Introduction

Health care is on a collision course with patient needs and economic reality. In today's dysfunctional health care competition, players strive not to create value for patients but to capture more revenue, shift costs, and restrict services. To reform health care, we must reform the nature of competition itself. Redefining Health Care provides an overall framework for diagnosing and solving this immense problem, with detailed action steps for all participants in the health care system.

Brown Rice Can Prevents Diabetes

Incorporate the rice and other grains to the diet is a good idea because these foods appear to reduce the risk of developing type II diabetes, according to a recent study concluded.

Incorporate the rice and other grains to the diet is a good idea because these foods appear to reduce the risk of developing type 2 diabetes, new research found.

The study by Qi Sun, School of Public Health, Harvard (USA) found that replacing the rice for white rice, if only a bit per week down the chances of this metabolic disease. The findings were published in Archives of Internal Medicine.

BAD WITH SERIOUS CONSEQUENCES

Type 2 diabetes represents, according to World Health Organization, 90% of diagnosed diabetes worldwide. Its incidence increased much in recent decades and is considered an epidemic. This pathology is strongly associated with sedentary lifestyles and obesity, and is often triggered in adulthood. However, today has begun to be detected in young children.

Diabetes Could Be in The Bones

The bones appear to have a role in regulating blood sugar and could be the underlying cause of diabetes.

“Skeleton”

The skeleton has a role in regulating blood glucose and may be the underlying cause of diabetes, show two studies conducted in the United States.

Both studies discovered the role of a hormone derived from the bones called osteocalcin, and its link with insulin.

One study, conducted in mice, found that the breakdown of old bone, which occurs to allow new bone growth also helps maintain a healthy level of blood glucose.

And the link, say scientists at the Medical Center of Columbia University, is osteocalcin.

The researchers, who published the study in the journal Cell, believe the finding could lead to better treatments to control the global epidemic of type 2 diabetes.

Dr. Gerard Karsenty and his team had already shown in previous studies that osteocalcin may regulate glucose levels.

This hormone can “turn” the production of insulin in the pancreas, which in turn improves the ability of other cells to absorb glucose from the blood.

Health Care Management Science

Health Care Management Science publishes important articles that promote systems thinking, offer rigorous scientific approaches for solving tough health care problems, and address policy implications. The journal uses an interdisciplinary approach, covering such topics as productivity and operations analysis, information systems, financial management, strategic management, managed care, and systems dynamics.

Providing a single forum for researchers and practitioners of health care services and management, the journal fosters the development and exchange of new ideas and the discussion of important findings in the field. Moreover, it disseminates knowledge rapidly across traditional disciplinary boundaries.

Health Care Quotes

    * Individual Health Insurance This is the main type of medical insurance purchased by people that do not have access to a group health plan through an employer. We help you find individual health insurance coverage at a price you can afford.
    * Group Health Insurance Despite increases in costs and the cutback of health-related benefits in recent years, close to 60% of Americans who have health insurance receive employer-based group medical benefits. Learn what to look for.
    * Student Health Insurance If you are a fulltime student between the ages of 17 and 29, this type of policy may be right for you. We provide health insurance quotes so that you can get decide what best fits your needs.
    * Medicare Supplemental Insurance This type of product is also known as Medigap insurance, it is a private health plan option designed to provide additional benefits above those offered through Medicare Part A and Part B.
    * Short-Term Health Insurance For those times when you are in transition, there is no need to put yourself or your family at risk. Acquiring this type of policy will help you be covered and provide you with the support needed should something unexpected happens.
    * Dental Insurance Dental plans are available for individuals, small businesses, and families. There are two main types of dental insurance: indemnity plans and managed care plans.

Handicap on Gathering the Local Public health Data

Health is something real important. That is why; we need to maintain it well, or if it was possible, we should be able to improve it. For some reasons, some of us want to improve the lever of the local health.

Surely, to be able to improve it, we should make sure that we could get many kinds of information about the local public health. But somehow, that efforts might not as smooth as it was planned.

There are some handicaps on the field. Gathering the local public health data wasn’t as easy as it was planned. In facts, for some privacy reasons, the local community prefers the keep the information.

State guides to health plans and health care quality

You'll also find information on the quality of health care in individual states. Each guide also gives you the opportunity to receive free, no-obligation health insurance quotes, complete with health insurance rates and plan details from competing health insurance companies.

Many states are seeking ways to tackle the problem of access to affordable health insurance plans on their own, and we look to health care reform initiatives on our state pages. We also have links to the contact forms for your elected officials, so you can easily lend your support, or offer alternative ideas.

FSB: Best Lawyers in America 2011

Below is a list of all the 2011 FSB honorees:


    * Mike Bonasso - Commercial Litigation
    * Stephen Brooks - Medical Malpractice Law and Personal Injury Litigation
    * Bob Coffield - Health Care Law
    * Tom Flaherty - Personal Injury Litigation
    * David Givens - Medical Malpractice Law
    * Ted Martin - Medical Malpractice Law
    * Mark Robinson - Medical Malpractice Law
    * Don Sensabaugh - Medical Malpractice Law and Personal Injury Litigation
    * Jeff Wakefield - Bet-the-Company Litigation, Commercial Litigation, Medical Malpractice

Best Lawyers is based on an exhaustive peer-review survey in which more than 39,000 leading attorneys cast almost 3.1 million votes on the legal abilities of other lawyers in their practice areas. Corporate Counsel magazine has called Best Lawyers "the most respected referral list of attorneys in practice."

CMS Awards WV Medicaid $945K Federal Matching Funds for EHR Incentive Programs

iHealthBeat reports that West Virginia Medicaid along with five other states will receive federal matching funds from the Centers for Medicare and Medicaid (CMS)to help implement electronic health record (EHR) incentive programs.


West Virginia Medicaid will receive $945,000 in federal matching funds. The CMS press release indicates that West Virginia will use the funds for planning activities that include conducting a comprehensive analysis to determine the current status of HIT activities in the state. The funds will be used to gather information on issues such as existing barriers to its use of EHRs, provider eligibility for EHR incentive payments, and the creation of a State Medicaid HIT Plan.


The CMS press release states:

    WEST VIRGINIA TO RECEIVE FEDERAL MATCHING FUNDS FOR ELECTRONIC HEALTH RECORD INCENTIVES PROGRAM

    In another key step to further states’ role in developing a robust U.S. health information technology (HIT) infrastructure, the Centers for Medicare & Medicaid Services (CMS) announced today that West Virginia’s Medicaid program will receive federal matching funds for state planning activities necessary to implement the electronic health record (EHR) incentive program established by the American Recovery and Reinvestment Act of 2009 (Recovery Act). West Virginia will receive approximately $945,000 in federal matching funds.

    EHRs will improve the quality of health care for the citizens of West Virginia and make their care more efficient. The records make it easier for the many providers who may be treating a Medicaid patient to coordinate care. Additionally, EHRs make it easier for patients to access the information they need to make decisions about their health care.

    The Recovery Act provides a 90 percent federal match for state planning activities to administer the incentive payments to Medicaid providers, to ensure their proper payments through audits and to participate in statewide efforts to promote interoperability and meaningful use of EHR technology statewide and, eventually, across the nation.

