The success of PPACA (Obamacare) depends heavily on innovative delivery systems such as ACOs.
With the health care industry there is lot of chatter and lots of thinking about how these innovations can be achieved.
One problem though. Over the past couple of decades the federal government (Congress, FTC, Justice) have been concerned about anti-competitive actions. The Stark legislation (I, II, III) and antikickback statutes add to the mix (being a health care transaction lawyer has been and will be very lucrative).
There is much concern about innovating organizations into trouble, and the possible considerable costs if all parties in a transactions have to buy legal assurance each step of the way.
Suggested solutions include "safe harbor" rules (a big help with Stark) or perhaps an omnibus pre-screening mechanism.
Innovation can be very complicated.
Further recommended reading: Modern Healthcare and other major journals and newsletters
Saturday, January 29, 2011
Thursday, January 13, 2011
Informed Consent Before Injections
Before injecting patients with anything the patient should be informed of:
what is being injected
how much is being injected
the type and location of the injection
the probable benefit of the injection
the possible after effects, including pain and swelling (and alleviating the
symptoms)
Then, any questions should be answered before proceeding.
Physicians need to assure that clinical staff are properly trained in injection procedures, including age appropriate site selection.
what is being injected
how much is being injected
the type and location of the injection
the probable benefit of the injection
the possible after effects, including pain and swelling (and alleviating the
symptoms)
Then, any questions should be answered before proceeding.
Physicians need to assure that clinical staff are properly trained in injection procedures, including age appropriate site selection.
New Health Insurance Regulations
Numerous PPACA changes became effective for insurance plan years starting after 9/23/10 (for most patients this would be January 1). Many changes are related to insurance coverage, including:
coverage extends to dependents up to age 26
certain preventive and immunization services will be covered with no patient cost sharing
lifetime dollar limits will be removed from benefit plans
pre-existing condition exclusions and waiting periods are eliminated for patients under 18 (older patients phase in later)
retroactive cancellation will be only in cases of fraud or failure to pay
Other 1/1/11 changes:
increases in penalties for misusing health savings account funds
changes in flexible savings accounts (FSAs)
Providers need to be aware that insurance policies are changing policies rapidly and billing and collection procedures will be impacted.
coverage extends to dependents up to age 26
certain preventive and immunization services will be covered with no patient cost sharing
lifetime dollar limits will be removed from benefit plans
pre-existing condition exclusions and waiting periods are eliminated for patients under 18 (older patients phase in later)
retroactive cancellation will be only in cases of fraud or failure to pay
Other 1/1/11 changes:
increases in penalties for misusing health savings account funds
changes in flexible savings accounts (FSAs)
Providers need to be aware that insurance policies are changing policies rapidly and billing and collection procedures will be impacted.
HIPAA Nightmares
Technology both enabled these offenses and enabled the discovery of the offenses.
First:
Three employees and a contract nurse were terminated from the Tuscon University Medical Center for looking at medical records of the Tuscon shooting victims. None are accused of leaking any information.
Second:
A relative called this week during the 11 o'clock news. Ohio Health had announced that patient data from Grant Hospital in Columbus had been compromised. She has been a patient there in the last six months.
An employee had stolen computers from the IT inventory, attempted to wipe the hard drives and then to sell the computers. Whatever data was lost was encrypted and the probability of a compromise is low, but Grant will be required to do the full court press on HIPAA security procedures (at no small cost).
How is your HIPAA security program working? Would breaches be detected?
First:
Three employees and a contract nurse were terminated from the Tuscon University Medical Center for looking at medical records of the Tuscon shooting victims. None are accused of leaking any information.
Second:
A relative called this week during the 11 o'clock news. Ohio Health had announced that patient data from Grant Hospital in Columbus had been compromised. She has been a patient there in the last six months.
An employee had stolen computers from the IT inventory, attempted to wipe the hard drives and then to sell the computers. Whatever data was lost was encrypted and the probability of a compromise is low, but Grant will be required to do the full court press on HIPAA security procedures (at no small cost).
How is your HIPAA security program working? Would breaches be detected?
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