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

Magazine Proves MD Ratings Are Questionable

August 15, 2024November 2, 2010 by Jeffrey Segal, MD, JD

We have long questioned the validity of physician rating systems. Not just one, or some, but all MD rating systems. Even if you put two doctors in an identical circumstance, notions that the comparison between them is significant is questionable. 5280 Magazine, a publication for the Mile High city, may seem to be the exception. In reality, they prove the point for us.

Seeing the cover, though it seems quite charming. Smiling physician, complete with lab coat. A critical mind might expect a negative, though. After all, naming the top 2oo+ doctors within a city of 8000 practitioners is certain to be exclusionary. When one delves in and reads the story, though, it seems the rare exception. They’re not taking patient critiques. Quite the opposite, they’ve asked physicians to rate each other, and even gone so far as to do so in a positive fashion. They ask area physicians which doctor THEY would most trust, within a given specialty. Certainly that’s a fair appraisal, right? After all, it’s physicians performing the ratings, looking for the best. What could possibly be more fair than that?

Their methodology may seem entirely free of malevolence, without bias. Thinking it through, though, reveals the flaws. It’s still a popularity contest, even though qualified physicians are performing the “appraisals”. When you ask someone who THEY trust the most, that’s still a subjective opinion, perhaps based on many irrelevant factors. Most certainly, though, the result will come from within those physicians the individual comes into contact with, and therein lies the fatal flaw. A physician who is a social butterfly is going to be known by more people. If his reputation is that of an expert of great renown, if he speaks or educates often within the field, that will make it seem all the more certain that he’s the one to trust most, the best. The contest continues to ignore the fact that there may be several better practitioners within the field who are simply less celebrated. Perhaps they’re simply too busy treating patients with their excellence to be giving lectures or blowing their own horn. Regardless of the reason, they’re less known than the social butterfly, and yet the well-known figure is the one likely to gain the most votes.

Tort Reform Is Dead. Now What?

August 15, 2024October 26, 2010 by Jeffrey Segal, MD, JD

More than a few state Supreme Courts have overturned tort reform laws in the past year. The concept is that everyone is entitled to a trial by jury, and that the courts, not legislature, should decide how much is enough. Oddly enough, the legislative branches are often opposed to tort reform as well. Whether we agree or not is irrelevant. Enough Supreme Courts have spoken that we concur that tort reform certainly in jeopardy.

What’s the next step? Do we just “stay the course,” continue the trend towards increasingly extensive defensive medicine? That is a waste of the physician’s resources as well as the patient’s time and money. The insurance companies can’t care very much for it either, since raising rates to compensate for such costs is easier said than done these days.

Other Concealed Faults of the New HCR; The Case For Universal Healthcare

August 15, 2024October 21, 2010 by Jeffrey Segal, MD, JD

When the new health care reform legislation was presented to the American people, one of the pushing points was that one could keep dependent children on one’s policy until they turn 26. But guess what? Not really. If your son or daughter’s employer offers health care of any kind, s/he MUST take it from the employer. It doesn’t matter if that coverage is horribly inadequate. It doesn’t matter if it costs an arm and a leg and still doesn’t actually cover anything. Yep, s/he still has to take it from the employer, and you cannot cover your child on your policy any more. That’s right, it is forbidden. So your young adult dependent MUST take the inferior coverage at the higher price. Think it’s not happening? All over the nation, companies are being sold similarly overrated policies as employers scramble to lower costs. Some do it because of economic conditions, some because they’re about to shoulder costs they didn’t have before the law, and some because reducing costs is what corporations do. Regardless, if an employer offers it, you’re stuck with it, no matter how inadequate it may be.

Some Hidden Gems in the Patient Protection and Affordable Care Act

August 15, 2024October 18, 2010 by Jeffrey Segal, MD, JD

Given the wordiness of the Patient Protection and Affordable Care Act, it is no surprise that some surprises lurk deep within. A few selected pearls: Providers must return any Medicare overpayment within 60 days after identifying such an overpayment. An overpayment not returned during the 60 day period can be deemed a violation of the … Read more

Win the Battle; Lose the War

August 15, 2024October 12, 2010 by Jeffrey Segal, MD, JD

We heard of a doctor who performed a routine injection on his patient. No written consent. Should have been plain-vanilla and without consequence. Until he dropped her lung. The patient was sent to the ER, had a chest tube placed, and was out of the hospital in a couple of days. The doctor never visited … Read more

The Most Outrageous HIPAA Release – from Angie’s List

August 15, 2024October 12, 2010 by Jeffrey Segal, MD, JD

Most of you know Angie’s List as a consumer rating site. They launched as a web portal, rating assorted service providers such as roofers and plumbers. Believing that the practice of medicine is little different than roofing and plumbing, they dipped a toe into rating doctors.

One of our beefs with their system is that doctors are foreclosed from responding to outrageous posts. The reason: federal and state privacy laws. Whereas roofers and plumbers can tell their side of the story, doctors cannot.

Angie’s List has doubled down by offering a service to resolve complaints patients may have with their doctors. This is where the most outrageous HIPAA Release emerges. In an effort “to be fair,” Angie’s List appears to require the full medical record to make its determination. Do you think they have experts from the specialty in question deliberating over the material?

Dr. Jeff Segal published in “Health Reform Report”

August 15, 2024September 25, 2010 by Jeffrey Segal, MD, JD

Dr. Segal’s article, “Doctor-to-Doctor: The Administration Promises “Budget Dust” To Fix Medical Malpractice Morass” was just published by the Center for Health Transformation’s Health Reform Report. Read the article here.

Litigation Promotes Patient Safety – Are You Kidding?

August 15, 2024September 24, 2010 by Jeffrey Segal, MD, JD

Recently, a defense attorney hosted Malpractice 101 on the physician social networking site, sermo.com. A multitude of questions were answered.

Sprinkled in the answers was the conclusion the tort system has a number of salutary effects – namely patient safety. The moderator recited the (now stale) observation from the 1980’s. To paraphrase: Anesthesiologists embraced pulse oximetry because their med mal premiums were too high. They identified the source of high premiums – anoxic injuries and deaths, and crafted a solution. Pulse oximetry. Once embraced, their ORs became safer, and premiums went down.

While I will not quibble that pulse oximetry is a good thing, (it is), I would argue it was a basic innovation that was embraced by the profession, irrespective of premium cost. Here’s why.

Medical Justice on ReachMD

August 15, 2024September 24, 2010 by Jeffrey Segal, MD, JD

Medical Justice CEO, Dr. Jeff Segal, was recently featured on the ReachMD radio program “Preventing Frivolous Lawsuits and Frivolous Testimony,” hosted by Shane Jackson, Executive Vice President of Jackson Healthcare/President, LocumTenens.com. Dr. Segal shared his experience of being sued, and his expertise in the areas of defensive medicine, frivolous lawsuits, frivolous testimony, and non-legislative solutions … Read more

Healthcare Reform – A Duty To Patients, A Call To Arms

August 15, 2024September 17, 2010 by Jeffrey Segal, MD, JD

Being a physician, one’s first duty is to one’s patients. When Congress passed the healthcare reform bills, more than a few of us were doubtful that this was going to help. Many more felt there were far better possible solutions to be found. Few felt the entire 500+ seats of Congress should have taken an entire year to come up with that legislation. But when it passed, we hoped for the best, and figured it could always be changed before it went into full effect. That last may be the best idea in the whole stew.

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