.
OIG auditors reviewed claim files from fiscal year 2011 in the Medicaid Statistical Information System (MSIS), a national database in which states must submit managed care encounter data. Medicaid managed care programs deliver health services through contracted arrangements between state Medicaid agencies and managed care entities. In 2013, 70% of the 55 million Medicaid patients nationwide were enrolled in managed care programs, according to the report.
The OIG examined encounter information from 38 states. Auditors found eight of the states did not report encounter data from any managed care entities by the required deadline. Eleven states did not report encounter data for all managed care entities. An additional seven states submitted information with missing fields and invalid identifiers that precluded the OIG from verifying the status of encounter data. Past OIG audits have also raised concerns about the completeness, timeliness, and accuracy of national Medicaid data. In a 2009 report, OIG found that 15 states did not report encounter data to the MSIS.
OIG recommended that CMS withhold federal funds from states that fail to submit encounter data to the MSIS until the data is reported. CMS should also monitor encounter data to ensure information is reported for all managed care entities, OIG recommended.
The Affordable Care Act gives CMS the authority to withhold federal Medicaid matching funds from states that fail to provide proper encounter data to the national database. However, rules for implementing the ACA provision have not been finalized, and as a result, CMS has not exercised its authority to withhold funds. In June, CMS issued a “notice of proposed rule-making” that would authorize the withholding of federal funds.
CMS agreed with both OIG recommendations, according to the OIG’s report. The agency stated that it will continue to work with states to ensure that managed care programs submit timely encounter data to states, that data is complete, and that information includes valid fields.
On Twitter @legal_med
Federal auditors are calling on the Medicaid program to withhold money from states that don’t provide complete information on managed care companies.
The recommendation from the Department of Health and Human Service’s Office of the Inspector General (OIG) comes after an audit found that at least 26 states had committed reporting errors when submitting managed care treatment data to the Centers for Medicare & Medicaid Services. The errors included incomplete information, missing identifiers, and missed deadlines.
“The high proportion of beneficiaries enrolled in managed care makes accurate encounter data essential for the oversight of Medicaid as well as prevention of fraud, waste, and abuse,” OIG auditors said in a July 6 report.
OIG auditors reviewed claim files from fiscal year 2011 in the Medicaid Statistical Information System (MSIS), a national database in which states must submit managed care encounter data. Medicaid managed care programs deliver health services through contracted arrangements between state Medicaid agencies and managed care entities. In 2013, 70% of the 55 million Medicaid patients nationwide were enrolled in managed care programs, according to the report.
The OIG examined encounter information from 38 states. Auditors found eight of the states did not report encounter data from any managed care entities by the required deadline. Eleven states did not report encounter data for all managed care entities. An additional seven states submitted information with missing fields and invalid identifiers that precluded the OIG from verifying the status of encounter data. Past OIG audits have also raised concerns about the completeness, timeliness, and accuracy of national Medicaid data. In a 2009 report, OIG found that 15 states did not report encounter data to the MSIS.
OIG recommended that CMS withhold federal funds from states that fail to submit encounter data to the MSIS until the data is reported. CMS should also monitor encounter data to ensure information is reported for all managed care entities, OIG recommended.
The Affordable Care Act gives CMS the authority to withhold federal Medicaid matching funds from states that fail to provide proper encounter data to the national database. However, rules for implementing the ACA provision have not been finalized, and as a result, CMS has not exercised its authority to withhold funds. In June, CMS issued a “notice of proposed rule-making” that would authorize the withholding of federal funds.
CMS agreed with both OIG recommendations, according to the OIG’s report. The agency stated that it will continue to work with states to ensure that managed care programs submit timely encounter data to states, that data is complete, and that information includes valid fields.
On Twitter @legal_med
Fee schedule update includes advance care planning, PQRS changes
Physicians are praising a new proposal by the Centers for Medicare & Medicaid Services to pay for end-of-life counseling as part of a sweeping draft of updates to its 2016 physician payment schedule.
The proposed fee schedule – the first since repeal of the Sustainable Growth Rate (SGR) formula and enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – includes modifications to reimbursement policies, changes to misvalued codes, and updates to quality performance metrics for physicians who participate in the Physician Quality Reporting System (PQRS).
As part of the proposal, released on July 8, two new advance care planning codes would be created to pay physicians for time discussing patient options for advance directives. The first code would cover an initial 30 minutes of the doctors’ time, and the second would cover additional 30-minute blocks as necessary.
Dr. Andrew W. Gurman, president-elect of the American Medical Association, said the proposed rule affirms the need to support conversations between doctors and patients about end-of-life wishes before critical medical events occur. The AMA Current Procedural Terminology (CPT) Editorial Panel and the AMA Relative Value Update Committee (RUC) created the new CPT codes and recommended the associated payments for calendar year 2015.
“This is a patient-centered policy intended to support a careful planning process that is assisted by a physician or other qualified health care professional,” Dr. Gurman said in a statement. “This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions.”
The American College of Physicians (ACP) applauded inclusion of the advance care planning codes, calling it an important step to improve care for Medicare patients with serious illnesses.
“The nation’s physicians believe that conversations among physicians, patients, and loved ones is the standard of care,” ACP President Dr. Wayne J. Riley said in a statement. “The College is pleased that CMS has recognized what the medical community is doing to address the needs and requests made by patients and their loved ones.”
CMS’ proposal also includes updates to the PQRS, the federal program that provides incentive payments to eligible professionals and group practices that report data on quality measures for covered services and/or participate in a qualified clinical data registry (QCDR). The proposal would establish criteria for satisfactory reporting similar to that of previous years, including the general reporting of nine measures covering three National Quality Strategy domains.
Eligible professionals and practices who do not report on PQRS standards in 2016 will see their 2018 Medicare pay cut by 2%. The proposed fee schedule also would eliminate measures that are topped out, duplicative, or are being replaced with more robust measures. If the proposal is finalized, 300 total measures in the PQRS program are slated for 2016.
The proposed fee schedule also would modify the the Medicare Shared Savings Program (MSSP) by:
• Allowing participants to add or delete a measure if it no longer aligns with updated clinical practice or causes patient harm.
• Clarifying how PQRS-eligible professionals participating within an ACO can meet PQRS requirements when their ACO satisfactorily reports quality measures.
• Amending the definition of primary care services to include claims submitted by certain teaching hospitals and excluding those submitted by skilled nursing facilities.
The proposed fee schedule also addresses telemedicine services. CMS says it will pay for telemedicine if the treatment is on the list of approved Medicare telehealth services, and if:
• the service is furnished via an interactive telecommunications system.
• The service is furnished by a physician or authorized practitioner.
• The service is furnished to an eligible telehealth patient.
• The patient receiving the service must be located in a telehealth originating site.
If these conditions are met, Medicare will pay a facility fee to the originating site and make separates payment to the distant site health provider furnishing the service.
CMS is also proposing payment changes for certain specialty services based on codes determined to be misvalued. Specifically, physicians who practice radiation therapy, radiation oncology, and gastroenterology would experience significant decreases to payments for services that they frequently furnish as a result of widespread revisions to the Relative Value Unit (RVU) structure used to establish such codes. Other specialties, such as pathology, would experience significant increases to payments for similar reasons, CMS states. The modifications are a result of an initiative to review misvalued codes and establish new and revised codes.
Meanwhile, CMS is seeking feedback on several components of MACRA, including the definition of clinical practice improvement activities and input on how to define a physician-focused payment model. The agency is also asking for feedback on whether to expand the Comprehensive Primary Care Initiative, a 4-year multipayer pilot that aims to strengthen primary care by offering population-based care management fees and shared savings opportunities to participating health providers.
The proposed rule will be published in the Federal Register on July 15; comments will be accepted through Sept. 8.
On Twitter @legal_med
Physicians are praising a new proposal by the Centers for Medicare & Medicaid Services to pay for end-of-life counseling as part of a sweeping draft of updates to its 2016 physician payment schedule.
The proposed fee schedule – the first since repeal of the Sustainable Growth Rate (SGR) formula and enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – includes modifications to reimbursement policies, changes to misvalued codes, and updates to quality performance metrics for physicians who participate in the Physician Quality Reporting System (PQRS).
As part of the proposal, released on July 8, two new advance care planning codes would be created to pay physicians for time discussing patient options for advance directives. The first code would cover an initial 30 minutes of the doctors’ time, and the second would cover additional 30-minute blocks as necessary.
Dr. Andrew W. Gurman, president-elect of the American Medical Association, said the proposed rule affirms the need to support conversations between doctors and patients about end-of-life wishes before critical medical events occur. The AMA Current Procedural Terminology (CPT) Editorial Panel and the AMA Relative Value Update Committee (RUC) created the new CPT codes and recommended the associated payments for calendar year 2015.
“This is a patient-centered policy intended to support a careful planning process that is assisted by a physician or other qualified health care professional,” Dr. Gurman said in a statement. “This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions.”
The American College of Physicians (ACP) applauded inclusion of the advance care planning codes, calling it an important step to improve care for Medicare patients with serious illnesses.
“The nation’s physicians believe that conversations among physicians, patients, and loved ones is the standard of care,” ACP President Dr. Wayne J. Riley said in a statement. “The College is pleased that CMS has recognized what the medical community is doing to address the needs and requests made by patients and their loved ones.”
