Home2019-01-17T20:58:16+00:00

National Practitioner Data Bank Urges Hospitals to Provide More Discipline Info

By JESSE ADAM MARKOS, ESQ.
The National Practitioner Data Bank (Data Bank) has published an article in the April 2019 issue of NPDB Insights that urges reporting entities to include a detailed narrative when submitting an Adverse Action Report. The Data Bank’s stated purpose for requesting detailed information is to give organizations a more complete picture of what occurred to assist in making critical hiring and credentialing decisions. However, it will also result in healthcare providers being saddled with a career-damaging Data Bank report that contain inaccurate details and contested facts. Importantly, options are available to these providers to help minimize the damage. More specifically, healthcare providers have the right to submit a Subject Statement to the report at any time to give a more accurate and complete picture of what occurred.

By way of background, the Data Bank is an alert system that collects and discloses certain adverse information about physicians and other healthcare providers. A report to the Data Bank can significantly impact a healthcare provider’s reputation and career. NPDB Insights is published by the Data Bank to provide guidance to users on topics such as eligibility, querying and reporting requirements, and the dispute process. The April 2019 version of NPDB Insights contains an […]

LANSING LINES

GOP Lawmakers Think DHHS Caro Study A Sham
Two Republicans representing Tuscola County say the state has already made up its mind about moving the replacement Caro Center, based on emails published by a TV station.

ABC 12 got its hands on emails from Gov. Gretchen Whitmer administration officials discussing the future of the proposed replacement for the psychiatric facility, including messages from Robert Gordon, director of the Michigan Department of Health and Human Services.

According to the report, Gordon in January “increasingly believes that closing Caro entirely is the correct path forward.”

In another email “within weeks,” Gordon suggested the idea of forming a commission “that would help us get the right answer, building support for that answer, and perhaps hold off the Legislature from doing anything rash,” according to the report.

It was in that same email that Gordon said a leading idea was to instead expand the Center for Forensic Psychiatry in Saline and build a smaller location in a better location than Caro.

In mid-March, the state publicly announced it would halt construction on the new Caro Center and hire a consultant to study where best to locate the project.

The state had already broken ground under the previous administration on a new psychiatric facility located close to […]

IN MY OPINION: Predictable Economic Consequences

By ALLAN DOBZYNIAK, MD
Economics is apolitical. Economists can and often do have biases. But there are basic economic principles that are accepted. There are empiric data that provide the proof for their reliability. Trying to plough through healthcare and arrive at logical economic conclusions for a non-economist is not that easy. But hang in there if you can, and follow along as an attempt is made to do just that.

Healthcare is, like most everything, a scarce resource. Besides that, it is so complex that no single person or any limited group of persons is capable of completely planning and supervising the goods and services included in healthcare. It requires elaborate coordination of multitudes of producers of both goods and services. An unchallengeable statement by Armand Alchien is as follows. “The modes of coordination in a basic private property, individualistic society have dominated all other forms in productivity, growth and freedom.”

A free good or service exists when there is no scarcity; it is hard to think of any. Healthcare is certainly not one of them. Even if a zero price is charged, healthcare cannot be free. Consuming healthcare for “free”, really at a zero price, does not convert this limited, scarce, service into a “free” service. […]

Taking Another Shot At Lower Drug Prices

The head-spinning experience of navigating the pharmaceutical pricing world came to town Feb. 28, leaving lawmakers and laypeople alike with no greater understanding of why the entire scheme leaves consumers light in the pocket.

The basics are clear. Drug companies set the price for their drugs, but rarely does anyone pay it, Peter Fotos, PhRMA’s Chicago-based regional director for state advocacy told the House Health Policy Committee.

Generally, health insurers go through this relatively new layer of bureaucracy called Pharmacy Benefit Management (PBM) companies to negotiate cheaper rates based on bulk purchases. Then there are other assorted rebates and discounts patients can score. When the smoke clears, about 33 percent of the initial list price disappears.

In 2017, pharmaceutical companies paid $153 billion in rebates, up from $74 billion in 2012.