    “We congratulate West Virginia for qualifying for these federal matching funds to assist its plan for implementing the Recovery Act’s EHR incentive program,” said Cindy Mann, director of the Center for Medicaid and State Operations at CMS. “Meaningful and interoperable use of EHRs in Medicaid will increase health care efficiency, reduce medical errors and improve quality-outcomes and patient satisfaction within and across the states.”

    West Virginia will use its federal matching funds for planning activities that include conducting a comprehensive analysis to determine the current status of HIT activities in the state. As part of that process, West Virginia will gather information on issues such as existing barriers to its use of EHRs, provider eligibility for EHR incentive payments, and the creation of a State Medicaid HIT Plan, which will define the state’s vision for its long-term HIT use.

WVHCA: Proposed CON Standards for Megavoltage Radiation Therapy Services/Units

The West Virginia Health Care Authority has issued a Notice of Public Comment Period on a new Proposed Certificate of Need Standard for Megavoltage Radiation Therapy Services/Unit.


Written comments on the proposed Certificate of Need Standard must be filed with the Authority on or before July 30, 2010. Written comments should be directed to Timothy E. Adkins, Director of Certificate of Need Division.

WVHCA: Proposed Amendment to West Virginia CON Law Defintion of "Private Office Practice"

On June 15, 2010, the West Virginia Health Care Authority filed a Notice of a Comment Period on a Proposed Rule with the West Virginia Secretary of State amending West Virginia CSR 65-7, Certificate of Need Rule.


According to the Summary and Statement of Circumstances filed with the Proposed Rule the "amendment clarifies the definition of "private office practice" for purposes of administering the Certificate of Need Program. Those entities meeting this criteria may be eligible for an exemption from Certificate of Need review pursuant to West Virginia Code 16-2D-R(a)."


Written comments on the Proposed Rule are due on or before July 16, 2010.

What Health Care Employers Need to Know about the West Virginia Patient Safety Act

Ryan Brown, a health care attorney at Flaherty Sensabaugh Bonasso PLLC who specializes in medical malpractice defense, health care regulatory work and health care related employment issues wrote this summary of the West Virginia Patient Safety Act.


In 2001, the West Virginia Legislature passed the Patient Safety Act (“PSA”), W.Va. Code § 16-39-1 et seq. The purpose of the PSA was to provide an avenue for health care workers to report instances of waste or wrongdoing without the fear of retaliatory or discriminatory treatment by their employers through termination, demotion, reduction of time, lost wage, or lost benefits. The PSA requires the identity of a health care worker who reports waste or wrongdoing to a health care entity (e.g., hospital, clinic, nursing facility, etc.) or appropriate governmental authority to remain confidential. Health care entities are also required to post a summary of the important provisions of the PSA on the premises for its employees.


It is important for health care entities to understand that the PSA prohibits retaliation or discrimination against a health care worker who made a good faith report; advocated on behalf of patients, services or conditions of a health care entity; or cooperated in any investigation relating to the care, services or conditions of the health care entity. A health care worker who has been retaliated or discriminated against by his or her employer in violation of the PSA may file a civil suit and recover payment of back wages, costs of the litigation, reasonable attorney fees, and even reinstatement.


Many employers in West Virginia have had experience with the West Virginia Human Rights Act (“WVHRA”), W.Va. Code § 5-11-1 et seq, and its exception to the “at-will” employment doctrine. The WVHRA prohibits discrimination on the basis of race, religion, color, national origin, ancestry, sex, age, disability, and familial status. The WVHRA has been used by former employees as a way to defeat “at-will” employment by alleging that they were wrongfully terminated based on a protected status, rather than for unsatisfactory job performance. Although initially designed to improve the quality of patient care, the PSA has also been used by some former health care employees as a way to get around the concept of “at-will” employment. For example, a discharged health care worker could potentially sue his former employer using the PSA to allege that he was discriminated against after he reported instances of the employer’s waste and wrongdoing.


Health care entities must take special care not only to document the unsatisfactory performance of its employees, but also document and investigate complaints of waste or wrongdoing to shield itself from such PSA lawsuits. These lawsuits can be quite complicated as they encompass elements of both employment litigation and medical professional liability litigation.

ONC Issues Final Rule for EHR Temporary Certification Program

Last Friday the Office of National Coordinator for Health Information Technology (ONC) issued a final rule providing the details on how organizations can be authorized by ONC to test and certify EHR technology. ONC discusses the details the Temporary Certification Program.


Certification is important because the Medicare and Medicaid EHR incentives under HITECH require the use of certificate EHR technology for eligible hospital and providers to recieve payments under the incentive program.


For more information check out the Temporary Certification Program information on the ONC Health IT website, including a link to a complete copy of the Temporary Certification Program Final Rule.


More information from Government Health IT, ONC launches health IT certification program and iHealthBeat, ONC To Start Accepting Bids for Entities to Certify EHR Products.


UPDATE (6/24/2010): The official Federal Register version of the Final Rule is now available: 45 CFR Part 170, Establishment of the Temporary Certification Program for Health Information Technology; Final Rule (75 Fed. Reg. 36158, June 24, 2010). The Final Rule is effective on June 24, 2010.

SAMHSA and ONC: FAQs on Substance Abuse Confidentiality Regulations for HIEs

The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the National Coordinator for Health Information Technology (ONC) announced last week the release of FAQs for Applying the Substance Abuse Confidentiality Regulations to Health Information Exchanges (HIEs).


Cover letter regarding the FAQs by Pamela S. Hyde, the Administrator of SAMHSA, and David Blumenthal, National Coordinator for ONC. The letter describes that the the Substance Abuse Confidentiality Regulations under 42 CFR Part 2 were enacted years ago (circa 1975). Due to the age of the regulations SAMHSA and ONC created the FAQs to provide guidance and understanding of the scope of these regulations in the context of today's move toward an electronic health information system.


The FAQs outline the general requirements under 42 CFR Part 2, provide guidance on its application to HIEs, and identify methods for including substance abuse related health information into HIEs that is consistent with the Federal statute.


As a follow-up to the release of the FAQs, SAMHSA and ONC will convene a meeting of concerned or interested parties from both the Behavioral Health and Information Technology (BH-IT) communities on August 4, 2010. The meeting will be an opportunity for SAMHSA and ONC to receive questions and comments on the FAQs.


The FAQs for Applying the Substance Abuse Confidentiality Regulations to Health Information Exchanges (HIEs) provide information on the following 37 questions:

   1. Does the federal law that protects the confidentiality of alcohol and drug abuse patient records allow information about patients with substance use disorders to be included in electronic health information exchange systems?
   2. What types of providers are covered programs under 42 CFR Part 2 (“Part 2”)?
   3. What patients, and which records and information, are protected by 42 C.F.R Part 2?
   4. For the purposes of the applicability of 42 CFR Part 2, does it matter how HIOs are structured?
   5. Does 42 CFR Part 2 permit the disclosure of information without a patient’s consent for the purposes of treatment, payment, or health care operations?
   6. Under Part 2, can a Qualified Service Organization Agreement (QSOA) be used to facilitate communication between a Part 2 program and an HIO?
   7. May information protected by Part 2 be made available to an HIO for electronic exchange?
   8. If Part 2 information has been disclosed to the HIO, either pursuant to a Part 2- compliant consent form authorizing such disclosure or under a QSOA, may the HIO then make that Part 2 information available to HIO-affiliated members?
   9. How do different HIO patient choice models regarding whether general clinical health information may be disclosed to or through an HIO (e.g., no consent, opt in or opt out) affect the requirements of 42 CFR Part 2?
  10. If an HIO is holding or storing Part 2 patient data through a QSOA, can the HIO redisclose the data coming from the Part 2 program to a third party without patient consent?
  11. What are the required elements of a patient consent under Part 2?
  12. What must a Part 2 program do to notify the HIO, or any other recipient of Part 2 protected information, that it may not redisclose Part 2 information without patient consent?
  13. Can a single consent form be used to authorize the disclosure of Part 2 information to an HIO, as well as authorize the redisclosure of that information to other identified parties, such as HIO affiliated members?
  14. Does Part 2 allow the use of multiple-party consent forms?
  15. Does Part 2 require the use of original signed consents?
  16. Under Part 2, may an HIO release demographic information about Part 2 patients without patient consent?
  17. Under Part 2, can an HIO reveal that a patient had an encounter at a mixed use facility (or “general medical” facility – see FAQ #2) as long as the HIO does not reveal that the patient was in the mixed use facility’s Part 2 program? A mixed use facility can be defined as a service provider organization that provides substance abuse treatment services as well as other health services such as primary care, dental care, mental health services, social services, etc.
  18. Under Part 2, can an HIO use a consent form that provides for disclosure to “HIO members” and refers to the HIO’s website for a list of those members?
  19. Can an HIO use a consent form under Part 2 to allow for the disclosure of information to future HIO affiliated health care providers?
  20. Can an HIO use a consent form under Part 2 to allow for the disclosure of information to health care providers who are providing on-call coverage for HIO affiliated health care providers or with whom those affiliated providers consult?
  21. Can a Part 2 patient consent be used to enable multiple disclosures?
  22. Can a Part 2 program or HIO use a consent form that has no specific expiration date but rather states that disclosure is permitted until consent is revoked by the patient?
  23. Is “treatment” a sufficient description of the intended purpose of a disclosure on a Part 2 consent?
  24. Under Part 2, can any health care provider make the determination that a medical emergency exists, or must a Part 2 provider make that determination?
  25. May a computer system be used to automatically determine whether a medical emergency exists and whether a disclosure of Part 2 data can be made without the patient’s consent?
  26. If a medical emergency exists, can the entire Part 2 record be released?
  27. For documentation purposes, if a medical emergency is present, would it be permissible under Part 2 to have treating providers simply check a drop down box signifying the existence of such a medical emergency?
  28. Under Part 2, may an HIO system make clinical decision support functions (such as showing a patient’s medications to clinicians when they write prescriptions, automatically ordering medications, and/or alerting clinicians about potential drug interactions) available to HIO affiliated health care providers in a medical emergency?
  29. Does the Part 2 definition of medical emergency also include mental health emergencies?
  30. When the HIO keeps an electronic record of a medical emergency, does that fully meet Part 2’s requirement to document disclosures made in a medical emergencies in the patient’s record?
  31. If an HIO’s electronic system makes a disclosure in a medical emergency, would documenting the name of the discloser as “electronically disclosed through the system administered by HIO” meet Part 2’s requirement that the name of the person who made the disclosure be documented in the patient’s record?
  32. If an HIO’s electronic system sends Part 2 data in a medical emergency to a printer or fax machine in the emergency room, can “the printer in the emergency department” meet Part 2’s requirement to document in the patient’s record the name of the person to whom the disclosure was made?
  33. Once Part 2 information is disclosed in a medical emergency, can that information be redisclosed without obtaining patient consent?
  34. If a patient has previously refused to consent to the release of his/her Part 2 record to a particular HIO affiliated health care provider, and then the patient is brought to that provider in a bona fide medical emergency situation, can that provider gain access through the HIO to the information without the patient’s consent under Part 2?
  35. Can an HIO disclose data for Disease Management purposes under Part 2 without patient consent?
  36. Under Part 2, would an HIO be permitted to disclose to an HIO affiliated payer the data of several patients held by the HIO, which may include Part 2 data, in order for the payer to target where interventions could be made with particular patients to improve care and management of disease?
  37. If an HIO affiliated health care provider wishes to gain access to a minor’s Part 2 record held by the HIO, may the HIO or provider obtain only the consent of a parent or guardian, or must the minor’s consent also be obtained?

Thanks Blogger Team! Blogs of Note - June 14, 2010

Wow! Thanks to the Blogger Team for highlighting my Health Care Law Blog as a Blogs of Note on Blogger Buzz, the official buzz from Blogger at Google, for Monday, June 14, 2010. More on the Historie of Blogs of Note.


Welcome to all stopping by the Health Care Law Blog for the first time. If you are interested in health care law, privacy, security, and technology I hope you will check out my recent posts and add my blog to your regular reading list. You can follow my future posts via RSS or on Twitter at @HealthLawBlog.

Reversal of Conviction Because Undisclosed MySpace Friendship Between Defendant and Juror

Brian Peterson posts on a fascinating West Virginia Supreme Court of Appeals decision involving the use of social media between a juror and defendant and the issue of disclosure of such connections during voir dire.


In State v. Dellinger, No 3573 (W.Va. Supr. Ct. June 3, 2010) (PDF version) the West Virginia Supreme Court reversed a felony conviction of a Braxton County Sheriff due to a juror's "complete lack of candor" during voir dire. The juror and defendant were MySpace friends, but hardly knew each other. The Court found that the juror should have disclosed the relationship.


The Court describes the juror misconduct as follows:

    At the direction of the trial judge, an investigation into alleged juror misconduct was conducted concerning Juror Amber Hyre. During the course of the investigation and at the June 11, 2008, hearing, it was learned that on February 7, 2008, approximately one week before Appellant's trial began, Juror Hyre sent a message to Appellant on “www.MySpace.com,” a social networking website. In that message, Juror Hyre, known as “Amber,” wrote to Appellant:

        Hey, I dont know you very well But I think you could use some advice! I havent been in your shoes for a long time but I can tell ya that God has a plan for you and your life. You might not understand why you are hurting right now but when you look back on it, it will make perfect sence. I know it is hard but just remember that God is perfect and has the most perfect plan for your life. Talk soon!

    According to Juror Hyre, after she sent this message to Appellant, the two became MySpace “friends,” which allowed Appellant to view postings on Juror Hyre's MySpace page and vice versa.

At the end of the decision, the Court in footnote 11 highlights the need for lawyers and judges to instruct jurors of their responsibility and provides a cautionary note to them about using technology during the trial process and deliberation. The Court provides a link to the model jury instruction developed by the Committee on Court Administration and Case Management of the Judicial Conference of the United States. I previously blogged about this Model Jury Instruction here.