CMS’ proposal also includes updates to the PQRS, the federal program that provides incentive payments to eligible professionals and group practices that report data on quality measures for covered services and/or participate in a qualified clinical data registry (QCDR). The proposal would establish criteria for satisfactory reporting similar to that of previous years, including the general reporting of nine measures covering three National Quality Strategy domains.
Eligible professionals and practices who do not report on PQRS standards in 2016 will see their 2018 Medicare pay cut by 2%. The proposed fee schedule also would eliminate measures that are topped out, duplicative, or are being replaced with more robust measures. If the proposal is finalized, 300 total measures in the PQRS program are slated for 2016.
The proposed fee schedule also would modify the the Medicare Shared Savings Program (MSSP) by:
• Allowing participants to add or delete a measure if it no longer aligns with updated clinical practice or causes patient harm.
• Clarifying how PQRS-eligible professionals participating within an ACO can meet PQRS requirements when their ACO satisfactorily reports quality measures.
• Amending the definition of primary care services to include claims submitted by certain teaching hospitals and excluding those submitted by skilled nursing facilities.
The proposed fee schedule also addresses telemedicine services. CMS says it will pay for telemedicine if the treatment is on the list of approved Medicare telehealth services, and if:
• the service is furnished via an interactive telecommunications system.
• The service is furnished by a physician or authorized practitioner.
• The service is furnished to an eligible telehealth patient.
• The patient receiving the service must be located in a telehealth originating site.
If these conditions are met, Medicare will pay a facility fee to the originating site and make separates payment to the distant site health provider furnishing the service.
CMS is also proposing payment changes for certain specialty services based on codes determined to be misvalued. Specifically, physicians who practice radiation therapy, radiation oncology, and gastroenterology would experience significant decreases to payments for services that they frequently furnish as a result of widespread revisions to the Relative Value Unit (RVU) structure used to establish such codes. Other specialties, such as pathology, would experience significant increases to payments for similar reasons, CMS states. The modifications are a result of an initiative to review misvalued codes and establish new and revised codes.
Meanwhile, CMS is seeking feedback on several components of MACRA, including the definition of clinical practice improvement activities and input on how to define a physician-focused payment model. The agency is also asking for feedback on whether to expand the Comprehensive Primary Care Initiative, a 4-year multipayer pilot that aims to strengthen primary care by offering population-based care management fees and shared savings opportunities to participating health providers.
The proposed rule will be published in the Federal Register on July 15; comments will be accepted through Sept. 8.
On Twitter @legal_med
Physicians are praising a new proposal by the Centers for Medicare & Medicaid Services to pay for end-of-life counseling as part of a sweeping draft of updates to its 2016 physician payment schedule.
The proposed fee schedule – the first since repeal of the Sustainable Growth Rate (SGR) formula and enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – includes modifications to reimbursement policies, changes to misvalued codes, and updates to quality performance metrics for physicians who participate in the Physician Quality Reporting System (PQRS).
As part of the proposal, released on July 8, two new advance care planning codes would be created to pay physicians for time discussing patient options for advance directives. The first code would cover an initial 30 minutes of the doctors’ time, and the second would cover additional 30-minute blocks as necessary.
Dr. Andrew W. Gurman, president-elect of the American Medical Association, said the proposed rule affirms the need to support conversations between doctors and patients about end-of-life wishes before critical medical events occur. The AMA Current Procedural Terminology (CPT) Editorial Panel and the AMA Relative Value Update Committee (RUC) created the new CPT codes and recommended the associated payments for calendar year 2015.
“This is a patient-centered policy intended to support a careful planning process that is assisted by a physician or other qualified health care professional,” Dr. Gurman said in a statement. “This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions.”
The American College of Physicians (ACP) applauded inclusion of the advance care planning codes, calling it an important step to improve care for Medicare patients with serious illnesses.
“The nation’s physicians believe that conversations among physicians, patients, and loved ones is the standard of care,” ACP President Dr. Wayne J. Riley said in a statement. “The College is pleased that CMS has recognized what the medical community is doing to address the needs and requests made by patients and their loved ones.”
CMS’ proposal also includes updates to the PQRS, the federal program that provides incentive payments to eligible professionals and group practices that report data on quality measures for covered services and/or participate in a qualified clinical data registry (QCDR). The proposal would establish criteria for satisfactory reporting similar to that of previous years, including the general reporting of nine measures covering three National Quality Strategy domains.
Eligible professionals and practices who do not report on PQRS standards in 2016 will see their 2018 Medicare pay cut by 2%. The proposed fee schedule also would eliminate measures that are topped out, duplicative, or are being replaced with more robust measures. If the proposal is finalized, 300 total measures in the PQRS program are slated for 2016.
The proposed fee schedule also would modify the the Medicare Shared Savings Program (MSSP) by:
• Allowing participants to add or delete a measure if it no longer aligns with updated clinical practice or causes patient harm.
• Clarifying how PQRS-eligible professionals participating within an ACO can meet PQRS requirements when their ACO satisfactorily reports quality measures.
• Amending the definition of primary care services to include claims submitted by certain teaching hospitals and excluding those submitted by skilled nursing facilities.
The proposed fee schedule also addresses telemedicine services. CMS says it will pay for telemedicine if the treatment is on the list of approved Medicare telehealth services, and if:
• the service is furnished via an interactive telecommunications system.
• The service is furnished by a physician or authorized practitioner.
• The service is furnished to an eligible telehealth patient.
• The patient receiving the service must be located in a telehealth originating site.
If these conditions are met, Medicare will pay a facility fee to the originating site and make separates payment to the distant site health provider furnishing the service.
CMS is also proposing payment changes for certain specialty services based on codes determined to be misvalued. Specifically, physicians who practice radiation therapy, radiation oncology, and gastroenterology would experience significant decreases to payments for services that they frequently furnish as a result of widespread revisions to the Relative Value Unit (RVU) structure used to establish such codes. Other specialties, such as pathology, would experience significant increases to payments for similar reasons, CMS states. The modifications are a result of an initiative to review misvalued codes and establish new and revised codes.
Meanwhile, CMS is seeking feedback on several components of MACRA, including the definition of clinical practice improvement activities and input on how to define a physician-focused payment model. The agency is also asking for feedback on whether to expand the Comprehensive Primary Care Initiative, a 4-year multipayer pilot that aims to strengthen primary care by offering population-based care management fees and shared savings opportunities to participating health providers.
The proposed rule will be published in the Federal Register on July 15; comments will be accepted through Sept. 8.
On Twitter @legal_med
MOC: ABIM eliminates ‘underlying certification’ requirement
Physicians certified in nine internal medicine subspecialties no longer have to maintain underlying certifications, according to a policy change from the American Board of Internal Medicine.
In a July 1 statement, ABIM announced that no disciplines within its MOC program will require underlying certification, and that all ABIM diplomates can choose the certifications they wish to maintain. The policy goes into effect on Jan. 1, 2016.
Dr. Wayne J. Riley, president of the American College of Physicians called the change necessary and welcome.
“ABIM’s policy change regarding underlying certifications reflects ACP’s repeated recommendation that the MOC process be relevant to a variety of practice settings, not redundant with other requirements, and sensitive to cost and time,” Dr. Riley said in an interview.
ABIM President and CEO Richard J. Baron said the underlying disciplines are important in building the foundation of knowledge for initial subspecialty certification, but that keeping the MOC requirement in place did not account for the increased specialization of physicians’ practices over their careers.
“As we work to increase the relevancy of the Maintenance of Certification program for physicians, we want to give them greater flexibility to choose to recertify in those areas that best reflect what they are doing in practice,” Dr. Baron said in a statement.
Subspecialists in the following areas will no longer be required to maintain an underlying certification:
• Advanced heart failure and transplant cardiology (cardiovascular disease).
• Clinical cardiac electrophysiology (cardiovascular disease).
• Interventional cardiology (cardiovascular disease).
• Adult congenital heart disease (cardiovascular disease).
• Transplant hepatology (gastroenterology).
Further, diplomates in adolescent medicine, hospice and palliative medicine, sleep medicine, and sports medicine will no longer be required to maintain another certification.
The policy will not change requirements for initial certification in such subspecialties, and doctors will still need to be certified in a foundational discipline in order to initially certify in a subspecialty, according to ABIM.
The board decided to remove the MOC requirement after discussion and input from 15 medical specialty societies, including the American College of Cardiology, the American College of Gastroenterology, and the American Gastroenterological Association. The team of physicians concluded that once the initial certification process is completed, physicians should only be required to maintain one specialty board certification, said Dr. John I. Allen, AGA president.
“This is compatible with many other physician practices,” Dr. Allen said in an interview. “For example, I maintain GI boards but not internal medicine, which was required during my initial certification. We believe this policy facilitates consistency among all specialties.”
Dr. Allen noted that physicians can choose to maintain more than one certification.
Dr. Kim A. Williams Sr., ACC president, said the modification is a good start, but that the ABIM’s MOC program needs more work. The ACC looks forward to continuing to work with ABIM to address other areas that require potential revision, he said.
“It’s a welcome change, but it’s part of a process that we’re hoping will make the entire Maintenance of Certification [program] more user friendly, more focused on improving practice, and, indeed, making it something that physicians are happy to embrace,” Dr. Williams said in an interview.