All of this led Rep. James Lower (R-Cedar Lake) to ask the obvious question: “Why do the clawbacks? Why do the rebates? Why not have a lower price to begin with and not go through this bureaucratic nightmare?”

The answer: That is the way it is. Apparently, there are rebates available for people buying in volume. Everyone wants the sweet deal. Human resource people do not want to mess with it so these PBMs take care of it for […]

Americans Ready To Crack Down On Drug Prices

By JAY HANCOCK
Large majorities of Americans from both major parties support steps to control prescription drug costs such as showing prices in ads, removing barriers to generics and letting patients get less expensive drugs from Canada, a new poll shows.

By a 9-to-1 ratio, Republicans, Democrats and independents favor making drug companies show list prices in their advertising, says a new survey from the Kaiser Family Foundation. Highly advertised medicines such as Humira, for arthritis, cost tens of thousands of dollars a year, even after discounts.

Although Republicans tend to frown on government control over commerce, 8 in 10 Republican respondents said they support giving negotiating power to the $700 billion Medicare program in order to lower drug prices for seniors.

More than 70 percent of all respondents back importing drugs from Canada and capping out-of-pocket Medicare costs. More than 80 percent said they favor making it easier for less expensive generics to compete with brand-name drugs.

As President Donald Trump and Congress vow to act against drug inflation and journalists chronicle patients experiencing medical and financial shock from drug expenses, increasing numbers of Americans blame pharmaceutical companies for high health care costs.

Expensive drugs are one of several factors in rising medical costs that strain government, employer and household […]

ON POINT WITH POs: Patient Care Organizations

By EWA MATUSZEWSKI
What’s in a name? Sometimes, limitations. A physicians’ organization, for example, is the name given to organizations originally designed to help private practice physicians build and maintain an independent practice. Broadly speaking, the PO handled the foundational business aspects and insurance provider contracts of the practice, while the physicians tended to the needs of their patients and day-to-day operations. The role of POs in the past 10 years, however, has changed dramatically. Yes, we still negotiate contracts, trouble shoot patient registries and implement EHRs, but we also provide in-office care teams and care managers to support the 21st century model of medicine; and we introduce quality initiatives and measure their success. We partner with our members to enhance patient care and its delivery.

Perhaps the first tangible evidence of change in the PO community goes back to 2005, when Blue Cross Blue Shield of Michigan introduced the Physician Group Incentive Program (PGIP). Recognizing the million+ adult and pediatric patient population that Michigan POs represent, PGIP (now called Value Partnerships) has had tremendous success in recent years harnessing the collective power of these organizations to introduce patient-centric primary care initiatives such as the Patient-Centered Medical Home designation, the High-Intensity Care Management program for the frail […]

COMPLIANCE CORNER: Guidance On Leaves Of Absence

By JESSE MARKOS
The National Practitioner Data Bank has published an article in a recent version of NPDB Insights to help clarify when a hospital privileging action is reportable to the Data Bank. Since a Data Bank report can have significant professional and economic ramifications, it is important for all healthcare providers to understand when a report is required and when one can be avoided.

By way of background, the Data Bank is an alert system that collects and discloses certain adverse information about physicians and other healthcare providers. An adverse report to the Data Bank can significantly impact a health care provider’s reputation and career. State licensing authorities, hospitals and other health care entities, and professional societies search the Data Bank when investigating qualifications. A response that contains an adverse report can act as a permanent blackmark and result in a denial of credentialing, loss or limitation of hospital privileges, loss or limitation of licensure, exclusion from participation in health plans, and increases in premiums or exclusion from professional liability insurance.

NPDB Insights is published by the Data Bank to serve as a forum to provide updated guidance to users on topics such as eligibility, querying and reporting requirements, and the dispute process. The December 2018 […]

LANSING LINES: Lawmakers Push Hospital Staff Ratios

Hospitals would have to hire more nurses to meet staff-to-patient ratios and avoid excessive overtime under a package of bills, known as the Safe Patient Care Act, introduced this in late February in the House and Senate.

