Improving Your Practice

CMS’ Interoperability and Patient Access Final Rule Soon to Be Enforced

May 12, 2021 | Little Health Law

On May 1, 2020, the Centers for Medicare and Medicaid Services (“CMS”) published final rule CMS-9115-F known as the Interoperability and Patient Access final rule. “This final rule is the first ehrsiner_770-300x200 phase of policies centrally focused on advancing interoperability and patient access to health information.” 85 Fed. Reg. 25511. CMS states that this rule “puts patients first by giving them access to their health information when they need it most, and in a way they can best use it.” Policies and Technology for Interoperability and Burden Reduction, CMS.gov. The rule requires coordinated communication between patients, providers, and payers. These changes largely require the use of improved and updated technology, and CMS provides implementation support here. Although many of the requirements under the final rule went into effect on January 1, 2021, because of the hardships posed by COVID-19, “CMS will not enforce these requirements until July 1, 2021.” Id.

Payors carry the brunt of this regulatory change. Without detailing all requirements under the rule, a few are as follows. CMS-regulated payors must maintain a secure, standards-based application programming interface (API) that will support the exchange of patient electronic health information (“EHI”). These payers must also maintain a patient-facing API allowing patients to access their EHI, including information about claims and costs, and make provider directory information publicly available through an API. Further, payors are required to implement a process for exchanging data, which is not required until January 1, 2022.

Governed hospitals will soon have a duty to send event notifications of a patient’s hospital “admission, discharge, and/or transfer to another healthcare facility or to another community provider or practitioner” to “improve care coordination.” Interoperability and Patient Access Fact Sheet, CMS.gov (Mar. 9, 2020). CMS-regulated providers are encouraged to register all interoperability digital contact information through the National Plan and Provider Enumeration System (NPPES). A list of providers who fail to do so will be publicly available as a way to incentivize compliance. Landi, H., CMS’ New Interoperability Rule Requires Major Changes for Payers, Hospitals. Here are 6 Key Elements, Fierce Healthcare (Mar. 9, 2020).

Ringing in the New Year in Compliance with the Equal Pay Act

December 31, 2020 | Little Health Law

Welcome to the fifth and final of our business and healthcare law firm’s holiday-themed blog posts. We hope you have enjoyed this holiday season so far and have a great time ringing in the new new-years-eve-hero-300x300 year tonight. Happy 2021!

Many of our healthcare provider and healthcare business clients own their businesses and employ many individuals. Being an employer carries with it numerous statutory and regulatory obligations. As legal counsel, we often take the role of advising our healthcare employer clients on employment matters. Herein, we discuss the requirements placed on employers by the Equal Pay Act (“EPA”), which attempts to eliminate gender discrimination in pay.

At 29 U.S.C. § 206(d)(1), the EPA provides: “No employer having employees subject to any provisions of this section shall discriminate . . . between employees on the basis of sex by paying wages to employees in such establishment at a rate less than the rate at which he pays wages to employees of the opposite sex in such establishment for equal work on jobs the performance of which requires equal skill, effort, and responsibility, and which are performed under similar working conditions.” To avoid violating the EPA, it is useful to analyze what must be proven if an employer is accused of violating the EPA.

“The Theme I’ve Been Waiting for All My Life”: CMS’ Proposed Rule Promoting Electronic Access to Health Information

December 11, 2020 | Little Health Law

Welcome to the third of our business and healthcare law firm’s holiday-themed blog posts. This week’s post is inspired by my favorite holiday movie, A Christmas Story, and the eloquent words websiteshowart15167-300x300 Ralphie wrote: “A Red Ryder BB gun with a compass in the stock, and this thing which tells time.” Analyzing Ralphie’s literary genius, he gave Miss Shields three enticing facts: the main description, a vital component, and an interesting addition. Following suit, I will provide three enticing facts of CMS’ new proposed rule.

First, the shortened name of the rule is: “Reducing Provider and Patient Burden by Improving Prior Authorization Processes and Promoting Patients’ Electronic Access to Health Information.” According to CMS, the purpose of the proposed rule is “[t]o drive interoperability, improve care coordination, reduce burden on providers and payers, and empower patients.” The ingenuity of the proposed rule stems from the fact that it is not only designed to grant patients better access to their records; it is designed to grant all vital parties’ necessary access to records—meaning patients, payors, and providers.