The change to the underlying certification requirement is the latest in an ongoing series of modifications to ABIM’s MOC process. In early June, ABIM rolled out changes to its exam outline and score report. Starting with spring 2015 exams, physicians will receive enhanced score reports with more performance details, according to a June 9 announcement by ABIM. The board has also updated its internal medicine MOC blueprint – the exam content outline – to ensure that the exam reflects how internists are practicing today and to provide more detailed explanations of topics that may be included in the exam.
The growing list of changes follows a February announcement by ABIM apologizing to physicians for an MOC program that “clearly got it wrong.”ABIM pledged to make the program more consistent with physicians’ practice and values. Among the immediate changes are updates to its internal medicine exam, suspension of the practice assessment, patient voice, and patient safety requirements for at least 2 years, and setting MOC enrollment fees at or below 2014 levels through at least 2017.
On Twitter @legal_med
Physicians certified in nine internal medicine subspecialties no longer have to maintain underlying certifications, according to a policy change from the American Board of Internal Medicine.
In a July 1 statement, ABIM announced that no disciplines within its MOC program will require underlying certification, and that all ABIM diplomates can choose the certifications they wish to maintain. The policy goes into effect on Jan. 1, 2016.
Dr. Wayne J. Riley, president of the American College of Physicians called the change necessary and welcome.
“ABIM’s policy change regarding underlying certifications reflects ACP’s repeated recommendation that the MOC process be relevant to a variety of practice settings, not redundant with other requirements, and sensitive to cost and time,” Dr. Riley said in an interview.
ABIM President and CEO Richard J. Baron said the underlying disciplines are important in building the foundation of knowledge for initial subspecialty certification, but that keeping the MOC requirement in place did not account for the increased specialization of physicians’ practices over their careers.
“As we work to increase the relevancy of the Maintenance of Certification program for physicians, we want to give them greater flexibility to choose to recertify in those areas that best reflect what they are doing in practice,” Dr. Baron said in a statement.
Subspecialists in the following areas will no longer be required to maintain an underlying certification:
• Advanced heart failure and transplant cardiology (cardiovascular disease).
• Clinical cardiac electrophysiology (cardiovascular disease).
• Interventional cardiology (cardiovascular disease).
• Adult congenital heart disease (cardiovascular disease).
• Transplant hepatology (gastroenterology).
Further, diplomates in adolescent medicine, hospice and palliative medicine, sleep medicine, and sports medicine will no longer be required to maintain another certification.
The policy will not change requirements for initial certification in such subspecialties, and doctors will still need to be certified in a foundational discipline in order to initially certify in a subspecialty, according to ABIM.
The board decided to remove the MOC requirement after discussion and input from 15 medical specialty societies, including the American College of Cardiology, the American College of Gastroenterology, and the American Gastroenterological Association. The team of physicians concluded that once the initial certification process is completed, physicians should only be required to maintain one specialty board certification, said Dr. John I. Allen, AGA president.
“This is compatible with many other physician practices,” Dr. Allen said in an interview. “For example, I maintain GI boards but not internal medicine, which was required during my initial certification. We believe this policy facilitates consistency among all specialties.”
Dr. Allen noted that physicians can choose to maintain more than one certification.
Dr. Kim A. Williams Sr., ACC president, said the modification is a good start, but that the ABIM’s MOC program needs more work. The ACC looks forward to continuing to work with ABIM to address other areas that require potential revision, he said.
“It’s a welcome change, but it’s part of a process that we’re hoping will make the entire Maintenance of Certification [program] more user friendly, more focused on improving practice, and, indeed, making it something that physicians are happy to embrace,” Dr. Williams said in an interview.
The change to the underlying certification requirement is the latest in an ongoing series of modifications to ABIM’s MOC process. In early June, ABIM rolled out changes to its exam outline and score report. Starting with spring 2015 exams, physicians will receive enhanced score reports with more performance details, according to a June 9 announcement by ABIM. The board has also updated its internal medicine MOC blueprint – the exam content outline – to ensure that the exam reflects how internists are practicing today and to provide more detailed explanations of topics that may be included in the exam.
The growing list of changes follows a February announcement by ABIM apologizing to physicians for an MOC program that “clearly got it wrong.”ABIM pledged to make the program more consistent with physicians’ practice and values. Among the immediate changes are updates to its internal medicine exam, suspension of the practice assessment, patient voice, and patient safety requirements for at least 2 years, and setting MOC enrollment fees at or below 2014 levels through at least 2017.
On Twitter @legal_med
Physicians certified in nine internal medicine subspecialties no longer have to maintain underlying certifications, according to a policy change from the American Board of Internal Medicine.
In a July 1 statement, ABIM announced that no disciplines within its MOC program will require underlying certification, and that all ABIM diplomates can choose the certifications they wish to maintain. The policy goes into effect on Jan. 1, 2016.
Dr. Wayne J. Riley, president of the American College of Physicians called the change necessary and welcome.
“ABIM’s policy change regarding underlying certifications reflects ACP’s repeated recommendation that the MOC process be relevant to a variety of practice settings, not redundant with other requirements, and sensitive to cost and time,” Dr. Riley said in an interview.
ABIM President and CEO Richard J. Baron said the underlying disciplines are important in building the foundation of knowledge for initial subspecialty certification, but that keeping the MOC requirement in place did not account for the increased specialization of physicians’ practices over their careers.
“As we work to increase the relevancy of the Maintenance of Certification program for physicians, we want to give them greater flexibility to choose to recertify in those areas that best reflect what they are doing in practice,” Dr. Baron said in a statement.
Subspecialists in the following areas will no longer be required to maintain an underlying certification:
• Advanced heart failure and transplant cardiology (cardiovascular disease).
• Clinical cardiac electrophysiology (cardiovascular disease).
• Interventional cardiology (cardiovascular disease).
• Adult congenital heart disease (cardiovascular disease).
• Transplant hepatology (gastroenterology).
Further, diplomates in adolescent medicine, hospice and palliative medicine, sleep medicine, and sports medicine will no longer be required to maintain another certification.
The policy will not change requirements for initial certification in such subspecialties, and doctors will still need to be certified in a foundational discipline in order to initially certify in a subspecialty, according to ABIM.
The board decided to remove the MOC requirement after discussion and input from 15 medical specialty societies, including the American College of Cardiology, the American College of Gastroenterology, and the American Gastroenterological Association. The team of physicians concluded that once the initial certification process is completed, physicians should only be required to maintain one specialty board certification, said Dr. John I. Allen, AGA president.
“This is compatible with many other physician practices,” Dr. Allen said in an interview. “For example, I maintain GI boards but not internal medicine, which was required during my initial certification. We believe this policy facilitates consistency among all specialties.”
Dr. Allen noted that physicians can choose to maintain more than one certification.
Dr. Kim A. Williams Sr., ACC president, said the modification is a good start, but that the ABIM’s MOC program needs more work. The ACC looks forward to continuing to work with ABIM to address other areas that require potential revision, he said.
“It’s a welcome change, but it’s part of a process that we’re hoping will make the entire Maintenance of Certification [program] more user friendly, more focused on improving practice, and, indeed, making it something that physicians are happy to embrace,” Dr. Williams said in an interview.
The change to the underlying certification requirement is the latest in an ongoing series of modifications to ABIM’s MOC process. In early June, ABIM rolled out changes to its exam outline and score report. Starting with spring 2015 exams, physicians will receive enhanced score reports with more performance details, according to a June 9 announcement by ABIM. The board has also updated its internal medicine MOC blueprint – the exam content outline – to ensure that the exam reflects how internists are practicing today and to provide more detailed explanations of topics that may be included in the exam.
The growing list of changes follows a February announcement by ABIM apologizing to physicians for an MOC program that “clearly got it wrong.”ABIM pledged to make the program more consistent with physicians’ practice and values. Among the immediate changes are updates to its internal medicine exam, suspension of the practice assessment, patient voice, and patient safety requirements for at least 2 years, and setting MOC enrollment fees at or below 2014 levels through at least 2017.
On Twitter @legal_med
AAP opinion: Reduce barriers to telemedicine, encourage responsible use
The American Academy of Pediatrics is advocating for the expansion of pediatric telemedicine to increase access to care for underserved communities and improve quality of care for children.
In an opinion published online June 29 in Pediatrics, the AAP called for a reduction in ongoing barriers to telemedicine, equitable pay for telemedicine doctors, and further efforts to facilitate interstate licensure (Pediatrics 2015 [doi:10.1542/peds.2015-1253]).
At the same time, AAP warns that fragmented telemedicine services should be avoided, and that use of telemedicine for episodic care should be done within the context of the medical home. The timing is right for the AAP opinion because of increasing telemedicine technology, and the need to distinguish between responsible telemedicine and otherwise, said Dr. James P. Marcin, lead author of the opinion and a pediatrician at the University of California, Davis, Children’s Hospital in Sacramento.
“The technologies are booming and becoming more and more available, including things that might take [telemedicine] in the wrong direction, such as direct-to-consumer, online services,” Dr. Marcin said in an interview. “Telemedicine is a really great opportunity to strengthen the medical home, increase access, and provide better, more efficient care to children, but there’s also market forces in place [affecting telemedicine] that may not address the priorities of the AAP.”
In its opinion, the AAP writes that the use of telemedicine technologies by primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists has “the potential to transform the practice of pediatrics.” For example, telemedicine technology may improve models of care within the medical home by enhancing communication among health providers and contributing to better, more efficient care, according to the policy statement. Such models also may serve as a platform for more continuous care and the linking of primary and specialty services to better treat complex patients.
