Holland & Hart Healthcare Law Blog

President Issues Executive Order On Health Information Technology and Transparency In Pricing.

President Bush issued an Executive Order today requiring Federal Agencies administering or sponsoring Federal health care programs to implement new guidelines to enhance health information technology development and to force transparency in billing practices. The Order requires Federal agencies to utilize health information technology systems and products that meet "recognized interoperability standards." (Whatever that means). It requires such agencies to require in future contracts or agreements with health care providers, health plans or health insurance issuers that as each provider, plan or issuer implements, acquires, or upgrades health information technology systems, it shall utilize, where available, systems that meet "recognized interoperability standards."  The Order requires the agencies to implement programs measuring the quality of services supplied by health care providers to beneficiaries  based upon standards established by "multi-stakeholder entities" (whoever they are), identified by the Secretary or another agency subject to the Order. Each agency must develop its metrics in collaboration with similar initiatives in the private and non-Federal public sectors.  Each agency must make available to the beneficiaries or enrollees of a Federal program the prices that its health insurance issuers , or its health insurance plans pay for procedures to providers in the health care program. Each agency must also participate in the development of information regarding the overall costs of services for common episode of  care and the treatment of common chronic diseases.  Each agency shall develop and identify approaches that encourage and facilitate the provision and receipt of high-quality and efficient health care including  pay for performance models and consumer-directed health care insurance products.  (All this is to be accomplished without any additional funding.) The effective date is January 1, 2007, for new contracts in the regular contracting cycle. 

Hospital Board Hijacks Non-Profit Hospital, Court Removes Board.

The line between governance and day to day management of a Non Profit Hospital Board can sometimes seem like a moving target and difficult to properly define. Tensions between management and the governing board can sometimes become combative if not downright hostile in undertaking their separate corporate duties in any given circumstances. The circumstances in a recent Tennessee Case may set a new mark for dysfunctional board-administration confrontation. The Tennessee Court of Appeals recently affirmed a trial court decision in Memphis Health Center, Inc., by Sadie Davis and Cornelia Berry, Directors, and Morristein J. Holman, Chief Executive Officer and Director  v. Gregory Grant, et al., in their capacity as the Board of Governors of Memphis Health Center, No W2004-02898-COA-R3-CV (July 28, 2006), to remove the defendant board of directors and return the management of the hospital to the CEO and two plaintiff board members.  This action followed a "derivative" action brought by the plaintiffs on behalf of the corporation against the rest of the Board.

Florida Appeals Court Finds No Immunity For Peer Review of Malpractice Expert Witness

Dr. John Fullerton is a physician and medical malpractice expert witness. He is licensed to practice in Florida and California, but he lives and practices primarily in California. He is not a member of the Florida Medical Association ("FMA") He testified in Florida in a medical Malpractice case brought against Drs. Jonathan B. Wrach, Pravinchandra Zala and Joseph O. Krebs.  After a judgment in their favor, the doctors filed a complaint with the FMA asserting that Dr. Fullerton's opinion testimony fell below reasonable professional standards. and was made for the sole purpose of propagating a frivolous lawsuit for financial gain. Dr. Fullerton then filed suit against the three doctors and the FMA. He alleged the statements in their complaint were false and were submitted for processing by the FMA's Expert Witness Committee of its Council on Ethical and Judicial Affairs, which he alleged was organized for the purpose of "intimidating, hindering , and deterring persons, including Plaintiff Fullerton , from appearing as expert witnesses on behalf of plaintiffs in cases involving medical malpractice." He claimed to have suffered damages and irreparable harm to his reputation. The trial court granted the defendants' motion for summary judgment on the basis that the Florida peer review statute and the Health Care Quality Improvement Act of 1986 ("HCQIA") barred Fullerton's claims in the absence of proof of intentional fraud.

Arizona Assesses Patient Impact In Determining Reasonableness of Physician Non-compete Covenant.

The knotty issue of physician non-competition and non-solicitation agreements continue to surface with some restrictions going so far as to prohibit a physician from having any contact with his own patients after termination of the physician’s employment with a hospital or physician group.  Frequently, little or minimal attention is paid to by an employed physician to the precise wording of non-competition and non-solicitation provisions at the beginning of an employment relationship.  Often the physician has little bargaining power at the beginning of the relationship and every expectation that things will work out fine.Some few states ban non-compete provisions for physicians outright.  Most states will enforce them if they meet minimum standards of reasonableness as to time, scope and circumstances.  Almost all look to the impact on the physician.  Arizona looks at all the circumstances including the impact upon patients.

McClinics: Limited Service Clinics Advance.

Is there money to be made in providing health care services to the uninsured or under insured?  The the percent of the population in these categories seems to be rising faster than the increase in global warming. A recent study  by the California Healthcare Foundation, "Healthcare in the Express Lane", tracks the advance of limited service clinics in drug stores, grocery chains and big box stores. These are not "doc in the box' or "urgent care" centers.  These are low overhead, nurse practitioner manned facilities that limit their services to every day, non-invasive procedures that  do not require fluid samples or disrobing. They will normally limit treatment to sore throat, bronchitis, ear infection, sinusitis, fue, allergies, conjunctivitis and female unary tract infections and similar maladies. Business is walk-in without appointments. Services are pre-priced and posted at $40 to $70 dollars per visit. Limited medical records are maintained and clinics are experimenting with proprietary software for the clinic records and evidence based treatment guidelines.