By: Emily Black Grey
Hospitals face a pivotal moment in care delivery with rising patient volumes, shrinking physician supply, and increasing operational costs. Integrating Advanced Practice Providers (APPs) into their hospital care models can fill critical gaps, and hospitals should consider legal, regulatory, and operational strategies to ensure compliance and optimize performance.
Continue readingBy: Emily Black Grey
Background: A New Wave of CAH Terminations
Critical Access Hospital (CAH) status is vital to the survival of small, rural hospitals that rely on the enhanced Medicare reimbursement that the program provides. Losing CAH status can mean financial ruin, service reductions, or full hospital closure. The Center for Medicare & Medicaid Services (CMS) has begun revoking CAH designations based on new mileage calculations, even where there has been no change to a hospital’s location, the roads, or the terrain. In several recent cases, CMS used simplified mapping tools like Google Maps to reverse its prior decision on CAH status, disregarding prior determinations with re-measured driving distances.
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By: Robert Hinyub, III
Written by: Kirti Vaidya Reddy, Quarles and Robert Hinyub III, Breazeale, Sachse & Wilson, L.L.P.
As some studies estimate that nearly 23% of the adult population lives with a mental illness, the integration of artificial intelligence (AI) into mental health care has transformative potential in terms of accessibility, cost reduction, personalization, and provider efficiency. To improve the prediction of risk of mental health disorders and the treatment of mental health, AI is commonly used for: (1) AI therapy, (2) wearables that interpret bodily signals using sensors and providing assistance when needed, (3) diagnosing and predicting outcomes by analyzing patient data, (4) improving adherence to treatment by using AI to predict when a patient is likely to slip into noncompliance or issue reminders for medication or provider appointments, and (5) personalizing treatments and adjusting individual treatment plans. To support these advancements, the American Medical Association Current Procedural Terminology (CPT) Editorial Board has incorporated billing codes applicable to the use of AI as well as AI taxonomy that provides guidance for classifying various AI-powered medical services applications. While AI has potential to improve behavioral health care, it also presents challenges as technology is advancing at a much faster pace than regulatory controls that ensure safety and efficacy. This article discusses various challenges with the use of AI in the behavioral health setting and regulatory developments that are attempting to provide safeguards in this dynamic space.
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By: Carrie L. Jones
Question: Should we consult an attorney before removing a disruptive physician from the hospital’s medical staff?
Answer: Yes! You should absolutely consult an attorney before removing a disruptive physician from the medical staff. Removing a disruptive physician from a hospital’s medical staff is a serious decision that can have significant legal, regulatory, and reputational consequences. While it may be tempting to act swiftly to restore a safe and effective care environment for patients and hospital staff, failing to consult legal counsel beforehand can expose the hospital to unnecessary risks.
Continue readingBy: Carrie L. Jones
Disruptive behavior in healthcare settings diminishes employee morale and collegiality and negatively impacts patient safety and quality of care. The Joint Commission previously noted a significant breakdown in team communication resulting from poor behavior and identified a clear link between disruptive behavior and medical errors and other adverse patient events. (Sentinel Event Alert 40: Behaviors That Undermine a Culture of Safety, TJC, June 18, 2021.) The American Medical Association Code of Ethics defines disruptive behavior as “… any abusive conduct, including sexual or other forms of harassment, or forms of verbal or nonverbal conduct that harms or intimidates others to the extent that quality of care or patient safety could be compromised.”
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