In addition, pediatric physicians working in remote locations can use telemedicine to receive ongoing medical education. Consultations, case discussions, and ongoing clinical support also can be enhanced by telemedicine, according to the AAP policy statement.
However, the academy adds that telemedicine used for episodic care by nonmedical home providers could disrupt continuity of care and “create redundancy and imprudent use of health care resources.” Such fragmentation is not the proper way to practice telemedicine, and the usage should be avoided, the AAP said in its opinion. The practice of telemedicine instead should be coordinated through the medical home.
“Companies are coming out that will charge a certain fee to be able to provide [telemedicine services] to patients at home, but that adds to fragmentation” of care, Dr. Marcin said. “If you see a doctor online and get treated for an ear infection, and go see your regular doctor, and go to a retail-based clinic the next day, you have three different providers, three different opinions, and maybe three different prescriptions. That’s not going to help further the care of the child.”
Among its recommendations, the AAP calls for reducing barriers to telemedicine, such as the cost of telemedicine implementation and support, and the lack of reimbursement for physicians who provide telemedicine. Not all states pay equally for telemedicine services nor recognize rules by the Centers for Medicare & Medicaid Services and the Joint Commission on privileging by proxy for telemedicine providers.
Insurance coverage for telemedicine services greatly depends on the state and each state’s Medicaid program, explained Dr. Mary Ellen Rimsza, chair of the AAP Committee on Pediatric Workforce and a professor at the University of Arizona, Tucson.
“For private insurance companies, [coverage] is highly variable,” Dr. Rimsza said in an interview. “Particularly, if they don’t have a big network of physicians, it would be especially important to [cover] telemedicine. Obviously, physicians can’t do it if they are not going to get paid.”
Other obstacles include a general absence of malpractice coverage for telemedicine, and failure to consider the delivery of telemedicine in hospital and practice-based credentialing and privileging policies. Stable funding methods should be developed by both public and private payers to support the continued growth and maintenance of telemedicine, the AAP recommended in its opinion. The academy also stressed the importance of further research to study the effectiveness of telemedicine and the development of financial incentives for health providers that demonstrate health care improvements linked to telemedicine usage.
The opinion notes that telemedicine topics should be included in existing medical school and residency curricula, as well as CME courses. In addition to the opinion, a separate paper in the June 29 Pediatrics (doi:10.1542/peds.2015-1517) discusses applications for telemedicine in pediatric medicine.
Dr. Rimsza hopes the AAP’s policy statement helps to increase knowledge about telemedicine, possible usages for pediatricians, and challenges faced by physicians who use the technology.
“We hope that it will raise awareness about some of the barriers to telemedicine and the importance of how the care is delivered, within the medical home, especially,” she said. “We plan to use the policy statement as various legislation is presented both at the national and local levels.”
On Twitter@legal_med
The American Academy of Pediatrics is advocating for the expansion of pediatric telemedicine to increase access to care for underserved communities and improve quality of care for children.
In an opinion published online June 29 in Pediatrics, the AAP called for a reduction in ongoing barriers to telemedicine, equitable pay for telemedicine doctors, and further efforts to facilitate interstate licensure (Pediatrics 2015 [doi:10.1542/peds.2015-1253]).
At the same time, AAP warns that fragmented telemedicine services should be avoided, and that use of telemedicine for episodic care should be done within the context of the medical home. The timing is right for the AAP opinion because of increasing telemedicine technology, and the need to distinguish between responsible telemedicine and otherwise, said Dr. James P. Marcin, lead author of the opinion and a pediatrician at the University of California, Davis, Children’s Hospital in Sacramento.
“The technologies are booming and becoming more and more available, including things that might take [telemedicine] in the wrong direction, such as direct-to-consumer, online services,” Dr. Marcin said in an interview. “Telemedicine is a really great opportunity to strengthen the medical home, increase access, and provide better, more efficient care to children, but there’s also market forces in place [affecting telemedicine] that may not address the priorities of the AAP.”
In its opinion, the AAP writes that the use of telemedicine technologies by primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists has “the potential to transform the practice of pediatrics.” For example, telemedicine technology may improve models of care within the medical home by enhancing communication among health providers and contributing to better, more efficient care, according to the policy statement. Such models also may serve as a platform for more continuous care and the linking of primary and specialty services to better treat complex patients.
In addition, pediatric physicians working in remote locations can use telemedicine to receive ongoing medical education. Consultations, case discussions, and ongoing clinical support also can be enhanced by telemedicine, according to the AAP policy statement.
However, the academy adds that telemedicine used for episodic care by nonmedical home providers could disrupt continuity of care and “create redundancy and imprudent use of health care resources.” Such fragmentation is not the proper way to practice telemedicine, and the usage should be avoided, the AAP said in its opinion. The practice of telemedicine instead should be coordinated through the medical home.
“Companies are coming out that will charge a certain fee to be able to provide [telemedicine services] to patients at home, but that adds to fragmentation” of care, Dr. Marcin said. “If you see a doctor online and get treated for an ear infection, and go see your regular doctor, and go to a retail-based clinic the next day, you have three different providers, three different opinions, and maybe three different prescriptions. That’s not going to help further the care of the child.”
Among its recommendations, the AAP calls for reducing barriers to telemedicine, such as the cost of telemedicine implementation and support, and the lack of reimbursement for physicians who provide telemedicine. Not all states pay equally for telemedicine services nor recognize rules by the Centers for Medicare & Medicaid Services and the Joint Commission on privileging by proxy for telemedicine providers.
Insurance coverage for telemedicine services greatly depends on the state and each state’s Medicaid program, explained Dr. Mary Ellen Rimsza, chair of the AAP Committee on Pediatric Workforce and a professor at the University of Arizona, Tucson.
“For private insurance companies, [coverage] is highly variable,” Dr. Rimsza said in an interview. “Particularly, if they don’t have a big network of physicians, it would be especially important to [cover] telemedicine. Obviously, physicians can’t do it if they are not going to get paid.”
Other obstacles include a general absence of malpractice coverage for telemedicine, and failure to consider the delivery of telemedicine in hospital and practice-based credentialing and privileging policies. Stable funding methods should be developed by both public and private payers to support the continued growth and maintenance of telemedicine, the AAP recommended in its opinion. The academy also stressed the importance of further research to study the effectiveness of telemedicine and the development of financial incentives for health providers that demonstrate health care improvements linked to telemedicine usage.
The opinion notes that telemedicine topics should be included in existing medical school and residency curricula, as well as CME courses. In addition to the opinion, a separate paper in the June 29 Pediatrics (doi:10.1542/peds.2015-1517) discusses applications for telemedicine in pediatric medicine.
Dr. Rimsza hopes the AAP’s policy statement helps to increase knowledge about telemedicine, possible usages for pediatricians, and challenges faced by physicians who use the technology.
“We hope that it will raise awareness about some of the barriers to telemedicine and the importance of how the care is delivered, within the medical home, especially,” she said. “We plan to use the policy statement as various legislation is presented both at the national and local levels.”
On Twitter@legal_med
The American Academy of Pediatrics is advocating for the expansion of pediatric telemedicine to increase access to care for underserved communities and improve quality of care for children.
In an opinion published online June 29 in Pediatrics, the AAP called for a reduction in ongoing barriers to telemedicine, equitable pay for telemedicine doctors, and further efforts to facilitate interstate licensure (Pediatrics 2015 [doi:10.1542/peds.2015-1253]).
At the same time, AAP warns that fragmented telemedicine services should be avoided, and that use of telemedicine for episodic care should be done within the context of the medical home. The timing is right for the AAP opinion because of increasing telemedicine technology, and the need to distinguish between responsible telemedicine and otherwise, said Dr. James P. Marcin, lead author of the opinion and a pediatrician at the University of California, Davis, Children’s Hospital in Sacramento.
“The technologies are booming and becoming more and more available, including things that might take [telemedicine] in the wrong direction, such as direct-to-consumer, online services,” Dr. Marcin said in an interview. “Telemedicine is a really great opportunity to strengthen the medical home, increase access, and provide better, more efficient care to children, but there’s also market forces in place [affecting telemedicine] that may not address the priorities of the AAP.”
In its opinion, the AAP writes that the use of telemedicine technologies by primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists has “the potential to transform the practice of pediatrics.” For example, telemedicine technology may improve models of care within the medical home by enhancing communication among health providers and contributing to better, more efficient care, according to the policy statement. Such models also may serve as a platform for more continuous care and the linking of primary and specialty services to better treat complex patients.
In addition, pediatric physicians working in remote locations can use telemedicine to receive ongoing medical education. Consultations, case discussions, and ongoing clinical support also can be enhanced by telemedicine, according to the AAP policy statement.
However, the academy adds that telemedicine used for episodic care by nonmedical home providers could disrupt continuity of care and “create redundancy and imprudent use of health care resources.” Such fragmentation is not the proper way to practice telemedicine, and the usage should be avoided, the AAP said in its opinion. The practice of telemedicine instead should be coordinated through the medical home.
“Companies are coming out that will charge a certain fee to be able to provide [telemedicine services] to patients at home, but that adds to fragmentation” of care, Dr. Marcin said. “If you see a doctor online and get treated for an ear infection, and go see your regular doctor, and go to a retail-based clinic the next day, you have three different providers, three different opinions, and maybe three different prescriptions. That’s not going to help further the care of the child.”
