All posts in Health Care Law

The Beginning of Health Care Reform Nears Its End

This article was first published in the Los Angeles Daily Journal on December 16, 2013.

Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” — Sir Winston Leonard Spencer Churchill

The countdown to 2014 has begun. In the days to come, millions of Americans will choreograph exactly where to be at midnight on New Year’s Eve, full of resolutions and expectations for the coming year. This January 1 holds a special significance for our country, as the dropping of that massive 11,875-pound ball in New York City’s Times Square represents what many have for four years hoped to be the heralding of an epic transformation in our nation’s health care. Though unable to predict the future as in fairy tales of old, the descent of that Waterford crystal ball marks the coming of age of the Affordable Care Act, still shrouded in controversy and fighting for a foothold on which to support itself. Continue reading →

Health Care Reform Goes Live: Day Three

The Familiar Path of Health Care Reform

This article first appeared August 5, 2013, in the Daily Journal.

Friedrich Nietzsche wrote: “When we are tired, we are attacked by ideas we conquered long ago.”

More than three years deep into the Affordable Care Act, 13 months since the U.S. Supreme Court confirmed its constitutionality, and almost 10 months after the American public approved reform through the Electoral College, modern American health care is now poised to shine or make its claim as a historical disaster. As the nation prepares for the health insurance exchange, the next few months shall prove critical in determining the trajectory — and thus the fate — of our health care system, and we would be remiss not to notice the storm clouds forming overhead. Continue reading →

Don’t Fear the Federal Register

The article was first published on June  24, 2013, at

“’What is the use of a book,’ thought Alice, ‘without pictures or conversations?’”

Lewis Carroll, Alice in Wonderland

When it comes to federal regulations, there is an unfortunate dearth of illustrations. Instead, promulgation comes solely through the written word, as it did recently on the first business day in June 2013, when the Federal Register published volume 78, Number 108.  Born from an act of Congress known as the “Federal Register Act” (49 Stat. 500-503 (July 26, 1935)), the Federal Register will be 78 years old this summer and boasts its own international standard serial number (ISSN 0097-6326). By its own admission, “[t]he Federal Register provides a uniform system for making available to the public regulations and legal notices issued by federal agencies.  These include Presidential proclamations and Executive Orders, federal agency documents having general applicability and legal effect, documents required to be published by act of Congress, and other federal agency documents of public interest.”

The value of the Register is beyond measure. To be sure, regulatory transparency is a fundamental tenet upon which industry leaders must rely, and health care compliance professionals are certainly no exception. Continue reading →

Modern American Health Care (in 83 slides)

This presentation provides an overview of the Affordable Care Act three years after its passage. It explains how the landmark legislation evolved, what provisions are in place today, and what can we expect in the years to come. The implications for patients, providers and payers are massive, and this presentation is designed to provide a comprehensive overview for anyone interested to learn about health care reform.

Inland Empire Provider Positioning for Growth in Reform

This article first appeared on March 11, 2013, in California Healthline.
(by Lauren McSherry, California Healthline Regional Correspondent)

SAN BERNARDINO — Marking yet another step in the steady expansion of its reach in the Inland Empire, Loma Linda University Health is planning to construct a medical and educational complex in San Bernardino that could serve up to 250,000 patients each year.

Experts said the expansion is likely part of the health system’s strategy to better position itself for changes to health care reimbursement and hospital patient volume expected as a result of the Affordable Care Act.

In recent years, Loma Linda University Health has undertaken a number of construction projects in San Bernardino County, where its main medical campus is based, and in Riverside County. The health system, which includes the region’s only Level 1 trauma center and children’s hospital, now has more than 1,000 beds in six hospitals in the Inland Empire.

In 2009, the health system opened a 90,000 square-foot outpatient satellite campus in Beaumont. Through partnerships with Beaver Medical Group and Redlands Community Hospital, Loma Linda University Health’s Highland Springs Medical Plaza offers specialty services, such as oncology, cardiology, neurosurgery and orthopedics. Continue reading →

Two Strikes and Contraception Is Out

On February 1, 2013, the Federal Government issued proposed rules that may finally end the contraception controversy and its challenge to the Affordable Care Act’s commitment to preventative services, including addressing requirements relating to all FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive ability.

