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

Access Issues; Are Nurse Practitioners The Key To Functional Health Care Reform?

August 15, 2024April 9, 2010 by Jeffrey Segal, MD, JD

The news is shifting away from health care reform. Speculation is even starting to wind down a bit. Maybe now we can get down to the nuts and bolts, the real practical aspects of healthcare and what the new legislation means for both patients and providers. In a recent discussion between physicians, it was noted that the 32 million people (who are expected to join the ranks of the insured in just under a decade,) are not new patients. They exist right now, get ill and need treatment already. They’re just not getting it in efficient or conventional ways.

That’s a good thing. Our system is already overburdened, so adding 32 million new patients would be untenable, if they were actually new patients. But our country still needs more physicians and more access to health care providers.

Medical law concept with gavel and stethoscope on desk

Healthcare Bill Lies

September 17, 2024April 5, 2010 by Jeffrey Segal, MD, JD

President Obama is talking about healthcare reform a lot, pushing hard to win public favor for the bill. Representative Dennis Kucinich is amongst those who have yet to decide how they will vote. He was also present at one of the speaking engagements in which the people yelled out their support, their desire to have health care reform. In a passionate speech, the President cited a 50 year old cancer survivor, Natoma Canfield, and how she could not afford the heath care premiums any more. It was even more pointed that she couldn’t attend herself, because she was lying in a hospital bed again, fighting through chemotherapy after 11 cancer-free years. President Obama emphasized that detractors were lying about losses of coverage via Medicare/Medicaid, etc. And all of that may very well be true. But the President isn’t telling the whole truth either.

The Natoma Canfields of America will find no relief in this bill. It’s very possible that they may not live to see the benefits kick in at all. Though taxes would be raised effective in the current tax year; those 30 million uninsured won’t see any relief for about 9 years. Some aspects may commence sooner, but we’re still talking about something that is going to take 10 years to happen, if we start now.

Patient’s Bill of Responsibilities: #1 Take Good Care of Yourself

August 15, 2024March 30, 2010 by Jeffrey Segal, MD, JD

It seems people are always talking about (and demanding) Rights. With Rights, though, come Responsibilities. Here are a few thoughts on how patients can be more responsible for their own well-being.

The single most valuable piece of advice, a refrain echoed time and time again by physicians, is taking proper care of one’s body to avoid problems in the first place. This is something that the individual (and family) must practice, but the government can promote. Our current system rewards getting ill while providing little direct incentive to practice wellness. It costs a lot less to address obesity in a child than to perform a coronary bypass operation. It costs less to prevent smoking (or help a smoker quit that addiction,) than to treat lung cancer, emphysema, and heart problems, premature births and infant deaths (amongst the problems caused by first-hand smoke, let along second-hand smoke.)

Even what we eat makes a profound difference. A finding within The China Study

A Place At The Table; Heathcare Reform Decisions Being Made Without Doctors: Dr. D. Berwick New Head of CMS

August 15, 2024March 29, 2010 by Jeffrey Segal, MD, JD

The eminent appointment of Donald Berwick, MD, as head of CMS (Centers for Medicare & Medicaid Services) may seem like a step in the right direction. After all, Dr. Berwick is well known for championing improvements to health care. “At least he’s a doctor,” some might say. But is appointing a doctor really giving physicians a place at the table? Dr. Berwick is also politically capable. Few could argue the reasons for putting him on the list of candidates. But is that reason enough to make the appointment? Is appointing an MD really a place at the table, or is that allowing a doctor to work as a server for the dinner guests?

It stands to reason that Washington is going to appoint someone who is politically astute. It also stands to reason that President Obama would appoint someone capable of delivering fiery rhetoric. In 2004, he unequivocally stated “I’m losing my patience. Not with the people in healthcare, but the system itself. Healthcare professionals are doing so many things so well; they’re putting actual transformation within reach. Now we need to grab it. The clock is a tyrant, and if you spend too much time ‘getting ready,’ you’re going to lose.” In another campaign, he noted “… the attention of the strategic leaders in healthcare has not been focused on the improvement of care. The strategic objectives have focused on more traditional goals such as growth, marketing and capital development. We need leaders to create a new future, not defend the status quo.” In a keynote speech last year, Dr. Berwick was bold enough to state that anyone who claims the U.S. healthcare system is the best in the world is not looking at the facts. Dr. Berwick is clearly a man of passion, unafraid to challenge the system. Sounds like the perfect man to repair a broken system, doesn’t it? Unfortunately, the White House has not asked us that question.

Serious man wearing medical coat and stethoscope

Procedural Issues To Send Reconciliation Back To House For Another Vote

September 17, 2024March 25, 2010 by Jeffrey Segal, MD, JD

A fatigued Harry Reid (D-NV) called for the session to come to a close at 2:45 am, shortly after the discovery of those technicalities. They will return to continue work on the bill at 9:45 today, just 7 hours later. It was not clear who noticed the errors.

