Telemedicine Technology: Tackling Rural Health Care Challenges


In honor of National Rural Health Day on November 20, it’s important to recognize the challenges — and opportunities — facing health care providers in delivering the highest quality care to rural populations. Our recent survey of senior-level health care executives shows that telemedicine technology is becoming a key way of improving the access and quality of care for these communities.

According to the National Organization of State Offices of Rural Health (NOSORH), approximately one in five Americans lives in a rural/frontier area. While nearly 85 percent of U.S. residents can reach a Level I or Level II trauma center within an hour, only 24 percent of residents living in rural areas can do so within that time frame. Continue reading this entry

HHS Withdraws Proposed 340B Drug Pricing Program "Mega Regs:" Further Guidance Forthcoming


The Department of Health and Human Services (HHS) has withdrawn its greatly anticipated 340B Drug Pricing Program (340B Program) proposed regulations. The proposed regulations, nicknamed the 340B Program “Mega-Regs,” had been drafted by HHS and sent to the White House Office of Management and Budget for review in April, but had not been made available to the public. The withdrawn Mega-Regs were expected to address a variety of critical 340B Program issues, such as the definition of an eligible patient, compliance requirements for contract pharmacy arrangements, hospital eligibility criteria, and eligibility of off-site hospital facilities. The Health Resources and Services Administration (HRSA), within HHS, issued a statement that the agency plans to propose guidance for notice and comment in 2015 that will address key 340B Program policy issues. HRSA also plans to propose regulations related to the following specific 340B Program issues: civil monetary penalties for manufacturers; how the ceiling prices of 340B drugs are calculated; and dispute resolution. Continue reading this entry

Will the Mid-Term Elections Help Telemedicine Reimbursement?


Our recent survey of senior-level health care executives reinforced that lack of reimbursement remains the primary barrier to providers in adopting telemedicine services. Of our respondents, 41 percent indicated that their organizations receive no reimbursement for telemedicine visits.

While telemedicine’s impact on increased access and quality of patient care seems clear – especially in areas deemed a Health Professional Shortage Area (HPSA) by the Health Resources and Services Administration (HRSA) and the Census Bureau — what should be covered is not. The HRSA views Medicare coverage as a standard, but acknowledges that there is no single standard for reimbursement on single-payer services. Continue reading this entry

Is Provider-Based Reimbursement Going Away?


We get this question every year: will Medicare, Medicaid or other payors continue to recognize hospital-level facility fee reimbursement for hospital outpatient departments meeting the provider-based designation criteria at 42 C.F.R. 413.65? This year, there have been suggestive developments and a few data points to consider as you evaluate your operations: Continue reading this entry

Leading Private Equity Investment Themes Topic of Second Annual Health Care Investors Summit


With a keynote speech by Tenet Vice Chair Keith Pitts, and three panel discussions lead by investor representatives from Thomas Lee Partners, Riverside Partners, Nautic, and Welch Carson as well as provider and payer speakers from Aetna, Kindred, Mass General and others, a full house in Boston was treated to the major investment themes resonating in Board rooms and investment committees across the United States at the second annual Health Care Investors Summit co-sponsored by Foley & Lardner LLP and Deloitte on September 30, 2014.

Keith Pitts gave a comprehensive and engaging review of the process of vertical integration occurring within both provider and payer sectors citing several recent examples of acquisitive parent firms reaching vertically to control the consumer and the insured dollar including Davita and Optum’s recent acquisitions. Viewing healthcare systems as investors with a view toward a reimbursement system based on a total cost of care were themes Mr. Pitts introduced as emerging trends– while the still consolidating hospital sector prepares for the next wave of reimbursement change ignited by the Affordable Care Act. Continue reading this entry