Physicians Hospitals

News & Analysis as of

New Part B Drug Payment Model Proposed

On March 11, 2016, CMS proposed implementation of a new two-phase model for drugs reimbursed under Part B of the Medicare Program (“the Proposed Model”). Drugs reimbursed under Part B include drugs administered in hospital...more

Health Law Insights Newsletter - Issue 8 - April 2016

McCarter & English, LLP’s Health Care Group presents Issue 8 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - New Payment Model for Part B Drugs Proposed -...more

All Right Stop, Collaborate and Listen! CMS Is Back with Its Brand New Invention, Preparing for CJR Gainsharing

Understandably, there is anticipation surrounding the April 1st start date for CMS’s newest bundled payment program, the Comprehensive Care for Joint Replacement (CJR) program. As participant hospitals consider gainsharing...more

Oregon's Statutory Peer Review Privilege for Health Care Providers: What It Is and How to Not Waive It

Where would you rather undergo coronary bypass surgery? At a hospital where mistakes and concerns that occurred during prior surgeries of other hospital patients are analyzed to develop and implement surgical policies that...more

The "predicate facts" rule: Providers, be vigilant!

Medicare GME payments do not compensate teaching hospitals for their actual costs of training residents in a given year. Rather, Medicare GME reimbursement is determined, in part, on the basis of historic cost data and...more

GAO Examines Hospital Challenges in Implementing Patient Safety Practices

The Government Accountability Office (GAO) has issued a report focusing on the roadblocks hospitals face in implementing evidence-based patient safety practices, such as the use of antiseptics to reduce Central...more

Six Trends Impacting Health Care M&A in 2016

From hospital expansions with large insurance deals to physician group consolidation, the continued outlook for health care mergers and acquisitions in 2016 is expected to be rampant. The following six factors will likely be...more

Also in The News - Health Headlines - February 2016 #2

ALSO IN THE NEWS: CMS Extends Deadline for Hardship Exception Applications – On February 26, 2016, CMS updated its online instructions for submitting a hardship exception application to reflect that hardship exception...more

SJC Rules in Employment Discrimination Cases a Plaintiff Need Only Show the Reason for Discharge was Untrue to Survive Summary...

On February 29, 2016, the Massachusetts Supreme Judicial Court (“SJC”), in Bulwer v. Mount Auburn Hospital, articulated the type of evidence required for a plaintiff to survive summary judgment and have his claims heard by a...more

Illinois Supreme Court Rules Physician's Application File and Data Bank Report Information Discoverable in a Negligent...

Klaine v. Southern Illinois Hospital Services (2016 IL 118217) Background - The plaintiff filed a negligent credentialing medical malpractice lawsuit against a physician and two hospitals where he was a member of...more

Health Care Update - February 2016 #4

What to Expect from Congress this Work Period - The next Hill work period basically runs from February 22nd to March 23rd. As Congress returns, here’s a brief look at the pending health care issues on the radar for this...more

King & Spalding Submits Comments to CMS Regarding Two-Midnight Rule, Rejecting Agency’s Latest Rationale for Payment Reduction

On February 2, 2016, on behalf of more than 200 client hospitals, King & Spalding responded to CMS’s latest justification for its two-midnight rule and associated 0.2 percent payment reduction, published at 80 Fed. Reg. 75107...more

Private Equity Market Intelligence: Physician/Hospital Quarterly Report - Q4

Key Findings - ..ACA enrollment reached 11.3 million by the end of the third open enrollment period, surpassing HHS expectations. Three-quarters of the enrollees were from the 38 states that use the healthcare.gov...more

Credentials Materials Are Not Privileged Under the Health Care Professional Credentials Data Collection Act

The Illinois Supreme Court recently held in Klaine v. Southern Illinois Hospital Services, 2016 IL. 118217 that a physician’s application for hospital privileges, which included information obtained from the National...more

Alert: What is MOLST and Do I Need It?

You may have heard about Connecticut’s pilot program for Medical Orders for Life-Sustaining Treatment (“MOLST”) and wondered what it is and whether it impacts your estate plan. Similar programs, such as Physician Orders for...more

Day Three Notes – JP Morgan Healthcare Conference, San Francisco

On January 13, 2016, conference sessions surfaced interesting questions and approaches regarding the post-acute sector, bundled payment, emergency medicine and anesthesia. Post-Acute Focus: With more and more focus on...more

GAO Recommends Equalizing Payment for Evaluation & Management Visits

The Government Accountability Office (GAO) has issued a report examining trends in “vertical consolidation” — hospital acquisition of physician practices or hiring of physicians as salaried employees – and the impact on...more

Catastrophe Averted…What’s Next for ICD-10?

If the October 1, 2015 ICD-10 transition buildup felt to you like Y2K all over again, then you are not alone. Although some hospitals have reported delays in payments, physician practices have not experienced delays in...more

GAO Recommends Payment Reform in Response to Increase in Hospital/Physician Consolidation

On December 18, 2015, the Government Accountability Office (GAO) released a report analyzing the increase in hospital/physician consolidation and a related increase in Medicare hospital outpatient spending. Finding that...more

New Year, New Flexibility: Top 10 Takeaways from CMS Stark Law Final Rule

On November 16, 2015, the Centers for Medicare & Medicaid Services (“CMS”) published the Calendar Year 2016 Physician Fee Schedule final rule with comment period, which includes a final rule (the “Final Rule”) that amends...more

Also In The News - Health Headlines - December 2015

HHS Extends Comment Deadline for NPRM on Protection of Human Subjects – In response to requests from stakeholders, HHS extended the comment period for its Notice of Proposed Rulemaking (NPRM) to revise the Federal Policy for...more

[Webinar] 2016 OIG Work Plan: Focus on Compliance - Dec. 10th, 12:00pm ET

This webinar will include an overview of OIG’s new and ongoing areas of focus related to hospitals and physicians. The focus of the discussion will be the practical impact of these key enforcement priorities on planning and...more

Summary of 2016 CMS Final Rule for Advance Care Planning

On October 30, 2015, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2016 final Medicare payment rules for physicians, hospitals and other providers. The rules include a provision that empowers patients,...more

Health Care Group News: Bi-Partisan Budget Act Affects New Provider-Based Facilities

On October 30, 2015 Congress passed the Bi-Partisan Budget Act of 2015 (hereinafter the "Act"). Section 603 of the Act is of particular relevance to hospitals and health care providers because of its potential to chill the...more

CMS Finalizes Controversial Changes to "2-Midnight Rule" for Inpatient Stays

On October 30, 2015, the Centers for Medicare & Medicaid Services (CMS) released its final rule updating the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for...more

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