Monday, September 26, 2011

The Legality of Online Health Care Discounts

Attached you find a link,0,6420216.story to an interesting article titled "Are Groupon discounts for medical treatments illegal?" highlighting an important issue: Those big discounts on health care treatments offered on websites like Groupon may be illegal, medical law experts say. Not for the patients but for the medical professionals giving them.
"The law is very strict. This seems like a problem," said Michael Segal, a South Florida health-care lawyer. "I would urge [practitioners] to be very careful. You don't want to find out there's a concern after you have done it."
A number of national and local medical associations, including the Palm Beach County Medical Society last month, have warned members because the issue is still in doubt. Florida regulators said they have not discussed it. Medicare has taken no position. Nor has the American Medical Association or other medical trade groups.


Sunday, September 18, 2011

Hospital Performance

Attached a link to an interesting article titled "Report Finds Improved Performance by Hospitals," reporting that in the latest advance for health care accountability, the country’s leading hospital accreditation board, the Joint Commission, released a list on Tuesday of 405 medical centers that have been the most diligent in following protocols to treat conditions like heart attack and pneumonia. Almost without exception, most highly regarded hospitals in the United States, from Johns Hopkins in Baltimore to the Mayo Clinic in Rochester, Minn., did not make the list!

"With evidence-based ratings gaining prevalence, and a strengthening link between quality and payment, the Joint Commission report raised questions about how consumers should best use the data newly available to them. Increasingly, one component of that inquiry may be whether hospital reputations are deserved or mythologized."

"As an example, none of the 17 medical centers listed by U.S. News & World Report on its “Best Hospitals Honor Roll” this year are on the Joint Commission’s list of 405 hospitals that received at least a 95 percent composite score for compliance with treatment standards. About one-third of a hospital’s score in the U.S. News methodology is based on its reputation as gauged by a survey of physicians...the Joint Commission list of top performers included a disproportionate share of small and rural hospitals, as well as 20 Veterans Affairs medical centers. About 14 percent of roughly 3,000 eligible hospitals made the cut."

"As it is, both private and government health insurers are beginning to tie hospital reimbursements to quality measures like infection rates and readmissions. Next year, compliance with procedural standards will become even more consequential, as the Joint Commission plans to withhold accreditation from any hospital that posts a composite score below 85 percent."

This report serves as a reminder that payers will use this data to strengthen the link between quality and payment.
Therefore, physicians should consider adjusting their treatment protocols and quality measurements accordingly.



Wednesday, September 14, 2011

Wollschlaeger et al vs. Farmer et al

Court Grants Preliminary Injunction Against Physician Gag Law

Since Taking Effect, Unconstitutional Gag Law Had Chilled Speech by Florida Doctors

The Florida chapters of three national medical organizations, along with six physicians, applauded the decision of a federal district judge today to immediately block enforcement of the new state law that bars healthcare professionals from asking patients if they own guns and have them stored properly. These questions are a key element in the practice of preventive medicine.

The groups, along with individual doctors, had asked Judge Marcia Cooke of the U.S. District Court for the Southern District, Miami Division to issue a preliminary injunction because the new law has already curtailed the First Amendment rights of physicians across the state to speak with their patients about gun safety. A preliminary injunction is an order that prevents a party from pursuing a particular course of conduct until a case has been decided. To grant a preliminary injunction, the court must find that plaintiffs have a substantial likelihood of success on the merits of the case.

Lisa A. Cosgrove, M.D., FAAP, President of the Florida Chapter of the American Academy of Pediatrics (Florida Pediatric Society) said: “Pediatricians simply want to do what they do best: protect children. We hope that now we will be able to get back to working with parents to maintain their guns, pools and poisons to keep kids safe."

Dennis Mayeaux, MD, Chair, Board of Directors, Florida Academy of Family Physicians said: “The impact of this law has already caused serious rifts in physician-patient relationships. Casual conversations with patients often bring other medical issues to light, and erosion of these opportunities also erodes the quality of care. The preliminary injunction will now allow us to talk to our patients again about firearm safety.”

Stuart Himmelstein, M.D., American College of Physicians Governor for Florida, stated: "Reversing this law is essential in order to preserve the sanctity of the doctor -patient relationship by keeping the government out of the exam room. The preliminary injunction will preserve free speech between both doctors and patients as protected by the Constitution and which is necessary to obtain the highest of quality care that every citizen deserves."

