The regulatory changes include:

Allowing physician extenders (NPs and PAs) to be appointed to hospital medical staffs, with all of the rights and privileges of physicians, including the ability to administer anesthesia and powerful pain killers, vulnerable to abuse;

• Permitting podiatrists to lead a hospital medical staff, despite lacking a specific degree in medicine or doctor of osteopathic medicine degree;
• Allowing one governing board to oversee multiple hospitals within a single system; 
• Eliminate outdated infection control standards for ambulatory surgical centers; and 
• Allowing smaller hospitals to outsource some laboratory and radiology tests.

The administrative changes should save money in the long run and certainly are logical. The effects of expanding the role of physician extenders, while many would argue is needed since there will be a shortage of primary care physicians, remains to be seen. In this instance, the educational programs should be updated in light of the recent changes, to ensure proper training.    

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association.  Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

School-based health centers enable children with acute or chronic illnesses to attend school as well as help to improve the overall health and wellness of children and adolescents through health screenings, health promotion and disease prevention activities. 

"Whether establishing a new site or upgrading an existing facility, the availability of funding for school-based health centers will help kids more easily get the health services they need to thrive," said Sebelius. "The goal is to keep our children healthy so they can learn, grow and prosper."

The Affordable Care Act appropriated $200 million for the SBHCC Program to address capital needs in school-based health centers.  The funding opportunity is the third in a series of awards that will be made available to school-based health centers through the Affordable Care Act. The Health Resources and Services Administration (HRSA) oversees the SBHCC Program.

Very soon many readers will be part of a new healthcare program that will integrate cutting edge technology, coordinate care amongst many different providers and even take an active interest in your well-being. Curious?

Twenty-seven large medical groups have been selected by CMS to be the first participants as Accountable Care Organizations (ACOs). ACOs are new multi-provider organizations that incorporate hospitals, physician groups, laboratories, and even nursing facilities, coordinating care among the various levels through technology and follow-up. This should reduce unnecessary and harmful duplication of services, improve the overall quality of patient care and lower costs to the healthcare system.

ACOs are required to adhere to 33 quality standards, including patient safety, usage of preventive healthcare and coordination of care. In return, the ACOs will share in the savings and receive up to 25% of the savings produced.

In addition, ACOs will be required to carefully monitor chronically ill patients, who are known to be the most expensive participants (i.e., diabetics and those with pulmonary and heart ailments). The monitoring of these patients will be particularly challenging,

If the program works, we will all be part of an ACO in the near future.

Click here to see a list of the 27 organizations selected.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

The new law, known as Bill 1580, provides legislative approval to start creating local coordinated care organizations. The network of providers will deliver more comprehensive mental, physical and dental care for the state's 600,000 Medicaid clients.

The new health plan utilizes an Accountable Care Organization approach, by using the coordination of care amongst many providers, including physicians, nurses, mental, dental and health providers, to ensure better communication and outcomes. In addition, those providers who save Medicaid money will be financially compensated for keeping their patients healthy, especially those with chronic illnesses, which costs millions of dollars to the Medicaid system each year.

Unlike the federal healthcare law, the Oregon law does not have mandates for the uninsured or for private insurers, but it does create oversights for the program. The new law is expected to save Oregon Medicaid $155 million in the next year, and by 2017, as much as $4.6 billion. If successful, this bill may very well be the future healthcare model.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

This week Congress and the Senate passed legislation that will have an immediate effect on healthcare payments to most providers, including: hospitals, physicians, rehabilitation specialists and laboratories. The new legislation, which is called the Middle Class Tax Relief and Job Creation Act of 2012, extends the payroll tax cut and unemployment benefits, as well as makes the following adjustments to the healthcare system:

·         Freezes the current reimbursement rate that Medicare pays physicians, preventing the proposed 27.4% cut in payments, which was to begin on March 1, 2012. The cuts are now postponed to Dec. 31, 2012;

·         Extends the outpatient therapy cap exception process, whereby Medicare beneficiaries can exceed the caps on obtaining therapy as long as the physician certifies that the therapy is medically necessary; and

·          Stops a planned reduction in hospital payments for evaluation and management services in outpatient departments.

To assist paying for the cuts in reimbursement, the bill reduces the amount of money hospitals and nursing facilities are reimbursed for bad debt. Under current law, Medicare reimburses hospitals and nursing facilities for 70% of what they are unable or unwilling to collect and 100% of the nursing facility bad debt resulting from the treatment of the dual eligibles (those with Medicare and Medicaid).

