The Health Law Ticker

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 ...

COVID-19 accelerated the trend of physician employment with hospitals, with recent data showing that nearly 70 percent of physicians are employed by hospitals or hospital-affiliated foundations or groups.  While physician integration improves quality of care and clinical efficiency, it also blurs the separation of responsibilities between the medical staff and the employer.  This can create headaches for stakeholders who want to address physician performance issues. … 

A recent California First District Court of Appeal (“Court”) decision, Futterman v. Kaiser Foundation Health Plan, Inc., (“Futterman”) has shed light on potential liabilities for noncompliance with the State’s mental health parity requirements.¹

As background, the COVID-19 pandemic served as a catalyst for increasing already soaring behavioral health care demand, by intensifying mental health and substance use conditions across the country. In a 2020 survey by the California Health Care Foundation, Californians ranked mental health treatment as their top ...

It’s no secret that patients from marginalized groups experience lower quality health care.  Acknowledging its role in closing the health care disparity gap, the Joint Commission recently announced new and revised requirements to reduce health care disparities in accredited facilities.  For medical staffs, the new accreditation standard provides an opportunity to lead the fight against health care disparities.

Medical literature over the past twenty years confirms the persistence of health care disparities.  In August 2021, the Journal of the American Medical Association ...

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 ...

On January 19, 2017, the Federal Trade Commission announced a settlement which would resolve allegations that competing ophthalmologists violated federal antitrust laws when they refused to negotiate contracts with MCS Advantage, Inc. (MCS), a Medicare Advantage Plan, and Eye Management of Puerto Rico (Eye Management), MCS’s network administrator.

According to the complaint, the charges arise from an arrangement between Eye Management and MCS entered into in April, 2014.  Eye Management agreed to create and manage a network of ophthalmologists to provide services to MCS enrollees and to do so at a cost savings to MCS.   Eye Management planned to replace MCS’s existing contract with each individual ophthalmologist with a new contract between Eye Management and the ophthalmologist at a lower reimbursement rate. In early June 2014, Eye Management sent a proposed contract to every ophthalmologist contracted with MCS at the time. These contracts offered payments at rates that were about 10% lower, on average, than the rates under the existing contracts between MCS and each ophthalmologist.