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271 posts categorized "Physicians"

January 29, 2015

Better, Smarter, Healthier: Medicare and Value Based Purchasing

EvolutionThe big announcement this week from Medicare -- setting forth specific targets for a historic shift away from fee-for-service reimbursement in order to reduce costs and improve quality -- is less than it seems.

Medicare has been talking about value based purchasing for decades now, and thus far has taken baby steps towards implementation. Even the strides taken in recent years, and the targets laid out this week for the future, don't really leave FFS medicine in the dust. ACOs and other MSSP innovations don't entirely move away from FFS reimbursement; they just add cost and quality kickers as part of a retrospective reconciliation.

CMS identified four categories of payment and targets related to each of these categories.

  • category 1—fee-for-service with no link of payment to quality
  • category 2—fee-for-service with a link of payment to quality
  • category 3—alternative payment models built on fee-for-service architecture
  • category 4—population-based payment

Continue reading "Better, Smarter, Healthier: Medicare and Value Based Purchasing" »

November 14, 2014

HIPAA: Liability to Private Parties for Violations

Judge flickr ccThis week, Connecticut joined at least nine other states (DE, KY, ME, MN, MO, NC, TN, UT, WV -- see cases cited in the opinion, linked to below) in recognizing that, while HIPAA does not create a private right of action for violation of privacy, it does constitute a standard against which the actions of a defendant in such a case will be judged. In other words, if a covered entity or business associate or downstream contractor releases PHI other than in accordance with HIPAA (i.e., for treatment, payment or health care operations purposes, or to or at the direction of the data subject or his or her legal representative), the breach of the HIPAA rule may be the basis for a finding of a breach of a duty of care in a state court negligence action.

As the Connecticut Supreme Court observed in its opinion in Byrne v. Avery Ctr. for OB GYN, which was released earlier this week:

[A]ssuming, without deciding, that Connecticut's common law recognizes a negligence cause of action arising from health care providers' breaches of patient privacy in the context of complying with subpoenas, we agree with the plaintiff and conclude that such an action is not preempted by HIPAA and, further, that the HIPAA regulations may well inform the applicable standard of care in certain circumstances . . . .

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November 13, 2014

Telemedicine: CY 2015 MPFS reportage and dangers of the echo chamber

Station-grungeMany of us are waiting with bated breath for CMS to broaden its coverage of telemedicine services. Upon the release of the CY 2015 MPFS, the American Telemedicine Association got a little ahead of itself in the excitement over some changes in the physician fee schedule, and announced that CMS had added payment for remote patient monitoring of chronic conditions (99091). In fact, CMS's response to the proposal that this and other E&M codes should be payable if provided via telemedicine was: "These services are not separately payable by Medicare. It would be inappropriate to include services as telehealth services when Medicare does not otherwise make a separate payment for them." (79 FR at 67600.)

Continue reading "Telemedicine: CY 2015 MPFS reportage and dangers of the echo chamber" »

October 14, 2014

Apple HealthKit - Epic Integration at Ochsner Health System - David Harlow Interviews Dr. Richard Milani

Apple-healthkitThe first health system to announce that it had integrated HealthKit into its Epic EHR is Ochsner Health System in Louisiana. It is a 12-hospital, 40-clinic operation with over 900 physicians. I spoke recently with Dr. Richard Milani, Ochsner's Chief Clinical Transformation Officer. He was enthusiastic about the improvements in clinical outcomes realized to date through homegrown integrations of things like Withings scales, and sees significant expanded potential using the Epic-HealthKit integration including dissemination of data to clinicians for more efficient and effective management of care and presentation of data to patients in a way that may motivate behavior change to improve health status.

Continue reading "Apple HealthKit - Epic Integration at Ochsner Health System - David Harlow Interviews Dr. Richard Milani" »

October 09, 2014

Innovation, Primary Care Style

Kids playing doctorOn a recent evening at Harvard Medical School, the Primary Care Innovation Challenge and Pitch-Off brought together six finalists, primary care luminaries and trainees, and a host of hangers-on and camp followers for a couple of hours of demos and discussions. The tenor of the evening, which was in many ways a pep rally for primary care – not that there’s anything wrong with that — was best captured by the rhetorical question posed by Asaf Bitton to the primary care practitioners and trainees in the hall, “Are you going to be a playwright or a critic?”

