Nedra Weinreich over at Spare Change explores uses for Twitter to improve health care in her post Twitter for Health. Great ideas on how Twitter might be used by those of us in the health care industry.Summary: This final rule is the third phase (Phase III) of a final rulemaking amending our regulations regarding the physician self-referral prohibition in section 1877 of the Social Security Act (the Act). Specifically, this rule finalizes, and responds to public comments regarding, the Phase II interim final rule with comment period published on March 26, 2004, which set forth the self-referral prohibition and applicable definitions, interpreted various statutory exceptions to the prohibition, and created additional regulatory exceptions for arrangements that do not pose a risk of program or patient abuse (69 FR 16054).
In general, in response to public comments, in this Phase III final rule, we have reduced the regulatory burden on the health care industry through the interpretation of statutory exceptions and modification of the exceptions that were created using the Secretary’s discretionary authority under section 1877(b)(4) of the Act to promulgate exceptions for financial relationships that pose no risk of program or patient abuse.
I. Background
II. General Comments
A. General
B. Compliance with the Anti-kickback Statute
III. Definitions--§411.351
A. Employee
B. Entity
C. Fair Market Value
D. “Incident to” Services
E. Physician in the Group Practice
F. Radiology and Certain Other Imaging Services and Radiation Therapy
G. Referral
H. Rural Area
IV. Group Practice--§411.352
V. Prohibition on Certain Referrals by Physicians and Limitations on Billing--§411.353
VI. Financial Relationship, Compensation, and Ownership or
Investment Interest--§411.354
A. Ownership
B. Compensation
C. Special Rules on Compensation
VII. General Exceptions to the Referral Prohibition Related
to Both Ownership/Investment and Compensation--
§411.355
A. Physician Services
B. In-office Ancillary Services
C. Services Furnished by an Organization (or Its Contractors or Subcontractors) to Enrollees
D. Reserved
E. Academic Medical Centers
F. Implants Furnished by an Ambulatory Surgical Center
G. EPO and Other Dialysis-related Drugs Furnished in or by an End-Stage Renal Dialysis Facility
H. Preventive Screening Tests, Immunizations, and Vaccines
I. Eyeglasses and Contact Lenses Following Cataract Surgery
J. Intra-family Rural Referrals
VIII. Exceptions to the Referral Prohibition Related to
Ownership or Investment Interests--§411.356
A. Publicly-traded Securities and Mutual Funds
B. Hospitals Located in Puerto Rico
C. Rural Providers
D. Ownership Interest in a Whole Hospital
IX. Exceptions to the Referral Prohibition Related to
Compensation Arrangements--§411.357
A. Rental of Office Space
B. Rental of Equipment
C. Bona Fide Employment Relationships
D. Personal Service Arrangements
E. Physician Recruitment
F. Isolated Transactions
G. Remuneration Unrelated to Designated Health Services
H. Group Practice Arrangements with a Hospital
I. Payments by a Physician
J. Charitable Donations by a Physician
K. Nonmonetary Compensation
L. Fair Market Value Compensation
M. Medical Staff Incidental Benefits
N. Risk-sharing Arrangements
O. Compliance Training
P. Indirect Compensation Arrangements
Q. Referral Services
R. Obstetrical Malpractice Insurance Subsidies
S. Professional Courtesy
T. Retention Payments in Underserved Areas
U. Community-wide Health Information Systems
X. Reporting Requirements--§411.361
XI. Miscellaneous (Other)
XII. Provisions of the Final Rule
XIII. Technical Corrections
XIV. Collection of Information Requirements
XV. Regulatory Impact Analysis
A. Overall Impact
B. Anticipated Effects
C. Alternatives Considered
The welcome page reads, “At Google, we feel patients should be in charge of their health information, and they should be able to grant their health care providers, family members, or whomever they choose, access to this information. Google Health was developed to meet this need.”
A presentation of screen images from the prototype — which two people who received it showed to a reporter — then has 17 other Web pages including a “health profile” for medications, conditions and allergies; a personalized “health guide” for suggested treatments, drug interactions and diet and exercise regimens; pages for receiving reminder messages to get prescription refills or visit a doctor; and directories of nearby doctors.
The article also mentions West Virginia native, David Brailer, former Bush administration National Coordinator for Healthcare Information Technology, who now heads up Health Evolution Partners. Note: Yesterday Matthew Holt posted at The Health Care Blog that Dr. Brailer will be joining the list of speakers at the Health 2.0 Conference to be held next month. Mr. Bosworth of Google will also be on the consumer aggregator panel being moderated by another top health care thinker, Jane Sarasohn-Kahn.
UPDATE: Interested in learning more about Google Health? Check out this post by Jeff O'Conner at the Health Care Information System Blog with links to the Clinical Cases and Images Blog with links to screen shots of the prototype.Of course, all the same old data issues have to be worked out - privacy, malpractice, storage, interoperability, and security . . . Plus, there's a little problem with funding and business model (hopefully we will never see a Google banner ad within our medical record!) . . . Make no mistake about it- this is not a continuation of the Google vs. Microsoft War that's been going on for years. This is Google or [insert brave company name here] against the most powerful force of them all: the healthcare industry status quo.
. . . Nowhere in this debate is the patient, the consumer, and the citizen: the American! We lack accountability, responsibility and civic sensibility. It is Joe Diabetic that snacks on ice cream, misses appointments and doesn't take his insulin that increases the cost of health care. This diabetic will be admitted to your local ER with diabetic ketoacidosis and have many subsequent hospital admissions at our (read: your) expense, not his. This is a fundamental collective action problem.If you use Twitter -- please join the effort.
