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

Shotgun Law-Suits: Coming to California in 2015

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California implemented substantive tort reform in the 1970s. The cap on non-economic damages (pain and suffering) has held firm at $250,000 since. And, compared to the rest of the country, professional liability premiums in California have remained “reasonable.”

 

Last year, enterprising lawyers spearheaded a referendum, Proposition 46, to overturn these caps. The Proposition was labeled Drug and Alcohol testing of Doctors. Medical Negligence Lawsuits.  The marketing pitch behind the proposition was clever – pilots and bus drivers are randomly tested for drugs and alcohol. Surely, this list should include physicians. (Buried in the Proposition was– “hey, by the way, let’s raise the cap on non-economic damages.”) The measure failed. For now, there is no state mandated random drug and alcohol testing for doctors. And, the cap on non-economic damages continues at $250k.

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Health Sharing Ministries – An Alternative to Traditional Expensive Health Insurance

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Many Americans purchase individual policies from health insurance carriers. Since the advent of the Affordable Care Act, the marketplace for such policies has changed. If you purchased an individual policy issued before 2010, and you maintained that policy in place, you are “grandfathered in.”  You can continue to purchase that policy – provided the carrier still sells the plan. Whether or not the carrier still sells that flavor depends upon the policy’s profitability.

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Can a Wife With Dementia Consent to Sex With Her Husband?

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Consent is intertwined with all aspects of medical care. A patient must give consent before undergoing treatment by a physician. If the patient presents emergently (in the absence of an advance directive) and cannot signal consent, our laws presume consent – namely a reasonable person would want everything done to save his life. And, if … Read more

Selective Breeding in Humans – A Slippery Slope? Nah.

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October 26th, 60 Minutes featured a segment on selective breeding in humans. The story focused on Genesis Genetics, a company which developed the technology for identifying those embryos within a larger set which have defective genes. Once identified, the family can choose the other “disease-free” embryos to implant via standard in-vitro fertilization techniques. When born, such children would be disease-free.

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Steamed About a $15 Copay For Medication. Try $400,000 For Some Drugs.

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The genomics revolution is here. We are accumulating new information almost daily about how our genes cause various diseases. More importantly, the door is opening to new treatments. As we fine tune our diagnostic capabilities, we are discovering small groups of individuals who can be effectively treated, but at a very high cost. In that model, the cost is high because the development cost is high, as it is for all pharmaceuticals. But for these small groups, the cost cannot be spread out among millions of patients. “Specialty pharmaceutical companies” are racing to create and distribute these high priced treatments.

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Refusing to Treat Patients – When You Want Distance From a Patient’s Infection, Morality, and Politics – Part 2

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We return to our discussion of can you refuse to treat a patient.

2. Moral opposition to a treatment

The analysis again starts with the contractual nature of the physician-patient relationship. The patient seeks care and the doctor agrees to provide it. In that idealized situation both parties remain in full agreement on the care.

However, along the way the doctor and patient disagree as to what treatments are “moral.” This raises the question to what extent the doctor may step away from that care. A patient may also seek care from the start that the doctor finds morally objectionable but the patient may not have reasonable alternatives (such as very rural area or a very specialized type of practice).

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Word to the Wise. Not All Subpoenas to Doctors Are the Same.

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Doctors receive subpoenas all the time. Lawyers send subpoenas for medical records when their client has been injured in a fender-bender; is seeking money from worker’s compensation; and when suing a doctor for negligence. In each of these cases, the lawyer is seeking the medical record to serve his client – (the patient).

 

What happens when a lawyer sends a subpoena for medical records when his client’s interests are adverse to the patient? This can create a pickle for the doctor. We are taught to comply with subpoenas. We are also taught to respect patient privacy.

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