Employee Management
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Not All Capitated Payment Models Work
Nearly a decade ago, Maryland experimented with a global budget payment model for rural hospitals. The plan was to give them a set amount of money, called Total Patient Revenue, to improve their efficiency. But it did not quite work out. ED visits dropped 12%, and non-ED admissions declined 23%. But there was little incentive for the hospitals to collaborate with community providers to improve patients’ health. Instead, the hospitals just reduced overall services.
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Health System Reaches ED Visit Reduction Goals by Focusing on Frequent Users
When a five-year, federally funded demonstration project began in New York, the goals were lofty: reduce preventable readmissions by 25% or more. NYU Langone Health achieved this goal through identifying frequent users and working with them through a targeted case management approach.
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Social Engineering Scams, Attacks Can Threaten HIPAA Security
Despite years of educating healthcare staff about the need for data security and the myriad ways people can worm their way into an otherwise secure system, employees still can fall prey to social engineering scams and allow HIPAA data breaches.
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Checklist Items for Selecting a Compliant Vendor
There is no quick and easy way to select a vendor to trust with HIPAA-sensitive data. It requires some legwork to determine what kind of security they have in place and possibly identify any shortcomings.
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Vendors Continue to Be Weak Point in HIPAA Security
Vendors always have been one of the most worrisome parts of HIPAA security because hospitals and health systems must rely on them for the appropriate technological and physical security for protected data — without the ability to dictate exactly how. Research shows that those fears are well founded, with many health organizations experiencing an increase in investigations and fines from HHS that are related to poor vendor HIPAA security.
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Misreading of Test Results Causes More Harm, Results in $3.5 Million Verdict
A lesson from this case is the varying standards that courts and juries apply when evaluating the sufficiency of evidence. This case focused on an alleged “increased risk of harm,” which is less common than a typical medical malpractice action involving a patient directly suffering harm. The patient here presented expert witness testimony concerning ejection fractions and the course of treatment that the expert contended satisfied the standard of care in such circumstances. The defendant hospital argued that this evidence was insufficient as a matter of law to support the jury’s significant verdict.
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Gastroenterologist’s Negligent Procedure Results in Patient’s Death, $4.8 Million Verdict
One of the most critical lessons is the importance of experts in medical malpractice cases. Since medical malpractice cases almost always involve issues beyond the knowledge of laypersons, experts play a vital role in the litigation process and in convincing a jury that a physician or care provider satisfied, or failed to satisfy, the applicable standard of care.
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Opioid Order Should Ease Physician Discretion
An order from the judge overseeing the National Prescription Opiate Litigation should make it easier for healthcare providers to comply with best practices designed to reduce opioid abuse. The order was in response to a motion from Webb County, TX, filed in September 2018, addressing the fact that pharmacy benefit managers' standard national offerings were not consistent with the CDC Guidelines, even though they had endorsed the guidelines as the standards of care.
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False Claims Act Ruling Is a Win for Healthcare Providers
A recent ruling in a False Claims Act Case affirms that relators must be specific with claims. Summary judgment was issued because the relator did not tie allegations to particular patients and bills.
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DOJ Specifies What Can Earn Credit in False Claims Investigations
The Department of Justice has released formal guidelines on how it will award credit to entities for cooperating with False Claims Act (FCA) investigations, giving healthcare organizations under scrutiny a way to reduce the potential effect. The guidelines state that entities will qualify for credit by voluntarily disclosing additional misconduct even after an FCA investigation is initiated.