Our town square is so big that we can get away with malfeasance to our village (and our country) with no shame. Yet, the forces of economics do not defy gravity and the cost of health care is now affecting all of us. Those of us that are untethered from the reality of cost are driving our health care 'car' into the ground. . .
Ms. Miller writes:
The CDC did all the research and evaluation work, so individual communities don't have to. They assembled a group of people with experience in urban planning, nutrition, physical activity, obesity prevention and local government. The group reviewed a couple years' worth of research, evaluated various tactics and settled on 24 recommendations. For each one, the CDC summarizes the evidence behind it and suggests ways to measure progress. Communities should:
1. Make healthier food and drinks available in public places. Schools are key, but think also of after-school programs, child care centers, parks, playgrounds, swimming pools, city and county buildings, prisons and juvenile detention centers.
2. Make healthier food more affordable in those public venues. Lower prices, provide discount coupons or offer vouchers for healthy choices.
3. Improve the availability of full-service grocery stores in underserved areas. One study of 10,000 people showed that black residents in neighborhoods with at least one supermarket were more likely to consume the recommended amount of fruits and vegetables than those in neighborhoods without supermarkets. Residents consumed 32 percent more fruits and vegetables for each additional supermarket in their census tract.
More supermarkets also raised real estate values, economic activity and employment and lowered food prices.
4. Provide incentives to food retailers -- supermarkets, convenience stores, corner stores, street vendors -- to locate in underserved areas or to offer healthier food and drinks. Incentives can be tax benefits and discounts, loans, loan guarantees, start-up grants, investment grants for improved refrigeration, supportive zoning and technical assistance.
5. Make it easier to buy foods from farms.
6. Provide incentives for the production, distribution and procurement of foods from local farms.
Did you know that the United States does not produce enough fruits, vegetables and whole grains for every American to eat the recommended amount of these foods? Dispersing agricultural production throughout the country would increase the amount of available produce, improve economic development and contribute to environmental sustainability.
7. Restrict availability of less healthy foods and drinks in public places.
8. Offer smaller portion options in public places.
9. Limit advertisements of less healthy foods and drinks.
10. Discourage people from drinking sugar-sweetened beverages.
11. Support breastfeeding, which appears to provide some protection from obesity later in life.
12. Require physical education in schools.
13. Increase the amount of physical activity in school PE programs. Modify games so that more students are moving at all times, or switch to activities in which all students stay active. Improving phys ed improves aerobic fitness among students.
14. Increase opportunities for extracurricular physical activity.
15. Reduce screen time in public settings. TV and computer time displaces physical activity, lowers metabolism, increases snacking and exposes children to marketing of fattening foods.
16. Improve access to outdoor recreational facilities, such as parks, green spaces, outdoor sports fields, walking and biking trails, public pools and community playgrounds. Access also depends on how close such places are to homes and schools, cost and hours of operation.
17. Support bicycling. Create bike lanes, shared-use paths and routes on existing and new roads. Provide bike racks near commercial areas. Improving bicycling infrastructure can increase how often people bike for utilitarian purposes, such as going to work and school or running errands.
18. Support walking. Build sidewalks, footpaths, walking trails and pedestrian crossings. Improve street lighting, make crossings safer, use traffic calming approaches. Walking is a regular activity of moderate intensity that a large number of people can do.
19. Locate schools within easy walking distance of residential areas.
20. Improve access to public transportation to increase biking and walking to and from transit points.
21. Zone for mixed-use development, including residential, commercial, institutional and other uses. This cuts the distance between home and shopping, for example, and encourages people to make more trips by foot or bike.
22. Enhance personal safety in areas where people are or could be physically active.
23. Enhance traffic safety in areas where people are or could be physically active.
24. Participate in community coalitions or partnerships.
The American Health Lawyers Association's Public Interest Committee recently published a new white paper on on the federal self-referral law also known as the "Stark Law" which looks at and considers what, if any, changes to the Stark Law might be beneficial under the current health care system and the proposed reform efforts.
The white paper is entitled, A Public Policy Discussion: Taking the Measure of the Stark Law. The white paper was written as a result of the Committee's Convener on Stark Law, held in Washington, DC on April 24 and June 30, 2009.
Scott Shreeve, MD one of my favorite Health 2.0 thinkers skeptically examines Sermo's business model of incentive pay for physician opinions and gives us non-physicians a glimpse (with screen shots) of how Sermo works in his post, "Change Agents: Knowledge Prostitution."This is a great example of why it's important to tell your lawyer about things like this. If Flea's lawyers had gone through all the posts on his blog, they would undoubtedly have prepared him for this question. These kinds of prior statements are neither unusual nor damning - you just have to know how to handle them.In fact I'll say it again - TELL YOUR LAWYER ABOUT THINGS - whether you are the plaintiff or defendant. Usually its embarrassing or uncomfortable things that clients don't want to tell you and these things can significantly impact the outcome of litigation. It's these hidden facts or facts that weren't explored far enough (or understood) by defense counsel that can come back and bite. I suspect that defense counsel has a new appreciation for blog content.
We are entering an unprecedented season of change for the United States health care system. Americans are united by their desire to fundamentally reform our current system into one that delivers on the promise of freedom, equity, and best outcomes for best value. In this season of reform, we will see all kinds of ideas presented from all across the political spectrum. Many of these ideas will be prescriptive, and don’t harness the power of innovation to create the dramatic breakthroughs required to create a next generation health system.
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