Among its recommendations, the AAP calls for reducing barriers to telemedicine, such as the cost of telemedicine implementation and support, and the lack of reimbursement for physicians who provide telemedicine. Not all states pay equally for telemedicine services nor recognize rules by the Centers for Medicare & Medicaid Services and the Joint Commission on privileging by proxy for telemedicine providers.
Insurance coverage for telemedicine services greatly depends on the state and each state’s Medicaid program, explained Dr. Mary Ellen Rimsza, chair of the AAP Committee on Pediatric Workforce and a professor at the University of Arizona, Tucson.
“For private insurance companies, [coverage] is highly variable,” Dr. Rimsza said in an interview. “Particularly, if they don’t have a big network of physicians, it would be especially important to [cover] telemedicine. Obviously, physicians can’t do it if they are not going to get paid.”
Other obstacles include a general absence of malpractice coverage for telemedicine, and failure to consider the delivery of telemedicine in hospital and practice-based credentialing and privileging policies. Stable funding methods should be developed by both public and private payers to support the continued growth and maintenance of telemedicine, the AAP recommended in its opinion. The academy also stressed the importance of further research to study the effectiveness of telemedicine and the development of financial incentives for health providers that demonstrate health care improvements linked to telemedicine usage.
The opinion notes that telemedicine topics should be included in existing medical school and residency curricula, as well as CME courses. In addition to the opinion, a separate paper in the June 29 Pediatrics (doi:10.1542/peds.2015-1517) discusses applications for telemedicine in pediatric medicine.
Dr. Rimsza hopes the AAP’s policy statement helps to increase knowledge about telemedicine, possible usages for pediatricians, and challenges faced by physicians who use the technology.
“We hope that it will raise awareness about some of the barriers to telemedicine and the importance of how the care is delivered, within the medical home, especially,” she said. “We plan to use the policy statement as various legislation is presented both at the national and local levels.”
On Twitter@legal_med
Supreme Court upholds use of federal subsidies under ACA
In a decision that keeps the Affordable Care Act intact, the U.S. Supreme Court has upheld the use of federal subsidies under the health law in states that have not created state-run marketplaces.
With a 6-3 vote in favor of the Obama administration, justices ruled that residents in states that rely on the federal marketplace are eligible for tax credits to purchase insurance, based on the high court’s interpretation of ACA language.
In their opinion, justices said the context and structure of the act’s language compel the conclusion that tax credits are available for insurance purchased on any exchange created under the law. The credits are necessary for the federal exchanges to function like their state exchange counterparts, the high court stated, and to avoid calamitous results that Congress intended to avoid.
“When read in context, the phrase ‘an exchange established by the state’ [in the ACA], is properly viewed as ambiguous,” the majority justices said. “The phrase may be limited in its reach to state exchanges. But it could also refer to all exchanges – both state and federal – for purposes of the tax credits. If a state chooses not to follow the directive to establish an exchange, the Act tells [HHS] to establish ‘such exchange.’ By using the words ‘such exchange,’ the Act indicates that state and federal exchanges should be the same.”
President Obama quickly praised the decision, calling it a win for the nation and a testament to the law’s value.
“The Court upheld a critical part of this law; the part that’s made it easier for Americans to afford health insurance, regardless of where you live,” President Obama said during a press conference. The ruling “is a victory to hardworking Americans all across this country whose lives will continue to become more secure in a changing economy because of this law.”
Supporters for the plaintiff issued sharp criticism of the decision and the ACA itself.
The “ruling is deeply disappointing, but it does not change the fact that Obamacare is a fundamentally flawed law,” House Ways and Means Committee Chair Paul Ryan (R-Wisc.) said in a statement. “It’s increasing health care costs, reducing coverage choices, and weighing down our economy. We need a system that makes coverage more affordable and puts patients – not Washington – in charge of health care decisions.”
Former Arkansas Gov. Mike Huckabee, a 2016 Republican presidential candidate, went a step farther, calling the Supreme Court decision “an out-of-control act of judicial tyranny.”
“Our Founding Fathers didn’t create a “do-over” provision in our Constitution that allows unelected Supreme Court justices the power to circumvent Congress and rewrite bad laws,” Mr. Huckabee said in a statement.
Meanwhile, the American Medial Association and other physician leaders expressed relief at the decision, stressing that millions of patients can now continue to access necessary health care.
“The subsidies upheld today help patients afford health insurance so they can see a doctor when they need one and not have to wait until a small health problem becomes a crisis,” AMA President Steven J. Stack said in a statement. “The subsidies provide patients with peace of mind that they will not risk bankruptcy should they become seriously ill or injured and experience catastrophic health care costs.”
The closely watched case was heard before the Supreme Court on March 4, and analysts had issued mixed predictions about how justices would find. The case centered on a handful of words in the ACA’s language that states tax credits apply to insurance purchased through an exchange “established by the state.” Challengers argued the language did not mention the federal exchange and that subsidies should be available only for purchases through state exchanges.
However, the Supreme Court countered this interpretation, arguing that such a reading would destabilize the individual insurance market in any state with a federal exchange, and likely create the death spirals that Congress designed the law to avoid.
“Under petitioners’ reading … one of the Act’s three major reforms – the tax credits – would not apply. And a second major reform – the coverage requirement – would not apply in a meaningful way, because so many individuals would be exempt from the requirement without the tax credits. If petitioners are right, therefore, only one of the Act’s three major reforms would apply in states with a federal exchange. … It is implausible that Congress meant the Act to operate in this manner,” the majority justices wrote in their decision.
Justice Antonin Scalia, Justice Clarence Thomas, and Justice Samuel Alito Jr. disagreed. The dissenters accused the majority of failing to interpret the ACA and instead rewriting the law as they saw fit.
“Words no longer have meaning if an exchange that is not established by a state is ‘established by the state,’ ” Justice Scalia wrote in his dissent. “It is hard to come up with a clearer way to limit tax credits to state exchanges than to use the words ‘established by the state. And it is hard to come up with a reason to include the words ‘by the state’ other than the purpose of limiting credits to state exchanges.”
Justice Scalia and his fellow dissenters added that normal rules of interpretation don’t appear to apply to a Court that yields always to the overriding principle of saving the ACA.
“Having transformed two major parts of the law, the Court today has turned its attention to a third,” Justice Scalia wrote. “The Act that Congress passed makes tax credits available only on an ‘exchange established by the state.’ This Court, however, concludes that this limitation would prevent the rest of the Act from working as well as hoped. So it rewrites the law to make tax credits available everywhere. We should start calling this law SCOTUScare.”
On Twitter @legal_med
This story was updated 6/25/2015.
In a decision that keeps the Affordable Care Act intact, the U.S. Supreme Court has upheld the use of federal subsidies under the health law in states that have not created state-run marketplaces.
With a 6-3 vote in favor of the Obama administration, justices ruled that residents in states that rely on the federal marketplace are eligible for tax credits to purchase insurance, based on the high court’s interpretation of ACA language.
In their opinion, justices said the context and structure of the act’s language compel the conclusion that tax credits are available for insurance purchased on any exchange created under the law. The credits are necessary for the federal exchanges to function like their state exchange counterparts, the high court stated, and to avoid calamitous results that Congress intended to avoid.
“When read in context, the phrase ‘an exchange established by the state’ [in the ACA], is properly viewed as ambiguous,” the majority justices said. “The phrase may be limited in its reach to state exchanges. But it could also refer to all exchanges – both state and federal – for purposes of the tax credits. If a state chooses not to follow the directive to establish an exchange, the Act tells [HHS] to establish ‘such exchange.’ By using the words ‘such exchange,’ the Act indicates that state and federal exchanges should be the same.”
President Obama quickly praised the decision, calling it a win for the nation and a testament to the law’s value.
“The Court upheld a critical part of this law; the part that’s made it easier for Americans to afford health insurance, regardless of where you live,” President Obama said during a press conference. The ruling “is a victory to hardworking Americans all across this country whose lives will continue to become more secure in a changing economy because of this law.”
Supporters for the plaintiff issued sharp criticism of the decision and the ACA itself.
The “ruling is deeply disappointing, but it does not change the fact that Obamacare is a fundamentally flawed law,” House Ways and Means Committee Chair Paul Ryan (R-Wisc.) said in a statement. “It’s increasing health care costs, reducing coverage choices, and weighing down our economy. We need a system that makes coverage more affordable and puts patients – not Washington – in charge of health care decisions.”
Former Arkansas Gov. Mike Huckabee, a 2016 Republican presidential candidate, went a step farther, calling the Supreme Court decision “an out-of-control act of judicial tyranny.”
“Our Founding Fathers didn’t create a “do-over” provision in our Constitution that allows unelected Supreme Court justices the power to circumvent Congress and rewrite bad laws,” Mr. Huckabee said in a statement.
Meanwhile, the American Medial Association and other physician leaders expressed relief at the decision, stressing that millions of patients can now continue to access necessary health care.
“The subsidies upheld today help patients afford health insurance so they can see a doctor when they need one and not have to wait until a small health problem becomes a crisis,” AMA President Steven J. Stack said in a statement. “The subsidies provide patients with peace of mind that they will not risk bankruptcy should they become seriously ill or injured and experience catastrophic health care costs.”
