Healthcare Reform: A Time To Wait, or Expiate?0

This article first appeared in Becker’s Hospital Review on April 12, 2012.

If Dante Alighieri had written an epic poem describing the recent evolution of American healthcare, it might have much in common with his famous Purgatorio.   As the nine U.S. Supreme Court Justices continue deliberation  on the fate of the 2010 Affordable Care Act, it is unclear whether our nation’s healthcare system is heading toward Inferno or Paradiso. While experts on both sides of the aisle attempt to divine the secret codes shared between Justices over a record-breaking three days of oral argument, the rest of us have little choice but to wait until summer for clarity.

In the 25 months since President Obama signed the Patient Protection and Affordable Care Act into law, the structure of our modern American healthcare system has changed dramatically, dividing the nation down political lines amid questions of constitutionality. With the bill currently under debate in our highest court, now is the time to consider the practical implications of an adverse ruling, and what the resultant ramifications may entail for the future of both the Affordable Care Act and the patients for whom the legislation was designed to protect. … Read more →

Administrative, Clinical, Community, Health Care Law, Health Care Reform, Historical, Hospitals, News

HAPPY ANNIVERSARY TO THE AFFORDABLE CARE ACT0

March 23 marks the two-year anniversary of President Barack Obama’s ambitious and controversial Patient Protection and Affordable Care Act. While the ultimate legacy of this landmark legislation remains to be seen, its fate will soon rest in the hands of the nine U.S. Supreme Court Justices, and then possibly the Electoral College.

With talk of constitutional challenges and potential repeal sharing headlines almost every day, now is the perfect opportunity to trace the changes in American health care over these past 24 months.

As our health care system continues to experience growing pains, certain basic tenets of reform have already made their mark, and may be difficult to retract in the event of the bill’s failure. The number of insured young adults under the age of 26 has continued to rise since 2010, as has the estimated 105 million Americans who no longer face lifetime limits on health benefits. Statistics also point to 50,000 newly insured who had in the past failed to qualify for health insurance due to pre-existing conditions.

Across the nation, individual states are gearing up for health insurance exchanges, while hospitals and physicians prepare for monumental changes in the Medicare reimbursement infrastructure as it transitions from a historically cost-based to a performance-driven platform.

Under the reform bill, the Federal Government has increased its presence with an unprecedented focus on eliminating health care fraud, abuse and waste.

Thanks to the Office of the Inspector General, Centers for Medicare & Medicaid Services and Department of Justice having procured health care fraud-related settlements and judgments in excess of $3 billion last year (capping the largest three-year streak in history with a total of $8.7 billion since January 2009), health care providers are now busy crafting or fine tuning their own custom-tailored compliance programs.  At the same time, providers must also fight off Medicare and Medicaid related audits from a number of newly created entities known only by their acronyms (RACs, MICs, MACs and ZPICs to name a few).

No matter what effects the Supreme Court’s decision and upcoming elections may hold for the Affordable Care Act, it is clear that American health care will never be the same.

Only time will offer any definitive perspective for us to evaluate the changes it has imposed upon the delivery of our nation’s health care.

Welcome to health care reform, year three, as it promises to be a busy one.

Administrative, Children's Health, Clinical, Community, Health Care Law, Health Care Reform, Historical, Hospitals, Miscellaneous, News, Non Clinical, Regulatory, Technology

Adjudicating health care reform by dissent0

This article first appeared in the Daily Journal on March 15, 2012.

The procedural infrastructure within which the nation’s judicial system operates is as important as the canons of law the Courts espouse. In many ways, the doctrine of justiciability affords the federal courts an opportunity to rule with finality in matters of the U.S. Constitution, while at the same time ensuring that an appropriate distance is maintained between the three branches of federal government. Given the numerous preconditions upon which certiorari is determined, rightful passage through the Supreme Court’s Corinthian columns can seem as improbable as procuring a return ticket across the river Styx.