This provision would reduce the reimbursement to 65% within a 3 year period, saving approximately $7 billion to the Medicare system; however, it would cause unknown harm to the providers, who have razor thin margins already.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran’s law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna’s website at www.nyandctlaw.com for more information. 

In August 2011, the White House issued an interim final rule which required health insurers to cover a wide range of preventive services for women, including:

• Well-woman visits;
• Gestational diabetes screening;
• Contraception; and
• Breastfeeding counseling and supplies.

The health plans were required to cover the services without any cost-sharing, deductibles or co-pays. 

Since August, the White House and President Obama have been under tremendous scrutiny from religious organizations, especially the Catholic Church and other non-profit employers who would be required to cover the contraceptive services, despite deep religious views opposing such usage.

However, the White House announced last week that they would compromise and exempt churches, other houses of worship and similar organizations from subsidizing, providing, paying for or referring to contraception usage or services based on religious objection, instead shifting the responsibility directly to the employers' insurance providers.  The services would be required to be offered free of charge to the insured.    

It is unclear what the impact will be on health insurance premiums, as the White House predicts the coverage will be budget neutral, however it is hard to predict at this time. 

Stay Tuned!

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association.  Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

Consumers concerned about the quality of care they will receive at their next hospital visit, can turn to the Internet. Armed with the knowledge that hospital acquired infections are one of the leading causes of death in this country, approximately 100,000 deaths a year, more than car crashes or breast cancer, utilizing a free and easy online tool is a necessity prior to scheduling  surgery. By accessing www.hospitalcompare.hhs.gov, consumers can access clinical, patient outcome and satisfaction data that can assist them with making an informed decision.

Hospital Compare is a consumer friendly website that provides data through the joint efforts of CMS and the Hospital Quality Alliance (HQA), a public and private partnership. The clinical and performance related data includes variables such as the rates of:

·     Surgery patients who were given an antibiotic at the right time to prevent infection;

·     Surgery patients whose doctors ordered treatments to prevent blood clots after certain types of surgery;

·     Appropriate initial antibiotic selection for pneumonia;

·     Death rates for heart attacks, heart failure and pneumonia;

·     Hospital readmission rates for heart attacks, heart failure and pneumonia; and

·     Central-line associated bloodstream infections (information available next year).

The website allows the reader to compare up to three hospitals against national benchmarks as well as the individual hospitals. At the very least, if the hospital being used by your physician did not measure up to the standards of care, you can ask for clarification and the measures undertaken to improve the quality of care or patient satisfaction.   

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran’s law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association.  Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna’s website at www.nyandctlaw.com for more information. 

As expected, when funding gets tight, there has been a reduction in many mental health coverage options, especially regarding plans not covered under MHPAEA. In Iowa, California, Pennsylvania and Connecticut, there are proposed bills, viewed as national models, which will redesign how services to the mentally ill are provided and require insurers to cover the diagnosis and treatment of mental illnesses, and developmental disorders such as autism. Moreover, pilot programs are being developed that would utilize thousands of community help workers to hit the streets to aid the mentally ill, which very often are in the shadows.

More specifically, the proposed legislation will increase coverage for the mentally ill, including funding for:

• Self-help centers run by other people with mental illness or disability;
• Crisis services for people with psychiatric needs;
• Residential services for people who need assistance, but don't need hospitalization;
• Jail-diversion efforts to keep people from being jailed for behaviors sparked by mental illness;
• Community treatment, support services, case management, and supported community living and family services;
• Employment and education services; and
• Transportation.

Although the status of the legislation is unsure, at least the conversation at a State and national level has started.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.

In the recently released report by the Congressional Budget Office, the demonstration projects showed that the savings first predicted were not be achieved, negating many of the initial assumptions of the new health law. The cost savings centered on shared risk models, whereby healthcare companies would share the burden of cost savings and profit based on a percentage of savings to Medicare. The report revealed that the dual objectives of decreasing costs and improving quality could not be met.

The measurable factors that the demonstration projects focused on were: decreasing hospital admissions and changing the way Medicare pays providers, by bundling payments (one payment across multiple healthcare providers). Although the demonstration projects did not show any appreciable savings or care improvement, the report recommended further projects, whereby:

• Care managers would have substantial in-person contact with physicians and patients (in person);
• Programs would have a smooth transition (for example, by providing additional education and support to patients moving from a hospital to a nursing facility or between a primary care provider and a specialist) leading to fewer hospital admissions; and
• Programs target interventions to beneficiaries they identified as being at greatest risk of being hospitalized, i.e., those with chronic conditions.

