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The Unhappy Intersection of Hospital Mergers and Antitrust Laws

March 5, 2015
Posted In Affordable Care Act, Hospitals

The rapidly-evolving field of health care has been moving lately towards a single-minded goal – coordination of patient care in the name of efficiency and efficacy. Hospital systems are more and more often merging with other medical practices to better achieve the standards and goals of the Patient Protection and Affordable Care Act (“ACA”). The Ninth Circuit Court of Appeals, however, recently provided a stark reminder that the ACA isn’t the only law hospitals need to consider compliance with in these mergers.Modern Hospital More >

Medical Staff By-laws are Contracts? Minnesota Supreme Court Says “Yes”

March 3, 2015
Posted In Hospitals, Medical Staff By-Laws

That sound you just heard was the simultaneous gasp of hospital boards of directors throughout the state of Minnesota. In Medical Staff of Avera Marshall Regional Medical Center v. Avera Marshall, Minnesota’s highest court made two holdings that strengthened the autonomy of physicians and may shed light as to how courts may interpret medical staff by-laws in the future. More >

The Importance of HPSA and MUA Designation

February 24, 2015
Posted In Affordable Care Act, Health Professional Shortage Area ("HPSA"), Medically Underserved Area ("MUA"), Rural Health Clinic

Rural communities in Kentucky are still largely underserved by health care providers. With the expanded range of Medicaid and Medicare services now available as a result of the Patient Protection and Affordable Care Act (“ACA”), rural health care infrastructure needs a shot in the arm to meet the demand. Fortunately, several programs exist to incentivize the provision of rural health care, and Kentucky providers in underserved areas should begin taking advantage of them. More >

HIPAA and “Meaningful Use” Audits: Issues to Consider and How to Prepare

By Christopher J. Shaughnessy on February 19, 2015
Posted In Audit, Electronic Health Records (“EHR"), Health Insurance Portability and Accountability Act of 1996 (HIPAA), HIPAA Risk Assessment, Meaningful use incentives

As more and more providers adopt electronic health records (“EHRs”) systems (and with new regulations concerning their required use for purposes of Medicare billing for chronic care management, their popularity can only continue to grow), a myriad of compliance issues continue to surround them. To that end, the federal government has stepped up auditing programs to ensure compliance with HIPAA/HITECH as well as making sure taxpayer money has been invested wisely through the Meaningful Use program. The bent of these audit programs is clearly along the lines that applicable covered entities and business associates should be preparing with a “when” mindset, rather than “if,” as these audits are going to happen. More >

What the Anthem Cyberattack Means for the Health Care Industry

By Anne-Tyler Morgan on February 12, 2015
Posted In Data Breach, Electronic Protected Health Information (ePHI), Health Insurance Portability and Accountability Act of 1996 (HIPAA), Patient Privacy

Unfortunately, account hacks and data breaches are nothing new. Every day, we hear reports of hackers compromising networks and their protected data. When it happens on a massive scale to a powerful player in the health insurance industry, however, all health care entities should sit up and take note. On February 4, 2015, Anthem Inc. (“Anthem”), the second largest health insurance company in America, admitted that hackers compromised the company’s network and stole the information of up to 80 million customers. This may be the largest health-related data breach in history. More >

Quality Over Quantity: The Shift from Fee-for-Service to Value-Based Payment Systems

By Anne-Tyler Morgan on February 10, 2015
Posted In Accountable Care Organizations (“ACO”), Alternative Payment Models, Fee for Service, Health Care Law, Medicare

The United States Department for Health and Human Services (“HHS”) recently announced its intention to tie thirty percent of fee-for-service Medicare payments to alternative and value-based payment models by 2016. HHS hopes to increase that amount to fifty percent by the end of 2018. Currently, up to twenty percent of payments are made through alternative models, a substantial increase in a short amount of time since almost no payments were made through alternative models as recently as 2011. Two days after HHS’ announcement, a group of key health care industry stakeholders announced the formation of the Health Care Transformation Task Force, a new industry consortium making a public commitment to transition seventy-five percent of its business between now and 2020 to value-based arrangements. These developments demonstrate the shift from fee-for-service payments based on quantity of work regardless of outcome and signals a larger trend to seek quality over quantity. With the seemingly meteoric rise of value-based care, it is important to understand the ramifications of alternative payment models within the health care industry as a whole. More >

New Rule on Medicare Reimbursement for Chronic Care Management Services

February 5, 2015
Posted In Centers for Medicare & Medicaid Services (“CMS”), Chronic Care Management, Medicare

In November 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a final regulation with changes intended to ensure Medicare’s payment system “reflect[s] changes in medical practice and the relative value of services, as well as changes in the statute.”[1] One of the beneficial changes for physicians is the new Medicare reimbursement of chronic care management (“CCM”) services, which began with the New Year on January 1, 2015. All providers should pay special attention to the essential requirements for chronic care management reimbursement and begin identifying eligible fee-for-service Medicare patients. More >

Charitable Hospitals and Community Health Needs Assessments

February 3, 2015
Posted In Affordable Care Act, Charitable Hospitals, Community health needs assessment (“CHNA”), Patient Protection and Affordable Care Act (“ACA”)

In the last days of 2014, the IRS released regulations that finalized the compliance requirements for charitable hospitals. These new 2014 IRS regulations relate to the Community Health Needs Assessment (CHNA or needs assessment) requirements for nonprofit hospitals or nonprofit organizations Senior female doctor using a tablet computer in her officeoperating a hospital contained in Section 501(r) of the tax code, which was created by the Patient Portability and Affordable Care Act (“ACA”). Section 501(r) requires that thorough CHNAs be conducted every three years in order to maintain their 501(c)(3) nonprofit status. These needs assessments must define the community served by the hospital, the needs of the community, and a strategy addressing the identified community needs. Since each facility that fails to meet CHNA requirements loses its nonprofit status and has to pay a $50,000 excise tax, nonprofit hospitals and networks need to pay special attention to the changes and incorporate these new requirements into their needs assessments. More >

Three Factors Affecting the Mid-Level Practitioner Workforce, Part Two

By Lisa English Hinkle on January 29, 2015
Posted In Advanced Practice Registered Nurses, APRNs, HPSA, HRSA, Limited Services Clinics, Mid-Level Practitioners

In the last post, the subjects of collaborative agreements and autonomy were discussed in relation to how they affect mid-level practitioners. Today’s post now turns to how HRSA designation and limited services clinics will ultimately influence that workforce as well. More >

Three Factors Affecting the Mid-Level Practitioner Workforce, Part One

By Lisa English Hinkle on January 27, 2015
Posted In Advanced Practice Registered Nurses, Affordable Care Act, APRNs, Mid-Level Practitioners

As more Kentuckians gain access to health care as a result of the Affordable Care Act, healthcare workforce shortages for primary care providers becomes problematic particularly in rural Kentucky. Never before have mid-level practitioners been more important. The Health Resource and Services Administration (“HRSA”) estimates that there will be a shortage of 20,400 primary care ­physicians by 2020, but this number could be drastically reduced – as low as 6,400 – with an abundant increase in the autonomous practice of mid-level providers[1]. The same HRSA study concluded that a fully-utilized workforce of mid-level practitioners could account for 28% of all primary care by 2020. Three factors make mid-level practice more attractive than ever in Kentucky. More >

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