The footnote reads:

    As noted above, Juror Hyre posted a message on her MySpace page during the course of the trial in which she wrote, “Amber Just got home from Court and getting ready to get James and Head to church! Then back to court in the morning!” Next to “mood,” she wrote the word “blah.” The trial court found that Juror Hyre “did not state which trial she was hearing or any facts or opinions about the trial.” Though this Court does not condone any communication about a case by a sitting juror, we agree with the trial court's apparent finding that Juror Hyre's posting was benign in nature. We believe that, standing alone, it was not sufficient to find that she engaged in juror misconduct. However, we also believe some cautionary words are warranted concerning the prominent presence of the internet and routine use of and dependence upon various technologies by everyday Americans called to jury service. In an effort to preclude jurors from using cell phones, computers and social media websites such as MySpace, the Committee on Court Administration and Case Management of the Judicial Conference of the United States has endorsed a model jury instruction for federal district court judges to help deter jurors from using such technology for improper purposes (such as communicating about their case or conducting their own research). [Rules for Jurors: No Talking, Texting, Tweeting,] The National Law Journal, February 9, 2010, available at http//www.law.com/jsp/law technologynews/PubArticleLTN.jsp?id=1202442983764. For example, the jury instruction to be given before trial cautions, inter alia:
    I know that many of you use cell phones, Blackberries, the internet and other tools of technology. You also must not talk to anyone about this case or use these tools to communicate electronically with anyone about the case. . . .You may not communicate with anyone about the case on your cell phone, through e-mail, Blackberry, iPhone, text messaging, or on Twitter, through any blog or website, through any internet chat room, or by way of any other social networking websites, including Facebook, MySpace, LinkedIn, and YouTube.”

    The jury instruction to be given at the close of the case similarly provides:
    During your deliberations, you must not communicate with or provide any information to anyone by any means about this case. You may not use any electronic device or media, such as a telephone, cell phone, smart phone, iPhone, Blackberry or computer; the internet, any internet service, or any text or instant messaging service; or any internet chat room, blog, or website such as FaceBook, MySpace, LinkedIn, YouTube or Twitter, to communicate to anyone any information about this case or to conduct any research about this case until I accept your verdict.

    We note that, presently, there are no similar uniform standards for jurors in state trials. Id.

Lesson: If you are called for jury duty be sure to review all your MySpace, Facebook, Twitter, etc. contacts to make sure you have no connection to the parties in the matter. The case also highlights that technology has allowed all of us to develop new (more extended, not necessarily deeper) relationships with people that we don't really consider part of our "in person" social circle.The case also points out that jurors need to "go off the grid" during trial and deliberation process.


To get the full context of what occurred I recommend reading the full decision. Also, jump over to Brian's blog post to read more of his comments on the decision. I agree with his conclusion, "It's clear that voir dire and jury instructions need to catch up with technology."


UPDATE (6/15/10): Eric Goldman at the Technology & Marketing Blog and Molly DiBianca at Going Paperless provides additional analysis and thoughts on the decision.


UPDATE (6/18/2010): Ry Rivard at the Charleston Daily Mail covers the decision in his story, Web stirs problems in jury selection.

WVBOM: Policy Statement - Guidelines for Physicians in Collaborative Relationships with Advanced Nurse Practitioners

On May 10, 2010, the West Virginia Board of Medicine has issued a new Policy Statement - Guidelines for Physicians in Collaborative Relationships with Advanced Nurse Practitioners or Certified Nurse Midwives; Standard of Practice.


The new Policy Statement provide West Virginia physicians with guidance on the role and responsibility they play in the collaborative relationship with advanced nurse practitioners and certified nurse-midwifes. In summary, the guidance provides:


A. The physician must be permanently and fully licensed in West Virginia without restriction or limitation.


B. There should be a written collaborative agreement should should include certain specific provisions as outlined in the Policy Statement.


C. Other considerations that are outlined in the Policy Statement


The Policy Statement indicates that the failure by a physician to adhere to these minimum requirements and guidelines may result in discipline by the Board of Medicine.

Credentialing and Privileging Telemedicine Physician and Practitioner

Last week the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule revising the conditions of participation (CoPs) for hospitals and critical access hospitals allowing for a new credentialing and privileging process for physicians and practitioners who provide telemedicine services. The proposed rule should make it easier on smaller hospital (especially critical access hospitals) who don't have the in-house medical staff to adequately evaluate and privilege a wide range of specialty physicians who provide services through telemedicine.


The proposed rule was published in the Federal Register on May 26, 2010, and titled, Credentialing and Privileging of Telemedicine Physicians and Practitioners, 75 Fed Reg 29479 (May 26, 2010). Comments on the proposed rule must be submitted by July 26, 2010.


Traditionally the CoPs have required the governing body of the hospital to make all privileging decisions based on the recommendations of its medical staff using specific criteria. Hospitals often use third-party credentialing verification services to assist in compiling the voluminous documents needed to verify credentialing and then have the governing body of the hospital review and sign off on the privileging decision.


The proposed rule points out that there has been a Joint Commission standard policy that allows "privileging by proxy," which has been in direct conflict with CoPs. "Privileging by proxy" allows Joint Commission accredited hospitals to utilize a different methodology to privilege"distant-site" physicians and practitioners. Basically, allowing one Joint Commissioned accredited hospital to accept the privileging decisions of another Joint Commissioned accredited hospital. In the past, hospitals were deemed (deemed status) to meet the CoPs if they were accredited by the Joint Commission. However, changes in the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) will halt (effective July 15, 2010) the statutory recognition of the Joint Commission's hospital accreditation program and now requires the Joint Commission to meet CMS standards in order to confer Medicare deemed status.


CMS has decided that requiring each hospital to independently privilege providers is a duplicative and burdensome process, especially for small hospitals who often use telemedicine services from larger academic medical centers and hospitals to provide access to needed specialty services. Thus, CMS is proposing in the rule to revise the hospital credentialing and privileging requirements to allow a hospital who obtains telemedicine services by agreement with another hospital that the agreement can specify that the hospital providing the telemedicine services is responsible for credentialing the telemedicine provider and can provide this information to the medical staff of the hospital receiving the telemedicine services who can then rely upon the credentialing and privileging decisions of the hospital providing the telemedicine services.


For a more detailed discussion and understanding of the proposed revisions read the proposed rule in the May 26, 2010, Federal Register.

OCR Request for Information: HIPAA Privacy Rule Accounting of Disclosures under HITECH

Today the Office for Civil Rights (OCR), Department of Health and Human Services issued a Request for Information titled HIPAA Privacy Rule Accounting of Disclosures Under the Health Information Technology for Economic and Clinical Health Act (75 Fed Reg 23214 May 3, 2010). More information at the OCR website.


The Request for Information by OCR seeks comments from health consumers and health care providers/organizations. OCR seeks information on the following areas:

    * Understanding the interests of individuals (health consumers) with respect to learning of such disclosures; and
    * The administrative burden on covered entities (health care providers/organizations) and business associates of accounting for such disclosures.

The Request for Information states that Section 13405(c) of the Health Information Technology for Economic and Clinical Health (HITECH) Act expands an individual’s right under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule to receive an accounting of disclosures of protected health information made by HIPAA covered entities and their business associates. In particular, section 13405(c) of the HITECH Act requires that the HIPAA Privacy Rule be amended to require covered entities to account for disclosures of protected health information to carry out treatment, payment, and health care operations if such disclosures are through an electronic health record.


The Request for Information requests specific comments on the following nine questions:

1. What are the benefits to the individual of an accounting of disclosures, particularly of disclosures made for treatment, payment, and health care operations purposes?

2. Are individuals aware of their current right to receive an accounting of disclosures? On what do you base this assessment?

3. If you are a covered entity, how do you make clear to individuals their right to receive an accounting of disclosures? How many requests for an accounting have you received from individuals?

4. For individuals that have received an accounting of disclosures, did the accounting provide the individual with the information he or she was seeking? Are you aware of how individuals use this information once obtained?

