On Tuesday, August 1, 2017, the Senate Health Committee (the “Committee”) announced hearings, to take place in September, on the issue of stabilizing the individual health insurance market. The announcement of these hearings is in response to continued legislative efforts to repeal Obamacare and President Trump’s threats to stop paying insurance companies cost-sharing subsidies, currently availed under Obamacare, that reduce out-of-pocket expenses for low-income policyholders. Republican Senator Lamar Alexander, Chair of the Committee, is working with Democratic Senator Patty Murray to make the hearings bipartisan. Congress must develop a solution before September 27th, when insurers enter into contracts with the
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According to a report issued last month by the Department of Health and Human Services’ Office of Inspector General (“OIG”), the Centers for Medicare & Medicaid Services (“CMS”) overpaid an estimated $729 million under the Medicare and Medicaid Electronic Health Record (“EHR”) Incentive Program (the “EHR Incentive Program”) to physicians and other eligible professionals who did not actually comply with federal meaningful use requirements.    In addition, the Report estimates that CMS mistakenly paid $2.3 million in EHR incentive payments to eligible professionals who switched incentive programs.  These overpayments represent approximately twelve percent (12.0%) of total Medicare/Medicaid spending. Since the Report’s
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Over the past several months, a steady stream of security breaches, coupled with a number of settlements recently announced by the U.S. Department of Health and Human Services – Office for Civil Rights (“OCR”), have put healthcare providers on high alert.  Several OCR decisions, including a $5.5 million settlement with Memorial Healthcare System last month—have highlighted the legal implications of security breaches in the wake of a record-setting year of hackers targeting the healthcare industry. The costs associated with a breach will likely far exceed any settlement with OCR because the significant majority of corrective action plans require providers to
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On March 31, 2017, Dr. Karen Murphy, Secretary of the Pennsylvania Department of Health (the “Department”) announced an important new development in the implementation of the Pennsylvania Medical Marijuana Act (the “MMA”).  Secretary Murphy stated that the Department will, in the very near term, begin the application review process for growers/processors and dispensaries, the key business entities in the production and sale of medical marijuana under the MMA.  She also stated that the Department anticipates being able to release information about who applied, and for which region or county, after the permits are issued in late June 2017. The Department
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President Trump recently submitted his first formal budget proposal to Congress.  It is viewed by many to be one of the most ambitious ever proposed, and seeks to “redefine the proper role” of the federal government by dramatically reducing its involvement in many domestic areas, including health spending.  while boosting investments in security and defense.  This post focuses on the health-related highlights of this budget proposal (the “Proposal”): Under the Proposal, the annual budget of the Department of Health and Human Services (“HHS”) would be reduced by more than $15 billion (or 17.9 percent) in 2018.  The Proposal seeks to
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As health systems develop and implement strategies around clinical care redesign and health care reform, industry participants often ask how clinically integrated networks (“CINs”) relate and compare to accountable care organizations (“ACOs”). While unquestionably linked, each of these concepts has its own unique definition and purpose. The following table presents a summary comparison of key operating features and characteristics of CINs and ACOs. DEFINITION CIN – A network of independent medical practices and physicians who collectively commit to quality and cost improvement. Physicians in the CIN may collectively negotiate third party payer contracts under a “safe harbor” from federal antitrust
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On January 27, 2017, President Trump signed his first executive order relating to the Affordable Care Act (the “Act”).  The executive order directs the Secretary of the Department of Health and Human Services and all government agencies to “…exercise all authority and discretion available to them to waive, defer, grant exceptions from or delay the implementation of any provision or requirement of the act that would impose a fiscal burden on any state or a cost, fee, tax, penalty or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare insurance, purchasers of health insurance, or makers
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Primary care physician groups, especially those employed through health systems, are increasingly using mid-level practitioners (i.e., nurse practitioners, physician assistants) to visit patients “virtually” through the use of telemedicine technologies. This combination of clinical and technological resources is being directed toward patients who have difficulty getting to the doctor’s office, such as those in nursing homes and assisted living facilities, and is expanding access to care by eliminating the need for a patient to come into the doctor’s office. Some primary care practices are using NPs and PAs to monitor patients with chronic conditions, such as diabetes, hypertension and asthma.
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A recent Government Accountability Office (GAO) report highlights that small and rural physician practices face significant problems with the implementation of Medicare’s value-based payment models under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Value-based payment models require physicians to take steps toward using electronic health record (EHR) systems to better track and monitor quality of patient care. The GAO review found that small physician practices (defined as having fifteen (15) or fewer physicians) and rural physician practices (defined as those located outside of an urban area) are less prepared for this transition than their large, urban counterparts.
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