The report theorized that if the above factors were achieved, there should be cost savings and care improvement to the Medicare program and services. The demonstration projects were particularly important to accountable care organizations (ACOs), because ACOs are large multiple provider super-facilities, created by the healthcare law, based on the very factors shown to be unsuccessful in this report. ACOs are currently in pilot programs and will be unveiled later this year.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@tllawoffices.com, call him at 914-819-0663 or visit attorney LaMagna's website at www.nyandctlaw.com for more information.

Trustmark has responded by disagreeing with the characterization, citing the relatively small dollar increases, i.e., an increase of $48 per year, the rising costs and increased utilization of health care services, as justification for the increases and vowed to continue fighting to have the increases move forward.

Prior to the Health Care Reform Law, some states, including, New York and Connecticut, maintained the ability to review and block unreasonable health care insurance rate increases; however, this new federal authority appears to have much more clout. This is actually the second time this new law was used. In November, Everence Insurance Company was cited by the federal regulators for unreasonable rate increases. It remains to be seen what the overall effect will be on the industry, but at the very least, the insurance companies are called on the carpet and the consumers are made aware.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and Estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Visit Attorney LaMagna's website at http://www.nyandctlaw.com/, email him at Mlamagna@tllawoffices.com or call him at 914-819-0663 for more information.

In 2012 the Health Care Reform law kicks in full gear.  Although the constitutionality of the law and more specifically the individual mandate portion, which requires the purchase of a health care plan or a penalty, will be decided by the Supreme  Court this year,  there are several provisions that implemented January 1, 2012, here is a summary:

• Accountable Care Organizations

This year Accountable Care Organizations or ACOs will be the health care structure of the moment.  This health care system will be comprised of hospitals, physician groups and individual physician practices, that will be monetarily rewarded for reducing waste, increasing patient satisfaction and improving care, or penalized for not living up to expectations.     

• E-Prescribing

You will probably start seeing more of your physicians e-prescribing because this year many physicians will see a 1% reduction in their take home pay if they do not begin to e-prescribe.  The penalty will rise to 1.5% in 2013 and 2% in 2014. E-prescribing is seen as more efficient, less wasteful and more accurate.

• Reduced Payments for Hospital Readmissions

It is estimated that Medicare pays more than $15 billion a year for unplanned hospital readmissions. Later on this year, hospitals will be penalized for above-average readmission rates, which mean that hospitals and ACOs will step up discharge planning and patients will receive after-care from community workers, who will become integral to the health care system.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association.  Email him at Mlamagna@tllawoffices.com, call him at 914-819-0663 or visit attorney LaMagna's website at www.nyandctlaw.com for more information.

In the report issued on January 6, 2012, the OIG found that 13.5 percent of hospitalized Medicare beneficiaries experienced adverse events during their hospital stays. The result of the medical errors caused prolonged hospitalization, life-sustaining interventions, permanent disability, and/ or resulted in death. An additional 13.5 percent experienced temporary harm events that required some form of treatment.

The report cites lack of staff perception that the adverse event constituted patient harm and should be reported as the main reason for the under-reporting. Other explanations included staff fear to admit mistakes and the erroneous assumption that someone else would report the error. These reasons are especially troubling because the lack of reporting involved serious events, including: medication errors, pressure ulcers, hospital acquired infections, delirium resulting from over medication, excessive bleeding and surgical lacerations. The report recommends that hospital employees should be further educated on reporting practices, change policies and procedures regarding reporting and Medicare should generate an official list of reportable events.

It is clear that hospitals need to change their culture. Hospitals not only should institute quality management oversight to ensure that the adverse events are identified and properly reported, but also must form task forces to decrease medical errors and prevent them from occurring again and again. Hospital employees fear losing their jobs and do not want to get fellow employees in "trouble," which prevents many errors from being reported. Hospitals need to adopt systems and processes for allowing staff members to report errors without the fear of reprisal, in most instances.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@tllawoffices.com, call him at 914-819-0663 or visit attorney LaMagna's website at www.nyandctlaw.com for more information.

The law states, in order of priority, that the following people can be appointed as a surrogate decision maker:

• Guardian
• Spouse or domestic partner
• Adult child
• Parent
• Sibling
• Close friend

The facility is required to have a policy and procedure in place to assist with the appointment of the surrogate, who can make almost any healthcare decision that the patient could, if they had the ability, including end-of-life decisions. A physician, social worker and possibly an ethics committee must meet and assess the patient's decision-making ability and notify the patient and the possible surrogate of the outcome. Surrogate decision makers are protected from civil and criminal liability if they are acting in the best interest of the patient.

Moreover, for financial decisions or other decisions not covered by the FHCDA, a Guardianship may be the only alternative.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@tllawoffices.com, call him at 914-819-0663 or visit attorney LaMagna's website at www.nyandctlaw.com for more information.

