By ALLAN DOBZYNIAK, MD
The solution to healthcare’s costs and access problems is quite obvious. It has been repeatedly suggested that what is needed is a plethora of doctors. Of course this would lower cost and increase access. “Overpayment” of U.S. doctors would disappear as the market becomes oversaturated. Access to care would no longer be an issue as doctors compete for patients.

Only a few minor adjustments would be needed. Time and cost as barriers to manufacturing legions of new doctors could be rectified by eliminating the non-essential four years of college and the extraneous liberal arts courses. A year or so of several science courses in the local community college should suffice. Once in medical school, students could be indoctrinated to give up their rights and self-determination for the general good. Compromise as an approach to regulatory serfdom could be declared one of the most laudable qualities. The chorus of righteousness and the PR mumbo-jumbo of “openness,” “caring,” “sharing,” “community,” and “compassion” could be further integrated into the curriculum. Being taught to think like thinking machines would be pursued. Following the protocols and checking boxes in the myriad screens in the EMR to satisfy the masters of the very “moral” RVU invention would relegate thinking [Read More]

By: KERRY B. HARVEY & ANDREW L. SPARKS
Michigan, like the rest of the country, suffers from an opioid epidemic. Every day, more than 100 Americans die from an opioid overdose. Some economists estimate that the opioid crisis has cost the U.S. economy more than $1 trillion since 2001 and is on pace to cost an additional $500 billion through 2020.

The profligate use of opioid pain relievers has contributed mightily to the epidemic. A few data points tell the story:

• About a quarter of patients prescribed opioids for chronic pain do not use them as directed.

• Roughly 4 out of 5 heroin users first abused prescription opioids.

• United States citizens consume about 80 percent of the world supply of oxycodone and almost all of the supply of hydrocodone

Predictably, lawyers and their clients have engaged the legal system to assign responsibility for the opioid epidemic. The wave of opioid litigation has reached Michigan. Opioid litigation, modeled largely on the tobacco lawsuits of the 1990s, has grown exponentially over the last few years. State and local governments initially targeted pharmaceutical manufacturers. Now, distributors such as McKesson and Cardinal have been sued. In 2017, more than 250 state and local governments sued organizations throughout the opioid supply [Read More]

Legalized Pot Goes To Ballot, House Opts Not To Vote
Not only did the House Republican caucus not have the votes to legislatively adopt and amend a citizen initiative to legalize recreational use of marijuana, House Speaker Tom Leonard (R-DeWitt) said June 5 he’s not convinced the state Senate really did either.

Senate Majority Leader Arlan Meekhof (R-West Olive), presented with polling showing recreational marijuana passing this fall, said he had 20 votes in the Senate to pass the marijuana legalization citizens initiative.

Had the House passed it June 5, the last day of the 40-day constitutional deadline, Meekhof pledged he would have, too, giving Republican lawmakers an easier shot at amending the proposal to better regulate “home-brew” marijuana businesses, potency restriction and possession amounts.

But the House didn’t have the votes. Inside sources project the chamber had about 40 and likely weren’t going to get any more. Democrats had presented a united front against the proposal and hardline conservatives philosophically opposed legalizing pot.

And Leonard questioned whether the Senate had the 20 votes to pass it anyway, despite Meekhof’s claims.

“I have to believe that if they had the votes to pass this, if they were serious, that they would have taken the vote. And they have yet to take [Read More]

A Flint doctor whose research helped expose the lead contamination crisis in Flint’s drinking water said it was the chief medical executive’s work that moved state officials “to change course” in the water crisis.

Dr. Mona Hanna-Attisha, a pediatrician with Hurley Medical Center and Michigan State University, said Dr. Eden Wells’ phone call to her in October 2015 got the state to relook at its results—which contradicted the doctor’s research—of lead blood levels in Flint’s children.

“It was her phone call and I think what she did at the state level to re-look at the data . . . that really got them to change course,” the doctor testified April 24 at day 15 of Wells’ preliminary examination. “I’m grateful she was able to look at the data and to realize we did have a problem. If not for her action, I think it, the attacks and denials, would have gone on much longer.”

