2017 Nevada Legislative Session – Potential for Additional Anesthesiology Practice Opportunities in Nevada

On February 27, 2017, Senate Bill 210 (“S.B. 210”) was introduced into the Nevada Legislature, which paves the way for expanded anesthesiology practice and patient care opportunities in the State of Nevada.  Specifically, S.B. 210 provides for the licensure and regulation of anesthesiology assistants, a category of medical professionals who practice exclusively in the anesthesiology field.  Under the proposed legislation, anesthesiology assistants would be permitted to practice under the direct supervision of a licensed physician anesthesiologist as part of an anesthesia care team designed to increase treatment capacity while improving practice efficiency through the use of highly skilled, lower cost providers. The catalyst for S.B. 210 stems from ongoing financial constraints facing Nevada’s anesthesiology practitioners and increased demand for anesthesiology services, particularly among Medicaid enrollees.  During Nevada’s 2010 special legislative session, Medicaid payments to physician anesthesiologists and nurse anesthetists were reduced by 50%, which led to a shortage of anesthesiology services for Nevada’s Medicaid participants.  The state’s access to care dilemma was later exacerbated by the individual health insurance mandates under the Patient Protection and Affordable Care Act and Nevada’s expansion of Medicaid coverage in 2014, which increased Nevada’s Medicaid … Continue reading

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HIPAA and the Cloud’s Shared Responsibility Models

Cloud-based service providers (CSPs), like Amazon Web Services and Microsoft Azure, offer online access to shared computing resources. As such, they have developed a “shared responsibility model” for how CSPs and companies that use their cloud services will share responsibilities when it comes to ensuring security in the cloud. A lot of companies believe that, if they host protected health information (PHI) with a CSP, it is the CSP that is ultimately responsible for ensuring HIPAA compliance. That is NOT the case. While the CSP will generally be responsible for ensuring that their cloud infrastructure is secure under the HIPAA rules, companies using the cloud services are responsible for ensuring the use and disclosure of their own PHI, as well as any of their platforms, applications, and operating systems that live in the cloud, comply with HIPAA. Business Associate Agreements CSPs that want to do business with a company that is subject to HIPAA (like a hospital or physician) will need to sign a Business Associate Agreement (BAA) with that company before any PHI is transmitted or uploaded. Under this BAA, the CSPs generally will agree to maintain appropriate safeguards … Continue reading

Posted in Cloud Based Services, Health Care, HIPAA

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Is Your Arbitration Agreement Enforceable?

Health care providers may favor arbitration due to the perception that it is a faster, less expensive alternative to litigation. State and federal policy favors arbitration for the same reasons.  Because of the strong public policy favoring arbitration, doubts as to whether a case is subject to arbitration are resolved in favor of arbitration.  (Arbitration may also provide a desired level of confidentiality by preventing allegations from becoming a matter of public record in court.)  Arbitration agreements, however, are subject to the same defenses to enforceability as any other contract. A recent decision of the Arizona Court of Appeals provides guidance for evaluation of the enforceability of arbitration agreements. Gullett v. Kindred Nursing Centers West, LLC arose out of the plaintiff’s claims that a rehabilitation center had abused and neglected his father, who lived there for the last month of his life.  After the complaint was filed, the defendant moved to compel arbitration pursuant to an agreement signed by the decedent upon admission.  The plaintiff opposed arbitration, arguing that the agreement was substantively and procedurally unconscionable.  After evaluating several aspects of the agreement, the Court held that the agreement was … Continue reading

Posted in Health Care

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Does Defensive Medicine Impact the Cost of Healthcare?

By Paul Giancola Healthcare in the United States costs at least two to three times as much as healthcare in other developed countries. One of the reasons usually given is defensive medicine – doctors who order unnecessary tests and procedures due to fear of being sued.  Some also argue that such treatments unnecessarily drive up the cost of care and expose patients to the risk of complications.  Surveys vary but a significant majority of physicians surveyed do report practicing some defensive medicine.  The reasons include: to avoid being named in a lawsuit, defensive medicine is the standard of care, patients demand that everything possible be done, fear of missing something, and peer pressure. By way of example, several recent studies showed that in stable patients with the same degree of coronary artery occlusion, stents yielded no benefit over noninvasive treatment, yet most cardiologists would recommend a stent. Common rationales were that they had heard of someone dying suddenly, they could better defend themselves in a lawsuit if the patient did get a stent and then died, and the stent would relieve patient anxiety. The draft of the original Affordable Care … Continue reading

Posted in Health Care, Uncategorized

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Top Board Concerns Heading into 2017 Remain a Hot Topic

