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Medical Practice Strategies:  Systems Based Practice - Business Laws Ethics

Janet Lerman, J.D.

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New News - Class 10

1-21-17:  Lisa Schencker, "Walgreens to pay $50 M in anti-kickback case" subtitle "Company gave illegal discounts, government says"  Chicago Tribune, January 21, 2017, 9.

 

1-20-17:  "Executive Order Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal" www.whitehouse.gov 

President Trump signed an executive order on Friday, January 20, 2017, involving the Patient Protection and Affordable Care Act as one of the new president's first actions.  

 

 

 

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9-22-15:  John Carpenter, "Health Law Speeds Merger Frenzy" The Wall Street Journal, September 22, 2015, B1 & B2.

Regulators and others are looking at, among other things, the potential impact on Consumers by the pending consolidation of some health insurance companies.  Currently there are 5 top players in the health insurance market and the number will become 3 if the consolidations occur.  Aetna plans to acquire Humana.  Anthem plans to acquire Cigna.  United Healthcare  is the other big insurer. 

Since 1999 the year 2015 is on pace to the most U.S. hospital deals with 71 announced through end of August.  Growing pressures to constrain costs and new forms of payments that require providers to meet efficiency and care-quality goals are said to be the impetus for the supersizing arising from or due to health reform. 

Some say the health insurers are responding to providers that say "take my rates or you'll have no network".  Providers such as Everett Clinic, a medical group with around 360 physicians in Washington state said it would be acquired by DaVita Healthcare Partners Inc., a publicly traded company base in Denver. Everett's CEO said it sought a larger partner because it needed more capital to expand beyond its base region north of Seattle.  Also, Everett's CEO stated because hospital systems have consolidated Everett needed greater size and scale to grow to effectively compete with those systems. 

Aetna and Anthem indicated their planned acquisitions will lead to lower costs and more healthcare provider partnerships with better communication; helping to evolve the health care industry to a new model in which insurers, doctors and hospitals work together to keep patients as healthy as possible.

There is a hearing scheduled with the Senate Judiciary antitrust subcommitee as health sector deals are drawing increased concern from state and federal officials worried the combinations would reduce competition and push up prices.  The Federal Trade Commission (FTC) and the Justice Department's Antitrust Division held a two-day conference about health care competition and the effects of consolidation.

Internet Resources

RE:  Public Law 111-148, March 23, 2010, "Patient Protection and Affordable Care Act".  See:  www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf

RE:  Federal Funds Information for States - Health Care Reform Legislation, Health Care Reform Grants, Health Care Updates  See:  http://www.ffis.org/issues/health-care-reform

See the Department of Health and Human Services strategic plan at its website at:  http://www.aspe.hhs.gov/hhsplan/index.htm.

Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news

See:  http://www.oig.hhs.gov/publications/redbook.html#1

See:  http://www.oig.hhs.gov/publications/workplan.html#1

Office of Inspector General--U.S. Department of Health and Human Services (www.hhs.gov/oig)

This website includes a variety of information relating to Federal health care programs, including the following:

Advisory Opinions Anti-Kickback Information Compliance Program Guidance Corporate Integrity Agreements Fraud Alerts Links to web pages for the: Office of Audit Services (OAS) Office of Evaluation and Inspections (OEI) Office of Investigations (OI) OIG List of Excluded Individuals/Entities OIG News OIG Regulations OIG Semi-Annual Report OIG Workplan

OTHER COUNTRIES

Yukari Iwatani Kane, "Pulling off Adventure Travel With a Serious Illness", The Wall Street Journal, September 22, 2015, D1 & D2.

The author of this article describes her experience along with her physician's approval to travel to other countries even though she had a serious illness.  She gave some recommendations in hindsight of what she would have done differently, such as:  (1)  Research before the trip health centers in different countries to get her blood tested.  She asked at her hotels which was not always reliable; and  (2)  Bring a letter from her doctor explaining her medical condition, in case she ended up in a hospital.

 

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