The bills would set nurse-staffing levels according to what kind of care they provide. In the intensive care unit (ICU), the ratio would be one-to-one. On a medical-surgical floor, the ratio would be four patients per registered nurse. In post-partum, where baby and mother are fine, the level would be six-to-one, explained sponsor Rep. Jon Hoadley (D-Kalamazoo).

“We think this will encourage hospitals to do what they should be doing, which is to have enough nurses on staff and to be properly prepared for every situation,” said Dawn Kettinger of the Michigan Nurses Association. “A lot of nurses are leaving the profession because of unreasonable workload and unreasonable hours, putting them and their patients in jeopardy.

Until we make a real commitment to proper staffing and keep it at the levels that it should be, we are going to continue to lose nurses out of the profession. It is not just a matter of producing more nurses. It is also a matter of keeping them in the profession.”

Hospital human resources departments […]

Cannabis Advocates Look To End Controlled Substance Tag

A group of Michigan citizens and organizations is suing the Michigan Board of Pharmacy to eliminate marijuana from the Schedule I list of controlled substances.

The state’s Public Health Code, which was enacted in 1978, treats marijuana like opioids and heroin, and that is “unconstitutional under Michigan law,” wrote Michael Komorn, attorney for the residents and organizations in the complaint recently filed in the Court of Claims.

“Even opium, a ‘hard narcotic’ and the root of the opioid epidemic, is a Schedule 5 drug when sold in small concentrations,” he said. “As there is no rational basis to classify marijuana with hard narcotics, it now must be classified below Schedule 5. As no such schedule exists, marijuana must be de-scheduled.”

Komorn, president of the Michigan Medical Marijuana Association, also argued that by passing the Medical Marihuana Facilities Licensing Act (MMFLA), the “Legislature has by implication repealed . . . marijuana’s controlled substance status.”

The MMFLA and Michigan Controlled Substances Act (MCSA), he noted, are “fundamentally inconsistent and incapable of being harmonized.”

The lawsuit also takes aim at Board of Pharmacy’s Chair Nichole Cover, who is named as a defendant, because she oversees both the pharmacy board, which considers marijuana illegal, and is a member of the licensing board, where medical […]

Ads For Short-Term Plans Overwhelm Searches

By STEVEN FINDLAY
Consumers shopping for insurance online last fall — using search terms such as “Obamacare plans,” “ACA enroll” and “cheap health insurance” — were most often directed to websites that promote individual health plans that didn’t meet consumer protections of the Affordable Care Act, according to a new study.

They also failed to get adequate information about those plans’ limitations, according to the analysis by researchers at Georgetown University’s Center on Health Insurance Reforms.

The study probed online marketing practices in eight states.
“It was disturbing, but not unexpected, to find such a high proportion of misleading ads and come-ons,” said Sabrina Corlette, the lead author. “That raises the risk that consumers could be duped into buying health insurance that they think offers comprehensive and secure coverage, but does not.”

The study focused primarily on the marketing of short-term plans, which don’t have to meet most ACA provisions, such as the requirement to cover preexisting conditions. The researchers found that regardless of the search term used, companies promoting or selling only these kinds of plans dominated the results.

Insurance regulators from each of the states told Corlette’s team that tracking the marketing and sales of short-term plans is challenging, as is educating consumers about the risks of limited coverage.

Michael […]

On Point With POs: Community Health Navigators

By  EWA MATUSZEWSKI
Community Health Navigators, Medical Assistants Gain New Respect—And Billing Codes
It’s not unusual for words and phrases to fall in and out of favor in the healthcare space, but it seems once they are assigned a billing code people start to take notice. Such is the case with “community health navigator.” Frequently used in conjunction with the social determinants of health (SDOH), the role of a community health navigator is rightly taking on significance as the go-to solution finder for the web of challenges that can vex consumers, often in the context of primary care, seeking non-medical answers to their quality of life issues.

Community health navigators are used in a variety of outreach organizations and have operated officially or unofficially throughout the years with an array of titles; yet their foray into primary care practice teams is relatively new. That makes sense though, as understanding of the role of social determinants of health continues to evolve and take root in primary care.

