This series explores legal issues related to physician burnout and potential solutions. Our first post addressed how healthcare organizations can foster the psychological safety and emotional wellbeing of their physicians. Clients regularly report that charting and documenting, and communicating with patients via EMR is a substantial contributor to physician burnout. Here, we discuss artificial intelligence as a potential way to attract, support and retain clinicians overwhelmed by ever-growing to-do lists, allowing them to focus on delivering clinical care.
Continue Reading Solving for Physician Burnout: How Organizations Can Deploy AI Solutions to Effectively Support Physician Workloads and Avoid Legal PitfallsSearch results for: SUPPORT
The PACE Solution to Increasing Demands for Long-Term Services and Supports in the U.S.
As individuals continue to live longer beyond retirement and the U.S. population size of those 65 years and older continues to increase, the demand for long-term services and supports (“LTSS”) is also expected to increase.[1] LTSS represents the wide-ranging health and social services that individuals require over an extended period of time, including assistive services.[2] The increasing demand for these services will also likely proportionally increase health care expenditures of LTSS. According to the Congressional Research Service, which analyzed data from the Centers for Medicare & Medicaid Services (“CMS”) National Health Expenditure Accounts (“NHEA”) on the personal health expenditures for LTSS by payer, in 2021, an estimated $467.4 billion was spent on LTSS. This represents 13.2% of the $3.6 trillion spent on personal health care.[3] Notably, the first and second largest payers of LTSS are Medicaid and Medicare, respectively, accounting for 64.1% of all LTSS spending nationwide in 2021.[4] Absent public LTSS funding, individuals must rely on private funding, and in 2021, private sources accounted for just 28.6% of LTSS spending.[5]
Continue Reading The PACE Solution to Increasing Demands for Long-Term Services and Supports in the U.S.CMS Augments “In Lieu Of Services” Medicaid Guidance to Support State Medicaid Managed Care Efforts to Address Social Determinants of Health
Social determinants of health (“SDOH”) consider the non-clinical factors that can profoundly impact an individual’s well-being. They are extensive and often overlap, including housing instability, food insecurity, the inability to afford and obtain medications and more. Research has indicated that healthcare systems that connect patients to basic resources have observed improvements in population health metrics, fostered trust with their patient base, and experienced reduced hospitalization costs.
Continue Reading CMS Augments “In Lieu Of Services” Medicaid Guidance to Support State Medicaid Managed Care Efforts to Address Social Determinants of HealthAdapting To FDA’s Proposal For Diagnosis Support Software
*This article was originally posted in Law360 on November 4, 2019
With the rise of artificial intelligence and machine learning, clinical decision support, or CDS, software presents a novel opportunity to analyze immensely large amounts of data for patterns or other information that may be relevant to a particular patient’s diagnosis or health care options. Continue Reading Adapting To FDA’s Proposal For Diagnosis Support Software
Update to Texas v. United States: DOJ Files a Brief in Support of Eliminating the ACA
On May 1, 2019, the Department of Justice (“DOJ”) filed an initial brief (the “Brief”) with the U.S. Court of Appeals for the Fifth Circuit (the “Fifth Circuit”) on behalf of the United States, in favor of upholding the lower court’s decision that found the entire Patient Protection and Affordable Care Act (the “ACA”) unconstitutional.
As we discussed previously in our December 2018 blog post, a federal district court judge in Texas struck down the entire ACA by ruling that the “individual mandate,” which was reduced to $0 as part of the 2017 Tax Cuts and Jobs Act, no longer raises revenue and thus is no longer a constitutional exercise of Congress’s taxing power. The judge went on to determine that the unconstitutional individual mandate was inseverable from the rest of the ACA and therefore, the entire ACA was unconstitutional. The decision was then appealed to the Fifth Circuit. Continue Reading Update to Texas v. United States: DOJ Files a Brief in Support of Eliminating the ACA
Congress Passes “SUPPORT for Patients and Communities Act” — A Rare Example of Bi-Partisanship
In a September 14, 2018 Proclamation, President Donald Trump announced that the week of September 16 through September 22, 2018 would be Prescription Opioid and Heroin Epidemic Awareness Week (“Awareness Week”). As described in the Proclamation, the goal of Awareness Week is to “raise awareness about the prescription opioid and heroin epidemic and to consider concrete follow up activities.” Continue Reading Congress Passes “SUPPORT for Patients and Communities Act” — A Rare Example of Bi-Partisanship
New Venture Seeks to Support Independent Physicians in Texas
The Texas Medical Association (TMA) and Blue Cross Blue Shield of Texas are launching a new services company, TMA PracticeEdge, to facilitate bringing the benefits of value-based reimbursements to the state’s independent physicians.
Independent practitioners face challenges to participating in (and benefitting from) alternatives to fee-for-service payment, such as having the funds necessary to invest upfront in resources for improved care management. TMA PracticeEdge aims to help providers address the barriers. The company, for example, will offer consultations on basic practice management and administrative simplification, assistance with the implementation of health information technology infrastructure, and experience with risk-based contracts. Additional services will be available for practices interested in creating care teams or developing an Accountable Care Organization.
Continue Reading New Venture Seeks to Support Independent Physicians in Texas
New Approaches – and Increasing Oversight – for Medicaid Managed Long Term Services and Support
Approximately one-third of Medicaid spending, $136 billion, is on long-term services and supports (LTSS). While the majority of Medicaid LTSS takes place in institutional settings, such as nursing facilities and mental health facilities, there is an ongoing emphasis on the role of non-institutional facilities. A growing number of states, from 8 in 2004 to 16 in 2012 and an expected 26 through 2014, are adopting a managed care approach to expanding home-and community-based services. This transition is commonly referred to as a “rebalancing” of LTSS systems.
CMS Continues to Plan AHEAD Amid Rising Healthcare Costs
On October 28, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced the latest states to participate in the voluntary state total cost of care (“TCOC”) model: the All-Payer Health Equity Approaches and Development (“AHEAD”) Model. The initiative aims to curb healthcare costs and improve population health by allowing states to assume responsibility for their own healthcare systems. Specifically, the program holds states accountable for meeting state-specific Medicare targets, reducing cost growth, primary care investment, and advancing health equity principles. As of August 2024, Maryland, Vermont, Connecticut, Hawai’i, Rhode Island, and five downstate counties of New York have been selected to implement AHEAD.
Continue Reading CMS Continues to Plan AHEAD Amid Rising Healthcare CostsWomen’s Health on the Ballot in November: What the Election Could Mean for Reproductive Care and Beyond
Over two years into the post-Dobbs era, women’s health is taking center stage in the presidential election. In Dobbs v. Jackson, the Supreme Court overturned protections relating to abortion established in Roe v. Wade. Since then, approximately half of the states across the country have enacted or revived laws that ban or significantly restrict access to abortion. This case and the resulting cascade of legal disputes and legislative battles have created a highly dynamic and precarious legal landscape for women’s health. As a result, providers are left uncertain of their rights and obligations. Women in anti-abortion states face challenges obtaining reproductive care and, if pregnant, other medical treatments unrelated to reproductive care, while hospitals and clinics in nearby states without such restrictions are grappling with overwhelming patient loads.
Continue Reading Women’s Health on the Ballot in November: What the Election Could Mean for Reproductive Care and Beyond