By JESSE A. MARKOS, ESQ.
Wachler & Associates, P.C.

Hospitals have long been required to file a National Practitioner Data Bank (Data Bank) report on any health care provider’s voluntary surrender of clinical privileges if an investigation is underway or to avoid an investigation. In practice, the number of such cases that were reported was limited by the uncertainty and lack of sufficient guidance regarding which specific activities qualify as an “investigation” and when such an investigation officially commenced. However, the new adoption by the revised Data Bank Guidebook of an expanded description of what qualifies as a reportable investigation has resulted in increased reporting.

By way of background, the Data Bank [Read More]

Tim Bannister was a fun guy to have known. He even had a funny handle, “Handrail Harry,” based on his given name, Harry Bannister, and a play on words with bannister. In typical quirky fashion, “Tim” was also a nickname, the origin of which I never found out. He died April 9.

During the years I knew Tim, I often wished we were closer in age (he was 20-plus years my senior). I think given more time we would have had a blast serving clients, sharing ideas and enjoying our friendship.

I was regularly dosed with a small sample of that wished-for parity. Every client we met, including our last shortly before [Read More]

By MICHELLE N. KHAZAI
A 2017 Medscape survey indicated that over half of responding doctors had been sued for malpractice. The number one reason? Failure to diagnose a medical condition, given by 31 percent of respondents. Nearly half of doctors surveyed who were sued for malpractice spent between 11 and 50 hours in court, meetings with lawyers, or in other legal proceedings. And almost half of those surveyed stated that there was no triggering event and that they were taken by surprise by the malpractice claim.

Studies published in the Journal of the American Medicine Association, Lancet, and the Archives of Internal Medicine delved into the mindset of [Read More]

By PAUL NATINSKY
As efforts to dismantle the Affordable Care Act continue, Michigan’s Health Plans have stepped up their search for solutions to mounting complications.

The Trump White House has administratively chipped away at Obamacare’s policies, including cancelling in cost-sharing reduction (CSR) subsidies and non-enforcement of penalties consumers pay for not adhering to the ACA’s requirement that individuals buy comprehensive health insurance.

The two measures present a double whammy to health plans. The CSR payments were funds paid to insurers to offset the cost of care for individuals earning too little money to cover out-of-pocket healthcare expenses such as copays. The money totaled about $7 billion in payments to health plans nationally. It [Read More]

After almost two years of results showing Flint’s water testing below federal standards for lead, Gov. Rick Snyder announced April 6 the state will close the four remaining point of distribution (POD) centers for bottled water when the current supply runs out. Deliveries of bottled water to homebound residents will end at the same time, but residents will still be able to get free water filters and replacement cartridges at city hall.

“We have worked diligently to restore the water quality and the scientific data now proves the water system is stable and the need for bottled water has ended,” Snyder said. “For the past two years, I have repeatedly been [Read More]

By EWA MATUSZEWSKI
I know I’ve lamented the proliferation of acronyms in healthcare before, but I need to discuss yet another. You’ve likely heard of Value-Added Resellers (VARs); well, I’m here to challenge the “value” component of the name as it applies to Electronic Health Records (EHR). First, here’s a quick VAR definition from Wikipedia to get you up to speed, if necessary.

We learned the hard way when a member practice’s EHR went down recently that it is wrong to assume the VAR has a back-up plan. A physician’s office is dependent on its EHR for not only patient records, but also critical practice management tools like scheduling appointments, billing, phone [Read More]

By ERIN DIESEL ROUMAYAH, ESQ.
On Nov. 3, 2017 the Centers for Medicare and Medicaid Services and the Office of Medicare Hearings and Appeals (OMHA) (the division of the U.S. Department of Health and Human Services that administers the Medicare appeals process) announced two new settlement opportunity for Medicare Part A and Part B providers and suppliers with eligible fee-for-service appeals pending in the administrative appeals process. These new programs are the Low Volume Appeals Settlement (LVA) and the expanded Settlement Conference Facilitation program (SCF). CMS offered LVA as a lump-sum settlement offer for eligible Appellants with certain eligible appeals. SCF affords eligible Appellants an opportunity to negotiate a lump-sum [Read More]

By ERICA MORRIS & MARK WILSON
How can providers increase quality of care while reducing cost to patients? The answer is through innovation, creativity, increased patient responsibility, partnership, and real-time flow of information. Here are just a few ideas to consider in reaching this overarching goal. While none of the ideas articulated below are novel or groundbreaking on their own, they are strategies that we have observed to be successful and that have benefited both patients and practices.

Encourage Your Patients to Be Involved in Their Healthcare Decisions—Both Procedurally and Financially

One of the keys to bringing costs down and letting the competitive consumer market assist in the process is having [Read More]

By SUSAN ADELMAN, MD
As the endless dispute about reforming healthcare drags on in Washington, the participants might want to note two articles that appeared in the daily AMA Morning Rounds on February 9, 2018:

The first references several state-requested innovations to Medicaid:
Quoting the Congressional Quarterly, “in addition to work requirements,… several states “want to impose time limits on how long people can stay on the program.” A couple of states “want to roll back their Medicaid expansions to cover fewer people,” and still others would like “to require drug testing or limit the list of prescription drugs they’ll pay for…”

The press already has reported on some of these proposed work requirements. [Read More]

By ALLAN DOBZYNIAK, MD
Could it be that medical care is now taken for granted? Are the fantastic technologies, miracle drugs, futuristic hospitals, and finally even doctors now simply viewed as facts of nature, things that were always there and will always be there? Is there the expectation that doctors will forever improve the quality of life and add years to it?

Could it be possible that government intervention into healthcare was the origin of the concept that patients need do nothing to earn their medical care and even presume perfection and cures? All they needed to do was wish it, demand it, and the government would decree that it happen. Could [Read More]