Physicians and other healthcare professionals routinely provide their patients with information about a variety of health risks in the home and broader environment. Such preventive counseling has become a cornerstone in the practice of medicine and is recommended by numerous professional medical societies. In the course of practicing preventive medicine, healthcare professionals routinely ask and counsel patients about firearm safety.

The state chapters of the American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians collectively represent more than 11,000 healthcare professionals in Florida. On June 24, 2011, these organizations, along with six individual physicians, filed papers asking the court to enjoin the law because it substantially curtailed their First Amendment rights to exchange information with patients about gun safety.

The lawsuit challenging the Physician Gag law was originally filed on June 6, 2011, shortly after Governor Scott signed it into law. Prior to filing suit, the physician groups urged the Governor to veto the legislation since it infringes the First Amendment rights of healthcare professionals throughout Florida.

The organizations and individual physicians in the lawsuit are represented by Ropes & Gray (lead counsel), Astigarraga Davis (local counsel), and lawyers from the Brady Center to Prevent Gun Violence’s Legal Action Project.


Saturday, September 03, 2011

PDMP goes online!

Attached a link to an article from today's Miami Herald titled " Fla. prescription database goes into operation" highlighting the fact that as of September 1st Florida's prescription drug tracking system finally was up and running. That means that dispensers and pharmacies must upload their prescription data for Schedule II to IV to the database. Rebecca Poston, the system's program director in the Department of Health said that "Everything is working wonderful, I have not heard of any glitches related to the dispensers registering or uploading information in the system."
The Department of Health will not begin registering doctors and pharmacists until Oct 1, nor will they be able to get information out of the database until Oct. 17. In my opinion the registration and training process should start now and be phased in either by region, or other criteria to be determined by the Department to allow for a smooth transition and to motivate doctors to use the system. Its not too late to do that but leaving it until October 1st is cutting it too short.

Thursday, September 01, 2011

United Health On The Move

Attached a link to an article titled" UnitedHealth Buys California Group of 2,300 Doctors" reporting that United Healthcare will acquire the management arm of Monarch HealthCare, an Irvine, Calif., association that includes approximately 2,300 physicians in a range of specialties. This will establish United's Optum health-services unit as a formidable presence in California. Optum had previously taken over the management arms of two smaller southern California groups, AppleCare Medical Group and Memorial HealthCare Independent Practice Association.This serves as an example of how lines are blurring between insurance companies and health-care providers.
What can we do? Consider forming cohesive primary care and/or multi-specialty associations, utilizing EHR technology and based on the Patient-Centered-Medical-Home Model to compete in the rapidly changing healthcare marketplace.
We cannot ignore the writing on the wall. Change is inevitable!

Pill Mills Under Pressure

Attached a link to today's New York Times front page article titled "Florida Shutting ‘Pill Mill’ Clinics."
The article highlights the accomplishments made despite the initial resistance by the current administration in Tallahassee.:

As of July, Florida doctors are barred, with a few exceptions, from dispensing narcotics and addictive medicines in their offices or clinics. As a result, doctors’ purchases of Oxycodone, which reached 32.2 million doses in the first six months of 2010, fell by 97 percent in the same period this year.
One indication that law enforcement officials are choking the supply of prescription drugs sold illegally in Florida is that the price of Oxycodone on the streets here has nearly doubled from last year, to $15 per pill from $8.
On Commercial Boulevard, a major street in Broward County, the number of pain clinics has fallen in the past year from 29 to one.
The fallout from the tougher laws may include an increase in pharmacy robberies, a problem that has been worse in Florida than any other state since 2007 (there were 65 armed robberies of pharmacies here last year).

As of today any health care practitioner who has dispensed a Schedule II-IV controlled substance, as defined in section 893.03, F.S. (i.e., OxyContin®, Percocet®, Vicodin®, Klonopin®, Xanax®, and Valium®), is required to report dispensing information to the Prescription Drug Monitoring Program’s database within seven (7) days after dispensing, in accordance with section 893.055, F.S. This includes pharmacies licensed under chapter 465, F.S., and dispensing health care practitioners licensed under chapter 458, 459, 461, 462, or 466, F.S
Now we must push to start educate physicians on how to use the PDMP and to encourage accessing the database to identify "doctors shoppers."
I am optimistic that we can achieve our goals.