Hanna-Attisha summed up Flint’s situation rather succinctly: “Flint had no democracy; money was the bottom line.”

Wells is charged with involuntary manslaughter, lying to a special police agent and obstruction of justice in connection with the legionnaires’ disease outbreaks that killed 12 people and sickened nearly 80 more.

Special Prosecutor Todd Flood called the state’s last [Read More]

By JAY HANCOCK 
The Maryland Proton Treatment Center chose “Survivor” as the theme for its grand opening in 2016, invoking the reality-TV show’s tropical sets with its own Tiki torches, palm trees and thatched booths piled with pineapples and bananas.

It was the perfect motif for a facility dedicated to fighting cancer. Jeff Probst, host of CBS’ “Survivor,” greeted guests via video from a Fiji beach.

But behind the scenes, the $200 million center’s own survival was less than certain. Insurers were hesitating to cover procedures at the Baltimore facility, affiliated with the University of Maryland Medical Center. The private investors who developed the machine had badly overestimated the number of patients it could attract. Bankers would soon be owed repayment of a $170 million loan.

Only two years after it opened, the center is enduring a painful restructuring with investors poised for huge losses. It has never made money, although it has ample cash to finance operations, said Jason Pappas, its acting CEO since November. Last year it lost more than $1 million, he said.

Volume projections were “north” of the current rate of about 85 patients per day, Pappas said. How far north? “Upper Canada,” he said.

For years, health systems rushed enthusiastically into expensive medical technologies such as [Read More]

Budget Only Pays DHHS Officials’ Wages If Feds Approve Medicaid Waiver

Department of Health and Human Services Director Nick Lyon and his fellow unclassified employees would only be paid next year if the feds approve Michigan’s Medicaid expansion waiver as Republican lawmakers argue it was written, according to a Senate subcommittee spending plan approved April 17.

Sen. Mike Shirkey (R-Clarklake) and DHHS Subcommittee Chair Peter MacGregor (R-Rockford) argue the “Healthy Michigan” waivers the federal government approved do not reflect 2013 law that requires beneficiaries to pay more in co-pays and annual premiums after four years on the program.

SB 0856 puts a firm four-year cap on the Healthy Michigan program and withholds unclassified employees’ salaries unless the program that expands Medicaid to those between 100 and 133 percent of the federal poverty line follows expanded requirements.

And if Lyon and his top lieutenants don’t make that happen, $294,000 in their salaries and wages doesn’t get appropriated.

“Sometimes departments need motivation in making sure we get the best product out,” MacGregor said.

MacGregor added that he anticipates further discussion with the administration, but as he sees it, the federal waivers that allowed for the creation of Healthy Michigan doesn’t follow the state law Republicans passed. Either the law has to change, the [Read More]

By EWA MATUSZEWSKI
I’m still not done talking about the Social Determinants of Health (#SDOH). On the contrary, I’m fired up even further after the April 18 gathering at Oakland University for the conference MedNetOne Health Solutions co-presented with the Oakland University School of Health Sciences: Better Upstream Health for Better Downstream Care.

Approximately 170 kindred spirits and current and future upstreamists gathered for a full day of discussing how Michiganders can take aim at some of the key drivers of poor health by supporting (and funding) activities that mitigate negative social realities earlier in the game. An example I like to use is an individual with Type 2 diabetes whose social determinants are few economic resources, inability to purchase testing supplies and insulin, limited access to affordable, healthy food and fractured or non-existent personal support systems. Upstreamists would be called in (and reimbursed) for efforts that work to prevent the sometimes deadly and often costly disease. More intervention is needed before a crisis hits –although I’d argue the crisis is already here.

Speaking of diabetes, this offers me another opportunity to turn the conversation to one of my favorite professions on the health care continuum – pharmacists. If you’ve read this blog with any regularity, you know [Read More]

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 is an alert system that collects and discloses certain adverse information about physicians and other health care 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 black mark 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 [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 Tim’s death, placed him in his 50s. He was fit and looked healthy and bright-eyed, but he didn’t look particularly young. It was the energy and optimism he radiated that backdated Tim’s chronological age.

