Prescription Data-Mines and Insurance “Credit-Reports”

The End to “Rx” Privacy? 
Staff Reporters
Collecting and analyzing [HIPAA protected?] personal health information [PHI] in commercial databases is a fledgling, but exploding industry, despite privacy concerns.
Industry Leaders
For example, Milliman’s IntelliScript provides personal drug profiles to insurers. And, Ingenix’s MedPoint is owned by UnitedHealth, the corporation that owns UnitedHealthCare. UHC is also the nation’s second-largest [...]

Medicare GAO Report on Radiology

Prior Imaging-Authorization Suggested
Staff Reporters
As reported in the Wall Street Journal, on July 14, 2008, Medicare may be soon requiring prior authorization to curtail unnecessary utilization of CT scans, MRIs and other forms of medical imaging, a new Government Accounting Office [GAO] report suggests.
The Medicare Report
To cut imaging costs, Medicare has been reducing certain physician [...]

Patients Challenging Medical Invoices

Root Cause is Money, Failure-to-Disclose and Frustration
Staff Reporters
Patients are challenging their medical bills with lawyers and lawsuits, out of frustration about the lack of up-front disclosure over costs by doctors and hospitals.
Involve More than a Few Cases
For example, after being charged $82,282 for a 23-hour stay in doctor-owned Westfield Hospital for two operations on [...]

Physician Malpractice Liability Immunity

Free Charity Medical Care?
Staff Reporters
Sen. Mike Enzi [R-Wyoming], the senior Republican on the Senate Health, Education, Labor and Pensions Committee [HELP], recently introduced legislation that would allow physicians and other medical professionals to volunteer their services at charity clinics and community health centers free from medical liability concerns.
Query
What is your opinion on this idea, given [...]

CMS to Bonus Doctors for PQRI

July – December 2007 Reporting Period
Staff Reporters
According to Anne Zieger, of Fierce Health Finance, the Centers for Medicare and Medicaid Services [CMS] will pay out more than $36 million in monetary incentives to medical providers who reported data on quality of care delivered between July 2007 and December 2007; as part of its Physician Quality [...]

Internet Drug Rx Abuse

NCASA Study
Staff Reporters
A large majority of 365 Internet sites that advertise or sell controlled medications by mail are offering to supply the drugs without a proper prescription, while the online trade is stoking the rising abuse of addictive and dangerous prescription drugs, according to a National Center on Addiction and Substance Abuse [NCASA] at Columbia [...]

“Loss of Chance” Liability

Judicial Court of Massachusetts
Staff Reporters
The Supreme Judicial Court of Massachusetts [JCM] recently ruled that doctors can be held liable for negligence that reduces a patient’s chance of survival, even if the patient’s prospect for recovery was already less than 50 percent.
“Loss of Chance”
The SJC recognized for the first time a legal doctrine known in [...]

Doctors Unite!

On the “Open Letter from America’s Physicians”
By Dr. David Edward Marcinko; MBA, CMP™
Publisher-in-Chief
As we have seen in this healthcare-charged election season, almost every form of political activism or debate has moved online. So, it is no surprise that a coalition of disgruntled physicians would electronically socialize and network together, as seen with www.sermo.com
About Sermo - Peer [...]

Bernanke on Healthcare Spending

The Federal Reserve Chairman’s Report
Staff Writers
Benjamin S. Bernanke, chairman of the Federal Reserve, recently told Congress that health spending would “rise relentlessly” unless lawmakers overhauled the health care system.
Senate Finance Committee
Of course, this comes as no surprise to Executive-Post subscribers, and us all. Mr. Bernanke’s remarks opened a daylong bipartisan symposium convened by the [...]

AEM Report on Drug History Errors

Annals of Emergency Medicine Drug-Report
Staff Writers 
Medication histories for trauma patients were inaccurate for a rural population due to communication lapses, according to a new study published on June 9 2008, by the Annals of Emergency Medicine [AEM].
The Report
Researchers studied 234 trauma patients in a rural setting, the majority of whom were moderately injured. Medication lists [...]