However, those for whom certiorari is ultimately granted can count on a few basics from the Supreme Court, including a session each first Monday in October, quill pens on counsel tables, and the Court’s own general prohibition from issuing judicial advisory opinions. In commenting upon this most revered prohibition, Chief Justice Earl Warren noted: “When the federal judicial power is invoked to pass upon the validity of actions by the Legislative and Executive Branches of the Government, the rule against advisory opinions implements the separation of powers prescribed by the Constitution and confines federal courts to the role assigned them by Article III.”[1] … Read more →

Administrative, Community, Health Care Law, Health Care Reform, Historical, Hospitals, News, Regulatory

The Right to Strike vs. the Right to Care0

Modern day health care is a troubled industry. Enshrouded in a net of oft-conflicting regulations and entrusted with the safety of America’s sick and wounded, many of whom lack the necessary insurance to guarantee reimbursement to their providers, the financial stability of our nation’s medical facilities is called into question on a daily basis. Today’s hospital has the unenviable task of walking a fine line between caring for its patients and remaining solvent as a business, a laudable goal attainable at least in part by recognizing the inextricable connection between the institution itself and the nurses who form an infantry amongst its ranks. Even as these nurses form an ever-present “front line” on the hospital battlefield, their recent strike in California, threatened and averted strikes in New York, and a judicially-restrained “walk out” in Riverside County, California last month, shine a harsh if necessary light on certain issues plaguing our current health care system as it stands so precariously with one foot on either side of a dangerous fence.

The nature of the nurse’s role begs the question: does participation in a labor union extend to the right to strike? … Read more →

Administrative, Clinical, Health Care Reform, Hospitals, News, Regulatory

Health care reform experiences growing pains1

This article first appeared in the Daily Journal on January 27, 2012.

In its attempt to modify the basic structure of our nation’s health care system, President Barack Obama’s Affordable Care Act has understandably caused a series of rifts between competing factions within the health care industry.  As the entire nation waits to discover its ultimate fate, the fledgling program continues to promote conflict as it experiences growing pains, exemplified by recent modifications to federal regulations that push the invisible line separating church and state from a health care perspective. With an eye to the future, the Affordable Care Act must move cautiously in its attempt to revamp the foundations of health care, fending not only for its survival in the political arena, but in terms of constitutionality as well.

At its core, the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act (known colloquially as the “Affordable Care Act” or “health care reform”), promotes preventative measures designed in theory to eliminate health issues before they start. With such a sweeping directive, it is certainly understandable that constitutional challenges abound within, yet two of the more recent and most highly publicized concerns stand at opposite ends of the spectrum.

Last week, Health and Human Services Secretary Kathleen Sebelius issued a brief news release detailing a controversial August 2011 interim final rule that was specifically created to require health insurance plans to cover preventative services for women, including contraceptives, without charging a co-pay, co-insurance, or deductible.  Under this interim final rule, however, certain non-profit religious employers retained the option to omit contraceptive services from their employee insurance plan. Announced last week, the final decision now guarantees that women with health insurance as of Aug. 1, will be allowed access to all federally recommended preventative services, including contraception measures approved by the U.S. Food and Drug Administration. … Read more →

Administrative, Community, Health Care Law, Health Care Reform, Historical, Hospitals, News, Regulatory

California’s Vanishing Community Hospital: An Endangered Institution0

This article first appeared in the Fall 2011 Issue of California Health Law News, a Publication of the California Society of Healthcare Attorneys.

Across the nation, America’s community hospitals are under siege. Once considered indispensible to our health care system, the twenty-first century finds the local hospital fighting an uphill battle against a convergence of factors that favors the sharing of resources by multiple facilities.  Rising health care expenses, challenging regulatory hurdles, and a reimbursement structure in the midst of transition all bear some responsibility for the obstacles faced by today’s community hospital.  Nowhere is this phenomenon more pronounced than in California, where regular hospital closings amid an ever-growing population stand as incentive for remaining hospitals to team up (or remain teamed up) under the potentially false notion that in modern American health care, there is safety in numbers.

