Although physician offices were always classified as essential businesses under the Pennsylvania Emergency Closure Rules, and could always have remained open, many physician practices nevertheless opted to close the practices, reduce hours, or remain only open for emergency patients. Now that Pennsylvania is reopening to all businesses in stages, we thought it would be valuable to have a source of curated information specifically applicable to the reopening of physicians’ offices, similar to the COVID-19 Private Practice Checklist published by ACMS on March 19, 2020.

We believe the risk issues can be separated into four basic categories:

  1. Patient management
  2. Facility management
  3. Staff protection
  4. Patient consent forms and waivers

Patient management

The scheduling, management and testing of patients returning to the practice, and prioritizing their treatment based upon the severity of their medical conditions, will be one of the most challenging aspects of reopening the practice, if only because of your lack of actual control over patients’ conduct.

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Welcome to the second quarter of 2020! The coronavirus pandemic has changed the way physicians interact with their families, practice medicine and spend money. Perhaps you’ve been on the front lines in the critical care units. Perhaps you’ve been seeing patients by telemedicine or fielding lots of phone calls and trying to figure out how to get paid for what you do. Perhaps you’ve been isolating at home with not a lot to do, spending more time with family and doing some online CME. The question on your mind might be: When this pandemic ends, what position will I be in?

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Like most attorneys in the spring of 2020, I am working from home and composing this article on my laptop. Most of what I do can be done from anywhere that has an internet connection. Many forms of medical evaluation and treatment also can be performed remotely via commonly available technology. In some cases, telemedicine was already permitted, if not commonly used, before the advent of the novel coronavirus, COVID-19, and in other situations a number of regulatory and reimbursement barriers have been modified to respond to the crisis.

First, we should define what we mean by “telemedicine.”

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There is no doubt that medical and other personal information is more exposed in the cybersecurity realm than ever. When the Office of Inspector General (OIG) announced new proposed amendments to the existing Electronic Health Records (EHR) Safe Harbors in October 2019, perhaps OIG and the Centers for Medicare and Medicaid Services (CMS) were just acknowledging the serious privacy and cybersecurity challenges lurking in the vast scope of ostensibly legitimate sharing of PHI. Various state legislatures also are enacting far-reaching cybersecurity and privacy laws.

Electronic Health Records

By way of background, OIG first adopted the Safe Harbor for the donation of EHR software and training by hospitals to physicians in 2005, but placed limitations intended to discourage inducement or remuneration for referrals by requiring that physicians pay at least 15% of the cost and establishing a sunset provision, i.e.,

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The Honorable Jessica K. Altman
Insurance Commissioner
Pennsylvania Insurance Department
1311 Strawberry Square
Harrisburg, PA 17120

 

Re:   Improving Access to Telehealth Services during the State of Emergency in Pennsylvania

Dear Commissioner Altman:

 On behalf of the more than 3,600 members of the Allegheny County Medical Society, we urgently request that you issue an order applicable to all health insurance companies operating in Pennsylvania to expand payment for telehealth services.  During this state of emergency, Pennsylvanians enrolled in Commercial and Medicare Advantage plans now face uncertainty in accessing care normally provided in clinical settings. We ask you to order health insurance plans to increase the scope of covered telehealth services commensurate with the March 17th Centers of Medicare and Medicaid Services expansion of telehealth benefits.

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February 2020 Bulletin

Signed into law by Gov. Tom Wolf Nov. 27,1 Act 2019-112 (the Act) mandates the common practice among pain specialists of written agreements in connection with the treatment of chronic pain with opioids. Furthermore, the Act for the first time explicitly requires that treatment of chronic pain be “consistent with the Pennsylvania Opioid Prescribing Guidelines” (the Prescribing Guidelines). Notable exceptions include prescriptions for medical emergencies and for cancer, palliative care and hospice patients. Failure to abide by the Act, and its pending regulations, subjects prescribers to sanctions under their professional practice act by their licensing boards. The Act was effective immediately and emergency regulations are due to be promulgated by the Pennsylvania Department of Health by the end of February 2020.

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2020 Bulletin Cover

Are you a healthcare employer who is having difficulty recruiting physicians? If so, you may want to consider sponsoring a J-1 Exchange Visitor Physician for a Waiver. Providing J-1 Waiver sponsorship can be an effective option for healthcare providers to secure the necessary physician talent needed to serve their patients. This is particularly so for (but not limited to) employers in health professional shortage areas or medically underserved areas where it’s often difficult to recruit and retain U.S. physicians.

Why is J-1 Waiver sponsorship a good option? For context, a J-1 Alien Physician Exchange Visitor is subject to a two-year home presence requirement.

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On Oct. 22, 2019, the Centers for Medicare & Medicaid Services (CMS) and OIG (Office of Inspector General) released new proposed rules regarding Stark Law Exceptions and Anti-Kickback Safe Harbors in response to what has universally been christened as the “Regulatory Sprint to Coordinated Care,” first announced by the U.S. Department of Health and Human Services (HHS) in June 2018.
As background, please remember that, although the Anti-Kickback Safe Harbors and the Stark Law Exceptions are confusingly similar with respect to their intended purpose, they serve the following different functions:
1. The Stark Act prohibits physicians from referring only the Stark “designated health services” to healthcare entities with which they have financial relationships.

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As suspicion – or acknowledgement – that many cases of opioid use disorder (OUD) were iatrogenic and the opioid crisis grew, both federal and state governmental health agencies sought to develop and issue guidance for physicians. Having been fed misinformation by pharmaceutical companies for years, physicians needed evidence-based guidelines to appropriately treat their non-cancer chronic pain patients. The Centers for Disease Control and Prevention (CDC) responded definitively by issuing guidelines after seeking input from experts and stakeholders and combing through the evidence and responses. In addition, legislatures put strict limitations on prescribing in certain situations. It is clear that compliance with opioid prescribing legislation is mandatory, but what about compliance with guidelines?

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October 2019 Bulletin“History does not repeat itself, but it rhymes,” according to a popular proverb misattributed to Mark Twain. Healthcare trends tend to be cyclical, and the 1990s trend of publicly traded physician practice management (PPM) companies infusing investor capital into medical practices has returned from oblivion in the form of private equity (PE) transactions. Like the ill-fated PPMs, PE deals offer physicians cash up front and ownership in management companies that are designed to be sold in the future at a profit, and like PPMs, PE deals claim to be in a position to consolidate physician groups to achieve greater profitability. The results may not be in for a few years, but PE firms hope to avoid falling prey to the mistakes which led to the meteoric rise and fall of the PPM industry.

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