The closely watched case was heard before the Supreme Court on March 4, and analysts had issued mixed predictions about how justices would find. The case centered on a handful of words in the ACA’s language that states tax credits apply to insurance purchased through an exchange “established by the state.” Challengers argued the language did not mention the federal exchange and that subsidies should be available only for purchases through state exchanges.
However, the Supreme Court countered this interpretation, arguing that such a reading would destabilize the individual insurance market in any state with a federal exchange, and likely create the death spirals that Congress designed the law to avoid.
“Under petitioners’ reading … one of the Act’s three major reforms – the tax credits – would not apply. And a second major reform – the coverage requirement – would not apply in a meaningful way, because so many individuals would be exempt from the requirement without the tax credits. If petitioners are right, therefore, only one of the Act’s three major reforms would apply in states with a federal exchange. … It is implausible that Congress meant the Act to operate in this manner,” the majority justices wrote in their decision.
Justice Antonin Scalia, Justice Clarence Thomas, and Justice Samuel Alito Jr. disagreed. The dissenters accused the majority of failing to interpret the ACA and instead rewriting the law as they saw fit.
“Words no longer have meaning if an exchange that is not established by a state is ‘established by the state,’ ” Justice Scalia wrote in his dissent. “It is hard to come up with a clearer way to limit tax credits to state exchanges than to use the words ‘established by the state. And it is hard to come up with a reason to include the words ‘by the state’ other than the purpose of limiting credits to state exchanges.”
Justice Scalia and his fellow dissenters added that normal rules of interpretation don’t appear to apply to a Court that yields always to the overriding principle of saving the ACA.
“Having transformed two major parts of the law, the Court today has turned its attention to a third,” Justice Scalia wrote. “The Act that Congress passed makes tax credits available only on an ‘exchange established by the state.’ This Court, however, concludes that this limitation would prevent the rest of the Act from working as well as hoped. So it rewrites the law to make tax credits available everywhere. We should start calling this law SCOTUScare.”
On Twitter @legal_med
This story was updated 6/25/2015.
In a decision that keeps the Affordable Care Act intact, the U.S. Supreme Court has upheld the use of federal subsidies under the health law in states that have not created state-run marketplaces.
With a 6-3 vote in favor of the Obama administration, justices ruled that residents in states that rely on the federal marketplace are eligible for tax credits to purchase insurance, based on the high court’s interpretation of ACA language.
In their opinion, justices said the context and structure of the act’s language compel the conclusion that tax credits are available for insurance purchased on any exchange created under the law. The credits are necessary for the federal exchanges to function like their state exchange counterparts, the high court stated, and to avoid calamitous results that Congress intended to avoid.
“When read in context, the phrase ‘an exchange established by the state’ [in the ACA], is properly viewed as ambiguous,” the majority justices said. “The phrase may be limited in its reach to state exchanges. But it could also refer to all exchanges – both state and federal – for purposes of the tax credits. If a state chooses not to follow the directive to establish an exchange, the Act tells [HHS] to establish ‘such exchange.’ By using the words ‘such exchange,’ the Act indicates that state and federal exchanges should be the same.”
President Obama quickly praised the decision, calling it a win for the nation and a testament to the law’s value.
“The Court upheld a critical part of this law; the part that’s made it easier for Americans to afford health insurance, regardless of where you live,” President Obama said during a press conference. The ruling “is a victory to hardworking Americans all across this country whose lives will continue to become more secure in a changing economy because of this law.”
Supporters for the plaintiff issued sharp criticism of the decision and the ACA itself.
The “ruling is deeply disappointing, but it does not change the fact that Obamacare is a fundamentally flawed law,” House Ways and Means Committee Chair Paul Ryan (R-Wisc.) said in a statement. “It’s increasing health care costs, reducing coverage choices, and weighing down our economy. We need a system that makes coverage more affordable and puts patients – not Washington – in charge of health care decisions.”
Former Arkansas Gov. Mike Huckabee, a 2016 Republican presidential candidate, went a step farther, calling the Supreme Court decision “an out-of-control act of judicial tyranny.”
“Our Founding Fathers didn’t create a “do-over” provision in our Constitution that allows unelected Supreme Court justices the power to circumvent Congress and rewrite bad laws,” Mr. Huckabee said in a statement.
Meanwhile, the American Medial Association and other physician leaders expressed relief at the decision, stressing that millions of patients can now continue to access necessary health care.
“The subsidies upheld today help patients afford health insurance so they can see a doctor when they need one and not have to wait until a small health problem becomes a crisis,” AMA President Steven J. Stack said in a statement. “The subsidies provide patients with peace of mind that they will not risk bankruptcy should they become seriously ill or injured and experience catastrophic health care costs.”
The closely watched case was heard before the Supreme Court on March 4, and analysts had issued mixed predictions about how justices would find. The case centered on a handful of words in the ACA’s language that states tax credits apply to insurance purchased through an exchange “established by the state.” Challengers argued the language did not mention the federal exchange and that subsidies should be available only for purchases through state exchanges.
However, the Supreme Court countered this interpretation, arguing that such a reading would destabilize the individual insurance market in any state with a federal exchange, and likely create the death spirals that Congress designed the law to avoid.
“Under petitioners’ reading … one of the Act’s three major reforms – the tax credits – would not apply. And a second major reform – the coverage requirement – would not apply in a meaningful way, because so many individuals would be exempt from the requirement without the tax credits. If petitioners are right, therefore, only one of the Act’s three major reforms would apply in states with a federal exchange. … It is implausible that Congress meant the Act to operate in this manner,” the majority justices wrote in their decision.
Justice Antonin Scalia, Justice Clarence Thomas, and Justice Samuel Alito Jr. disagreed. The dissenters accused the majority of failing to interpret the ACA and instead rewriting the law as they saw fit.
“Words no longer have meaning if an exchange that is not established by a state is ‘established by the state,’ ” Justice Scalia wrote in his dissent. “It is hard to come up with a clearer way to limit tax credits to state exchanges than to use the words ‘established by the state. And it is hard to come up with a reason to include the words ‘by the state’ other than the purpose of limiting credits to state exchanges.”
Justice Scalia and his fellow dissenters added that normal rules of interpretation don’t appear to apply to a Court that yields always to the overriding principle of saving the ACA.
“Having transformed two major parts of the law, the Court today has turned its attention to a third,” Justice Scalia wrote. “The Act that Congress passed makes tax credits available only on an ‘exchange established by the state.’ This Court, however, concludes that this limitation would prevent the rest of the Act from working as well as hoped. So it rewrites the law to make tax credits available everywhere. We should start calling this law SCOTUScare.”
On Twitter @legal_med
This story was updated 6/25/2015.
Court: Telemedicine abortions cannot be banned in Iowa
Iowa physicians cannot be prohibited from using telemedicine to prescribe abortion-inducing medication to patients, according to a recent ruling by the state Supreme Court.
The Iowa Supreme Court overturned a lower court ruling that upheld a 2013 ban of the practice by the Iowa Board of Medicine. The ban places an “undue burden” on a woman’s right to an abortion and violates the state Constitution, the Supreme Court justices said.
Suzanna M. de Baca, president and CEO of Planned Parenthood of the Heartland, said the ruling protects women’s access to a safe, legal abortion.
“Medical experts opposed this law because it harms women by blocking access to safe medical care,” Ms. de Baca said in a statement. “When it comes to health care, politics should never trump medicine.”
Iowa Board of Medicine officials argued that a physical examination by a physician before the abortion and a follow-up examination after the abortion are essential, given the health risks associated with abortion-inducing drugs.
“The rule was adopted to address what the board saw as the unsafe practice of medicine, and not to place an undue burden on women who choose to terminate their pregnancies,” Mark Bowden, the board’s executive director, said in a statement. “The board will discuss the opinion at its meeting to determine its full application.”
The legal dispute began in 2013 when the Iowa Board of Medicine passed a rule that established standards of practice for physicians who prescribe or administer abortion-inducing drugs. The rules required that physicians personally perform a physical examination and be physically present when the abortion-inducing drug is provided. The regulation effectively prevented doctors from providing abortion treatment through telemedicine, a practice that Planned Parenthood clinics had used since 2008, according to court documents.
The rule immediately drew criticism, including from the Iowa Medical Society (IMS). In an October 2013 letter to the Board of Medicine, Jeanine Freeman, then-IMS legal counsel, wrote that board members failed to show that physicians – particularly those who care for pregnant women – agreed that the rule’s criteria were necessary and appropriate to assure patient safety and health. The board also made no effort to seek expertise, to consider other protocols, or to come to reasonable consensus on medical practice and patient safety, Ms. Freeman wrote.
And despite the Board of Medicine’s statement that the criteria in the rule would relate only to drug-induced telemedicine abortions, the medical society raised concerns about the impact of the rule on other areas of telemedicine.
“The criteria adopted here essentially eliminate telemedicine as a mechanism for the delivery of this medical service with little explanation and inadequate grounding in medical practice standards,” Ms. Freeman wrote.
Through its executive vice president, the Iowa Medical Society declined to comment for this article.
Planned Parenthood of the Heartland, which includes Iowa, sued over the rule in 2013. The regulation was temporarily halted pending the case’s outcome. In 2014, a district court ruled in favor of the Board of Medicine, and Planned Parenthood appealed. In the June 19 decision, the Iowa Supreme Court reversed the lower court decision, ruling that the burden placed on women seeking to terminate a pregnancy outweighed the Board of Medicine’s justification for its rule.
