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The U.S. healthcare industry is at a bit of a crossroads.

Constant legislative changes and pressures from the government make it difficult to stay afloat in what’s already a challenging industry to navigate. Rapid advances in telehealth and other technologies have made competition fiercer and the need to remain on the cutting edge more important than ever. Worries about litigation, especially in the long term and post-acute care space, make the need to be up to date on the latest trends absolutely critical.

Suffice to say, it isn’t easy for any one person to stay up to date on all there is to know about this uniquely complex industry.

That’s why each year, Buchanan Ingersoll & Rooney hosts its Healthcare Insider Symposium in Philadelphia. Featuring some of the firm’s most experienced attorneys, government relations professionals, and other healthcare experts, the seventh annual Healthcare Insider Symposium touched on a number of the most pressing challenges and opportunities for providers, insurers, suppliers, and anyone impacted by this multi-trillion dollar industry.

Here are eight of the biggest takeaways from this year’s 2019 Healthcare Insider Symposium.

  1. Proper licensure for telehealth remains a big issue for providers
    A number of states are beginning to implement state licensure compacts for telehealth, with the Interstate Medical Licensure Compact (IMLC) providing an expedited pathway to licensure for those who wish to practice in multiple states. This is key because the practice of medicine and standards for the physician-patient relationship can vary widely by state. In most instances, the practice of medicine (PoM) occurs where the patient is located at the time of the encounter. In Pennsylvania, for example, any physician who engages in diagnosing or treating a patient who’s in Pennsylvania must be licensed to practice in Pennsylvania. Yet, other states have rules that may differ and more are considering making changes to those existing rules.

  2. Telehealth reimbursement concerns still prevent full implementation
    Though some are still lagging – we’re looking at Pennsylvania here – more than 40 states now have relatively new or evolving statutes governing telehealth in some form. Some states will reimburse only for certain modalities like live video, while others are beginning to allow what’s called store-and-forward technology that allows a patient to send footage of their health concerns to their physician, with the physician sending feedback hours or even days later. Special PoM arrangements, such as provider to provider, provider to provider extender, and provider to non-treating provider to patient, complicate these licensure and reimbursement matters even further.

    The good news is that Medicare has made increasing efforts over the last year to expand reimbursement opportunities for telehealth providers, which will likely lead state Medicaid programs and other payors to follow suit. However, since each state is different, it requires that providers take the time to fully understand all the precise billing and reimbursement requirements for each telehealth service before deciding to implement the technology.

    View the slides, CLICK HERE

  3. Addiction treatment centers must decide – stay in-network or go out of network
    Many addiction treatment facilities have historically preferred to operate on an out-of-network model. Due to the possibility of higher revenues and fewer patients to manage, they chose not to enter services agreements with any insurers and as a result get the benefit of higher insurance payments. While the out-of-network model is certainly frowned upon by insurers and can cause issues of receiving payment for providers, choosing to go in-network has problems of its own. Many networks are closed to new facilities, and those insurers that agree to add new providers often offer rates that are low enough so that even a significant increase in patient volume resulting from in-network status may not be sufficient to make network participation financially viable. There are challenges with both options and in almost all instances, it’s worth negotiating contract terms with insurers to get the best possible terms and rates.

  4. Opioid 2.0 – predicting Congress’s next steps for solving the crisis
    At this point, it’s safe to say tackling the opioid crisis has been a bit out of Congress’s comfort zone. For the most part, those in Washington have punted the issue to the states, who themselves have focused primarily on education. It is still too early to tell if the state funding strategy will produce the intended results. But Congress will continue to monitor, examine, and introduce legislation to continue addressing the epidemic.

    Signed into law in October, the SUPPORT for Patients and Communities Act is a good first step to increase access to addiction treatment, offer more alternatives to opioids, and provide greater access to so-called “quality sober living.” Expect Congress to continue to look for ways to solve the issue and examine whether spending money helped fix the problem at all, or a completely new strategy is required.

    View the slides, CLICK HERE

  5. Pennsylvania considers changes to MCARE venue rule
    With the passage of the Medical Care Availability and Reduction of Error (MCARE) Act in 2002, Pennsylvania introduced sweeping medical malpractice tort reform with the hope of restoring balance and fairness to medical malpractice litigation. During the implementation of MCARE, the Rules of Civil Procedure were amended so that venue against a healthcare provider in a medical professional liability action is appropriate “where the cause of action arose.”

    Now, the Pennsylvania Supreme Court is considering a repeal of the venue rule in medical professional liability cases. Elimination of the venue rule would encourage forum shopping. There is concern among healthcare providers and defense attorneys that the Civil Procedural Rules Committee is accepting comments on the matter through February 22, 2019.

  6. New Rules for Staffing in Skilled Nursing Facilities
    Allegations by plaintiff’s attorneys of staffing shortages is a common theme in many suits against Skilled Nursing Facilities (SNFs). In November 2018, the Centers for Medicare and Medicaid Services (CMS) began informing state survey agencies of facilities with potential staffing issues. Previously, CMS required states to conduct at least 10 percent of the facility standard health surveys on “off hours,” or times outside 8 a.m. - 6 p.m. on Monday to Friday. Now, states are required to conduct at least 50 percent of the required off-hours surveys on weekends, using a list of facilitates provided by CMS. Additionally, CMS is updating the payroll-based journal policy manual regarding meal break policy and the methodology for allotting hours for universal care workers. This is all in an effort to improve the accuracy of reporting and healthcare outcomes. However, these new rules also could be utilized in litigation against SNFs.

    View the slides, CLICK HERE

  7. When does installing a CHP facility make sense for healthcare providers?
    Combined heat and power (CHP), also known as cogeneration, is the concurrent production of electricity or mechanical power and useful thermal energy (used for heating or cooling) from a single source of energy. For healthcare facilities, it’s the technology by which the facility can take a fuel source (typically natural gas) and create its own electricity and heating/cooling.

    Because of the long-term availability and affordability of natural gas and increased reliability of electric supply that come with CHPs, more and more healthcare facilities are installing them on-site. Of course, there are many variables to consider when it comes to deciding if a CHP is the right move for any one facility. Those facilities that are concerned about electricity reliability, concerned about the cost of the electricity they consume, or concerned about their environmental footprint would all be wise to consider developing a CHP facility. Simply put, they come with significant advantages that purchasing electricity through the local power company will simply never provide.

    View the slides, CLICK HERE

  8. Drug pricing transparency comes to the congressional forefront in 2019
    It’s wild to think about during the current shutdown, but once the federal government returns, drug transparency is one of the few issues the left and the right agree on these days. The White House’s plan, which is actually quite robust, includes strategies for improved competition, better negotiation, incentives for lower list prices, and lowering out-of-pocket costs. In the 116th Congress, look out for “bad actor” scapegoat companies to be brought in for questioning and continued conversation about the refiling of the lawsuit against CMS over the $1.6 billion in 340B cuts. Similar focus will occur at the state level on drug pricing and transparency, pharmacy reimbursement and accountability as it relates to pharmacy benefit managers, or PBMs.

    View the slides, CLICK HERE