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.