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Healthcare Industry Groups Comment on EHR and Health Reform

Posted by Western PA Hospital News on Jul 11, 2011 in Legal | 0 comments

Mike Cassidy

By Mike Cassidy

In two separate letters, one just by the American Hospital Association and one by a consortium of industry groups, AHA, AMA, AMDIS, CHIME, EHRA, FAH and HIMSS, industry has submitted extensive comments to HHS regarding these issues. Comments focus on five areas of opportunity and challenge:

1. Reduce regulatory complexity;
2. Clarify certification and site certification processes;
3. Address meaningful use issues;
4. Clarify and improve the compliance process; and
5. Evaluate/coordinate the overlapping regulatory time line

Although both letters are instructive, the attachments to the AHA letter provide a useful summary of the issues. Attachment A charts the legal barriers to clinical integration, i.e.

Antitrust
Stark
Anti-Kickback
Civil money penalties
IRS tax exemption issues

Attachment B indicates the complexity of the overlapping requirements for transition to ICD-10, meaningful use, health reform and HIPAA 5010.

ACOs and Anti-Trust

Posted by Western PA Hospital News on Apr 13, 2011 in Legal | 0 comments

Mike Cassidy

By Mike Cassidy

In last month’s post entitled “Reform Redux,” I mentioned that one of the foremost issues for the coming year would be the development of Accountable Care Organizations (ACOs). The two most troublesome issues in developing ACOs will probably be the Anti-Trust and the Anti-Kickback/Stark issues. Traditionally, this regulatory structure has made it almost impossible for multiple providers to agree in any joint venture to provide health care services:

The Anti-Trust laws basically prohibit agreements (affectionately known as conspiracies) among competitors to fix prices, which is evident by the many enforcement actions taken against IPAs, PHOs, etc.

The combination of the Stark law prohibiting referrals to entities with which physicians have financial relationships, the Anti-Kickback statutes prohibiting payment in exchange for referrals, and the Civil Money Penalties statute prohibiting incentives to withhold care, basically eliminate any meaningful opportunities to operate as anything other than an integrated delivery system, which operates as a single entity.

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ONC Announces Open Public Comment Period on the Federal Health IT Strategic Plan: 2011-2015

Posted by Western PA Hospital News on Apr 12, 2011 in Legal | 1 comment

Mike Cassidy

By Mike Cassidy

Several days ago, I posted an article about health reform and it’s Top Ten Issues. Just this week, CMS and ONC have launched massive projects along those line, i.e. the combined regs from CMS, FTC, OIG and the IRS regarding Accountable Care Organizations, and the 2011-2015 Heath IT Strategic Plan. Links to all material are available at www.medlawblog.com, and we’ll be addressing those issues here in the near future.

The Office of the National Coordinator for Health Information Technology (ONC) today announced an open public comment period on the Federal Health IT Strategic Plan: 2011-2015 (“the Plan”). The Plan reflects ONC’s strategy, developed in collaboration with other federal partners, over the next five years for realizing Congress and the Administration’s health IT agenda.

Despite evidence of the benefits of the use of health IT, today only 25-percent of physician offices and 15-percent of hospitals take advantage of electronic health records (EHRs). Two major pieces of legislation, enacted over the past two years, are dramatically changing the health IT landscape and providing an opportunity to modernize the way care is delivered and improve the health of all Americans – the Health Information Technology for Economic and Clinical Health (HITECH) Act and theAffordable Care Act. The Plan, originally published in 2008, is being updated to reflect the significant impact of these two pieces of legislation.

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Reform Redux

Posted by Western PA Hospital News on Mar 22, 2011 in Legal | 0 comments

Mike Cassidy

By Mike Cassidy

Will this next decade of health care reform be the real deal—or will these concepts falter as have the earlier generations of health care reform?

RB-RVS and DRGs were the reimbursement reforms of the 1980s;
Capitation and managed care were the payment reforms of the 1990s;
PPOs, PHOs, IPA were structural reforms of the 2000s.

These reform measures experienced some degree of initial success, although obviously not enough to avoid the Obama health care reform agenda, i.e. the Patient Protection and Affordable Care Act of 2010 (PPACA).

PPACA is an even more ambitious program than the Clinton health care reform package proposed in 1993, which may still be fresh enough in many peoples’ minds to believe it was almost 20 years ago. PPACA not only covers payment reform, but also covers insurance reform, expanded coverage, individual mandates, health insurance exchanges, and new taxes for funding purposes.

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Healthcare Reform Challenges-in Congress and the Courts

Posted by Western PA Hospital News on Mar 21, 2011 in Legal | 0 comments

William H. Maruca

By William H. Maruca, Esquire

The newly Republican-controlled House of Representatives voted 245-189 on January 19, 2011 to repeal the controversial 2010 healthcare reform law, the Patient Protection and Affordable Care Act (PPACA). Two federal courts have held it unconstitutional, and three others have upheld it. While no one seriously expects this vote to spell the end of what its opponents call “Obamacare,” the PPACA will remain a political football this year and into the next, and the judiciary, not the legislative branch, is more likely to have the final word.

Many provisions of the law are highly popular with voters: coverage of children under their parents’ plans to age 26; elimination of pre-existing condition coverage restrictions and lifetime caps; phase-out of the “doughnut hole” in Medicare drug coverage; and elimination of co-pays for certain preventative care, for starters. Other provisions are highly unpopular, particularly the “individual mandate” requiring the uninsured to buy coverage; the financial penalties that kick in after 2013 on certain employers who do not provide basic coverage to their full time employees; and the expansion of Form 1099 tax reporting requirements, a provision that nobody likes but which was included as a way to help fund the bill’s price tag. Some critics claim the law simply does too little to rein in runaway healthcare costs.

Here’s a look at the various challenges to the law, their possible outcomes, and their potential impact on healthcare in the U.S.

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Preparing for an ALJ Hearing Process

Posted by Western PA Hospital News on Nov 28, 2010 in Legal | 0 comments

Erin McDaniel

By Erin McDaniel

It’s November in Pennsylvania. Most people are looking forward to football, Thanksgiving turkeys, and the upcoming holiday season. For those who work in Pennsylvania’s healthcare field, something decidedly less cheery lurks on the horizon: the CMS Recovery Audit Contractor (“RAC”) process swinging into full gear.

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