CMS final rules aim to fulfill the promise of telehealth

Starting January 1, 2019, beneficiaries with end-stage renal disease who receive home dialysis treatments can have their monthly assessments at home, rather than in person. Patients who have difficulty traveling or are in remote areas clearly benefit, though all home dialysis patients will be able to stay home and communicate with their doctors, more fully realizing the benefit of home-based treatment.

Similarly, starting January 1st patients arriving at a hospital with acute stroke symptoms can use a telehealth consultation to determine the best course of treatment. Previously, only patients in certain geographies could access this care; now a patient’s location does not restrict the ability to leverage remote care.

Finally, CMS will begin paying physicians for check-in consultations with Medicare beneficiaries via telephone or other communication device. Physicians will also be paid for review of videos or pictures sent by a patient for initial evaluation and determination of whether in-person care is needed.

The above developments take steps toward leveraging the potential of telehealth. Patients in remote locations, and those with conditions that make travel difficult or unsafe, clearly benefit. But telehealth’s potential is much broader. Better outcomes, lower cost, broader access and more satisfied patients all can flow from a system that gives patients and providers the ability to most efficiently deliver care.

Dave Farr is Partner at Farr & Farr in Chicago, where he practices health and corporate law.

Preventing Violence Against Providers

Starting January 1, 2019, the Illinois Health Care Violence Prevention Act will offer additional protections to front-line healthcare workers (e.g., physicians, nurses, physicians assistants). With these protections come worker reporting requirements and provider obligations to design and implement programs that improve the safety of health care workers.

Health Care Workers:

  • Have a right to contact law enforcement regarding workplace violence incidents

  • Must provide notice of their contact with law enforcement to their employing health care provider within three (3) days of contacting law enforcement

  • Are expressly afforded the protections of the Illinois Whistleblower Act for reporting workplace violence incidents

Health Care Providers:

  • Must post in their facilities notice of health care worker reporting requirements

  • May not discourage health care workers from contacting law enforcement to report workplace violence, and the existing Illinois Whistleblower Act is specifically applied to health care providers and their employees

  • Must offer immediate post-incident services to individuals directly involved in a workplace violence incident

  • Must create and implement a workplace violence program that complies with OSHA requirements and meets the following new requirements of the Act:

    • Classification of the violence in one of four categories (Types 1-4)

    • Management commitment and worker participation, including, but not limited to, nurses

    • Worksite analysis and identification of potential hazards

    • Hazard prevention and control

    • Safety and health training with required hours determined by rule (not yet specified)

    • Recordkeeping and evaluation of the violence prevention program

The Act also outlines new obligations for entities responsible for bringing committed persons (e.g., prisoners) to facilities for health care treatment. An entity with custody of a committed person must:

  • To the greatest extent practicable, provide notice to the treating facility of the custodial relationship and any significant safety concerns of the patient

  • To the greatest extent practicable, provide the most comprehensive medical record possible

  • Provide at least one security guard trained in custodial escort of high-risk persons

  • Limit visitor access

  • Use appropriate security restraints for committed persons while in health care facilities

As always, specifics about these new requirements and how to meet them are still in development. However, the outline of new rights and obligations is in place and health care providers should take steps to comply with rules designed to help protect their team members.

Dave Farr is Partner at Farr & Farr in Chicago, where he practices health and corporate law.

So you want to be a Medical Director?

“Where do I sign?” That may be the question sliding off your tongue after being offered a medical director role with an outside healthcare organization. You listened as their team (operations, business development, maybe a senior leader or two) outlined the opportunity, and it seems like you’d be crazy not to sign up immediately.

The best course of action: take a breath, thank everyone for their time, and call your healthcare attorney.

A medical director agreement offers professional development and economic incentive. It also comes with significant responsibilities, restrictions and growth considerations. Likely missing from the presentation were details on what happens when things go wrong, what risks you face, and why the role might not fit with your background and other responsibilities.

First, the medical director role exposes a physician to additional risk, both as a medical professional and from regulatory compliance. A medical director is ultimately responsible for the care delivered in a clinic he or she oversees and can be sued as part of the care team for a given patient. A medical director is also responsible for compliance with various healthcare regulations. Two examples are the CMS Conditions for Coverage that an entity likely will need to follow, and privacy regulations like HIPAA. In addition, medical directors face exposure to complaints to state licensure boards, even if a complaining patient was treated only by other physicians.