5. With respect to treatment, payment, and health care operations disclosures, 45 CFR 170.210(e) currently provides the standard that an electronic health record system record the date, time, patient identification, user identification, and a description of the disclosure. In response to its interim final rule, the Office of the National Coordinator for Health Information Technology received comments on this standard and the corresponding certification criterion suggesting that the standard also include to whom a disclosure was made (i.e., recipient) and the reason or purpose for the disclosure. Should an accounting for treatment, payment, and health care operations disclosures include these or other elements and, if so, why? How important is it to individuals to know the specific purpose of a disclosure— i.e., would it be sufficient to describe the purpose generally (e.g., for ‘‘for treatment,’’ ‘‘for payment,’’ or ‘‘for health care operations purposes’’), or is more detail necessary for the accounting to be of value? To what extent are individuals familiar with the different activities that may constitute ‘‘health care operations?’’ On what do you base this assessment?

6. For existing electronic health record systems:
(a) Is the system able to distinguish between ‘‘uses’’ and ‘‘disclosures’’ as those terms are defined under the HIPAA Privacy Rule? Note that the term ‘‘disclosure’’ includes the sharing of information between a hospital and physicians who are on the hospital’s medical staff but who are not members of its workforce.
(b) If the system is limited to only recording access to information without regard to whether it is a use or disclosure, such as certain audit logs, what information is recorded? How long is such information retained? What would be the burden to retain the information for three years?
(c) If the system is able to distinguish between uses and disclosures of information, what data elements are automatically collected by the system for disclosures (i.e., collected without requiring any additional manual input by the person making the disclosure)? What information, if any, is manually entered by the person making the disclosure?
(d) If the system is able to distinguish between uses and disclosures of information, does it record a description of disclosures in a standardized manner (for example, does the system offer or require a user to select from a limited list of types of disclosures)? If yes, is such a feature being utilized and what are its benefits and drawbacks?
(e) Is there a single, centralized electronic health record system? Or is it a decentralized system (e.g., different
departments maintain different electronic health record systems and an accounting of disclosures for treatment,
payment, and health care operations would need to be tracked for each system)?
(f) Does the system automatically generate an accounting for disclosures under the current HIPAA Privacy Rule (i.e., does the system account for disclosures other than to carry out treatment, payment, and health care
operations)?
i. If yes, what would be the additional burden to also account for disclosures to carry out treatment, payment, and health care operations? Would there be additional hardware requirements (e.g., to store such accounting information)? Would such an accounting feature impact system performance?
ii. If not, is there a different automated system for accounting for disclosures, and does it interface with the electronic health record system?

7. The HITECH Act provides that a covered entity that has acquired an electronic health record after January 1, 2009 must comply with the new accounting requirement beginning January 1, 2011 (or anytime after that date when it acquires an electronic health record), unless we extend this compliance deadline to no later than 2013. Will covered entities be able to begin accounting for disclosures through an electronic health record to carry out treatment, payment, and health care operations by January 1, 2011? If not, how much time would it take vendors of electronic health record systems to design and implement such a feature? Once such a feature is available, how much time would it take for a covered entity to install an updated electronic health record system with this feature?

8. What is the feasibility of an electronic health record module that is exclusively dedicated to accounting for disclosures (both disclosures that must be tracked for the purpose of accounting under the current HIPAA Privacy Rule and disclosures to carry out treatment, payment, and health care operations)? Would such a module work with covered entities that maintain decentralized electronic health record systems?

9. Is there any other information that would be helpful to the Department regarding accounting for disclosures
through an electronic health record to carry out treatment, payment, and health care operations?

Written comments to OCR must be submitted on or before May 18, 2010.

Testing Google's New Search Story

Yesterday I saw a post on the Official Google Blog about making your own search story videos in minutes. The post announced Google's simple to use search story video creation tool. Google introduced these search stories during the Superbowl with this ad, Parisian Love. All you have to do is type in your searches, pick your music and transfer it over to Youtube. Try it out here.

I thought I would test out the tool by creating a quick sample video marketing my health care legal practice featuring my Health Care Law Blog.

Also thinking about how marketing staffs for physicians, hospitals and health care organizations might creatively use this tool to create great marketing and public informational pieces. For example, a search story that reminds people to do a self examination, promotes a public service announcement, recommend certain preventative health measures or make healthier micro decisions.

NCAA Final Four: It's a great day to be a Mountaineer wherever you may be!

Today the WVU Mountaineers take on the Duke Blue Devils in the NCAA Final Four. Good luck to the Mountaineers as they try to move on to the Championship Game on Monday night against the winner of the Bulter vs. Michigan State contest.

West Virginians everywhere are excited about the game and proud of the hard work and dedication put in by the Mountaineer players, coaches and staff. It is a great day to be a Mountaineer!

All week it has been exciting to watch the buzz and excitement grow throughout the state. I loved this picture of some Mountaineers leaving Morgantown headed to Indianapolis with their cooler and couch strapped to back. I had to share it with everyone. Thanks to Lisa Simmons for the photo. You have to be a Mountaineer to understand the couch burning tradition (some history on the tradition and one of my favorite videos below).

Go Mountaineers!

DEA Interim Final Rule on Electronic Prescribing of Controlled Substances

On March 24, 2010, the Drug Enforcement Administration (DEA) released the Interim Final Rule with Request for Comments on Electronic Prescribing of Controlled Substances.

The Interim Final Rule outlines the procedures for health care providers to electronically prescribe controlled substances. The DEA has revised its regulations to provide practitioners with the option of writing prescriptions for controlled substances electronically and permit pharmacies to receive, dispense and archive these electronic prescriptions.

The Interim Final Rule will be officially published in the Federal Register on Wednesday, March 31, 2010 and will include a 60 day comment period.

AHLA Teleconference: The Intersection of Social Media and Human Subjects Research

On May 4, 2010, I will be participating in a teleconference on The Intersection of Social Media and Human Subjects Research. The teleconference is co-sponsored by the American Health Lawyers Association Health Information Technology, Life Sciences and Teaching Hospitals and Academic Medical Centers Practice Groups.

The moderator for the teleconference will be Karl A. Thallner, Jr., Esquire, Partner, Reed Smith LLP, in Philadelphia, PA. The other panel presenters will be:

Naomi Halpern, Esquire
Partner
Frommer Lawrence & Haug, Washington, DC

Laura Odwazny, Esquire
Senior Attorney, Public Health Division
Office for Human Research Protections
Office of the General Counsel
U.S. Department of Health and Human Services, Rockville, MD

More information, including a description of the program and how to register, is available through the AHLA website.

OCR Update on Issuance of HIPAA HITECH Rulemaking

Update from Office for Civil Rights (OCR) on issuance of the Notice of Proposed Rulemaking (NPRM) implementing changes to HIPAA under the Health Information Technology for Economic and Clinical Health Act (HITECH). Health care organizations and health lawyers have been anxiously awaiting rules implementing and interpreting the changes because the effective date for many of the HITECH requirements was February 17, 2010. Of particular interest has been whether or not health care organizations are required to amend business associate agreement.

The notice seems to indicate that the the date for compliance and enforcement may be delayed since it states that the NPRM "will provide specific information regarding the expected date of compliance and enforcement." However, covered entities and business associates need to weigh the risks of not complying with the new requirements while waiting for further clarification from OCR.