While protecting confidential personal information, health IT can improve access to care, help coordinate treatments, measure outcomes and reduce costs. The new administrative actions, which were made possible by the HITECH Act, will make it easier for doctors and other healthcare professionals to receive incentive payments for adopting and meaningfully using health IT.

"When doctors and hospitals use health IT, patients get better care and we save money," said Sebelius. "We're making great progress, but we can't wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for healthcare providers to use new technology to improve the healthcare system for all of us and create more jobs."

In addition to improving the healthcare system, data indicate that the national transition to health IT is creating jobs. More than 50,000 health IT-related jobs have been created since the enactment of the HITECH Ac. According to the Bureau of Labor Statistics, the number of health IT jobs across the country is expected to increase by 20 percent from 2008 to 2018, much faster than the average for all occupations through 2018.

HHS also announced its intent to make it easier to adopt health IT. Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013. If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.

These policy changes are accompanied by greater outreach efforts that will provide more information to doctors and hospitals about best practices and to vendors whose products allow healthcare providers to meaningfully use EHRs. For example, in communities across the country HHS will target outreach, education and training to Medicare eligible professionals that have registered in the EHR incentive program but have not yet met the requirements for meaningful use. Meaningful use is the necessary foundation for all impending payment changes involving patient-centered medical homes, accountable care organizations, bundled payments, and value-based purchasing.

These efforts will complement existing outreach efforts to doctors and hospitals including the Obama Administration's work to create a nationwide network of 62 Regional Extension Centers. The extension centers are comprised of local nonprofits that provide guidance and resources to help eligible healthcare providers participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health IT.

Also released, a new CDC survey found 52 percent of office-based physicians in the U.S. now intend to take advantage of the incentive payments available for doctors and hospitals through the Medicare and Medicaid EHR Incentive Programs. EHR incentive payments for eligible healthcare professionals can total as much as $44,000 under the Medicare EHR Incentive Program and $63,750 under the Medicaid EHR Incentive Program.  The CDC data also show the percentage of physicians who have adopted basic electronic health records in their practice has doubled from 17 to 34 percent between 2008 and 2011 (with the percent of primary care doctors using this technology nearly doubling from 20 to 39 percent). 

To meet the demand for workers with health IT experience and training, the Obama Administration has launched four workforce development programs that help train the new health IT workforce. The training is provided through 82 community colleges and nine universities nationwide. As of October 2011, community colleges have had 5,717 professionals successfully complete their training in health information technology. Currently there are 10,065 students enrolled in the training programs across the nation. As of November 2011, universities have graduated over 500 post-graduate and masters-level health IT professionals, with over 1700 expected to graduate by July 2013.

While improving the healthcare system, health IT can help keep information private and secure. Federal laws require key people and organizations that handle health information to have policies and security safeguards in place to protect health information-whether it is stored on paper or electronically.

Effective Jan. 1, 2012, New York Medicaid will use the following figures:

Household       Medicaid Standard               Medically Needy

Size                SS/CC - LIF                         Income Level

                       Annual     Monthly            Annual     Monthly     Resources

1                    8,818         735                    9500        792              14250

2                    11008        918                    13900      1159            20850

3                    13098        1092                  15985      1333            23978

4                    15208        1268                  18070      1506            27105

5                    17389        1450                  20155      1680            302333

6                    18984        1582                  22240      1854            33360

7                    20665        1723                  24325      2028            36488

8                    22822        1902                  26410      2201             39615

Each ad'l        1236           104                    2085        174               3128

In addition:

• The community spouse minimum and maximum Community Spouse Resource Allowance (CSRA), which is the amount of assets that a spouse who remains in the community is allowed to keep, while their spouse remains permanently in a nursing home, will range from $74,820 to $113,640, depending on total assets of the couple.
• The community spouse Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the monthly income amount a community spouse can keep while their spouse remains in the nursing home, increases to $2,841.
• Social Security - Substantial Gainful Activity (non-blind), which is the amount that a person on disability cannot exceed while working and still be considered disabled, increases to $1,010/month, although any work can jeopardize disability payments.
• The Standard Medicare Part B payment will be $99.90.

Notwithstanding these figures, Medicaid planning can include utilizing spousal refusal, which protects the assets of the community spouse, drafting a Medicaid Asset Protection Trust, which can preserve assets and other trusts to preserve income while staying in the community.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /disability/veteran's law, trusts and estates, Social Security and general legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association. Email him at Mlamagna@tllawoffices.com or call him at 914-819-0663 for more information.