What’s the difference between an optimist and a pessimist?
An optimist believes these are the best of times.
A pessimist is afraid he’s right.
It’s an old joke. But, it exemplifies how we expect things will turn out.
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
Nationalizing Expert Review Panels
A handful of states mandate that medical malpractice cases first be reviewed by panels of experts. These panels rule on the merits of a case. They conclude the standard of care was violated or it wasn’t.
In the states that use such panels, such as Indiana and New Mexico, the panel’s decision is not binding. A plaintiff’s attorney can ignore a smack-down and take the case to trial. But, the panel gives a strong signal as to how the winds will blow. Many – but not all – plaintiff’s attorneys take the hint.
That’s a Bummer
Dr. Orlito Trias was sued for negligence. The lower court awarded $4 million in damages.
A summary of the case was presented on the Connecticut State Medical Society website.
The case claimed that during a preoperative consultation for the removal of fibroid tumors, Dr. Trias failed to “strongly advise” the plaintiff that her family history of breast cancer greatly increased her risk for developing ovarian cancer. Although clear from the medical records that the risk of ovarian cancer was discussed, the plaintiff claimed that she was not “strongly advised” to undergo removal of her ovaries. The plaintiff subsequently developed ovarian cancer.
Notes from a Plaintiff’s Attorney: Medicolegal Issues in Treating Minors – Part 2
We continue with our series of general educational 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.
We previously addressed who can determine treatment for the minor patient (addressed her in Part 1). We now move to confidentiality / records access issues for the minor patient in Part 2.
- Confidentiality issues and access to records.
Notes from a Plaintiff’s Attorney: Medicolegal Issues in Treating Minors – Part 1
We continue with our series of general educational 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 pitfalls in treating minors tend to fall into two areas: who can determine treatment for the minor patient (addressed here in Part 1); and confidentiality / records access issues (which will be addressed later in Part 2).
I. Treatment decisions.
Notes From a Plaintiff’s Attorney: Medical Malpractice Versus Criminal Negligence
We continue with our series of general educational 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.
A physician recently asked about the following case: a midwife committed serious, wrongful acts in the care of a patient in premature labor with twins. The patient was initially discouraged from going to the hospital; a naturopathic doctor at the midwife’s birthing center was not competent to treat the labor medically; an outside midwife recommended the patient be transferred to the hospital but the patient was again discouraged from doing so; there was no equipment to resuscitate one twin born at the birthing center; and CPR was applied incompetently. That twin later died. The midwife also lied to paramedics about the mother’s care and tried to conceal that the mother was, in fact, still in the birthing center, was still laboring and was bleeding profusely. The midwife was charged with manslaughter for the death of the twin delivered at her facility.
Notes From a Plaintiff’s Attorney: Avoiding Liability Involving Autopsies
We continue with 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. In this article, the author addresses “Avoiding liability involving autopsies.” 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.
I. Forensic autopsies
State and municipal law mandate autopsies in cases of “unnatural” deaths. These include the death of any person not under a doctor’s care and will always include cases that appear to be homicide, suicide or accident.
Notes From a Plaintiff’s Attorney: Legal Issues When Patients Offer You a Gift
We continue with our series of general educational 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.
Whether you can accept a gift from a patient is fundamentally a matter of ethics. But fiduciary violations can result in discipline for misconduct. And patients and estates of deceased patients can sue for the return of what was gifted. So, when accepting a patient’s gift, it’s important to keep basic legal issues in mind.
As a fundamental matter, the doctor-patient relationship imposes unique professional boundaries and gifting to doctors by patients blurs those.
Jim Morrison Had a Will When He Died. Do You?
The other night, I was channel surfing and started watching a documentary on Jim Morrison, the lead singer of The Doors. He died at the age of 27 in a Paris hotel room. No autopsy was performed. Morrison struggled with alcohol abuse. Many accounts noted he was snorting heroin close to the time of his death. While he made a number of choices that hindered longevity, he did have a will.
The will stated his entire estate would pass to his girlfriend Pamela Courson, provided she survived him by 3 months. If she didn’t, his estate would pass to his brother and sister.
Hepatitis C Drug Pricing – Let the Games Begin
Gilead Sciences had a banner year. Its blockbuster drug to cure hepatitis C, Sovaldi, had sales of $8.5 billion through third quarter this year. This is the most successful pharmaceutical launch ever. The retail cost for Sovaldi is $84,000 for a 12 week regimen – or about $1,000 per pill.