The notice states:

OCR will implement important privacy and security provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act through notice and comment rulemaking, as required by the Administrative Procedure Act. These provisions include: business associate liability; new limitations on the sale of protected health information, marketing, and fundraising communications; and stronger individual rights to access electronic medical records and restrict the disclosure of certain information. OCR continues work on a Notice of Proposed Rulemaking (NPRM) regarding these provisions. Although the effective date (February 17, 2010) for many of these HITECH Act provisions has passed, the NPRM and the final rule that follows will provide specific information regarding the expected date of compliance and enforcement of these new requirements.

However, interim final rules implementing HITECH Act provisions in two areas have already been issued and are currently in effect: enforcement and breach notification. New civil money penalty amounts apply to HIPAA Privacy and Security Rule violations occurring after February 17, 2009. Covered entities and business associates must comply now with breach notification obligations for breaches that are discovered on or after September 23, 2009. OCR announced previously that it would use its enforcement discretion not to impose fiscal sanctions with regard to breaches discovered before February 22, 2010. Since that date has passed, OCR will enforce the Breach Notification Interim Final Rule, including with the possible imposition of sanctions, as it does with the HIPAA Privacy and Security Rule requirements.

West Virginia State Bar Issues Advisory Opinion 10-001 Clarifying Rule 8 Pro Hac Vice Admission

Today the West Virginia State Bar announced that the West Virginia State Bar's Unlawful Practice of Law Committee has released Advisory Opinion 10-001, relating to questions from attorneys regarding its interpretation of Rule 8 of the West Virginia Rules of Admission to the Practice of Law, relating to admissions pro hac vice.

Advisory Opinion 10-001 addresses the following issues:

1. Whether the requirement in Rule 8 of of admission pro hac vice extends to matters in which no action, suit or proceeding is pending;

2. To what extent is the responsible local attorney required to participate in proceedings involving the attorney admitted pro hac vice;

3. Whether presiding judicial officers can "excuse" local counsel form participation or "waive" the requirement of participating; and

4. What limitations exist for attorneys seeking to be admitted pro hac vice, particularly their ability to be admitted on a frequent basis, or in multiple or consolidated actions.

AHLA Connections: Legal Implications of Health Care Social Media

The current issue of the American Health Lawyers Association's Connections magazine features an article I co-authored with fellow AHLA health lawyer, Jody Joiner, on the impact of social media use in health care.

The article, Risky Business: Treating Tweeting the Symptoms of Social Media (PDF version), is featured in the March 2010 issue of AHLA Connections (Vol.14, No. 3, March 2010), a health lawyer magazine for the health and life sciences law community.

We provide background context on the use of social media tools by health care providers, address why we think health lawyers need to understand social media, and explore some of the legal implications as social media and the law intersect. The article ends with practical guidance to health care providers and organizations on implementing policies emphasizing the appropriate use of social media.

You can peruse the complete digital edition of the March 2010 AHLA Connections (Vol. 14, No. 3, March 2010). AHLA members should also check out the article in this issue on the recently launch Health Law Wiki. Great to see AHLA adding a wiki resource for members to share their expertise and experience in the complex and ever changing health care legal and regulatory world.

Special thanks to the AHLA Connections staff for allowing Jody and I the opportunity to write the article and for their great editorial assistance.

Lesson for Hospitals and Health Care Providers: Photos of Shark Bite Victim

Martin Memorial too mum: Hospital staff violated privacy of shark victim, an article from the Palm Beach Post. The article highlights the impact ubiquitous mobile devices with cameras are having on our society and the potential liability risks associated with the use/misuse of these devices by health care employees.

The article indicates that various hospital employees took photos of a shark bite victim when he arrived in the emergency room. The article discusses the action taken by the hospital in response to the incident. Another article indicates that the photos were emailed to others.

This type of situation is a nightmare for hospital administration, the privacy officer and legal counsel. The effort and investigation that likely went into figuring out who took photos, where those photos went and the procedure for recapturing/removing the photos from the various sources was time consuming and expensive (both in $$ and reputation) for the hospital.

As such, this incident provides a good example for training and reeducating health care employees on patient privacy issues. Health care employees and professionals must always remember to start from a framework of protecting the health and privacy of their patients. As the use of mobile devices with cameras and social media tools becomes more ingrained in our every day lives -- the ability for private information to be captured, transferred and spread in a viral fashion has become much easier. Caution must be used and this case highlights the importance of retraining staff and highlighting the importance of protecting your patient's privacy.

HITECH Law Blog

A warm welcome to fellow AHLA member and health law blogger, Kathie McDonald-McClure.

I just ran across her blog, HITECH Law Blog. She focuses the blog on health information technology, privacy and security and the blog was named after the HITECH Act. Looks like a great addition to the health law blogosphere.

Ms. McDonald-McClure is a member of the Health Care Services Team at Wyatt Tarrant & Combs, LLP in Louisville, KY.

AHLA Hospital's Friend or Foe: The Age of Social Media and Health 2.0

Today Jody Joiner and I presented at the AHLA Hospitals and Health Systems Institute on the use of social media by hospitals and health care providers. We provided an overview of social media use by hospitals and health care providers, discussed the pros/cons of using social media in the health care environment, presented case studies of the risks and legal implications and did a short role play involving tweets in the context of a medical negligence case. We also provided those attending with recommendations on developing social media guidelines and policies.

To show the speed and ease of using social media tools to spread information, news and photos we we did some live shots during the presentations using an iPhone that were then loaded up to my blog, Twitter and Facebook. We then pulled up the posts and tweets at the end of our hour presentation.

Great audience with great follow up questions. Thanks go out to Mark Browne (@ConsultDoc) and Peter Leibold (@HealthLawyers) for live tweeting during the session.

AIS Report on Patient Privacy: Analysis of Willful Neglect Under HITECH

Recently I was interviewed for a story focused on the changes to the HIPAA civil penalty enforcement under the HITECH Act.

The article, Willful Neglect Is Difficult to Pin Down, but Can Result in Enormous HIPAA Penalties, appears in the Report on Patient Privacy: Practical News and Strategies for Complying with HIPAA, Volume 10, Number 2 February 2010 published by Atalantic Information Services, Inc. (AIS). The article discusses the definition and interpretation of "willful neglect" under the HIPAA penalty provisions. Health care privacy officers should find this article helpful in better understanding their role and responsibility in overseeing privacy compliance efforts.

The full story was reprinted on AIS Health Business Daily website.

WV HIT Funding Under HITECH: WVHIN Gets $7.8M and WV REC gets $6M

Health and Human Services Secretary Sebelius and the National Coordinator for Health Information Technology, David Blumenthal, announced the HITECH funding under the ARRA for State Health Information Exchanges (HIEs) and Regional Extension Center (RECs) across the country.

The White House Press Release provides a detailed list of HIEs and RECs receiving grants. Inormation is also available via the HHS News Release, Sebelius, Solis Announce Nearly $1 Billion Recovery Act Investments in Advancing Use of Health IT, Training Works for Health Jobs of the Future.

West Virginia will receive the following funding:

• West Virginia Department of Health and Human Resources in conjunction with the West Virginia Health Information Network HIE Award: $7,819,000

• West Virginia Health Improvement Institute, Inc. REC ward:$6,000,000

More information about the health information technology programs and awards can be found on the Office of National Coordinator HIT Website.