The proposed rules lower the bar for employers engaged in secular and religious purposes, as well as those religious employers who hire outside the fold. The latest version acquiesces to eligible organizations opposed to contraceptive coverage, finally offering absolution from the requirements of Section 2713 of the Public Health Service Act, Section 715(a)(1) of the Employee Retirement Income Security Act and Section 9815(a)(1) of the Internal Revenue Code.  In essence, the proposed rules let these employers practice what they preach. Continue reading →

7 Healthcare Leaders Share Thoughts on Sequestration

This article was first published in Becker’s Hospital Review on March 1, 2013.

Unless Congress passes a replacement budget bill tonight to save the federal government $1.2 trillion over the next 10 years, $85 billion in spending cuts known as sequestration will be struck from the federal budget automatically, including a 2 percent reduction in Medicare funding and a drying up of discretionary spending such as medical research grants. Here are healthcare leaders’ predictions on the effect sequestration would have on the healthcare industry.

Craig Garner, JD, Healthcare Attorney and Former CEO of Coast Plaza Hospital in Norwalk, Calif.: When investigating the overall strength of our nation’s healthcare system under the Affordable Care Act, lessons learned from the “debt ceiling” and “fiscal cliff” debacles provide ample insight in predicting that the sequestration story will end with a resounding “to be continued.” Although this message may be overlooked if a purported last-minute compromise wins the day, regardless of any healthcare related casualties incurred, the fact remains that there are not many ways to reduce the level of domestic healthcare spending other than by reducing the level of spending overall.

To an industry already in the depths of economic instability, it is difficult to identify any meaningful benefits resulting from lost revenue. At the same time, this remains a fundamental tenet within the [Patient Protection and Affordable Care Act], as providers shift from cost-based to performance-based reimbursement. Whether as a result of value-based purchasing, penalties due to readmissions, denials for hospital-acquired conditions or the anticipated 2 percent reduction from sequestration, today’s providers must find ways to accomplish more in exchange for less. Continue reading →

The Affordable Care Act: A Not-So-Little Train That Must

This article was first published in the Los Angeles Daily Journal on February 25, 2013.

“Things do not change. We change.”  - Henry David Thoreau

Finally free from the uncertainty of looming elections or Supreme Court decisions questioning consititutionality, modern American health care can now be compared to a speeding train serving infinite destinations, with conductors and passengers alike learning the routes along the way. Public transportation is usually forgiving, as the tardy or confused passenger always has the opportunity to catch the next train, but such is not always true in matters of public health.  Whether fan or foe of the Affordable Care Act (the ACA), this epic codification of health care reform is something that America cannot afford to miss.

At the time the ACA was passed in March 2010, by a margin of seven of the collective 431 Congressional votes, few of those involved had any real working knowledge of the 10,909 sections contained within the Patient Protection and Affordable Care Act, which were quickly adjusted and finalized by congressional changes the following week in the form of the Health Care and Education Reconciliation Act. Weighing in at over 900 pages, hindsight makes it clear that the ACA was only the beginning of the federal government’s plan to restructure the nation’s health care system, a fact that has been compounded by an estimated 70,000 pages of further regulations in the three years since President Barack Obama signed the ACA into law. Continue reading →

CCOs to Use Tools of Trade in New Payment Models, Delivery Systems

This article was first published on February 18, 2013 at AISHealth.

Compliance officers are starting to apply the tricks of their trade to new payment models and health care delivery systems.To keep up with the major transformations rippling through the industry, some compliance officers will need to monitor datathat are used to evaluate their health systems’ performance, tap into new resources and work more closely with finance,revenue cycle and other departments, experts say.

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More hospital revenue will depend on its performance on quality, value and patient satisfaction measures, which impactsthe way compliance officers identify risks. “Establishing a link between finances and compliance makes sense becauseperformance is now integral to compliance,” said attorney Craig Garner, who spoke at a recent Health Care ComplianceAssociation webinar. Continue reading →


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