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

How to Avoid Being Burned as an Employer

August 15, 2024November 14, 2014 by Jeffrey Segal, MD, JD

I’ve spoken with several doctors over the past couple of months. All were dragged into litigation related to their role as an employer. They were being sued by ex-employees. The allegations varied – sexual harassment; improper termination; discrimination. In 2011, the Equal Employment Opportunity commission (EEOC) received over 100,000 charges of employment discrimination. The … Read more

What Do You Do When Your Patient Is Sporting a Swastika Tattoo?

August 15, 2024November 7, 2014 by Jeffrey Segal, MD, JD

Any physician who has spent time taking care of trauma patients has been cursed at, spit at, and more. If you are a woman or member of racial or ethnic minority, some patients have belittled you. If you are from another country and speak with an accent, some patients have requested another doctor.

Not Your Everyday Informed Consent Issues

August 15, 2024November 7, 2014 by Jeffrey Segal, MD, JD

It’s no secret that availability of organs for transplantation in the US pales in comparison to demand. Many die each year waiting for an organ. The systems that oversee transplantation define rules which allow one to “wait in line.” You get an organ based on the seriousness of your condition, your place in line, and whether you can persuade a living donor to participate. (For a living donor, this assumes it’s a “non-vital” organ – eg: one of the donor’s two kidneys, liver, etc. Obviously a living donor cannot donate his heart.)

What’s With the Epidemic of Whining?

August 15, 2024October 31, 2014 by Jeffrey Segal, MD, JD

Watching the news, you’d think that US hospitals are being crushed by the weight of an Ebola epidemic. While Ebola poses a non-negligible risk, it pales in comparison to the epidemic of whining.

Ebola and Quarantine / Isolation Laws. What is the Government Allowed to Do?

August 15, 2024October 31, 2014 by Jeffrey Segal, MD, JD

The Centers for Disease Control and Prevention (CDC) publishes a webpage which gives excellent summary information on government powers to enforce isolation and quarantine.

First, the definitions.

Isolation separates sick people with contagious disease from people who are not sick. Quarantine separates and restricts the movement of people exposed to contagious disease to determine if they become sick.

To “Or” or Not To “Or”; That Is the Question.

August 15, 2024October 24, 2014 by Jeffrey Segal, MD, JD

Dr. Carolyn Lobo received a metaphorical “rectal exam” from two Boards of Medicine – first California; then Ohio.

Here’s what triggered the kerfuffle.

Surgical Warranties – Here They Come

August 15, 2024October 17, 2014 by Jeffrey Segal, MD, JD

It’s common knowledge that the US healthcare system is the priciest in the world. Some healthcare systems are testing new financial models to see if they can squeeze more efficiencies beyond the status quo. Warranties.

First Ebola Death in US. Is the First Ebola Lawsuit Far Behind?

August 15, 2024October 17, 2014 by Jeffrey Segal, MD, JD

Thomas Duncan returned from Liberia and presented to Texas Health Presbyterian Hospital with fever and abdominal pain. He was released with symptomatic treatment and returned 3 days later. Sadly, he died of Ebola.

The family of the first Ebola victim in the U.S. will “probably” take legal action against the Dallas hospital, where he died this week, a spokesman for his fiancee stated.

2,610 Hospitals Just Got Screwed by Medicare

August 15, 2024October 9, 2014 by Jeffrey Segal, MD, JD

Spare the rod and spoil the child.

Medicare fined 2,610 hospitals, a record, for too many re-admissions.

Interestingly, the national rate for readmissions is getting lower. Still, last year, 18% of Medicare patients were re-admitted within a month. Medicare believes these re-admissions costs them $26 billion; and that $17 billion comes from potentially avoidable readmissions.

Loss of Consortium in Med-Mal Cases for Same-Sex Couples

August 15, 2024October 9, 2014 by Jeffrey Segal, MD, JD

In a typical medical malpractice case, the patient is the plaintiff, seeking a remedy for the injury caused by the doctor’s negligence.

There’s a second type of claim – loss of consortium. Many laypeople narrowly interpret “loss of consortium” as an injury experienced by the patient’s spouse in not being able to enagage in and enjoy sexual relations. But, “loss of consortium” is much broader. It applies to deprivation of benefits of a family relationship.

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