Learning From Past Mistakes – What History Reveals About Health Care

Understanding the historical evolution of the American hospital is fundamental to recognizing the core problems faced by smaller hospitals today.  From the 1736 opening of an almshouse in New York City (which would eventually become Bellevue Hospital) through the expansion to nearly 5,000 hospitals by the 1920s, and continuing through the post-1960 shift toward multifunctional facilities, health care has responded to the socioeconomic and political influences of each era.  A trend of multihospital systems replacing freestanding community hospitals picked up speed after 1965, driven largely by a combination of economic factors (including the creation of Medicare) and technological advances in medicine.  The five hospital consolidations noted in 1961 ballooned to upwards of fifty per year in the 1970s.  By the 1980s, an estimated thirty percent of the hospital beds in the United States existed within hospital systems.[1] … Read more →

Administrative, Community, Health Care Law, Health Care Reform, Historical, Hospitals, News, Regulatory

Our Fear of Health Care Reform and the Household Vacuum0

“That’s the nice thing about carousels, they always play the same songs.”  –The Catcher in the Rye by J.D. Salinger

This article first appeared on the PBS affiliated website This Emotional Life.

It starts with a vacuum.

The sudden, unfamiliar dissonance signals fear in his little mind, which grows quickly, magnified by the sight of an unexpected entanglement between the woman he trusts most and this monstrous machine. As he turns to run (or crawl), I find myself thankful to be just inches away, in perfect position to catch my 10-month old boy as he does his best to flee the frightful scene. His two outstretched arms secure a tight grip around my neck, while a sad face burrows deep into my chest. For one sharp moment I feel like a hero, a wholly necessary, trustworthy entity whose sole purpose is to be relied upon in times of trouble.

Fear is a formidable foe, and the ways in which we as grown ups react to its presence can often be inconsistent. Regardless of its origin, any meaningful cause for alarm typically signifies a commonality of chaos, to be first understood, and then vanquished. Though my son’s safety was obviously never compromised during his run-in with the vacuum cleaner, his reaction illustrates the fact that in the eyes of an infant the world is full of uncertainties. In the mind of a child, laughter and tears coexist every day, yet we seldom stop to consider how these emotions actually resonate. Rather, we tend to focus on the cause, which with luck might lead us to a solution, as a means to restore the calm and save the day. Indeed, some of the most seasoned parents have an entire cache of remedies upon which to rely when a crisis hits, and they wield them like weapons of precision, each one crafted and selected for just the right moment.

But what about the child in the midst of a trauma?  … Read more →

Children's Health, Clinical, Community, Health Care Law, Health Care Reform, Historical, Hospitals, News, PBS This Emotional Life, Regulatory

Providing Care for the Uninsured Without the Federal Case0

The article first appeared in Becker’s Hospital Review.

Estimated at close to 50 million strong, the fate of America’s uninsured has caused quite a stir of late. As the media anxiously reports on the U.S. Supreme Court’s acquiescence to assess the constitutionality of certain tenets at the heart of healthcare reform, the nation sits anxiously on the sidelines, awaiting the outcome. Indeed, a suggested, unprecedented televised hearing on the insurance mandate could potentially attract even more viewers than the record-breaking 111 million football fans who watched the Green Bay Packers beat the Pittsburgh Steelers in Superbowl XLV on Feb. 6, 2011.

The uninsured conundrum

At the core of the debate lies an enormous price tag. The sheer volume in dollars it takes to provide medical treatment to the uninsured is astounding, and its ramifications affect many fundamental aspects of our healthcare structure. In 2008, uncompensated medical care in the United States approached an estimated $57 billion, of which nearly $43 billion was paid by federal, state and local governments from funds earmarked for this very purpose. Although the federal government typically foots close to half of this annual bill, its contribution equals only 2 percent of federal healthcare spending yearly. The great bulk of responsibility for America’s uninsured falls to our nation’s hospitals, who shoulder approximately 60 percent of uncompensated medical care, due largely to a regulatory structure mandating that emergency departments at hospitals participating in Medicare or Medicaid must treat just about anyone who arrives in need of medical care, regardless of citizenship, legal status or ability to pay.

To add to the friction, most Americans have a stronger grasp on the rules of professional cricket than they do the leading constitutional challenge to President Obama’s 2010 Patient Protection and Affordable Care Act. … Read more →

Administrative, Clinical, Community, Health Care Law, Health Care Reform, Historical, Hospitals, News, Regulatory

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