Healthcare Reform

Tracking Legislative & Regulatory Change

From Congressional budget deals that tweak Medicare conversion factors to state bills redefining scope of practice, our healthcare reform posts explain how evolving statutes may influence medical decision-making, office work-flows, and payer negotiations. We connect the dots between headline votes and real-world clinic operations, spotlighting key provisions on payment models, telehealth flexibility, prior authorization, and interstate licensure compacts.

Analyzing Agency Rules & Guidance

The Centers for Medicare & Medicaid Services, the FTC, and state boards frequently publish rulemakings that affect reimbursement and compliance. Our articles summarize the practical pieces—effective dates, required disclosures, documentation standards—so physicians can adjust coding processes, update consent language, or join new alternative payment programs with minimal disruption.

Physician Autonomy & Practice Economics

Healthcare reform debates often pivot on consolidation, ownership restrictions, and value-based care incentives. We discuss how policies such as site-neutral payment proposals, surprise-billing regulations, and antitrust enforcement may influence the viability of independent practices versus hospital employment. Posts highlight contract clauses to watch, pitfalls in acquiring ancillary services, and strategies for sustaining revenue as payment structures evolve.

Practical Tips Rooted in Real Cases

Every commentary includes actionable insights—sample language for payer appeals when codes are retired, talking points for patient cost-of-care conversations after a benefit redesign, and checklists for updating compliance manuals. We draw on Dr. Jeffrey Segal’s dual perspective as surgeon and attorney to illustrate how one practice modified its financial policy after a change in balance-billing rules, or how another leveraged state innovation waivers to expand telehealth reach.

Key Topics We Discuss

• MACRA and QPP updates
• Interoperability & information-blocking rules
• Scope-of-practice expansion bills
• Federal price-transparency mandates
• State efforts to curb prior authorization delays

A Tough Dilemma: Disclosing to Patients They May have Been Exposed to Creutzfeldt-Jakob Disease

August 15, 2024May 2, 2014 by Jeffrey Segal, MD, JD

Earlier this year, a number of media outlets reported that a North Carolina hospital was attempting to contact 18 neurosurgical patients who might have been exposed to Creutzfeldt-Jakob Disease (CJD). The potential source was a patient who had symptoms of CJD and had a neurosurgical procedure. Standard surgical instrument disinfection techniques are ineffective against … Read more

Guess Who’s Back Trying Med Mal Cases? John Edwards.

August 15, 2024April 19, 2014 by Jeffrey Segal, MD, JD

After a restful interlude, John Edwards has returned to his core competence – suing doctors.

Notes from a Plaintiff’s Attorney: Limiting the liability of patient portals

August 15, 2024April 11, 2014 by Jeffrey Segal, MD, JD

In the world of liability exposure, patient portals can be a blessing or a curse.

That is because they close gaps in communication that often lead to complaints and lawsuits but they also create updated standards that have to be met.

For example, through the use of a portal you can get information or inquiries from patients faster and more reliably, but once a communication from a patient has been received into your system you are charged with dealing with it and so you must have a way to bring it to your attention promptly.

Notes from a Plaintiff’s Attorney: Reporting a Deficient Physician

August 15, 2024April 4, 2014 by Jeffrey Segal, MD, JD

By Dr. JD, a plaintiff’s attorney, practicing in the Northeast

We continue our series of articles penned by one attorney, an MD, JD, giving you a view of the world through a malpractice plaintiff attorney’s eyes. This attorney is a seasoned veteran. The series includes a number of pearls on how to stay out of harm’s way. While I do not necessarily agree with 100% of the details of every article, I think the messages are salient, on target, and fully relevant. Please give us your feedback – and let us know if you find the series helpful.

The first question you must answer before you consider making a report is what do you actually know? That you not act without provable good cause is both a moral obligation and your defense if you are later accused of defamation.

Notes from a Plaintiff’s Attorney: Taking charge in your case – Impleader and Summary Judgment

August 15, 2024March 28, 2014 by Jeffrey Segal, MD, JD

By Dr. JD, a plaintiff’s attorney, practicing in the Northeast

A defendant doctor has options to change the landscape of the lawsuit against him – impleader and summary judgment.

Patient Privacy Breaches: Sexual, Creepy, and Illegal

August 15, 2024March 14, 2014 by Jeffrey Segal, MD, JD

by Michael J. Sacopulos, JD (General Counsel Medical Justice / Dental Justice)

Porn Stars Deserve Privacy, Too

Every day seems to bring word of new healthcare privacy breaches. A physician’s laptop goes missing in Illinois. A practice’s system is hacked in Maryland. Old patients’ charts turn up in a landfill in Ohio. Some of these breaches are not only frightening in terms of their ramifications, but they come across like plots of crime shows on TV. Here are some of the dramatic examples.

Porn Star HIV Test Database Leaked

Although porn stars are not typically known for their privacy concerns, they do often use stage names to keep their true identities confidential. In 2011, however, their personal lives were broadcast for the world to see, when medical test results and personal details about thousands of current and former porn performers were leaked.^[1]

Hospital WANTS Legal Case Against It Labeled as Medical Malpractice

August 15, 2024March 7, 2014 by Jeffrey Segal, MD, JD

If a patient is injured in a hospital, and a lawsuit emerges, it can fall under the category of “ordinary negligence” or “medical malpractice.” For cases that qualify as legal claims, the vast majority of such claims fall under the category “medical malpractice.”

Why does it even matter?

The two categories often have different statutes of limitations, damage caps, need for expert testimony, and so on. The cost to pursue the case and the amount of money which can be recovered may vary dramatically.

New Federal Minimum Wage Order and Doctors. Does It Affect You?

August 15, 2024February 28, 2014 by Jeffrey Segal, MD, JD

At the time of this writing, President Obama signaled he will be signing an Executive Order to increase the wage for workers under new federal contracts from $7.25 an hour to $10.10 an hour. Most doctors, of course, are not federal employees. But, most doctors accept reimbursement from the federal government under Medicare, … Read more

When Your Patient is a Wonderful Human Being; and His Family Is Not.

August 15, 2024February 21, 2014 by Jeffrey Segal, MD, JD

You are consulted to see a patient for possible surgery. On first meeting, he’s a great guy. But he’s 4+ sick. He had a heart transplant a number of years ago. Diabetes. COPD. And now he has an acute abdomen. He needs immediate attention. He’s awake, alert, and competent. You’ve discussed the risks, benefits, … Read more

Preventing a Lawsuit – Always Seek Consent Before Searching a Patient’s Anus

August 15, 2024February 14, 2014 by Jeffrey Segal, MD, JD

Drs. Michael Parsa and Christopher Cabanillas are employed by University Medical

Center of El Paso. They are two of numerous defendants in a lawsuit filed by the ACLU. Even though they are hospital employees, they are being sued in their individual capacity.

The plaintiff, Jane Doe, is a 54 year old New Mexico resident. She was visiting a family friend in Juarez, Mexico. On return, she crossed the bridge back to the US, where she was chosen at random for “additional screening.” This “secondary inspection” involved a pat-down where an agent “inserted her finger into the crevice of Ms. Doe’s buttocks.” Nothing was noted. But, that was not the end of this search.

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