Ending Governmental Barriers to e-Prescribing

AMA’s - HOD Wants End to Governmental e-Prescribing Barriers
Staff Writers
According to Modern Healthcare [June, 2008] the American Medical Association’s-House of Delegates [HODs] adopted a resolution calling for an end to government-imposed barriers to e-prescribing. 
The Resolution
The resolution called for the removal of all federal Medicare and state Medicaid requirements mandating the use of paper prescription forms for certain [...]

New Hospital Rating Service

Consumers Union
Staff Reporters 
The nonprofit Consumers Union is launching a new hospital ratings service, adding to the growing competition to provide online consumer information about health care, as reported in the Wall Street Journal.
A Consumer Reports Publication
The effort, by the publisher of Consumer Reports magazine, is a gamble that the credibility of the magazine’s [...]

Doctors and Divorce Settlements

Effects on a Physician’s Financial Plan
By John R. Connell, MBA, JD, CPA/PFS
Just because a physician or other couple is getting divorced, does not mean that all previous financial planning has become untenable. The parties’ goals and objectives may remain the same. However, even though assets are divided equally, income and expenses rarely follow the same [...]

HIT Congressional News

New CBO Report
Staff Reporters
Official congressional analysts just dealt a blow to the prospects of broad legislation to boost health information technology, by taking a skeptical view of the savings that would likely result.
Yet, iMBA Inc www.MedicalBusinessAdvisors.com - a sponsor of the Executive Post - took the opposite posture this past summer with release of [...]

Risky Business of Web 2.0 Doctor Bloggers

A Mashed-Up Opinion
By Dr. David Edward Marcinko; MBA, CMP™
Publisher-in-Chief
Today, after personally reviewing far too many blogs, and according to www.NPR.org, there are more than120, 000 health care forums on the Internet with opinions ranging from pharmaceuticals, to sexual dysfunction, to acne.
The same goes for commercial doctor blogs that promote lotions, balms and potions, diets [...]

Malpractice Award Caps

Struck Down in Georgia
Staff Reporters
The Atlanta Journal-Constitution recently reported that Fulton County Georgia, Superior Court Judge Marvin Arrington, struck down the cap on monetary awards in a medical malpractice case. It was a decision that if upheld on appeal, could undercut a major component of Georgia’s tort reform laws.
Non-Economic Damages
The judge wrote that the [...]

National Health Insurance [NHI] Survey

MDs Now Favor Reform - According to AIM
Staff Reporters
According to a study just released in the Annals of Internal Medicine [AIM], a majority of doctors now favor national health insurance [NHI] which represents a thought shift over the past five years.
Survey Results
The study conducted last year found that 59 percent of surveyed physicians supported “government [...]

Bars to Managed Care Lawsuits

A Historic Review
By Dr. Charles F. Fenton III; Esq 

Historically, managed care companies have been afforded immunity from negligence and malpractice lawsuits. Several state and federal bars, including ERISA (Employee Retirement Income Security Act of 1974), have insulated managed care companies from liability relating to the treatment of patients.  
Likewise, managed care companies have historically been immune [...]

The Federal False Claims Act

Understanding Qui Tam
Dr. Charles F. Fenton III; Esq. 

A civil war era law, titled the False Claims Act (qui tam [in the name of the king]), is increasingly popular with prosecutors who pursue inappropriate billing mishaps by physicians.  
Why the False Claims Act? 
The FCA rose to prominence because in 1990, the healthcare industry accounted for about 10% [...]

About CLIA

Clinical Laboratory Improvement Amendments
By Patricia A. Trites; PhD, MPA, CHBC, CMP™ (Hon) 
 
 
The Clinical Laboratory Improvement Amendment (CLIA) was passed in 1988 and pertains to any healthcare provider or entity that performs any laboratory test.   
A Series of Acts 
This legislation is actually a series of acts that established quality standards for laboratory testing in order to [...]