The hoots and hollers in response made clear that these are not your grandfather’s primary care docs. The call to action was echoed by many of the speakers, notably community organizer turned primary care physician Andrew Morris Singer and Dennis Dimitri, both advocating for, well, advocating for primary care.  Bitton’s opening also included the exhortation that proved to be predictive of the winner of the top honors from among the six pitches: Innovation in primary care is not about the technology; it needs to enable better human care.

Continue reading "Innovation, Primary Care Style" »

August 11, 2014

Practice Pointers in the Wake of the Johns Hopkins Hospital Privacy Settlement

An OB/GYN at Johns Hopkins was fired last year after a colleague reported her suspicions about a "pen-like device" that was always around his neck, and that turned out to be a camera. He had secretly photographed 7,000 patients over ten years while conducting pelvic exams. Ten days later he committed suicide. Last month, the hospital agreed to settle the class action lawsuit brought by patients whose privacy had been violated for $190 million.

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June 06, 2014

Telehealth: Roy Schoenberg, CEO of American Well, Speaks with David Harlow

5669123427_4ab5769ecf_oI had the opportunity to speak with Roy Schoenberg about the model policy recently adopted by the Federation of State Medical Boards (FSMB): Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine. The model policy is offered as a means for state medical boards to get up to speed quickly and to access standards of care that are both protective of patients' interests and, frankly, are baselines against which physician behavior may be judged by an individual board. Roy distinguishes between telemedicine (doc-to-doc communication) and telehealth (patient-to-doc communication). The latter, particularly using a secure live video platform is a disruptive innovation in a way that the former is not: it allows patients to access medical advice at their convenience, without the need for an office visit or a trip to a specialist.

Continue reading "Telehealth: Roy Schoenberg, CEO of American Well, Speaks with David Harlow" »

May 23, 2014

The Affordable Care Act: How Provider Organizations Can Succeed Under Health Reform

The Affordable Care Act has triggered many changes in the health care delivery system. Learn about the health reform-inspired approaches to redesigning care that work (or don't work) for management of chronic conditions, including diabetes -- from ACOs to bundled payments to patient centered medical homes.

I recently had the opportunity to present to the domestic affiliates of Joslin Diabetes Center on this topic.

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May 08, 2014

Medical Groups Need to Focus on HIPAA Compliance

HIPAA-download-button-2Why is it time for a HIPAA reality check? Because (1) Data breaches are a constant threat; (2) OCR audits reveal many health care providers are not in compliance; (3) Workforce members pose a significant risk for HIPAA liability; (4) Patients are aware of their right to file a complaint; (5) OCR is increasing its focus on HIPAA enforcement; and (6) HIPAA compliance is not an option, it’s the law. Read this white paper to learn the facts and understand if you are doing enough to mitigate the risk of a breach or HIPAA violation.

I've written before about the urgency involved in ensuring physician practice HIPAA compliance. The stakes are high, and the time to address the issue is now. Read more about the landscape in this free physician practice HIPAA compliance white paper and -- if you haven't done so already -- start planning for your own group's HIPAA compliance efforts. We have some HIPAA compliance tools that you can use on a DIY basis, or we can help you with a cost-effective customized solution.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

April 15, 2014

HIPAA Privacy and Security Compliance: Should You Care?

Open doorThe HIPAA/HITECH Omnibus Rule became effective just over one year ago. The compliance date was just over six months ago. Within about another six months (plus or minus), Federal regulators – at the Office for Civil Rights at the US Department of Health and Human Services – will begin a new round of HIPAA compliance audits. They are already actively involved in complaint investigations governed by the “new” HIPAA rules. Other Federal, state and territorial authorities are actively involved in HIPAA and related health data privacy and security enforcement activity: the Federal Trade Commission, the Secret Service, the Puerto Rico Health Insurance Administration, state attorneys general. The “Wall of Shame” on the OCR website adds information about newly disclosed data breaches on a regular basis. Fines under the new HIPAA rules may hit $1.5 million or more. Fines under other regulatory schemes have climbed significantly higher. Compliance agreements, follow-up audits and more await those covered entities (health care providers or payors) (CEs) or business associates (everyone else in the health care ecosystem – billing services, marketing HIPAA-download-button-2 agencies, consultants, shredding contractors, attorneys, accountants, etc.) (BAs) unfortunate enough to experience a lapse in their HIPAA compliance programs and to have occasion to file a breach notification, or to be the subject of a complaint investigation or random audit.  

Continue reading "HIPAA Privacy and Security Compliance: Should You Care?" »