“An issue of equal protection of the laws is lurking in this case,” the justices wrote. “The board appears to hold abortion to a different medical standard than other procedures.”
Iowa is not the first state to institute a prohibition against medication abortions via telemedicine. At least 16 states require that a clinician providing a medication abortion be physically present during the procedure, thereby prohibiting the use of telemedicine to prescribe medication for abortion remotely, according to a June 2015 report by the Guttmacher Institute, a nonprofit research and education group focused on advancing reproductive health.
On Twitter@legal_med
Iowa physicians cannot be prohibited from using telemedicine to prescribe abortion-inducing medication to patients, according to a recent ruling by the state Supreme Court.
The Iowa Supreme Court overturned a lower court ruling that upheld a 2013 ban of the practice by the Iowa Board of Medicine. The ban places an “undue burden” on a woman’s right to an abortion and violates the state Constitution, the Supreme Court justices said.
Suzanna M. de Baca, president and CEO of Planned Parenthood of the Heartland, said the ruling protects women’s access to a safe, legal abortion.
“Medical experts opposed this law because it harms women by blocking access to safe medical care,” Ms. de Baca said in a statement. “When it comes to health care, politics should never trump medicine.”
Iowa Board of Medicine officials argued that a physical examination by a physician before the abortion and a follow-up examination after the abortion are essential, given the health risks associated with abortion-inducing drugs.
“The rule was adopted to address what the board saw as the unsafe practice of medicine, and not to place an undue burden on women who choose to terminate their pregnancies,” Mark Bowden, the board’s executive director, said in a statement. “The board will discuss the opinion at its meeting to determine its full application.”
The legal dispute began in 2013 when the Iowa Board of Medicine passed a rule that established standards of practice for physicians who prescribe or administer abortion-inducing drugs. The rules required that physicians personally perform a physical examination and be physically present when the abortion-inducing drug is provided. The regulation effectively prevented doctors from providing abortion treatment through telemedicine, a practice that Planned Parenthood clinics had used since 2008, according to court documents.
The rule immediately drew criticism, including from the Iowa Medical Society (IMS). In an October 2013 letter to the Board of Medicine, Jeanine Freeman, then-IMS legal counsel, wrote that board members failed to show that physicians – particularly those who care for pregnant women – agreed that the rule’s criteria were necessary and appropriate to assure patient safety and health. The board also made no effort to seek expertise, to consider other protocols, or to come to reasonable consensus on medical practice and patient safety, Ms. Freeman wrote.
And despite the Board of Medicine’s statement that the criteria in the rule would relate only to drug-induced telemedicine abortions, the medical society raised concerns about the impact of the rule on other areas of telemedicine.
“The criteria adopted here essentially eliminate telemedicine as a mechanism for the delivery of this medical service with little explanation and inadequate grounding in medical practice standards,” Ms. Freeman wrote.
Through its executive vice president, the Iowa Medical Society declined to comment for this article.
Planned Parenthood of the Heartland, which includes Iowa, sued over the rule in 2013. The regulation was temporarily halted pending the case’s outcome. In 2014, a district court ruled in favor of the Board of Medicine, and Planned Parenthood appealed. In the June 19 decision, the Iowa Supreme Court reversed the lower court decision, ruling that the burden placed on women seeking to terminate a pregnancy outweighed the Board of Medicine’s justification for its rule.
“An issue of equal protection of the laws is lurking in this case,” the justices wrote. “The board appears to hold abortion to a different medical standard than other procedures.”
Iowa is not the first state to institute a prohibition against medication abortions via telemedicine. At least 16 states require that a clinician providing a medication abortion be physically present during the procedure, thereby prohibiting the use of telemedicine to prescribe medication for abortion remotely, according to a June 2015 report by the Guttmacher Institute, a nonprofit research and education group focused on advancing reproductive health.
On Twitter@legal_med
Iowa physicians cannot be prohibited from using telemedicine to prescribe abortion-inducing medication to patients, according to a recent ruling by the state Supreme Court.
The Iowa Supreme Court overturned a lower court ruling that upheld a 2013 ban of the practice by the Iowa Board of Medicine. The ban places an “undue burden” on a woman’s right to an abortion and violates the state Constitution, the Supreme Court justices said.
Suzanna M. de Baca, president and CEO of Planned Parenthood of the Heartland, said the ruling protects women’s access to a safe, legal abortion.
“Medical experts opposed this law because it harms women by blocking access to safe medical care,” Ms. de Baca said in a statement. “When it comes to health care, politics should never trump medicine.”
Iowa Board of Medicine officials argued that a physical examination by a physician before the abortion and a follow-up examination after the abortion are essential, given the health risks associated with abortion-inducing drugs.
“The rule was adopted to address what the board saw as the unsafe practice of medicine, and not to place an undue burden on women who choose to terminate their pregnancies,” Mark Bowden, the board’s executive director, said in a statement. “The board will discuss the opinion at its meeting to determine its full application.”
The legal dispute began in 2013 when the Iowa Board of Medicine passed a rule that established standards of practice for physicians who prescribe or administer abortion-inducing drugs. The rules required that physicians personally perform a physical examination and be physically present when the abortion-inducing drug is provided. The regulation effectively prevented doctors from providing abortion treatment through telemedicine, a practice that Planned Parenthood clinics had used since 2008, according to court documents.
The rule immediately drew criticism, including from the Iowa Medical Society (IMS). In an October 2013 letter to the Board of Medicine, Jeanine Freeman, then-IMS legal counsel, wrote that board members failed to show that physicians – particularly those who care for pregnant women – agreed that the rule’s criteria were necessary and appropriate to assure patient safety and health. The board also made no effort to seek expertise, to consider other protocols, or to come to reasonable consensus on medical practice and patient safety, Ms. Freeman wrote.
And despite the Board of Medicine’s statement that the criteria in the rule would relate only to drug-induced telemedicine abortions, the medical society raised concerns about the impact of the rule on other areas of telemedicine.
“The criteria adopted here essentially eliminate telemedicine as a mechanism for the delivery of this medical service with little explanation and inadequate grounding in medical practice standards,” Ms. Freeman wrote.
Through its executive vice president, the Iowa Medical Society declined to comment for this article.
Planned Parenthood of the Heartland, which includes Iowa, sued over the rule in 2013. The regulation was temporarily halted pending the case’s outcome. In 2014, a district court ruled in favor of the Board of Medicine, and Planned Parenthood appealed. In the June 19 decision, the Iowa Supreme Court reversed the lower court decision, ruling that the burden placed on women seeking to terminate a pregnancy outweighed the Board of Medicine’s justification for its rule.
“An issue of equal protection of the laws is lurking in this case,” the justices wrote. “The board appears to hold abortion to a different medical standard than other procedures.”
Iowa is not the first state to institute a prohibition against medication abortions via telemedicine. At least 16 states require that a clinician providing a medication abortion be physically present during the procedure, thereby prohibiting the use of telemedicine to prescribe medication for abortion remotely, according to a June 2015 report by the Guttmacher Institute, a nonprofit research and education group focused on advancing reproductive health.
On Twitter@legal_med
Feds charge 243 in huge Medicare fraud bust
A nationwide investigation by the federal Medicare Fraud Strike Force has led to health fraud charges against 243 people – including 46 medical providers – in the largest bust in strike force history.
The defendants are accused of various Medicare fraud schemes that involved $712 million in false billings to the Centers for Medicare & Medicaid Services, according to a joint announcement on June 18 by Health and Human Services Secretary Sylvia M. Burwell and Attorney General Loretta E. Lynch.
Among the allegations are that defendants submitted claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, Medicare beneficiaries, and other coconspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers so that physicians then could bill Medicare fraudulently, according to the announcement. The defendants include doctors, nurses, and other licensed professionals, along with lay individuals who participated in the alleged fraud. Several health professionals were also suspended from participating in federal government health care programs.
Accused defendants are from Los Angeles; Dallas, McAllen, and Houston, Tex.; Detroit; Brooklyn, N.Y.; Tampa and Miami; and New Orleans. Among the medical services involved in the alleged schemes are home health care, mental health services, pharmacy services, durable medical equipment, and physical and occupational therapy.
The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Department of Justice and HHS to prevent and deter fraud and enforce antifraud laws. Since its inception in March 2007, Strike Force operations in nine locations have charged more than 2,300 defendants for allegedly falsely billing more than $7 billion to the Medicare program.
On Twitter @legal_med
A nationwide investigation by the federal Medicare Fraud Strike Force has led to health fraud charges against 243 people – including 46 medical providers – in the largest bust in strike force history.
The defendants are accused of various Medicare fraud schemes that involved $712 million in false billings to the Centers for Medicare & Medicaid Services, according to a joint announcement on June 18 by Health and Human Services Secretary Sylvia M. Burwell and Attorney General Loretta E. Lynch.
Among the allegations are that defendants submitted claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, Medicare beneficiaries, and other coconspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers so that physicians then could bill Medicare fraudulently, according to the announcement. The defendants include doctors, nurses, and other licensed professionals, along with lay individuals who participated in the alleged fraud. Several health professionals were also suspended from participating in federal government health care programs.