About Medical Malpractice Depositions

Understanding the Legal Process
By Dr. Jay S. Grife; JD, MA 

Depositions are a legal discovery method that deserves specific discussion because the deposition, or oral statement under oath, is such a vital piece of the puzzle.
In general, either party may depose any other person but in general, a deponent has some relevance to the case, whether [...]

The Medical Malpractice Discovery Process

Understanding the Legal System
By Dr. Jay S. Grife; JD, MA 
 
Since most medical negligence cases are fact driven, the topic of discovery demands a specific and integral role in the trial process.  Discovery simply is the methodology used in American jurisprudence for each side to discover all of the evidence that is available in the case [...]

Malpractice Trial Types for Doctors

Understanding Different Trial Types
By Dr. Jay S. Grife; JD, MA 

There are two types of malpractice trials available to doctors involved in litigation; by jury or a bench trial exclusively by the judge. 
Jury Trial
In a trial by jury, the judge determines the law and the jury determines the facts.
Bench Trial 
In a bench trial, the judge wears both [...]

Certificates of Need [CONs] Questioned in Alabama

Good Health Policy or Competitive Anachronism?
Staff Writers
Modern Healthcare just reported on a new study by an Alabama policy research group that questions whether the state needs to have a certificate of need process in place to limit the growth of healthcare facilities in the state. 
The API Study 
The study, by the Alabama Policy Institute [API], argued [...]

New MSA / HSA Patient Identification Programs

Further Implications of the U.S. Patriot Act for Hospitals
By Dr. David E. Marcinko; MBA, CMP™
By Hope R. Hetico; RN, MHA, CMP™ 
 
With the recent popularity and growth of health savings accounts (HSAs) and / or medical savings accounts (MSAs), compliance with the USA Patriot Act of 2002 has become an important issue for these new, hybrid [...]

Senate Finance Committee to Limit Specialty Hospitals

Ban Due to Medicare Participation Prohibitions
Staff Reporters
 
A new report outlining violations of health and safety standards at some physician-owned specialty hospitals has some lawmakers renewing efforts to ban the facilities. 
The American Medical News [AMN] recently reported that Department of Health and Human Services [HHS], Office of Inspector General [OIG], investigated 109 of the country’s orthopedic, [...]

Department of Labor Curtails Healthy Habits

New DOL Regulatory Guidelines Seem Paradoxical
Staff writers 

New regulatory guidelines from the Department of Labor [DOL] may curtail the ability of employers to motivate workers and employees to kick unhealthy habits.  
According to a report in the Wall Street Journal, the guidelines close a legal loophole that could have allowed employers to make health insurance more expensive [...]

The US Supreme Court

Denies GA Hospital Peer-Review Case
Staff Writers

According to Gregg Blesch of Modern Healthcare, the US Supreme Court just declined to review a case that hospitals hoped would clarify whether federal courts must defer to state laws protecting the confidentiality of peer review. 
The 11th U.S. Circuit Court of Appeals ruled in June that peer-review records should be [...]

Sarbanes-Oxley and the Healthcare Industry

Applicability to Hospitals and Medical Organizations
By Gregory O. Ginn; PhD, CPA, MBA, CMP™
By Hope Rachel Hetico; RN, MHA, CMP™ 
 
In response to scandals involving Enron Corporation and its auditor, Arthur Andersen, the U.S. Congress passed Public Law 107-204, whose short title is “The Sarbanes-Oxley Act of 2002.”  
At first blush, the Sarbanes-Oxley Act seems to have very [...]

Healthcare Entities and the US PARIOT Act?

Applicability to Hospitals and Medical Organizations
By Gregory O. Ginn; PhD, CPA, MBA, CMP™
By Hope Rachel Hetico; RN, MHA, CMP™
 
After the September 11, 2001 terrorist attacks against the United States, the US Congress passed Public Law 107-56 whose short title is “Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism (USA [...]