He never failed to greet me with a hearty, “Paulie, my boy!” whenever we met or talked on the phone. Even our final conversation began that way, although it quickly became apparent that was the extent of the energy he could muster.

Tim and I worked together for seven or so years, after a mutual friend brought him into a promotional project we [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 patients who filed malpractice claims using various methods, including questionnaires, deposition transcripts, and phone surveys. Four primary reasons emerged: 1) prevention of similar incidents in the future; 2) a desire for an explanation about a harmful incident; 3) financial renumeration for pain, loss, and/or suffering or to offset future care expenses; and 4) the need to hold a doctor accountable.

At the root cause of many of these malpractice claims is a breakdown in the relationship between the physician and the patient—typically due to problems with communication. Patients complained that [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 is separate from the premium assistance offered to individuals buying marketplace plans.

Not enforcing the individual mandate has several effects. First, it is likely to reduce enrollment as young, healthy people now face no financial penalty if they forego health insurance, a trend that was in place before the ACA. Fewer young and healthy people paying premiums means insurers pay a higher percentage of premium dollars to provide healthcare services and are forced to raise premiums for everyone, another trend predating the ACA.

“I will tell you in talking to my plans that are involved I the [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 asked when I would declare the water safe in Flint and I have always said that no arbitrary decision would be made — that we would let the science take us to that conclusion.”

Flint Mayor Karen Weaver said the available supply of bottled water is expected to be exhausted over the weekend.

“We did not cause the man-made water disaster, therefore adequate resources should continue being provided until the problem is fixed and all the lead and galvanized pipes have been replaced. I will be contacting the governor’s office immediately to express the insensitivity of the [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 calls and e-prescribing. It’s like the power grid of the practice. At least when we lose power at home, we can call or text a number to find out how long the outage is expected to last, with status updates provided throughout the process.

When this member physician’s EHR was disabled, the VAR (it reminds me of the mortgage business, where mortgages are sold to third parties) offered no communication – nor proof of a disaster plan. When I repeatedly asked for one, I finally got a PDF of a copy of a generic disaster recovery [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 settlement offer on certain eligible appeals. SCF and LVA have complimentary eligibility criteria that collectively have the opportunity to resolve nearly every Medicare Part A or Part B claim under $100,000.00 in billed charges that is pending at the Administrative Law Judge (ALJ) or Medicare Appeals Council (Council) levels of the Medicare appeals process as of Nov. 3, 2017.

CMS and OMHA announced these new settlement opportunities consistent with their efforts in recent months and years to combat the backlog of appeals pending at the ALJ and Council levels of review in Medicare’s administrative appeals process. [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 an informed clientele. Often, patients do not see the costs of the services provided until after the numbers have gone through their insurance. In the past, consumerism had little impact on the healthcare cost structure due to fear overriding frugality—no one wants to save a few hundred dollars on a particular test and then “die” as a result of that decision. Find ways to encourage your patients to compare the true costs of their medical care by establishing the quality baseline. For example, two identical CT Scanners sitting next to each other can have very [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. As an example, The Washington Post reported on January 11 that 10 states are requesting federal permission to impose work requirements on able-bodied adults who are enrolled in Medicaid.

The second AMA article highlights the significant observation that enrollment in state-run ACA programs is up, and enrollment in Healthcare.gov programs is down:
“…A majority of the states which manage their own ACA exchanges “saw more people sign up in 2018 than last year, while 29 of the 34 states that rely on the federal government to promote enrollment saw their sign-ups fall,” according to data unveiled by [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 this thinking now be leading to the rise of a generation of patients who expect medical treatment and cures as a right simply because they wish it?

Was it not in the recent past considered above all important for physicians to have the ability to think and judge, to consider the countless variables and options relevant to the individual uniqueness of each patient, process the sum total of the information and render his or her decision? Of course physicians appreciate there are general approaches to the work-up and treatment of a variety of illnesses captured in [Read More]

State Permanently Yanks Nassar’s Medical License, Docks Him $1M

The state April 6 permanently revoked the medical license of Larry Nassar and fined him $1 million, making it the largest fine ever issued by a health professional or occupational board in the history of the Michigan Department of Licensing and Regulatory Affairs (LARA), according to the department.