• State Health Information Exchange Cooperative Agreement Program

• Health Information Technology Extension Program

Model Jury Instruction: Warning Jurors on Use of Electronic Technology and Social Media

The Committee on Court Administration and Case Management of the Judicial Conference of the United States has issued a memo regarding Juror Use of Electronic Communication Technologies.

At its December 2009 meeting, the Judicial Conference Committee endorsed a set of suggested jury instructions that federal district judges should consider using to help deter jurors from using electronic technologies to research or communicate about cases while they serve as jurors. The recommended instructions were developed as a result of the increased use of web enabled mobile phones and devices that can be used to research information and communicated in a variety of ways, including email, social media, etc.

The Proposed Model Jury Instruction reads as follows:

Proposed Model Jury Instructions

The Use of Electronic Technology to Conduct Research on or Communicate about a Case Prepared by the Judicial Conference Committee on Court Administration and Case Management

December 2009

Before Trial:
You, as jurors, must decide this case based solely on the evidence presented here within the four walls of this courtroom. This means that during the trial you must not conduct any independent research about this case, the matters in the case, and the individuals or corporations involved in the case. In other words, you should not consult dictionaries or reference materials, search the internet, websites, blogs, or use any other electronic tools to obtain information about this case or to help you decide the case. Please do not try to find out information from any source outside the confines of this courtroom.

Until you retire to deliberate, you may not discuss this case with anyone, even your fellow jurors. After you retire to deliberate, you may begin discussing the case with your fellow jurors, but you cannot discuss the case with anyone else until you have returned a verdict and the case is at an end. I hope that for all of you this case is interesting and noteworthy. I know that many of you use cell phones, Blackberries, the internet and other tools of technology. You also must not talk to anyone about this case or use these tools to communicate electronically with anyone about the case. This includes your family and friends. You may not communicate with anyone about the case on your cell phone, through e-mail, Blackberry, iPhone, text messaging, or on Twitter, through any blog or website, through any internet chat room, or by way of any other social networking websites, including Facebook, My Space, LinkedIn, and YouTube.

At the Close of the Case:
During your deliberations, you must not communicate with or provide any information to anyone by any means about this case. You may not use any electronic device or media, such as a telephone, cell phone, smart phone, iPhone, Blackberry or computer; the internet, any internet service, or any text or instant messaging service; or any internet chat room, blog, or website such as Facebook, My Space, LinkedIn, YouTube or Twitter, to communicate to anyone any information about this case or to conduct any research about this case until I accept your verdict.

WVHCA: 2010 CON Capital Expenditure Minimum

The West Virginia Health Care Authority announced that the capital expenditure minimum for calendar year 2010 is $2,767,500.

The capital expenditure minimum is typically used by the Authority when reviewing whether or not certain health relate projects require certificate of need review.

The Authority provided the following announcement via its website:

Pursuant to West Virginia Code §§ 16-2D-2(h) and (s), the Authority is required to adjust the expenditure minimum annually and publish an update of the amount on or before December 31 of each year. The expenditure minimum adjustment shall be based on the DRI inflation index published in the Global Insight DRI/WEFA Health Care Cost Review. The DRI inflation index as of December 31, 2009 is 2.5%.

The capital expenditure minimum for calendar year 2010 is $2,767,500.

State Attorney General HIPAA HITECH Enforcement

My health law colleague, David Harlow, covers the news today on the first HIPAA enforcement action taken by a state attorney general under the new HITECH provision of American Recovery and Reinvestment Act of 2009 (ARRA).

David's post, HIPAA enforcement by state attorney general: The shape of things to come, provides a good summary of the announcement by the Connecticut Attorney General. More information via the Connecticut Attorney General press release.

The lawsuit filed by the Connecticut Attorney General Richard Blumenthal (coincidentally brother of David Blumenthal, National Coordinator of Health Information Technology) alleges that a health insurer, Health Net of Connecticut, Inc., failed to promptly notify the AG and other officials of a missing portable computer disk drive that contained unencrypted protected health information, Social Security numbers and bank accounts for approximately 446,000 individuals. The lawsuit also named UnitedHealth Group Inc. and Oxford Health Plans, LLC who acquired ownership of Health Net of Connecticut. The action also seeks a court order against Health Net to encrypt all information held on electronic devices.

Since the early days of HIPAA implementation and compliance there has largely been a lack of real enforcement efforts. The new provisions under HITECH allowing state attorney generals to file HIPAA enforcement actions on behalf of the public bring a new era of enforcement against health care providers who are unfortunate to have a health data breach and fail to properly respond to such breach in a timely manner.

David offers some good advice and takeaway points to health care providers and others who regularly handle health information. It is not enough to have policies and procedures in place but to regularly monitor whether they are being followed. Today's health data is liquid and it can flow in many directions. Providers need to understand where and how data is stored, used and transferred.

HISPC Reports on State Health Information Law, Business Practice and Policy

The Office of the National Coordinator for Health Information Technology (ONC) has made available a compendium of reports which detail variations in state health information law, business practices and policy related to privacy and security of health information and the electronic exchange of health information.

The reports were developed in 2009 as a part of the ongoing efforts of the Health Information Security and Privacy Collaboration (HISPC) that started in 2006 when I had the the opportunity to work on the initial round of HISPC work as it related to West Virginia. The efforts by HISPC was to take a national look (at a state level) on the privacy and security challenges faced by the variation of state laws, policies and practices.

The reports will be a great resource for those who regularly look at state health information legal issues. Following are the summaries of the five reports along with links to the various tables/appendices:

• Report on State Medical Record Access Laws This report analyzes state laws that are intended to require health care providers (specifically, medical doctors and hospitals) to afford individuals access to their own health information and to identify potential barriers to the electronic exchange of health information. Specific state law provisions examined: scope of medical records to which patients are afforded access, format of information furnished, deadlines for responding to requests, fees for furnishing copies, record retention laws and access to records of minors.
• Report on State Law Requirements for Patient Permission to Disclose Health Information In Phase I of the HISPC project a majority of participants reported significant variation in the business practices and policies surrounding the need for and process of obtaining patient permission to use and disclose personal health information for a variety of purposes, including for treatment. This report furthers the initial work of this project by collating and analyzing state laws that govern the disclosure of identifiable health information for treatment purposes to identify commonalities and differences.
• Releasing Clinical Laboratory Test Results: Report on Survey of State Laws For this report, state statutes and regulations were analyzed to determine to whom clinical laboratories may release test results. This report focused on clinical laboratory and hospital licensing laws (that contain standards for hospital laboratories). It also examined general state medical record access laws to determine whether they provided an avenue for patients to access their clinical laboratory results directly.
• Report on State Prescribing Laws: Implications for e-Prescribing This report identifies and analyzes the impact and variation of state laws related to e-prescribing. The report addresses state laws related to the e-prescribing of controlled and non-controlled substances as well as topics such as record keeping and content requirements, out-of-state prescriptions, and generic substitution laws.
• Perspectives on Patient Matching: Approaches, Findings, and Challenges This report analyzes various approaches to matching patients to their health information in the context of electronic health information exchange. Current and potential methods for matching patients to their health records are discussed, challenges to performing patient matching such as scalability and ease of use are analyzed, and the types of information some HIOs use to match patients to their health records is described.

West Virginia Law Review: Call for Scholarly Health Care Articles

Over the weekend I received an email from Todd Bergstrom, Executive Editor of the West Virginia Law Review announcing a "Call for Articles" for an upcoming issue of the West Virginia Law Review focusing on health care.