While community health navigators may be degreed social workers, such a specialty is not required. I prefer to think of them as individuals with no one particular professional degree; rather, curious and empathetic fact-finders with deep knowledge of community resources that can be […]

Compliance Corner: Eliminating Kickbacks

By REESA N. BENKOFF & DUSTIN T. WACHLER
Effective Oct. 24, 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) aims to combat the nationwide opioid and other substance abuse crisis by improving treatment and recovery options, increasing education and prevention, safeguarding communities, and fighting deadly synthetic drugs. The SUPPORT Act is a bipartisan, wide-ranging federal law comprised of over 70 individual bills, including the Eliminating Kickbacks in Recovery Act of 2018 (EKRA). EKRA establishes a new all-payor federal anti-kickback law applicable to recovery homes, clinical treatment facilities, and laboratories. While EKRA was intended to prohibit patient brokers who profit from “illicit referrals” of substance abuse patients, EKRA’s broad statutory language implicates common healthcare arrangements structured in compliance with existing federal and state fraud and abuse laws. Accordingly, healthcare providers and other entities and individuals in the healthcare industry must review all arrangements with recovery homes, clinical treatment facilities, and laboratories for compliance with EKRA.

EKRA prohibits knowingly and willfully soliciting, receiving, offering or paying remuneration, directly or indirectly, in return for referring a patient to, or in exchange for an individual using the services of, a recovery home, clinical treatment facility, or laboratory with respect […]

Shirkey Challenges Industry On Uninsured

While the Legislature launches into its latest look into reducing auto insurance rates, Senate Majority Leader Mike Shirkey (R-Clarklake) said he will be asking the insurance industry to come up with “creative solutions” to entice uninsured drivers to come in compliance with the state law requiring drivers to carry insurance.

In Michigan, 19 percent of drivers are tooling around uninsured, the nation’s fourth-highest rate, according to Insurance Research Council. The country’s most insured state is Maine, where 4.5 percent of drivers are uninsured.

If the insurance industry is able to reduce rates for certain populations, possibly to those burdened by a bad credit rating, it may entice more customers to buy the product. Spreading risk reduces rates for everyone, he said.

“We have pockets of poor compliance that is really high,” Shirkey said. “If we don’t make that a key part of what good looks like, then we’ll have missed a tremendous opportunity.”

Shirkey’s thoughts come a day after Sen. Aric Nesbitt (R-Lawton) introduced SB 0001, legislation that, as written, is statements of intent on where Republicans see potentials for reform. House Speaker Lee Chatfield (R-Levering) tapped Rep. Jason Wentworth (R-Clare) to chair a special committee on no-fault insurance reform in the House.

The Senate leader said he believes “People […]

Integrated Primary Care Clinic Opens

MedNetOne Health Solutions (MedNetOne), a health care management organization offering infrastructure, clinical and technology services to more than 900 private practice physicians and other independent care providers, including behavioral health specialists, has been selected by Judson Center to provide clinical oversight to its new integrated primary care clinic, Judson Center Family Health Clinic, opening February 1, 2019 in Judson Center’s Warren location.

Judson Center is a multi-county human service agency providing autism programs, behavioral health services, child and family services including foster care and adoption in tandem with its affiliate, Child Safe Michigan, and employment services for adults with developmental disabilities. The organization received nearly $700,000 in grant funding in support of its planned integrated primary care clinic, Judson Center Family Health Clinic, and turned to MedNetOne to provide clinical oversight, technology, infrastructure and health programming.

The new clinic will provide primary care health services integrated with mental health care to existing Judson Center consumers, primarily children from low-income backgrounds, as well as surrounding communities, and will serve all ages from infants to seniors. A 2018 survey of Judson Center’s behavioral health patients indicated that many were not presently seeing a primary care physician. Psychological barriers faced by people with mental health challenges often make it difficult […]

Supremes Take Case On Where Medical Pot Can Grow

The Michigan Supreme Court agreed Jan. 23 to hear oral arguments in a lawsuit challenging whether local governments can restrict where medical marijuana caregivers can grow marijuana for medicinal purposes.