Nassar, the former physician for Michigan State University and team doctor for U.S.A. Gymnastics, has been sentenced to federal prison on child pornography possession charges. He was sentenced to state prison on numerous counts of criminal sexual conduct, stemming from his sexual abuse of hundreds of women, often under the guise of medical treatment.

The state’s Board of Osteopathic Medicine and Surgery initially revoked Nassar’s license on April 25, 2017, based on LARA’s order summarily suspending Nassar’s license and an administrative complaint filed in January 2017.

The permanent revocation stems from Nassar’s convictions, outlined in January 2018 administrative complaint filed by the Attorney General’s office on behalf of LARA.

The $1 million fine is to be paid to the state after all restitution, criminal fees and fines, and civil judgments Nassar is ordered to pay have been fully satisfied.

Supreme Court Asked To Review Healthy Kids Dental Contract

MCNA is taking its fight challenging Michigan’s [Read More]

By SHEFALI LUTHRA
When President Donald Trump signed the last-minute budget deal into law earlier this month, the news coverage emphasized how the bill boosted military funding, provided tens of billions in disaster aid and raised the debt ceiling.

But buried deep in the 652-page legislation was a repeal of a limit on Medicare coverage of physical and occupational therapy. It received little public attention, but to the American Physical Therapy Association, this headline was decades in the making.

The group had spent 20 years lobbying to reverse a component of the Balanced Budget Act of 1997, which would have limited patients to $2,010 worth of occupational therapy a year, and another $2,010 of physical therapy and speech-language pathology. Each time the limit was about to kick in, APTA managed to postpone its implementation — sometimes for just months, sometimes for another year or so.

Justin Moore, APTA’s CEO, quit his job as a physical therapist in Missouri and moved to Washington, D.C., in 1999 specifically to lobby Congress full time about staving off these so-called therapy caps. He recalls recruiting thousands of physical therapists to protest on Capitol Hill, long hours lobbying in congressional offices and eleventh-hour victories to keep the cap from taking effect.

Just hours after Trump [Read More]

In an email letter to members of the Michigan State University Board of Trustees, the university’s new interim president, John Engler, reports he wants to fire Dr. William Strampel, Dean of the Osteopathic Medical School since 2002, for his role in the Larry Nassar case.

The President’s recommendation, after five days on the job, requires an affirmative vote of a faculty hearing committee to reverse his tenure.

Strampel has been on medical leave since last December.

According to an MSU news release, he was accused of not following-up on the medical procedures he asked Nassar to follow after a joint FBI and campus police department investigation into sexual abuse allegations concerning Nassar.

The release quoted Strampel as saying he did not “see the need to follow up to ensure” Nassar complied with the recommendations to use a rubber glove and have another adult in the room during his medical exams.

“William Strampel did not act with the level of professionalism we expect from individuals who hold senior leadership positions, particularly a position that involves student and patient safety,” wrote Engler. “Further allegations have arisen that question whether his personal conduct over a long period of time met MSU’s standards. We are sending an unmistakable message today that we will remove [Read More]

A former University of Michigan-affiliated pediatric rheumatologist who was investigated for having sex with a patient is facing federal child pornography charges, according to a federal complaint unsealed Feb. 12.

Mark Franklin Hoeltzel, 46, stood mute—meaning a not guilty plea was entered for him—in front of U.S. District Magistrate Judge Elizabeth A. Stafford. He is charged with receipt of and possession of child pornography. He faces up to 20 years in prison if convicted as charged.

U.S. Assistant Attorney General Mollie O’Rourke asked that Hoeltzel be immediately detained, which Stafford granted.

Defense attorney Raymond Cassar said he demanded the hearing to argue for his client’s release because he believes Hoeltzel, who had returned from treatment out of state when he was arrested, is not a risk of flight nor is he a risk to the community.

“He was coming back into the state when they arrested him and the government knew that; we had made arrangements for him to come back,” Cassar said. “The biggest reason I want to get him out on bond is to get him back into treatment here in Michigan.