Accused defendants are from Los Angeles; Dallas, McAllen, and Houston, Tex.; Detroit; Brooklyn, N.Y.; Tampa and Miami; and New Orleans. Among the medical services involved in the alleged schemes are home health care, mental health services, pharmacy services, durable medical equipment, and physical and occupational therapy.
The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Department of Justice and HHS to prevent and deter fraud and enforce antifraud laws. Since its inception in March 2007, Strike Force operations in nine locations have charged more than 2,300 defendants for allegedly falsely billing more than $7 billion to the Medicare program.
On Twitter @legal_med
A nationwide investigation by the federal Medicare Fraud Strike Force has led to health fraud charges against 243 people – including 46 medical providers – in the largest bust in strike force history.
The defendants are accused of various Medicare fraud schemes that involved $712 million in false billings to the Centers for Medicare & Medicaid Services, according to a joint announcement on June 18 by Health and Human Services Secretary Sylvia M. Burwell and Attorney General Loretta E. Lynch.
Among the allegations are that defendants submitted claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, Medicare beneficiaries, and other coconspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers so that physicians then could bill Medicare fraudulently, according to the announcement. The defendants include doctors, nurses, and other licensed professionals, along with lay individuals who participated in the alleged fraud. Several health professionals were also suspended from participating in federal government health care programs.
Accused defendants are from Los Angeles; Dallas, McAllen, and Houston, Tex.; Detroit; Brooklyn, N.Y.; Tampa and Miami; and New Orleans. Among the medical services involved in the alleged schemes are home health care, mental health services, pharmacy services, durable medical equipment, and physical and occupational therapy.
The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Department of Justice and HHS to prevent and deter fraud and enforce antifraud laws. Since its inception in March 2007, Strike Force operations in nine locations have charged more than 2,300 defendants for allegedly falsely billing more than $7 billion to the Medicare program.
On Twitter @legal_med
VIDEO: How to avoid questionable physician compensation arrangements
CHICAGO – The U.S. Department of Health & Human Service’s Office of Inspector General (OIG) is warning doctors to be wary of improper physician arrangements that could violate the federal Anti-Kickback Statute.
The federal law prohibits doctors from receiving any form of payment in exchange for past or future patient referrals under the Medicare or Medicaid programs.
The OIG recently reached settlements with 12 individual physicians who entered into questionable medical directorship and office staff arrangements. The agency stated money paid to the doctors was improper because the payments took into account volume or value of referrals and did not reflect fair market value for services provided.
Physicians sometimes enter into questionable physicians arrangements, such as medical directorships, without fully understanding if they are proper, said attorney Adrienne Dresevic, who spoke at a recent conference held by the American Bar Association.
In a video interview during the conference, Ms. Dresevic discussed common physician compensation arrangements that come under government scrutiny and how well-intentioned doctors can fall prey to Anti-Kickback Statute allegations. Ms. Dresevic, who practices health law in Southfield, Mich., also spoke about how physicians can avoid risky physician compensation arrangements.
CHICAGO – The U.S. Department of Health & Human Service’s Office of Inspector General (OIG) is warning doctors to be wary of improper physician arrangements that could violate the federal Anti-Kickback Statute.
The federal law prohibits doctors from receiving any form of payment in exchange for past or future patient referrals under the Medicare or Medicaid programs.
The OIG recently reached settlements with 12 individual physicians who entered into questionable medical directorship and office staff arrangements. The agency stated money paid to the doctors was improper because the payments took into account volume or value of referrals and did not reflect fair market value for services provided.
Physicians sometimes enter into questionable physicians arrangements, such as medical directorships, without fully understanding if they are proper, said attorney Adrienne Dresevic, who spoke at a recent conference held by the American Bar Association.
In a video interview during the conference, Ms. Dresevic discussed common physician compensation arrangements that come under government scrutiny and how well-intentioned doctors can fall prey to Anti-Kickback Statute allegations. Ms. Dresevic, who practices health law in Southfield, Mich., also spoke about how physicians can avoid risky physician compensation arrangements.
CHICAGO – The U.S. Department of Health & Human Service’s Office of Inspector General (OIG) is warning doctors to be wary of improper physician arrangements that could violate the federal Anti-Kickback Statute.
The federal law prohibits doctors from receiving any form of payment in exchange for past or future patient referrals under the Medicare or Medicaid programs.
The OIG recently reached settlements with 12 individual physicians who entered into questionable medical directorship and office staff arrangements. The agency stated money paid to the doctors was improper because the payments took into account volume or value of referrals and did not reflect fair market value for services provided.
Physicians sometimes enter into questionable physicians arrangements, such as medical directorships, without fully understanding if they are proper, said attorney Adrienne Dresevic, who spoke at a recent conference held by the American Bar Association.
In a video interview during the conference, Ms. Dresevic discussed common physician compensation arrangements that come under government scrutiny and how well-intentioned doctors can fall prey to Anti-Kickback Statute allegations. Ms. Dresevic, who practices health law in Southfield, Mich., also spoke about how physicians can avoid risky physician compensation arrangements.
EXPERT ANALYSIS FROM THE PHYSICIANS LEGAL ISSUES CONFERENCE
VIDEO: The Most Pressing Health Law Risks for Clinicians
CHICAGO – From Stark law to HIPAA violations to whistle-blower claims, clinicians face a litany of legal land mines in today’s practice landscape.
Not only that, but rules and regulations are constantly changing, and the government continues to increase its scope in some areas, said Michael E. Clark, chair of the American Bar Association Health Law Section.
Clinicians should be mindful of the new – and old – laws that impact them and take steps to prevent legal scrutiny, Mr. Clark advised during a conference held by the American Bar Association.
In a video interview at the conference, Mr. Clark discussed the most pressing health law issues for clinicians and ways in which they can avoid such risks. Mr. Clark, who practices health law in Houston, also shared his perspectives on what the future holds for upcoming legal dangers.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – From Stark law to HIPAA violations to whistle-blower claims, clinicians face a litany of legal land mines in today’s practice landscape.
Not only that, but rules and regulations are constantly changing, and the government continues to increase its scope in some areas, said Michael E. Clark, chair of the American Bar Association Health Law Section.
Clinicians should be mindful of the new – and old – laws that impact them and take steps to prevent legal scrutiny, Mr. Clark advised during a conference held by the American Bar Association.
In a video interview at the conference, Mr. Clark discussed the most pressing health law issues for clinicians and ways in which they can avoid such risks. Mr. Clark, who practices health law in Houston, also shared his perspectives on what the future holds for upcoming legal dangers.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – From Stark law to HIPAA violations to whistle-blower claims, clinicians face a litany of legal land mines in today’s practice landscape.
Not only that, but rules and regulations are constantly changing, and the government continues to increase its scope in some areas, said Michael E. Clark, chair of the American Bar Association Health Law Section.
Clinicians should be mindful of the new – and old – laws that impact them and take steps to prevent legal scrutiny, Mr. Clark advised during a conference held by the American Bar Association.
In a video interview at the conference, Mr. Clark discussed the most pressing health law issues for clinicians and ways in which they can avoid such risks. Mr. Clark, who practices health law in Houston, also shared his perspectives on what the future holds for upcoming legal dangers.
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 THE PHYSICIANS LEGAL ISSUES CONFERENCE
VIDEO: The most pressing health law risks for physicians
CHICAGO – From Stark law to HIPAA violations to whistle-blower claims, physicians face a litany of legal land mines in today’s practice landscape.
Not only that, but rules and regulations are constantly changing, and the government continues to increase its scope in some areas, said Michael E. Clark, chair of the American Bar Association Health Law Section.
Physicians should be mindful of the new – and old – laws that impact them and take steps to prevent legal scrutiny, Mr. Clark advised during a conference held by the American Bar Association.
In a video interview at the conference, Mr. Clark discussed the most pressing health law issues for doctors and ways in which physicians can avoid such risks. Mr. Clark, who practices health law in Houston, also shared his perspectives on what the future holds for upcoming legal dangers.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – From Stark law to HIPAA violations to whistle-blower claims, physicians face a litany of legal land mines in today’s practice landscape.
Not only that, but rules and regulations are constantly changing, and the government continues to increase its scope in some areas, said Michael E. Clark, chair of the American Bar Association Health Law Section.
Physicians should be mindful of the new – and old – laws that impact them and take steps to prevent legal scrutiny, Mr. Clark advised during a conference held by the American Bar Association.
In a video interview at the conference, Mr. Clark discussed the most pressing health law issues for doctors and ways in which physicians can avoid such risks. Mr. Clark, who practices health law in Houston, also shared his perspectives on what the future holds for upcoming legal dangers.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – From Stark law to HIPAA violations to whistle-blower claims, physicians face a litany of legal land mines in today’s practice landscape.
Not only that, but rules and regulations are constantly changing, and the government continues to increase its scope in some areas, said Michael E. Clark, chair of the American Bar Association Health Law Section.
Physicians should be mindful of the new – and old – laws that impact them and take steps to prevent legal scrutiny, Mr. Clark advised during a conference held by the American Bar Association.
In a video interview at the conference, Mr. Clark discussed the most pressing health law issues for doctors and ways in which physicians can avoid such risks. Mr. Clark, who practices health law in Houston, also shared his perspectives on what the future holds for upcoming legal dangers.
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 THE PHYSICIANS LEGAL ISSUES CONFERENCE
