About This BlogThe SW Health Law Checkup is written by the attorneys of Snell & Wilmer to provide their insight on an array of regulatory and compliance matters related to federal and state fraud and abuse laws and regulations, reimbursement, credentialing and employment of providers, joint ventures and physician-entity integration, best practices in compensation and contracting, value-based purchasing and contracting with providers.
Arizona physicians must report to the Medical Board “any information that appears to show that a doctor of medicine is or may be medically incompetent, is or may be guilty of unprofessional conduct or is or may be mentally or physically unable to safely engage in the practice of medicine.” A.R.S. § 32-1451(A). In fact, failure to make such a report is an act of unprofessional conduct. Id. Physicians typically learn of the unprofessional or incompetent practice of others either: (1) when seeing a new patient for the first time and learning of their past providers’ practices; or (2) witnessing the potentially unprofessional practices of colleagues or peers. Occasionally, however, a physician may have another provider as her patient. In this case, if a medical condition is causing the patient to be “mentally or physically unable to safely engage in the practice of medicine,” the treating physician likely has an obligation to report her patient to the Arizona Medical Board. See id. The obligation and potential report, however, raise concerns for physician-patient privilege, HIPAA protections, and other privacy issues. The Arizona Medical Board has taken the position that these concerns … Continue reading
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In 2012, Turntable Health opened its doors in downtown Las Vegas with one goal—providing preventive healthcare at a reasonable cost. As a direct primary care (“DPC”) clinic, Turntable Health offered unlimited access to primary care physicians for a monthly fee. Only five years after opening, Turntable permanently closed in January 2017, citing an inability to reconcile its practice with the economic demands of the healthcare industry. Following Turntable’s lead, an industry forerunner based out of Seattle, Qliance Medical Management, closed in May. These closures leave medical professionals and patients in Nevada questioning DPC’s viability and, in consequence, its future. While large-scale DPC providers like Turntable and Qliance are a relatively new concept, small DPC practices have existed for decades. Under the DPC practice model, physicians offer contracts that allow patients to pay low monthly fees for unlimited access to primary care services, discounted blood work, and prescriptions. However, DPC memberships do not cover all healthcare needs, including costly hospitalizations, specialist visits, and surgery. For that reason, providers suggest—and federal law requires—that patients hold, at a minimum, high-deductible health plans. Rather than a standalone healthcare solution, a DPC membership is one … Continue reading
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by Allison Davis For providers interested in simplifying the provider-patient relationship, one option is direct primary care. Ironically, though, simplification can be complicated, particularly when the government is involved. One of the greatest hurdles to medical practice simplification is the role of Medicare on both the patient side and provider side. Any physician interested in the direct primary care (DPC) model should be very careful about how his/her practice interacts with the Medicare Program. The goal of this post is to clarify and stratify the different Medicare related risks a provider could encounter when establishing a DPC practice. The first natural question about DPC is: what is DPC and why is it appealing? The answer is that the current healthcare system is a behemoth, surpassing the three trillion dollar mark back in 2012. In addition to its growth in size, the healthcare industry is growing in complexity. When a patient or insurance company pays for healthcare, that payment is being divided into more and more pieces every day. Some payments will cover the cost of the physician’s visit itself, but a larger percentage of the payment will go elsewhere in … Continue reading
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