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Where Physician Burnout and Value-Based Care Intersect

This series explores legal issues related to physician burnout and potential solutions, and here we explore the potential impact of value-based care (“VBC”). Our first post addressed how healthcare organizations can foster the psychological safety and emotional well-being of their physicians. Our second post discussed artificial intelligence solutions as a potential way to attract, support and retain overwhelmed clinicians. Here, we explore how VBC can promote physician satisfaction and physician wellness by:Continue Reading Healing the Healers: Using Value-Based Care Strategies to Mitigate Physician Burnout

On July 31, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued its proposed rule (“Proposed Rule”) for the 2025 Medicare Physician Fee Schedule, which includes implications for telehealth services reimbursable by Medicare. Although the majority of telehealth waivers enacted during the COVID-19 public health emergency (the “PHE”) are set to expire at the end of 2024 in the absence of legislative action, CMS has proposed to leave certain key flexibilities in place, including the allowance for physicians and other practitioners to furnish remote “direct supervision” through their immediate availability via audio-video technology.Continue Reading Key Telehealth Updates in the CY 2025 Physician Fee Schedule Proposed Rule

The U.S. has long had a shortage of physicians in various practice areas. The shortage is even more pronounced in rural areas. International medical graduates (IMG’s) who come to the U.S. to complete a residency in a specialty area primarily come to the U.S. on J-1 visas. By statute, any physician who enters the U.S. on a J-1 must return home for 2 years before applying for H-1B status or permanent residency.Continue Reading Having Trouble Recruiting Physicians? The Conrad 30 Window is Opening Soon

The Centers for Medicare and Medicaid Services (“CMS”) recently announced that it is accepting applications for participation in a new population-based track (“Track 3”) as part of the Maryland Total Cost of Care Model’s Maryland Primary Care Program (“MDPCP”), which will begin on January 1, 2023 and continue through December 31, 2026. Track 3 provides a new option for participants to provide high value primary care services to Medicare beneficiaries within the State of Maryland.Continue Reading New Population-Based Option for the Maryland Primary Care Program in 2023

On July 31, 2019, the U.S. Court of Appeals for the Eleventh Circuit affirmed a lower court’s decision to grant summary judgment to hospital operator HCA and dismiss relator Thomas Bingham’s allegations. Bingham v. HCA (S.D. Fla. July 31, 2019) (“Op.”). In a well-reasoned opinion, the Court affirmed several key holdings:

  • There is no “remuneration”, for Federal health care program anti-kickback statute (“AKS”) purposes, unless a benefit is conferred for less than fair market value. In other words, as long as compensation to or from a referral source is consistent with fair market value, the AKS is not implicated.
  • With respect to the Stark Law, showing that a space lease arrangement effectuates an “indirect compensation arrangement” between a hospital and a referring physician requires a showing that the space, rental rates, or benefits under the lease correlate with the volume of the physician’s referrals to the hospital.
  • It may be appropriate for a court to strike allegations from an amended False Claims Act complaint if they are based on information uncovered by a relator during discovery.

These holdings should be welcomed by defendants of alleged AKS, Stark Law, and False Claims Act violations.
Continue Reading Eleventh Circuit Affirms Key Kickback Statute, Stark Law, and False Claims Act Principles in Dismissing Allegations Against HCA