Second, the new rule requires each payer to use an Application Programming Interface (“API”) that allows each payer’s system to communicate with other payers. The new rule also does not require patients to request the transfer of claims data. As such, a patient’s new payer will have access to all of his or her claims data almost immediately upon enrollment. Importantly, on the new API, payers can send “patient claims, encounter data, and clinical data directly to providers[].” Verma, Seema, Reducing Provider and Patient Burden and Promoting Patients’ Electronic Access to Health Information, CMS.gov (Dec. 10, 2020).

Let’s Talk Turkey…Considering Federal Age Discrimination Laws Before Reducing Your Healthcare Work Force

November 25, 2020 | Little Health Law

Welcome to the first of our holiday-themed (at least in title) blog posts. As we approach the holidays at the conclusion of a financially challenging year, cost savings may be on the minds of many index healthcare business owners. Healthcare employers may be considering—or have already considered—measures to save money and reduce payroll. 2020 was a difficult year for most businesses, and reducing payroll is an oft-appealing way to reduce expenses. Frequently, a business’s highest paid earners are also among the older employees. That fact prompts a look at the Age Discrimination in Employment Act of 1975 (“ADEA”) prior to making any employment decisions, such as eliminating positions.

For healthcare employers with 20 or more employees, the ADEA governs and makes it an unlawful employment practice to “discharge any individual or otherwise discriminate against any individual with respect to [her] compensation, terms, conditions, or privileges of employment, because of such individual’s age.” 29 U.S.C. § 623. The regulations create a protected class for individuals who are “40 years or older.” 29 C.F.R. § 1625.2. To be certain, the ADEA and accompanying regulations do not require preferential treatment of employees over 40, and “[f]avoring an older individual over a younger individual because of age is not unlawful discrimination.” Id.

An employee establishes a prima facie case of age discrimination by showing he or she “was (1) a member of the protected age group, (2) subjected to an adverse employment action, (3) qualified to do the job, and (4) replaced by or otherwise lost a position to a younger individual.” Johnson v. Unified Gov’t of Athens-Clarke Cnty., 209 F. Supp. 3d 1335, 1341–42 (M.D. Ga. 2016). The fourth prong, however, is generally not satisfied when it comes to position eliminations because the older employee was not replaced by anyone. See Mazzeo v. Color Resolutions Int’l, LLC, 746 F.2d 1264, 1271 (11th Cir. 2014). The law accounts for this by altering the fourth prong in “reduction in force” cases, requiring the employee to “present sufficient evidence from which a reasonable jury could find that the employer intended to discriminate on the basis of age through its employment decision.” Zaben v. Air Prods. & Chems., Inc., 129 F.3d 1453, 1459 (11th Cir. 1997). One such “method of establishing a nexus between age discrimination and adverse employment action is by statistical proof of a pattern of discrimination.” Pace v. S. Ry. Sys., 701 F.2d 1383, 1388 (11th Cir. 1983).

What Are Your Options When a Negative Reference Costs You a Job?

October 12, 2020 | Little Health Law

Your reputation as a medical provider is a commodity you must protect, especially regarding your aptitude for providing patient care. Of course, you may not be a perfect fit at every medical practice. When that happens, your employment may end, and you seek other employment. No harm, no foul.

But what happens when your past employer provides a negative reference to your prospective employer? Worse still, what if the reference falsely criticizes your competence as a medical provider? And what if that false reference costs you the position? Your past employer may be guilty of engaging in improper behavior providing you a remedy at law.

Defamation

To Compete or Not to Compete?

January 23, 2020 | Little Health Law

1221952_to_sign_a_contract_3 As a business and healthcare litigation firm focused exclusively on advising and representing health care providers, we work virtually every day with contracts that involve non-compete agreements and other forms of restrictive covenants. Almost all physician employment, for example, will involve a physician employment agreement that contains a restrictive covenant. Typically, a restrictive covenant will apply to prohibit certain competitive activities both during the employment and for some agreed period following employment, often one to three years. The details of such agreements can vary dramatically and, contrary to the impressions of many medical practice owners and employed physicians, there are not “standard” provisions for duration, geographic scope, etc. Further, Georgia and South Carolina case law and relevant statutory provisions are subject to interpretation, about which reasonable minds can often differ.

As a healthcare law firm, we are exposed to agreements on the transactional end, when the parties get married (i.e., when they sign the contract), and when they divorce (i.e., when the employment ends). If a non-compete issue is raised at the end of the relationship, the implications for employer and employee can be severe and, in unfortunate cases, devolve into litigation. For a highly compensated physician, whose ability to ply his/her trade following many years of education and training is suddenly impaired by the signed contract, whether to proceed with certain employment opportunities (that might violate a non-compete agreement) can make for a highly stressful decision-making process. Some factors that physicians may consider follow.

