The use of new technologies such as digital health applications, telemedicine, and information exchanges can provide game-changing benefits for providers and patients alike. However, with increased sharing comes increased risks to both the security and the privacy of patient information. Most digital health and telemedicine companies are aware of data security and breaches. However, an arguably more important compliance area is the intentional sharing of protected health information (PHI) with third parties, whether for data mining, research, or marketing purposes. Because data sharing and data mining will only continue to grow across the health care industry, providers and vendors must understand when and how they can share PHI, including monetization opportunities, and when they must obtain the patient’s express authorization.
Health care providers are under constant threat of lawsuits brought by whistleblowers under the federal civil False Claims Act, 31 U.S.C. §§ 3729, et seq. (FCA), the statute under which the government obtains most judgements against providers. These qui tam lawsuits can be costly even where they lack any merit, and counsel for providers are always on the lookout for defenses that can end these expensive lawsuits sooner rather than later. One of these defenses, the “first to file bar,” retains the ability to eliminate copycat lawsuits.
The Delaware Board of Medicine has issued proposed regulations clarifying certain statutory provisions pertaining to telemedicine and telehealth. As we previously reported, Delaware’s Medical Practice Act imposes certain practice standards for what constitutes an appropriate patient diagnosis and treatment via telemedicine, including the allowable modalities and when an in-person examination is required. The new proposed regulations are intended to clarify the language in the statute to further define the allowable modalities and address telemedicine prescribing of opioids. If enacted, the regulations would add a new Rule 19.0 to Chapter 1700 of the Code of Delaware Regulations.
Despite some initial difficulty in gaining momentum, the use of value-based payment methodologies will likely increase across all provider niches. This change is partly a function of cost savings driven by margin compression (e.g. inpatient care) as well as by government payment models rewarding quality and efficiency, such as the Medicare Access and CHIP Reauthorization Act (MACRA). Recent comments by Health and Human Services Secretary Azar suggest he finds that the results of the tested voluntary alternative payment models have been underwhelming and he may be ready for bolder payment programs to reform Medicare payments, including more mandatory programs. As the newest kid on the block of value-based payment programs, the Bundled Payment For Care Improvement–Advanced (BPCI-A) should be carefully assessed by and engaged in by providers for several reasons. We list six of these here.
California’s Medicaid agency has posted draft language of a new state plan amendment (SPA) that would make major changes to federally qualified health center (FQHC) and Rural Health Clinic (RHC) reimbursement. Public comments may be made on the proposal until 5 PM on March 23, 2018. Following review of public comments, the California Department of Health Care Services (DHCS) may make revisions to the SPA before submitting it to the federal Centers for Medicare and Medicaid Services (CMS) for approval. If approved, the SPA would be retroactive to January 1, 2018.