Medical Ethics Corner: Lattes & Health Care

health-care-coffeeBy: Dr. Brent Schillinger, Guest Contributor

If you’re not satisfied with your medical care at the Pennsylvania based Geisinger Health System you now have a recourse not often found in traditional medical practice. You can ask for a refund.  And thanks to technology you can conduct the entire transaction through an app on your smartphone and the money will come back to you in three to five business days.

This novel step in the world of medical practice is perhaps the latest consequence of the corporatization of medicine and the transition of patients into consumers.  In fact in numerous published articles, Geisinger CEO Dr. David Feinberg repeatedly suggests that delivering medical care is not very different from buying a coffee at Starbucks.  “If you don’t like the cappuccino, they don’t sip it and say, ‘We made it right, we’re not giving you a new one,’” was Feinberg’s quip in a recent edition of Healthcare IT News in defense of his refund policy, which started as a pilot in November of 2015 and now is in full swing. Continue reading

Medicare Reporting & The 60 Day Rule

health law complianceBy: Karina Gonzalez

Earlier this year, CMS (Centers for Medicare and Medicaid   Services) released its  final rule related to  reporting  and returning  identified  Medicare and Medicaid overpayments for Medicare Part A and B. The rule is referred to as the “60-day rule” and it governs when an “identified” overpayment must be repaid to the government before it will be subject to liability under the federal False Claims Act (FCA), Civil Monetary Penalties Law and exclusion from the federal health care programs.

The Final Rule went into effect on March 14, 2016

An overpayment is “identified” for the purposes of reporting and overpayment under the 60-day rule when a provider or supplier “has or should have, through the exercise of reasonable diligence, determined that the person has received an overpayment and quantified the amount of the overpayment.” Continue reading

Core Regulatory Issues for Healthcare Transactions

healthcare transactionBy: James Saling

Regulatory issues in healthcare transactions have the potential to drive a transaction.  A healthcare transaction is very different from your typical corporate transaction. This is so because the healthcare industry is highly regulated at many different levels, and the issues tend to be complicated and not necessarily intuitive.  Whenever a provider is contemplating a sale of their healthcare business, they can expect a number of regulatory hurdles as they navigate the transaction.  Typical regulatory issues in healthcare transactions include: (1) fraud and abuse; (2) compensation; (3) investigations and audits; (4) compliance; and (5) licensure.  Of course, there are other regulatory issues that may arise, but these are, by far, the most common: Continue reading

CEC Networks Technical Advisory Report – Crypto Virus

300x300_alertBy: Curtis Cameron, President CEC Networks Inc., Guest Contributor
The Crypto virus pandemic is still going strong! This particular virus comes in many different forms and flavors. However, the result is almost always the same: your data being held hostage for ransom.  There are multiple ways of acquiring this virus, the most popular being through emails! These cyber terrorists are very creative and savvy trying to disguise their email so you will open it (i.e., subject line of “Your UPS tracking number”) or “Hello, here is my resume.” Do NOT open them! As a good “rule of thumb” you should never open anything unexpected or suspicious attachments with .EXE or .ZIP file extensions. These are executable files that once opened, run wild and perform their function. That function is rarely a good thing.
The GOOD news: There are firewall devices out there to help stop these viruses from entering and infecting your entire network. The firewalls must have a specific function included in them so ask your IT staff if your firewall has DPI/SSL.
The BAD News: Once your machine is infected, there is very little that can be done.  Make sure you have a good reliable off-site backup in place because once these files are encrypted, recovering from backup is the only recourse for you/your IT staff. Yes, you could try to pay the ransom, but who can trust a terrorist to follow through with their side of the deal!
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Curtis Cameron is the Founder and President of CEC Networks, Inc. For over 10 years he has been in South Florida building and implementing I.T. solutions that drive efficiency and safety for clients. He can be reached via email Curtis@CECNetworksInc.com or by calling directly 954-369-0999. Visit him online at http://www.CECNetworksInc.com 

Medical Ethics Corner: CMS Pay Cut Controversy

By: Dr. Brent Schillinger, Guest Contributor

“Part B Drug Plan Draws Fire From All Sides,” shouts the headline in MedPage Today, an online newsfeed for physicians.  If you have enough time to read the entire article you will realize the headline is not exactly correct.   While oncologists and rheumatologists and their respective specialty societies are furious, the last paragraphs of the same article points out that the American Academy of Family Physicians applauds the measure.  Sounds like opinions based largely on special interests.

All this noise stems from a federal proposal to reformulate the equation by which the Centers for Medicare and Medicaid Services (CMS) reimburses doctors and facilities for in office dispensing and administration of drugs.    The current methodology reimburses providers the average sales price (ASP) plus a 6% add-on fee to “cover costs.”   The new proposal would replace this formula with a rate of the ASP plus 2.5% plus a flat rate of $16.80 per drug per day.   Continue reading

Medical Ethics Corner: Conditions of Participation for Transplants

By: Dr. Brent Schillinger, Guest Contributor

Quality control measures developed by the Centers for Medicare and Medicaid Services (CMS) seem to be creating an ethical dilemma for some of the sickest patients and their physicians.  This dilemma appears to be the case amongst liver transplant candidates based on an observation that has been quantitatively measured in a new nationwide study commissioned by the American College of Surgeons (ACS).

In 2007, CMS started a new regulatory policy on liver transplants called Conditions of Participation.  The policy was intended to encourage safe, high quality transplant services in Medicare-participating facilities.   New benchmarks for “quality” were arbitrarily constructed.  If the transplant centers were unable to meet the stipulated conditions there were consequences that followed.  The patient outcomes were specifically used to categorize a facility as a “good” or “bad” performer.   This label of  quality could greatly affect the patient and the referring physician confidence, and thus the quantity of referrals, as well as the size of the Medicare payment for services.  In fact if the rating was below a certain level, a hospital could actually lose Medicare funding altogether. Continue reading

Restoring a Medical-Ethical Balance to Zika

mosquito on zika virus

mosquito on zika virus

By: Dr. Brent Schillinger, Guest Contributor

Zika is the new Ebola.  The media is going crazy with scary stories.  On just one typical day Fox news reported “Brain damage in Zika is far worse than Expected,” CNN announced “South Korea unveils anti-Zika uniforms for the Rio Olympics,” and in the Washington Post, “First Zika virus-related death reported in US in Puerto Rico.”  While there may be some cause for real concern doctors have an opportunity to carry out their ethical obligation to their patients to help balance things out.

The Zika virus was first detected in mosquitoes from the Zika Forest in Uganda in 1947.  Until 2007 there were hardly any cases of human transmission ever reported.  Then an outbreak occurred on Yap Island of Micronesia, which infected nearly three-fourths of the island’s population.  Zika didn’t get much attention then.   Nearly 80 percent of the people who had been bitten by mosquitoes and contracted the virus showed no symptoms and not one person died. Continue reading