The HIPAA privacy rule: its effect on diabetes treatment. Health Insurance Portability and Accountability Act.
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Confidentiality↗
Biomedical subjects
P H Lebowitz
Publications and source records attributed to P H Lebowitz.
Physician unionization.
Typically, doctors have seemed unsuited for and uncomfortable with the idea of unions but with the current changes in practices and referral patterns, doctors are looking--at least warily--at unions. Two sets of laws apply to possible unionization of physicians; one, federal antitrust laws, the other, both federal and state labor laws as they apply to changes in the medical profession. Antitrust laws are designed to protect competition by prohibiting price fixing. Another typical antitrust issue that applies to healthcare is that of a group boycott or refusal to deal, where competitors try to coerce a third party to set prices where competitors want them set. Congress' earliest legislation to aide the labor movement involved exceptions to the antitrust laws. Some provisions of the laws are limited to workers who are employees, defined as someone who is employed by any person. Doctors are searching for solutions that provide the collective power of the labor laws without offending the antitrust laws. The question is whether doctors can form unions under these two conflicting forces. The first main issue is whether the doctor is or is not an employee. Although radiologic technologists, typically employees of hospitals or provider groups, have been unionized for years, doctors are usually not employees, at least not if they have their own practices. Although not employees, physicians may affiliate with a larger union to use that broader bargaining power, a purpose that is permissible under current law. Membership in a union does have its responsibilities and disadvantages. Some have suggested that the definition of employee be broadened to cover physician duties under managed care payer agreements, for example. Meanwhile, the Federal Trade Commission and the Justice Department are watching that non-employee physicians not use the union label to mask price fixing, boycotts or refusals to deal.
Antitrust Laws↗
"Stark" reality: self-referral rule holds risk and opportunity.
On January 4, 2001, the Health Care Financing Administration (now the Center for Medicare and Medicaid Services or CMS) issued Phase I of the final Stark II regulations (Final Rule). The Final Rule implements the Ethics in Patient Referral Act of 1989 (Stark I), as amended by the Omnibus Budget and Reconciliation Act of 1993 (Stark II), collectively the Stark Law. It is intended to provide more flexibility to providers by interpreting the prohibitions narrowly and the exceptions broadly. Generally, the Stark Law prohibits physicians from referring Medicare or Medicaid patients to an entity for the provision of "designated health services (DHS)" if the physician (or a member of the physician's immediate family) has a direct or indirect financial relationship with the entity. The Final Rule establishes two principal exceptions to the referral prohibition that apply to both ownership/investment interests and compensation arrangements. The physician service exception permits referrals for DHS that are furnished by a member or physician in the same group practice as the referring physician, or under their supervision. The in-office ancillary services exception permits referral for provision of DHS in the same building in which the referring physician or his group routinely provides the full range of the group's or physician's medical services. The final regulations redefine the prior description of radiology and radiation therapy services subject to Stark II. The principal change is to segregate radiation therapy and supplies from radiology and other imaging services. It is uncertain whether Stark Law enforcement will be a priority under the Bush Administration. Nonetheless, because the Final Rule offers more flexibility than the proposed rule, providers and suppliers should revisit proposed and abandoned arrangements that they believed to be prohibited.
Centers for Medicare and Medicaid Services, U.S.↗