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

Why Do Doctors Perceive Malpractice Lawsuits Differently Than Other Lawsuits?

August 15, 2024December 14, 2012 by Jeffrey Segal, MD, JD

A good question was posed on physician forum. Why do doctors treat medical malpractice differently than being in an auto accident? Shouldn’t we just turn it over to our carriers and be done with it?

The reason: The two systems have little in common. First, a med-mal lawsuit is packaged as an assault on your reputation. If you doubt that statement, just read the typical cut and paste summons. It often includes language such as “with willful and wanton neglect” and so on. It’s never couched in language such as “you are a talented doctor who made a mistake. We understand you are human and care deeply about your patients. But, with Mr. Smith, the injury has cost him lost wages and future medical costs.”

Accutane Litigation – The End Is Not Near

August 15, 2024December 7, 2012 by Jeffrey Segal, MD, JD

Gastroenterologist – and blogger – Michael Kirsch – brought the following two facts to my attention. In New Jersey, a jury awarded $18 million to two plaintiffs for damages related to the drug Accutane (isotretinoin). Was it because of the teratogenic effects of the medication on the unborn – a well described effect? No. … Read more

I Found It. A Benefit from the Affordable Care Act.

August 15, 2024November 30, 2012 by Jeffrey Segal, MD, JD

Finally…a non-controversial blog post.

My mother taught me not say anything if I could not say something nice. Suffice it to say, many times I have fallen short of that aspirational goal. And, diving deep into the Affordable Care Act, I could not find much positive to say.

In particular, there was almost nothing written about reigning in the dysfunctional medico-legal tort system. To the extent anything about med mal is buried in the ACA, it is limited to a “sense of the Senate” – a nonbinding statement used to express the position of the Senate on a particular issue. Through this language, the ACA suggests states should be prodded to “develop and test” alternatives to the existing medico-legal tort system. And Congress should “consider establishing a State demonstration” to run pilot projects on such solutions.” The ACA, however, includes no funding or binding provisions to those ends.

Our New Website

August 15, 2024November 23, 2012 by Jeffrey Segal, MD, JD

Technology moves fast these days. So fast sometimes it can be difficult to keep up. As part of our efforts to stay ahead of the curve, we have released a freshly redesigned website for Medical Justice. The new site boasts a variety of additions and improvements, so feel free to take it for a test … Read more

The Ethics of Amputating a Perfectly Healthy Leg

August 15, 2024November 16, 2012 by Jeffrey Segal, MD, JD

In 1997, Dr. Robert Smith, a Scottish surgeon saw a patient with an atypical request. He wanted the surgeon to amputate his perfectly healthy left leg. Why the request? The patient argued his left foot wasn’t part of him. “It felt alien.” Dr. Smith had the patient see a psychiatrist. The patient was diagnosed with Body Integrity Identity Disorder (BIID). Smith performed the operation. At follow-up a couple of years later, the patient reported his life was positively transformed by the operation. Word got out. Smith saw another such patient and performed a similar amputation. And the second patient also reported a positive result.

Then, the story hit the media. The public reacted. Smith was ordered by his hospital to cease and desist.

Can You Refuse to Operate on Patient with Hepatitis C?

August 15, 2024November 9, 2012 by Jeffrey Segal, MD, JD

Surgeons are typically afforded great latitude in choosing whether or not to operate on a patient. For example, Jehovah’s Witnesses generally eschew transfusion of blood products. If a Jehovah’s Witness needs a coronary artery bypass, you are not obligated to operate on this patient. You can, of course, send the patient to another surgeon who will accede to the restrictions. If you make the decision to cut, you must honor the patient’s religious request to avoid using blood products. But, if you’re not comfortable with the demand, you can Just Say No.

Further, you can generally refuse to operate on an elective patient because you don’t like him. If that is the real reason, and it’s not based on the fact the patient belongs to a particular protected class, such as race or religion, you’re typically on safe ground.

Can Anti-Aging Doctors Prescribe Human Growth Hormone as Elixir of Youth?

August 15, 2024November 2, 2012 by Jeffrey Segal, MD, JD

The FDA has been in the news lately. For those returning from two month news-free National Geographic vacation in Antarctica, a compounding pharmacy in Massachusetts was supplying vials of preservative free methyl-prednisolone for epidural injections and much more. Some of these vials were tainted with fungus. Many people got sick. Some died. The FDA does not typically have any statutory authority over such compounding pharmacies. But, anything related to pharmaceuticals gone bad gets the attention of the FDA. So, it took us a while to get an answer from the FDA about a completely unrelated item – also in the news, but less so.

The cycling world went public with evidence about performance enhancing ‘doping.” Doping is defined broadly, and includes anabolic steroids, EPO, human growth hormone, and more. Whether doping was or is ubiquitous in the cycling world is not the subject of this blog. It’s the question of whether doctors can prescribe various pharmaceuticals and stay on the right side of the law.

Steroid Injections and Meningitis. Lawsuits Begin. Doctors in Crossfire.

August 15, 2024October 26, 2012 by Jeffrey Segal, MD, JD

By now it’s common knowledge that a compounding pharmacy in Massachusetts delivered tainted preservative free methyl-prednisolone to a number of hospitals / clinics. The taint was a fungus. And morbidity and mortality have climbed.

Why did doctors/ facilities even order from a compounding pharmacy? Two reasons: First, the typical preservatives used to suppress fungus can wreak havoc if the injection accidentally strays into the spinal sac (CSF). So, preservative-free is, in principle, a good idea as it is impossible to know with certainty the injection is in the epidural space. There are ways to be quite sure – but not completely sure.

Lawyers Settle Case for Brain Injured Child. Gorge on Fees.

August 15, 2024October 19, 2012 by Jeffrey Segal, MD, JD

Warren West’s pregnant wife died during an emergency delivery in Nevada in 2005. His daughter was born with severe brain damage.

Attorney Chris Gellner filed a malpractice lawsuit. Another attorney, Dave Haley, served as guardian ad litem for the child.

Here’s what they negotiated. A $238,000 settlement. But, only $30,000 was to go to the daughter.

Notes from a Plaintiff Attorney: Covering Up

August 15, 2024October 12, 2012 by Jeffrey Segal, MD, JD

by Dr. J.D. – a physician and plaintiff’s attorney, practicing in the Northeast

It is sadly far from uncommon to hear physicians proudly stating that they withheld knowledge of malpractice by someone else from a patient because, well, that patient might sue.

That the choice to ally with someone who has harmed your patient and to deny your patient critical facts about their own health is an utter betrayal of the trust at the core of the physician-patient relationship is obvious.

However, it is also an excellent way to get yourself sued, and sued in a way that your malpractice insurance will not cover and that your malpractice carrier will not defend.

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