Great to see the law review staff looking at the social disparities in access and outcomes that exist in our current health care system. I hope that some of my fellow health care policy and legal colleagues will consider submitting a article for consideration. 

The West Virginia Law Review recently announcement the launch of its new website, including a blog. I look forward to following posts from the College of Law.

Todd asked that I post the following announcement with details on submitting an article for consideration.

The West Virginia Law Review announces a call for articles and invites scholars, practitioners, and researchers to submit contributions for its upcoming issue focusing on health care. This issue will include articles from the Law Review’s Lecture Series, “Beyond Politics: A Discussion of Health Care in America,” a thoughtful discourse on the social disparities in access and outcomes engrained in our current health care system. For this issue, we are particularly interested in scholarship discussing the following topics:

• Health care reform;
  
• Health care access and outcome disparities, especially as they affect women and children, racial minorities, and the rural poor;
• Health care as a human right;

Articles will be selected by our Articles Selection Team and the Editor-in-Chief based on scholarly merit, originality, relevancy, and writing style. Articles should be thoroughly researched and contain appropriate footnotes in bluebook format. Please submit articles electronically to wvlrev@mail.wvu.edu by June 30, 2010. Any questions regarding the call for articles or article submissions generally should be sent to wvlrev@mail.wvu.edu.

West Virginia Law Review Staff

WV Law Blog: Welcome BR Employment Law Blog

A welcome to West Virginia's newest law blog, BR Employment Law Blog, by the Bowles Rice Employment Law Group. The blog plans to provide information useful for employers with an emphasize on news from the region of West Virginia, Kentucky, Ohio, Virginia and Maryland.

The team of employment law bloggers at Bowles Rice is lead by Beth Walker, a partner in the Charleston office who focuses her practice on labor and employment law.

Congratulations on the launch and welcome to the blogosphere!

The Saga Over The Privacy of Medicare Claims Data Continues . . .

Guest post by Michele Grinberg, my colleague in the Health Care Practice Group at Flaherty, Sensabaugh Bonasso PLLC.

Through indirection find direction out? With apologies to William Shakespeare, the U.S. Court of Appeals for the11th Circuit and D.C. circuit say: NO, not this time.

In Jennifer D. Alley, Real Time Medical Data, LLC v. U.S. Dept. of Health and Human Services, issued Dec. 18, 2009, the Court held that plaintiffs Alley & Real Time Data cannot obtain certain Medicare data for procedures performed in Florida, Georgia, Mississippi and Tennessee by AMA physicians and for all Florida physicians (the certified class). Specifically, Medicare Part B raw claims data that could easily be matched to a particular physician and then aggregated to calculate the total annual Medicare payment by physician cannot be disclosed to Alley. Alley had sought the information through filing a federal Freedom of Information Request (FOIA).

The reason? Because the Florida District Court in 1979 issued a permanent injunction in Florida Medical Assn. v. Dept. of Health Education & Welfare, prohibiting DHHS (then HEW) from disclosing “any list of annual Medicare reimbursements…for any years, which would personally and individually identify those providers of services …. Any such disclosure of annual Medicare reimbursement amounts, for any years, in a manner that would personally and individually identify the providers….is contrary to federal law.” (quoted in Alley)

Judge Carnes in a well-authored opinion (for those of you, like me, who care about good writing) enjoys the irony of hearing argument that sounds much like the health policy arguments heard in the mid-1970s. His second sentence reads: “The present national debate over health care rhymes a lot with one that took place three decades ago.” But whether it’s still good policy or not, Judge Carnes holds that plaintiffs cannot collaterally attack the 1979 injunction by arguing it does not apply to the data sought or the context has shifted in favor of disclosure or the reimbursement methodology has changed. Rather, if plaintiffs believe the injunction is no longer valid, their recourse is to go back to the court where the injunction issued and challenge it there.

In a footnote, the 11th Circuit references a recent 2009, United States of Court of Appeals D.C. Circuit, decision: Consumers’ Checkbook, Center For Study of Services. v. U.S. Department of Health and Human Services. The lower court’s holding in this case was discussed in this blog in 2008 (Consumers' Checkbook v HHS Update). In the 11th Circuit footnote (No.9), the court observes that in a factually similar case, the D.C. Circuit has held that FOIA exemption 6 permits DHHS to not disclose the requested Medicare data. FOIA exemption 6 protects from disclosure government agency files that constitute “a clearly unwarranted invasion of personal privacy.”

What we have then are two cases: one that upholds a 1979 injunction which enjoins DHHS from providing Medicare data that can be manipulated to identify annual reimbursements to individual physicians and other providers but which injunction reaches only the certified class of providers (identified above); and a second case that holds that providing similar Medicare data that can be tied to individual providers is protected from disclosure by a FOIA exemption. Thus, data elements which might indirectly seem disclosable are not if they lead to a resulting disclosure which invades personal privacy. We will see what changes health insurance reform brings, if any.

The AMA provides additional analysis of the decision in a story posted January 11, 2010, Appeals court rejects effort to sell Medicare physician claims data. Also, Law.com reports on the decision in its article, Mark Twain Lives On in Federal Judge's Ruling on Release of Medicare Data.

2010 AHLA Hospitals and Health Systems Law Institute: Hot 2010 Health Law Legal Topics

Although it is cold today in West Virginia - I'm hoping it will be hot in Florida in February.

I thought I would take a moment on this cold wintry day to write about the hot health topics that will be discussed at the American Health Lawyers Association (AHLA) Hospitals and Health Systems Law Institute scheduled for February 25-26, 2010 at the Doral Golf Resort & Spa in Miami, Florida (Conference Brochure PDF).

I will be speaking at the Hospitals Law Institute along with my colleague, Jody Joiner, Assistant Operations Counsel at Sisters of Charity of Leavenworth Health System. Our topic scheduled for Friday, February 26 is Hospital’s Friend or Foe: The Age of Social Media and Health 2.0 where we plan to cover:

• The social media technology tools used by health care providers and hospitals
• Pros/cons and legal implications of social media and health 2.0 services such as blogs, wikis, social networking, podcasting, video sharing, etc.
• Best practices and development of policies and procedures which address staff and employees using social media

In addition to our session there will be variety of "hot" health law legal topic covered at the conference that will interest hospital administrators and their legal counsel, including sessions on government data mining to identify hospital compliance, understanding the recent ARRA HITECH developments impacting HIPAA and EHR, hospital/physician collaboration and relationships, best practices in hospital practitioner credentialing, peer review and privileging, voluntary disclosure strategies, hospital clinical research issues, and much more.

The AHLA Hospital and Health System Law Institute overlaps with the AHLA Physicians and Physician Organizations Law Insitute which will be held on February 24-25.The Physician Law Insitute will include "hot" physician topics on on call payments, Accountability Care Organizations, HITECH, disruptive physician behavior intervention, Stark issues for physicians, hospital/physician mergers, FMV for physician compensation and much more.

You can register for one or both. As an AHLA Member I regularly attend the Physician/Hospital Law Institutes every year or so because of quality and breadth of health law related materials for those who work in the health care industry. More information, along with how to register, can be found at the AHLA website:
Hospitals and Health Systems Law Institute
Physicians and Physician Organizations Law Insitute