“That’s important for him. The treatment he’s undergoing is important for him. It’s important for his growth and to address the charges,” added Cassar, declining to [Read More]

By SARAH HILLEGONDS
Recently, we have received reports that the Michigan Department of Health and Human Services (MDHHS) Office of Inspector General (OIG) is conducting aggressive audits of pharmacies that concentrate on invoice and inventory records. In most cases, the targets of these invoice and inventory audits are independent pharmacies. According to the OIG, the purpose of inventory audits is to ensure that a pharmacy is not billing Medicaid for more drugs than it purchased. But the methodology utilized by the OIG is susceptible to error, resulting in inaccurate overpayment demands, and there are questions as to the legality of these types of audits prior to July 1, 2015. This article will explore the legal framework governing inventory audits and one of the many legal defenses being raised by pharmacies subject to recoupment as a result of this type of audit.

Pharmacies, like any other healthcare provider, are required to comply with various federal and state laws, as well as state policies as a condition of participation in the Medicaid program. The OIG relies on authorities contained within the Medicaid Provider Manual, as well as its general powers under the Social Welfare Act, 400.1 et. seq., and Executive Reorganization Order 2010-1, MCL 333.26368, to perform inventory audits.

While [Read More]

By EWA MATUSZEWSKI
The upstreamists are coming! The upstreamists are coming! If you know what I’m talking about, I’ll consider you a loyal follower of this column—or someone who is already attuned to the social determinants of health (#SDOH). In my October 2017 column, I discussed a call to action on #SDOH and cited the upstreamist term used by Rishi Manchanda, MD, a physician and public health innovator who has worked in South Central Los Angeles and advocates for incorporating #SDOH into primary care.

I couldn’t be more excited to announce that Dr. Manchanda will be coming to Michigan (for the first time!) when MedNetOne joins with the Oakland University School of Health Sciences on Wednesday, April 18 to present a day-long symposium at OU on #SDOH, Better Upstream Health for Better Downstream Care. Dr. Manchanda will be joined by healthcare innovator Paul Grundy MD, MPH, who just stepped down after a stellar career as IBM’s Global Director of Healthcare Transformation and is considered the “godfather” of the Patient Centered Medical Home.

A quick review: social determinants of health may include:
• Economic resources, including access to jobs that provide a living wage
• Safe workplaces and safe neighborhoods
• Quality of schools and availability for advanced education and training
• Clean [Read More]

By SUSAN ADELMAN, MD
In the age of Larry Nassar, in the era of #metoo, what is a girl to think? What is a doctor to think? What are the rules these days? From the standpoint of doctor-patient relations, the fallout from the Larry Nassar case could be toxic for medical care.

First, how are doctors trained? When young people graduate from medical school and enter practice, traditionally they take the Hippocratic Oath, either as originally written, or as updated. The Oath has two salient sentences. The first is: “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing.”

The other pertinent sentence is “Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free.” Both of these promises are intended to prevent the doctor from engaging in self-serving behavior that is not in the best interests of the patient.

One more principle is taught to all medical students: “First do no harm,” often quoted in the original Latin: Primum non nocere.

It is assumed that the young doctor understands these admonitions. If not, [Read More]

By MARKI STEWART
The use of telemedicine has soared in recent years, as new technologies develop and consumer demand for instant access to healthcare increases. Indeed, the telemedicine market is expected to grow to $113.1 billion by 2025, at an estimated compound annual growth rate of 18.8%. It is expected that at least 7 million patients in the United States will access telemedicine services in 2018, a sharp increase from 2013, when the estimated number of telehealth patients was fewer than 350,000. Despite this momentous growth, reimbursement continues to be a key obstacle for telemedicine providers. However, reimbursement rules by various payors are slowly expanding to cover more telemedicine services.

Medicare remains one of the most restrictive payors for telemedicine services, with exceptionally limiting reimbursement rules. With some exceptions, Medicare will pay for a telemedicine encounter only when the patient is located in a rural area and present at an eligible originating site, the service must be delivered by one of eight eligible professionals and the modality must be real-time, interactive, and face-to-face (thus prohibiting “store and forward” telemedicine technologies), with a limited number of available codes. Notably, Medicare recently changed its coding for telemedicine services, eliminating use of the “GT” modifier traditionally used to indicate [Read More]