It’s Official, Obama Signed the Bill, But We STILL Don’t Know What It Means

August 15, 2024March 23, 2010 by Jeffrey Segal, MD, JD

A short while ago, the wire service put out (and everyone chimed in) that President Obama had signed the Affordable Health Care for America Act (as it is apparently now being called,) into law. Hurray! It’s a great day for America! Now if we could please find out what we just bought into?

The same rehash has been playing over and over again on the media. 16 million more get Medicare. Children won’t be saddled with Pre-Existing Conditions. Most (but not all) Americans will have to have health insurance, and those who are without coverage now because of pre-existing conditions can expect to be able to get insurance via a high-risk pool until more of the bill kicks in, a few years down the line. Could it possibly be more vague? Perhaps. Maybe if they just left it at that it’s “really gonna be good for everybody — you wait and see!”

This Is What Change Looks Like – Health Care Reform Act of 2010 Passes the House

September 17, 2024March 22, 2010 by Jeffrey Segal, MD, JD

As most of you know, Medical Justice has been watching the health care reform act’s progress closely. What played out was a bit like a soap opera, full of melodramatic statements. It was very informative, and demonstrated why the Democrats pushed this through procedurally.

Finally, debates were done, and it was time to vote.

The Democrats were slightly divided. Republicans all voted along party lines. By 10:45 pm, EST, the U.S. House of Representatives had enough votes to pass the bill. Two minutes later, the final tally showed 219 Democrats in favor, 34 opposed. The Republican vote was 176 against, with 2 abstaining. The final tally was 219 in favor, 212 against. The House had confirmed the Senate’s Heath Care Reform Act of 2010. This vote makes the Senate’s act law, subject to the President’s signature, which is expected in the first few days of this week.

AMA Supports Health Care Reform Bill, Throws Tort Reform Under The Bus

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

The House Health Care Reform bill of 2010 is almost a reality. Some have suggested that the entire bill be tossed out. Others are saying that it should be held off until our representatives have had sufficient time to read and analyze them. Yet another faction thinks that it’s not what anyone really wants, but it’s a good start, so they should vote for it and get that hurdle over with. Those who were opposed are jumping on the bandwagon for the sake of the 31,000,000 uninsured (who won’t actually get benefits for years.) Then there’s the AMA.

Dr. J. James Rohack, president of the American Medical Association, claims “qualified support” for the bill, because he believes the bill will be “extending health coverage to the vast majority of the uninsured.” Supposedly it it was further stated that doctors are deeply disappointed that the bill doesn’t repeal the method by which Medicare payments are calculated. Though Congress informally agrees to address the issue, physicians’ Medicare payments are repeatedly threatened by significant cuts, which Congress keeps putting short-term bandages on. Surprisingly enough, some Democrats (such as Peter DeFazio,) have said that they won’t support the bill unless it increases Medicare payments to states that provide high-quality care at low costs. It would seem the AMA wasn’t as interested in protecting the interests of their members as is Mr DeFazio.

Pelosi: Just Vote For It And Then You Can Find Out What It Says

August 15, 2024March 20, 2010 by Jeffrey Segal, MD, JD

It is the eve of historic change. With every new piece of news that hits the wire, it becomes clearer that Speaker Pelosi will have the votes necessary to pass the Heath Care Reform Act of 2010. Fantastic! A new day, a new era for America! But, uhm… what is it that we’re celebrating? What is it that they’re passing on our behalf? 2309 pages, and the representatives are still struggling to read PARTS of it… yet the Speaker of the House tells people to vote for it? When has there ever been a Congress so willing to vote in the blind?

Medical Justice is by and for healthcare professionals. Of course, we want people to have health insurance. We want them to have health care available to them, health care they can afford. After all, we’re here to alleviate suffering. But, come on, people, at least know WHAT it is you’re voting for!

In comments to a blog about the subject, a cardiologist admitted that while it may not be the best thing for him, it’s the best thing for his children, grandchildren, friends, and acquaintances, so he’s in favor of it. Noble… but he doesn’t know what’s in those 2309 pages either. And that’s not the end of it either.

Some of the votes are “secured” by agreements to change the bill AFTER it is voted on and before it is presented to President Obama for signature. What sort of things are we talking about?

Then there’s the quote from a trial attorney,

2309 Pages in 72 Hours = 32 Pages An Hour — If They Don’t Think Or Sleep

August 15, 2024March 19, 2010 by Jeffrey Segal, MD, JD

The Reconciliation Act of 2010 sits before us now, a 2309 page .pdf file chocked full of Therefors and Wherebys and a whole slew of legalese; one piece referencing another. Even if you have a law degree, there’s no way you’ll know what it all means and how (or IF) it all works together. In short, even legislators are going to have to take each others’ word for it. But that all assumes that any of them will have or will take the time to read it.

72 hours of “transparency” means over 32 pages per hour — if they don’t sleep, eat, shower, cross-reference the spaghetti-code, or think about what any of it means or how it all supposedly fits together. The reality is that there is barely time to read it all, never mind the hope of catching mistakes or misunderstandings. There is certainly no time to analyze it, to ponder, to decide… and yet the House is expecting to vote?

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