Posts tagged American Medical Association.
Colorado's Peer Review Privilege in Peril

The confidentiality of medical staff peer review has long been a cornerstone of hospital operations, fostering an environment where physicians can candidly evaluate medical care without the looming specter of malpractice exposure.  But this established norm is facing a new threat in Colorado, where a ballot proposal aims to gut peer review confidentiality.

The Foundation of Peer Review Confidentiality

Peer review is a process in which physician conduct that endangers patients within a hospital can be immediately reviewed by peers.  Peer review’s goal is to promote continuous ...

Peer Review Hearings Are Not Court Trials: California Reaffirms Flexible Nature of Fair Procedure

The California Supreme Court recently issued its decision in Boermeester v. Carry. Though the case deals with fair procedure within a private university’s internal disciplinary proceedings, it provides helpful guidance for peer review bodies navigating medical disciplinary hearings.

Boermeester reiterated the long-standing admonition that courts should not try to impose “rigid procedures” upon private organizations’ administrative proceedings. Rather, the organizations themselves should develop methods for providing the fundamentals of fair ...

Proposed Changes to the Health Breach Notification Rule

On May 18, 2023 the Federal Trade Commission (FTC) released a Notice for Proposed Rule Making (NPRM) for updates to the Health Breach Notification Rule, 16 C.F.R. Part 318 (the Rule). The Rule serves to ensure entities that are not defined as Covered Entities under the Health Insurance Portability and Accountability Act (HIPAA) are nevertheless accountable when the sensitive health information of consumers is compromised and that entities cannot conceal breaches from consumers. The Rule imposes notification requirements for a breach of unsecured identifiable health ...

Posted in COVID-19
The COVID-19 Public Health Emergency Has Ended - Now What for Managed Care Plans?

May 11, 2023 marked a milestone in the pandemic response with the expiration of the federal COVID-19 Public Health Emergency (PHE). The expiration of the PHE marks an end to the wide-reaching efforts undertaken by the federal government through emergency declarations, congressional and regulatory actions that provided flexibilities for the healthcare industry to ensure continuous delivery of health services during the PHE. As the Centers for Medicare & Medicaid Services (CMS) explained, while some of these changes are extended or made permanent, others are not. Medicare ...

Medical Group Peer Review: The Next Frontier

While hospital medical staffs have traditionally handled most of California’s peer review activity, recent trends are forcing more and more medical groups to wrestle with reporting and fair hearing obligations when disciplining physicians—or else face costly litigation from doctors and six-figure fines from the Medical Board of California.

Broadly speaking, peer review is how healthcare entities—including medical groups—determine whether a physician is qualified to practice in a particular healthcare setting and perform ongoing assessments of that ...

A proposed rule intended to stabilize the individual and small group insurance markets was issued on February 17, 2017, only a week after the Senate confirmed Tom Price as the Secretary of the U.S. Health and Human Services Department (HHS).[1] Although the proposed rule is intended to stabilize these markets, it may make it more difficult for individuals to obtain and maintain health insurance coverage, thereby reducing the number of people who are insured.

This is a turbulent time for American healthcare. Within weeks after the publication of the proposed rule, the American ...

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