Second, a medical director agreement will come with restrictions on other roles the medical director can serve, and where they can serve in those roles. Understanding these restrictions and how they may impact a physician’s practice and ability to grow is key, and a potential medical director should understand the legal and business implications to their practice and development. As healthcare organizations continue to consolidate, affiliate and coordinate their activities, additional restrictions may arise for their partners and service providers. Medical directors need to understand how a potential partner’s affiliations, whether current or prospective, could impact his or her ability to choose another partner or affiliate with a different entity. The increasingly complex healthcare environment requires a careful evaluation, and non-compete language within any agreement must be fully examined to preserve a provider’s ability to grow.

Farr & Farr leverages years of healthcare business and corporate development experience to help clients understand the legal and business implications of any action. Contact Dave Farr to discuss your goals and how best to reach them.

Partner Track (Why I went to work with my wife)

February in the Cleveland airport, watching for updates of my flight home to Chicago. Finally canceled. It’s the third return flight in as many trips that has been canceled or delayed. Catching up with my wife on the way to the hotel I learn our son has a fever and was quarantined from daycare. My wife had to reschedule a handful of meetings and lost a busy day at her fledgling law firm. Maybe you’ve been there before: lots of moving parts but none of them in sync. Lots to do but nothing getting done. Busy, but no sense of satisfaction or accomplishment. The time had come to be honest with ourselves.

Fast forward a year or so and I’m sitting in my home office in Chicago. I traded a United Club membership for the local Chamber of Commerce. In December I stepped off a healthcare business development track to join my wife’s growing law practice and put my experience and heretofore dormant JD degree to different use. I’m excited to announce that I’ve joined Farr & Farr to grow the health law and corporate law practices.

The decision was equal parts professional and personal. Feelings that I was pursuing goals that would never deliver what I was looking for started to pop up after the birth of our son and got more intense after our daughter was born two years later. My wife had started her firm in 2015, but growth was constrained by her having to manage nearly everything at home, including those all-too-frequent daycare sick days.

That’s when the honest reflection and self-assessment started. I am fortunate to have a spouse who is a true partner (not just in business!), and we began to have deeper conversations about what we want out of our careers and how best to square that with our personal lives. Turns out that we both want the same things out of work: intellectual challenge, the privilege of counseling and advising others, a balance of time spent with other people vs. time spent alone, autonomy and decision rights on key issues, a close connection between our efforts and their results, and the ability to grow a business and eventually build a team that works with us. Each of us was hitting a few of those factors alone, but on our current paths we knew we would not fulfill them all.

On the personal side, we both prioritize time spent together and with our kids. We both have interests outside of work that we want to spend time on. We both want to be involved in decisions and activities at home. Meshing professional and personal goals is daunting, but the more digging we did the more convinced we became that growing our firm together could accomplish almost everything we discussed.

This reflection and self-assessment made the next steps possible, and exciting.

We put together a business plan (and were realistic about the challenges we faced), discussed timing of key events (like leaving my job and when to re-launch as Farr & Farr), figured out a lot of administrative details (fun times with health insurance), and I focused my attention on passing the Illinois bar exam (lots of flashbacks to my first year of law school). During the months leading up to the bar exam I also took the opportunity to care for our kids two days a week (always good to conserve cash during ramp up, but they’ll go back to full-time daycare soon). The time spent with them on “Dad Days” has been an ongoing reminder that we made the right decision. It provided a glimpse of what my mom, who stayed at home and raised five children, must have experienced in terms of fulfillment and challenge. It also revealed some of the things my dad, who worked long hours as a hospital administrator, missed when his kids were young. Their division of labor worked well for them and still works for a lot of people today. My wife and I are not among that group, but we found our way. Equal partners at work, equal partners at home.

Our path has provided experiences our clients can identify with and benefit from. We understand the difficulty in planning a new business, making a significant professional change, evaluating an investment opportunity, and negotiating the right course when all your planning does not produce the expected outcome.

A decision on whether to pursue any significant undertaking will only be as good as the process used to reach it. We build our process around thoughtful, efficient counsel, and we’re excited to help our clients identify, set and accomplish their own goals.

Dave Farr is Partner at Farr & Farr in Chicago, where he practices health and corporate law.