Byron Township is asking the state’s highest court to reverse a July Michigan Court of Appeals decision that held the Michigan Medical Marijuana Act (MMMA) doesn’t allow municipalities to restrict where caregivers can grow medical marijuana.

“The decision of the Court of Appeals is clearly erroneous,” wrote Grand Rapids attorney Craig Noland in the Township’s application to appeal. “If left undisturbed, the decision effectively renders any and all zoning land use regulations, which address caregiver grow operations, void and unenforceable.”

The township also wants the court to order Kent County Circuit Court to order the lawsuit, filed by Christie DeRuiter, be dismissed.

The township sent DeRuiter, a registered caregiver, a letter in March 2016 that her medical marijuana-related activities constituted a zoning violation because she grew marijuana in an enclosed, locked facility at a commercial location.

DeRuiter sued, alleging the township’s ordinance prohibited what the MMMA permitted.

The Supreme Court placed a similar case, Charter Township of York v. Donald Miller, Katherine Null and David Miller, on hold pending the outcome of the DeRuiter case.

This story presented in cooperation with […]

New Neonatal ICU

DETROIT — To address the significant need to manage and minimize neurological complications associated with preterm and term newborn babies, Children’s Hospital of Michigan announced its newly developed Neuro-Neonatal Intensive Care Unit (NeuroNICU).

Children’s Hospital of Michigan’s NeuroNICU is the first-of-its-kind in the state of Michigan and one of a select few across the nation, according to DMC sources. This program offers a specially trained team of clinicians dedicated to providing an appropriate environment that will help optimize neurologic and developmental outcomes for this highly vulnerable population.

“We are excited to join other select premier children’s hospitals throughout the country in establishing the NeuroNICU program,” said Girija Natarajan, MD, Co-Chief Division of Neonatology, Clinical Operations and Education at Children’s Hospital of Michigan and Hutzel Women’s Hospital. “This program is aimed at ensuring preterm and term newborns at risk for brain injury and future developmental problems are meticulously cared for by a team of specialists.”

The NeuroNICU offers a six-bed unit housed within part of the newly expanded and renovated single room Neonatal Intensive Care Unit (NICU) on the third floor of the Children’s Hospital of Michigan Tower. The program will offer key pillars of care including neurological assessments, diagnostics, neuro-protection therapies and advancements in neurodevolopmental care. Transport cooling […]

Analysis: Can States Fix Disaster?

By ELISABETH ROSENTHAL
Last month, California’s new governor, Gavin Newsom, promised to pursue a smörgåsbord of changes to his state’s health care system: state negotiation of drug prices, a requirement that every Californian have health insurance, more assistance to help middle-class Californians afford it and health care for undocumented immigrants up to age 26.

The proposals fell short of the sweeping government-run single-payer plan Newsom had supported during his campaign — a system in which the state government would pay all the bills and effectively control the rates paid for services. (Many California politicians before him had flirted with such an idea, before backing off when it was estimated that it could cost $400 billion a year.) But in firing off this opening salvo, Newsom has challenged the notion that states can’t meaningfully tackle health care on their own. And he’s not alone.

A day later, Gov. Jay Inslee of Washington proposed that his state offer a public plan, with rates tied to those of Medicare, to compete with private offerings.
New Mexico is considering a plan that would allow any resident to buy in to the state’s Medicaid program. And this month, Mayor Bill de Blasio of New York announced a plan to expand health care access to […]

Lawsuit: Oxycontin Fortune Revealed

By CHRISTINE WILLMSEN & MARTHA BEBINGER
The first nine months of 2013 started off as a banner year for the Sackler family, owners of the pharmaceutical company that produces OxyContin, the addictive opioid pain medication. Purdue Pharma paid the family $400 million from its profits during that time, claims a lawsuit filed by the Massachusetts attorney general.

However, when profits dropped in the fourth quarter, the family allegedly supported the company’s intense push to increase sales representatives’ visits to doctors and other prescribers.