Each year, a number of surveys and commentators describe and predict the trending topics of interest and importance to boards of directors in the for-profit and non-profit sectors. As we wrap up the first quarter of 2017, it appears that many of the predicted hot topics continue to garner attention from various corners. Cybersecurity – According to various surveys, boards have ranked cybersecurity among their principal concerns coming into 2017.  An earlier blog post discussed some recent lawsuits against directors and officers alleging breach of fiduciary duties in shareholder derivative suits.  Amongst additional data breaches that have been reported in the news media as 2017 has been underway, the National Association of Corporate Directors recently published a Director’s Handbook for Cybersecurity Risk Oversight, illustrating the continued attention that the topic has been receiving in boardroom.  In March, three U.S. Senators have introduced the Cybersecurity Disclosure Act of 2017, which would require public companies to disclose whether any corporate directors have expertise in cybersecurity and, if so, the nature and extent of that expertise. Board Tenure, Diversity and Refreshment.  A number of boards and commentators have addressed their interest in balancing … Continue reading

Posted in Business Law, DOJ, Governance, Health Care, Securities | Tagged ,

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Direct Primary Care: Getting Calls from Patients While Avoiding Calls from Law Enforcement

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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ACA Changes – What is Being Considered? A Look Inside The Leaked Republican Bill

By Terry Roman On February 24, a Republican draft reconciliation bill was leaked to Politico.  While it hasn’t been introduced or acknowledged by House Republicans it provides the most comprehensive look so far at how House Republicans plan to change the Affordable Care Act (ACA). First, what does it not do. The bill does not repeal the ACA, but it replaces substantial portions of it.  It does repeal particular sections of the ACA, such as its taxes, the individual mandate, Medicaid expansion and subsidies.  Most of the ACA’s insurance reforms remain in place, such as the requirements that health plans: cover preexisting conditions not impose lifetime or annual limits no health status underwriting cover adult children up to age 26 not discriminate on the basis of race, nationality, disability or sex cap annual and lifetime out-of-pocket expenditures Now, here are some of the key provisions in the draft legislation: Under the ACA, people get subsides to help pay insurance premiums based on their income. The House bill replaces subsidies with tax credits that vary based on age. A person under 30 would be eligible for a $2,000 tax credit while … Continue reading

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SAMHSA Issues Final Rule Modernizing Confidentiality Requirements for Patients Receiving Substance Use Disorder Treatment

Last month, the U.S. Department of Health and Human Services (“HHS”) Substance Abuse and Mental Health Services Administration (“SAMHSA”) released a Final Rule updating the Confidentiality of Alcohol and Drug Abuse Patient Records regulations at Title 42 of the Code of Federal Regulations Part 2 (“Part 2”). The Final Rule serves to modernize the regulations to facilitate information exchange and health integration while protecting the privacy of patients seeking treatment for substance use and the confidentiality of their medical records. The Part 2 regulations were promulgated in 1975 to protect the identities of individuals seeking substance use treatment from possible negative social consequences and stigma that could deter individuals from seeking treatment. They have not been substantively updated since 1987. The Final Rule was intended to go into effect February 17, 2017; however a Trump administration memorandum issued in mid-January establishing a “regulatory freeze” has delayed the effective date for at least sixty days from the date of the memorandum. In response to this directive, SAMHSA has postponed the Final Rule’s effective date to March 21, 2017. The updates to the Part 2 Regulations seek to enable improvements in healthcare … Continue reading

Posted in Health Care | Tagged

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Navigating the California Corporate Practice of Medicine “CPM” Prohibition

By Paul Giancola CPM is a variation of the statutory prohibition against unlicensed practice of medicine. CPM states enforce the prohibition against corporations practicing medicine by requiring a separation between medical/clinical decisions made by physicians and business decisions made by corporations.  This generally means that physicians cannot be employed by non-medical professional corporations or LLCs absent an exception . In this regard, The California Medical Board (CMB) states that the following clinical decisions should only be made by a California-licensed physician and would constitute the unlicensed practice of medicine if performed by an unlicensed person: Determining what diagnostic tests are appropriate for a particular condition. Determining the need for referrals to, or consultation with, another physician/specialist. Determining how many patients a physician must see in a given period of time or how many hours a physician must work. Responsibility for the ultimate overall care of the patient, including treatment options available to the patient. In addition, the following “business” or “management” decisions and activities, resulting in control over the physician’s practice of medicine, should be made by a licensed California physician and not by an unlicensed person or entity: Ownership … Continue reading

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Recent Arizona appellate decisions of note to providers

With change, breaking news, and uncertainty dominating the legal concerns of health care providers on a federal level, it remains important to review and refresh on state-level concerns and legal rules. This is especially true for those currently or frequently involved in health care litigation. In particular, Arizona appellate courts issued three decisions early this year of which health care providers may wish to take note. First, in Stafford v. Burns, 756 Ariz. Adv. Rep. 34 (App Div. 1 January 17, 2017), the Arizona Court of Appeals held that the heightened standard of proof for claims against a health care professional set forth in A.R.S. s 12-572(A) (“clear and convincing evidence” instead of a preponderance of the evidence) applies broadly “whenever the acts or omissions the plaintiff contends were deficient were provided in the course of evaluating and treating a patient in a hospital emergency department.” The heightened standard of proof of proof under the statute applies when services are provided in compliance with the federal Emergency Medical Treatment and Active Labor Act. The appellant had argued for a narrower interpretation that would have ratcheted down the burden of proof … Continue reading

Posted in court of appeals, Health Care

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