Should you determine if the non-compete agreement is enforceable?

Employment Litigation Update

December 31, 2019 | Little Health Law

861958_hidoc-on-white Because our healthcare law firm often handles employment-related disputes and litigation (for employers and employees alike), we follow developing trends in employment litigation. Employment discrimination lawsuits continue to make headlines in the healthcare industry. Between 2018 and 2019, numerous allegations regarding doctors, nurses, and administrative staff have resulted in litigation challenging existing employment practices of large network hospitals and small practices. For managers and owners of physician practices or small businesses, employment concerns should be regularly discussed with legal counsel.

Georgia Healthcare Business Litigation Attorneys

Over the last two years, a variety of claims have been brought forward by employees against their employers. The stories range from allegations of discrimination on the basis of sex, age, or race. For example, on April 26, 2019, employees of Mount Sinai Health System (Mount Sinai Health) filed a lawsuit in federal court alleging age and sex discrimination against female senior leaders of the health system. The lawsuit discussed practices that occurred under Dr. Prabhjot Singh’s management. Before the lawsuit, Dr. Singh served as the chair of the Department of Health System Design and Global Health. According to the lawsuit, numerous female employees were fired or forced to resign before being replaced by younger male employees. Furthermore, the lawsuit cites instances of Dr. Singh’s “screaming” and other aggressive behavior towards women on staff at Mount Sinai Health. On July 3, 2019, it was reported that Dr. Singh resigned from his position of leadership.

When a Doctor Needs a Lawyer: Non-Compete Agreements and Restrictive Covenants

July 29, 2019 | Little Health Law

to-sign-a-contract-2-1221951-m Consulting legal counsel to review a physician’s employment agreement before a dispute arises may increase a doctor’s negotiating power and help obtain better working conditions. Employment agreements contain many provisions, which may include: compensation arrangements, arbitration clauses, terms defining the scope of liability insurance, and non-compete agreements. As physicians in the workplace are tending to move away from working in solo practices, we are finding that hospital, health system and other corporate employment agreements containing non-compete clauses are becoming more prevalent.

The American Medical Association advises against physicians entering into restrictive non-compete agreements, saying that they “can disrupt continuity of care, and may limit access to care.”. While the AMA advises physicians to be cautious about unreasonable restrictions and those that limit patient choice of providers, generally speaking, non-compete agreements have been upheld and determined enforceable in courts. Courts can limit the enforcement of these agreements, however, if they deem the provisions unreasonable or too restrictive. Courts have varied in what they define as unreasonable or overly restrictive, in terms of duration and geographic radius.

Sexual Harassment in Georgia: Healthcare & the #MeToo Movement

April 17, 2018 | Little Health Law

Healthcare employees filed the fourth largest number of sexual harassment claims with the EEOC from 2005 to 2015, according to Jocelyn Frye, a senior fellow at the Center for American Progress. As a result of the #MeToo movement, many healthcare organizations in Georgia are rethinking their sexual harassment policies, and employees are educating themselves on their rights. This post examines Georgia employees’ rights and how Georgia employers can reduce sexual harassment in the workplace.

Georgia Discrimination Laws

Georgia’s employment discrimination laws protecting employees in the private sector are limited to age, wage, and disability discrimination. Although Georgia’s Fair Employment Practices Act covers a wider range of protected classes, it only applies to state agencies with fifteen or more employees.

AMA Announces Physician Ownership of Medical Practices Drops Below 50%

June 13, 2017 | Little Health Law

medical-doctor-1314903-m1 Traditionally a hallmark of success for many physicians, physician ownership of medical practices continues to decline, for now, according to a recent study by the American Medical Association (AMA). The AMA recently issued the results of a survey, entitled Policy Research Perspectives, Updated Data on Physician Practice Arrangements: Physician Ownership Drops Below 50%.

Physician and Medical Practice Attorneys

The survey evaluated, among other things, whether physicians fall into one of four categories as to a physician’s “main” practice: (1) whether the physician is an owner, employee, or independent contractor of the medical practice; (2) the type of medical practice; (3) ownership structure of the practice; and (4) how many physicians are in the practice. The information and data reviewed spanned the period from 2012 to 2016. The survey results confirm a continued trend favoring employment and larger practices. 2016 was the first year with survey results demonstrating that less than half of practicing doctors (about 47%) own their own practice. Surveying over 30,000 physicians, the survey excluded physicians who work less than 20 hours/week providing patient care or are Federal employees.