Purdue had hired a consulting firm to help reps target “high-prescribing” doctors, including several in Massachusetts. One physician in a town south of Boston wrote an additional 167 prescriptions for OxyContin after sales representatives increased their visits, according to the latest version of the lawsuit filed Jan. 31 in Suffolk County Superior Court in Boston.

The lawsuit claims Purdue paid members of the Sackler family more than $4 billion between 2008 and 2016. Eight members of the family who served on the board or as executives as well as several directors and officers with Purdue are named in the lawsuit. This is the first lawsuit among hundreds of others that were previously filed across the country to charge the Sacklers with personally profiting from the harm […]

DPC Docs Bring Care Directly To Patients

By PAUL NATINSKY
When it comes to providing affordable basic healthcare, there is a group of entrepreneurial doctors poised to change the way healthcare is delivered: Direct Primary Care Physicians. These docs provide 80 to 90 percent of the healthcare their patients need for $50 to $70 per month. They offer prescription drugs and laboratory tests for up to 95 percent savings over what patients pay through insurance plans. They help negotiate discounted diagnostics like MRIs and colonoscopies and, in some cases help patients get lower cost visits with specialists. They see about half the patients of their insurance-model colleagues, but spend more time with each patient and offer unlimited visits with no copay or per-visit charge. They accomplish all of this by dealing directly with patients, many of whom have health insurance.

Born in the late 2000s out of frustration over red tape, physician burnout and the urge to take care of patients, Atlas MD in Wichita, Kansas and Qliance Medical Group in Seattle, Washington sparked a national movement that has grown from about 400 practices to close to 1,000 nationally since 2016, according to Paul Thomas, MD, of Plum Health Direct Primary Care in Detroit. Thomas opened his practice, the second in Michigan, in 2016, […]

New Director Talks About Opportunities In Combined DHHS

Incoming Director Robert Gordon said early this month he believes there are “huge opportunities to improve services through the combination” of agencies that turned the Department of Health and Human Services into a huge 14,000-employee department.

“There are enormous connections between health and human services. People don’t live their lives in bureaucrat boxes,” he said in a telephone press conference today. “. . . I also know it is clear there is much more work to be done to leverage the combination and to get the full benefit.”

Gordon was appointed this month as the new DHHS director by Gov. Gretchen Whitmer. He most recently was senior vice president of finance and global strategy for The College Board. Previously, he served under President Barack Obama as acting deputy director at the U.S. Office of Management and Budget, and was the acting assistant secretary for Planning, Evaluation, and Policy Development at the U.S. Department of Education.

Whitmer said in December she was considering breaking up DHHS and had been concerned with the combination when it was made under former Gov. Rick Snyder.

“I view it as an open question. I should say, I don’t think there is a final decision on this question. But my going in is to look […]

ON POINT WITH POs: We Need A Code Of Empathy

By EWA MATUSZEWSKI
We have a Code of Conduct and a Code of Ethics. Heck, for ONyou history buffs, we even have the Code of Hammurabi. Why don’t we have a Code of Compassion, though? More specifically, a Code of Empathy? It wouldn’t be limited to the healthcare profession, but I can’t think of a better place to begin the codification process.

Actually, a Google search did turn up a video on a code of empathy, but its views are relatively insignificant; plus, it was preceded in search findings by “coding with empathy” and “coding with compassion.” I think that means the door is open for a movement on empathy in healthcare.
Empathy requires an individual to put him or herself into the shoes of another who is vulnerable in some way, perhaps due to illness, surgery, grief, depression, or even embarrassment. We’ve all been vulnerable on occasion. In the hospital or other type of healthcare or rehabilitation setting, we may be at our lowest point of vulnerability. Responding to patient requests, or chastising patients in recovery, with the following comments reveals an utter absence of empathy (these are actual statements made by healthcare professionals to a patient):

• “I haven’t got time for that.”
• “Your cognitive skills are […]

COMPLIANCE CORNER: TPE Medicare Audits

By SARAH HILLEGONDS, ESQ.
Targeted probe and educate (TPE) audits are the latest type of audits facing Medicare providers and suppliers (collectively referred to as “providers”). TPE audits are unique in that providers may be subject to up to three rounds of record reviews. If a provider fails to improve the accuracy of their claims after three rounds, the provider will be referred to CMS for possible further action.

