All posts in Miscellaneous

Health Care Reform Goes Live: Day Three

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 →

Proceed With Caution: Matters to Consider for Business Lawyers Transitioning into Health Care

This article first appeared in the NY Business Law Journal in November 2012.

When venturing into areas of law outside their usual practice, attorneys should be mindful of state-specific standards to which they are held.  Rule 3-110 of the California Rules of Professional Conduct sets the standard on the west coast, just as Rule 1.1 of the New York Rules of Professional Conduct applies on the east.  Absent the requisite skill to accommodate a client’s needs, an attorney may still engage and adhere to the statutory definition of competence by “associating with or, where appropriate, professionally consulting another lawyer reasonably believed to be competent” or “by acquiring sufficient learning and skill before performance is required.”[1]  In 2003, a California Appellate Court explained:  “Attorneys are expected ‘to possess knowledge of those plain and elementary principles of law which are commonly known by well informed attorneys, and to discover those additional rules of law which, although not commonly known, may readily be found by standard research techniques.’”[2]

However, due to the sheer volume and complexity of information generated regularly in the wake of reform, modern health care law exists in a league of its own. Continue reading →

Book Review: “Obamacare on Trial”

This book review was first published in the Daily Journal on November 9, 2012.

With 225 years separating the ratification of the Constitution of the United States and the landmark United States Supreme Court decision National Federation of Independent Business v. Sebelius, 132 S. Ct. 2566 (2012), the Constitutional impact of Chief Justice John Robert’s majority opinion will resonate down the labyrinth of Federalism for decades to come.

As it relates to the 2010 Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act, the holding is clear and concise, even as the legacy of the Affordable Care Act has yet to be determined.  Few scholars will disagree on the meaning of the Court’s ruling – that the Affordable Care Act’s individual mandate is constitutional and the Medicaid expansion provisions will survive – although the way in which the Court reached its conclusion remains the subject of heated debate.

Einer Elhauge’s Obamacare on Trial approaches the Supreme Court decision much like the Phythia at Delphi, although sadly this latest collection of high profile, widely published essays conclude where the real story begins. Continue reading →

An Overview of the Hospital Value-Based Purchasing Program

Section 3001(a) of the Affordable Care Act (ACA) includes a new section 1886(o) to the Social Security Act and amended 42 U.S.C. § 1395ww to establish the hospital value-based purchasing (VBP) Program.

Under the VBP Program, beginning October 2012 hospitals will face a 1% reduction overall on Medicare payments under the Inpatient Prospective Payment System (IPPS), as these funds will be used to pay for the performance bonuses under VBP Program. By 2015, hospitals that continue to show poor performance ratings will not only be excluded from the bonus pool, they will also face additional cuts in reimbursement. Continue reading →

Medical Identity Theft

When personal information is compromised (name, Social Security number, and even a Medicare number), medical identity theft can occur.

Personal information may be used to obtain medical care, purchase medications, or submit fraudulent billings to Medicare, all in the wrong name.In addition to causing a disruption and damaging credit, Medical identity theft wastes taxpayer money.

The Office of the Inspector General (OIG) has additional information, including:

  • Deter:  Protect Your Personal Information
  • Detect:  Watch Out for These Common Fraud Schemes
  • Defend:  Check All Your Medical Bills, Medicare Summary Notices, Explanation of Benefits and Credit Reports.

The OIG’s full report can be accessed here.

The Right to Strike vs. the Right to Care

Modern day health care is a troubled industry. Enshrouded in a net of oft-conflicting regulations and entrusted with the safety of America’s sick and wounded, many of whom lack the necessary insurance to guarantee reimbursement to their providers, the financial stability of our nation’s medical facilities is called into question on a daily basis. Today’s hospital has the unenviable task of walking a fine line between caring for its patients and remaining solvent as a business, a laudable goal attainable at least in part by recognizing the inextricable connection between the institution itself and the nurses who form an infantry amongst its ranks. Even as these nurses form an ever-present “front line” on the hospital battlefield, the recent threat of strikes around the nation shines a harsh if necessary light on certain issues plaguing our current health care system as it stands so precariously with one foot on either side of a dangerous fence.

The nature of the nurse’s role begs the question: does participation in a labor union extend to the right to strike? Continue reading →

Proposed Rules for End-Stage Renal Disease PPS

This rule proposes to update and make revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2013. This rule also proposes to set forth requirements for the ESRD quality incentive program (QIP), including for payment year (PY) 2015 and beyond. This proposed rule will implement changes to bad debt reimbursement for all Medicare providers, suppliers, and other entities eligible to receive bad debt.  The entire proposed rule, eventually to be codified at 42 CFR Parts 413 and 417, can be seen here.

Hot Topics in Health Law

Hot Topics in Health Care Law

View more presentations from Craig B. Garner

 

This presentation “Hot Topics in Health Law” was a teleseminar sponsored by the California State Bar.

The Vanishing Community Hospital: An Endangered Institution

This was presented at California Hospital Association’s 27th Annual Rural Health Care Symposium on February 29, 2012.

 

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