A few thoughts on HIPAA
Real case scenario. A health care provider’s car gets broken into and private health information (“PHI”) is stolen, along with other items. Next steps? Once the provider determines that a breach of unsecured PHI has occurred (an incidental disclosure of PHI does not constitute a breach), the provider should perform a risk assessment to determine whether the event poses a significant risk of financial, reputational or other harm to the patient.
Expansion of CMS Never Events: They’re Not Just For Medicare Or Just For Hospitals Anymore
In 2005 when “Never Events” were proposed for hospitals through the Deficit Reduction Act, no one knew what the overall effect would be on hospitals or patient care. CMS later developed these and implemented these Never Events under the authority of the DRA to prevent Medicare payment to hospitals for certain “never events” or hospital acquired conditions (HACs) which were conditions that were high volume, involved higher payment, and which could be easily preventable. Now, hospitals and other health care providers have to worry about Never Events in the Medicaid space.
Those of us who have been in the health care industry for awhile have seen hospital employment of physicians come and go several times. In my early years as a health care attorney, I was an in-house counsel in the hospital industry. I represented hospitals in the rush to jump on the band wagon of physician employment. I am now in the private practice of law and while I continue to represent hospitals, I also represent physicians and physician groups exploring various relationships with hospitals including employment.
On April 12, 2011, The U.S. Department of Health and Human Services (HHS) announced its intentions to form a public-private partnership with stakeholders such as patient advocates, healthcare providers and leaders at major hospitals. Called Partnership for Patients, this national initiative was created to improve quality and safety in health care, while also substantially reducing health care costs. HHS estimated that the partnership could save up to $35 billion in health care costs. Under the authority of the Affordable Care Act, HHS will invest $1 billion dollars towards this endeavor.
The two main goals will be to assist hospital patients by (1) preventing injury and further illness and (2) eliminating or mitigating complications that would adversely affect patient recovery. To learn more about the Partnership for Patients, please visit HealthCare.gov.
The Federal Trade Commission and the U.S. Department of Justice have jointly issued a proposed enforcement policy for the application of the antitrust laws to healthcare collaborations among otherwise independent providers and provider groups that seek to participate as accountable care organizations (ACOs) under the Medicare Shared Savings Program. The agencies seek public comments until May 31, 2011, on the proposed enforcement policy and the new antitrust “safety zone” it would create.
For more information and the proposed antitrust policy, please visit the FTC and DOJ’s Proposed Statement.
On March 31, 2011, the Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) unveiled the long-awaited federal rule on accountable care organizations. This proposed rule would implement section 3022 of the Affordable Care Act, which allows service providers and suppliers to continue receiving traditional Medicare fee-for-service payments under Parts A and B, and to be eligible for additional payments based on meeting specified quality and savings requirements.
To view the proposed rule, please visit the Office of the Federal Register website.
On March 30, 2011, the Centers for Medicare and Medicaid issued the long-awaited, proposed regulations for the Medicare Shared Savings Program, including details of the requirements for qualifying as an accountable care organization (ACO), such as:
The full text of the summary is available as a Duane Morris Alert.
On March 18, 2011, the U.S. Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) issued this regulation, implementing section 6111 of the Affordable Care Act. Section 6111 gives CMS authority to impose and collect civil monetary penalties (CMPs) against nursing homes. The penalties are reserved for nursing homes that fail to comply with federal participation requirements outlined in section 6111. Although penalties for noncompliance existed before the Affordable Care Act was promulgated, this regulation revises and expands CMS’s authority to impose and collect CMPs. The final rule is effective January 1, 2012.
For additional information about this new regulation, please visit the Office of the Federal Register website.
This regulation was adopted to correct technical and typographic errors identified in a final rule published November 24, 2010, titled “Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates; Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Payments to Hospitals for Graduate Medical Education Costs; Physician Self-Referral Rules and Related Changes to Provider Agreement Regulations; Payment for Certified Registered Nurse Anesthetist Services Furnished in Rural Hospitals and Critical Access Hospitals.” The errors were found in the preamble and addenda B, AA and BB of the November 2010 final rule. The new regulation also incorporates changes to the Medicare Physician Fee Schedule (MPFS) for CY 2011, which appeared in a January 11, 2011, CY 2011 MPFS correction notice. The corrections are effective January 1, 2011, as if they were initially included in the November final rule.
More information about the November final rule can be found here. A detailed summary of the corrected errors can be found on the Office of the Federal Register website.
On March 8, 2011, a coalition comprised of physicians representing the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association, announced its completion of 12 new recommendations for accreditation organizations to use when developing and implementing standards for the patient-centered medical homes (PCMHs). The PCMHs are a central component of the Patient Protection and Affordable Care Act (ACA). The coalition developed the guidelines in anticipation of accreditation organizations, such as the Joint Commission, building upon its recommendations to establish updated standards for the PCMHs.
For additional information, please refer to the coalition’s guidelines.