The Centers for Medicare and Medicaid Services initially launched TPE as a pilot program in one Medicare Administrative Contractor (MAC) jurisdiction limited to certain types of claims. In October 2017, CMS expanded TPE audits to all MACs for all Medicare providers and all items and services billed to Medicare. TPE audits focus on providers with a history of high claim error rates or unusual billing practices compared to their peers, and items and services that have high national error rates and are a financial risk to Medicare. Common claim errors include: (1) the signature of the certifying physician was not included; (2) documentation does not meet medical necessity; (3) encounter notes did not support all elements of eligibility; and (4) missing or incomplete initial certifications or recertification.

Providers selected for a TPE audit will receive an initial notification […]

OPINION: Is Reinsurance Really A Solution?

By ALLAN DOBZYNIAK, MD
One of the drivers of increasing health insurance policy premiums, and especially ACA policies, is the so called “community rating.” This is the concept that requires health insurance companies to offer policies within a given territory at the same price to all persons without medical underwriting, regardless of their health status. This does not account for all premium increases such as coverage mandates and increasing provider costs (almost exclusively attributable to hospitals), but it has become increasingly consequential. For the ACA, as the premiums increase fewer healthy people, particularly the younger, can afford the increasing premiums, or they may voluntarily choose not to purchase the more expensive policies. The result is a greater percent of policy holders are high-risk with significant preexisting conditions. Therefore, there are fewer healthy people to defuse the continuing rise in risk and premium costs as the situation persists and worsens. Huge premium increases have been the unfortunate result.

The novel new definition of “reinsurance” as it applies to health care has nothing to do with the classic definition. Reinsurance has meant the purchase of insurance by an insurance company to cover large unanticipated losses that may be greater than its financial reserves. In healthcare, it is a part […]

Marijuana And Public Health

By FEDERICO MARIONA, MD
The Michigan voters recently approved Proposal 1 by a margin of 56 to 44 percent. Retail for-profit sales of marijuana and related products is now the law in Michigan. Our state is the first state in the Midwest to take this step. Our neighbor Canada already has this in place. There are no neighboring states that have approved the use of marijuana for retail sales, yet.

Marijuana is a product from the flowers, stems, leaves and seeds of the plant (Phyto cannabinoids), and is the most common illicit drug used in the United States. Phyto active elements have been described for centuries. Marijuana’s history as a source of these elements described as having “medical effects” dates to biblical times. The main psychoactive component is the delta-9-tetrahydrocannabinol (THC). Marijuana “extracts” are rich in this element. Industrial “hemp” contains low levels of d-9-THC. Emerging in the United States, specifically in the Midwest, are the “synthetic cannabinoids” that replicate the effects of the natural product, but they induce more severe adverse health effects. In addition, marijuana contains a number of other phytocannabinoids, such as Canabidiol (CBD) without psychoactive effects and, arguably, with […]

COMPLIANCE CORNER: HIPAA Fines Provider For Media Disclosure

By THOMAS MILES, ESQ. & REESA N. BENKOFF, ESQ
On Nov. 26, 2018, the Office for Civil Rights (OCR), a division of the U.S. Department of Health and Human Services, announced that it had entered into a settlement agreement with Allergy Associates of Hartford, P.C. regarding alleged violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. The settlement requires Allergy Associates to pay the OCR $125,000 and enter into a two-year Corrective Action Plan. Allergy Associates, a physician practice with four office locations in Connecticut, is comprised of four physicians and two mid-level providers. Despite the seemingly low settlement figure, this fine relates to a HIPAA Privacy Rule breach involving only one patient and is, therefore, significant in that it emphasizes the OCR’s focus on investigating smaller covered entities for breaches that affect very few patients. In fact, since 2015, the OCR has placed an emphasis on investigating smaller covered entities as well as breaches that affect less than 500 individuals following a report issued by the HHS Office of Inspector General finding that the OCR had historically focused its investigation efforts on larger covered entities and breaches affecting over 500 individuals.

The incident leading […]