Health care law newsletter最新文献

The significance of patient outmigration patterns, third-party payor reaction, and post-merger cost savings have been regularly argued by defense counsel and hospitals as important consideration in the antitrust evaluation of hospital mergers. The reliance placed by the Commission on these factors in its Ukiah decision is a welcome confirmation that the antitrust agencies are increasingly sensitive to these aspects of hospital mergers, reflecting a more sophisticated understanding of the health care market than was suggested by the staff's more mechanical evaluative approach. Hospitals and their counsel should therefore prepare for and document these factors if they anticipate antitrust agency scrutiny of a proposed acquisition or merger.

A number of steps are available to individual and institutional providers to minimize exposure under the new wave of enforcement activity. The first is education: learn what rules apply in your setting and share that knowledge with management and line employees. Second, undertake an independent compliance review to identify and resolve any existing exposure, including voluntary disclosure to the authorities, if appropriate. Third, institute an ongoing program to communicate to all employees not only the content of applicable rules, but also the genuine commitment of management to ensure continuing compliance above other concerns.

In view of the potential legal liability to which a recipient entity can be exposed when using registry employees, some care must be taken in drafting registry contract services and in modulating the recipient entity's behavior towards the registry personnel. The following steps should generally be taken by health care establishments purchasing registry services to minimize such exposure: (1) Ensure that the registry treats its personnel as employees and complies with all applicable employment law obligations, including state and federal employment tax requirements, workers' compensation laws, and any state law wage and hour requirements in the recipient's state. (2) If using an out-of-state registry, make sure that the registry also has workers' compensation insurance in the recipient's state and complies with that state workers' compensation laws. (3) Make sure that termination decisions regarding registry employees are not made for reasons that violate any federal anti-discrimination laws. (4) Provide in the registry agreement for full indemnification by the registry to the recipient. (5) Ensure that the registry is solvent and has adequate insurance to honor its indemnification obligation. (6) Obtain a warranty from the registry that it carefully screens all of its employees before hiring them. (7) Expressly state in the registry agreement that the registry has the right to discipline and supervise the personnel it refers. (8) Do not reject registry personnel for reasons that would be improper with respect to the facility's own employees, e.g., race, sex, age, religion, disability, etc.

Despite the simplicity of the basic objectives of health care reform-- greater access at manageable cost, these goals have not yet been achieved at either the federal or state level. One explanation may be that the American people are not willing to make the sacrifices that are probably necessary to achieve universal access to health care: increased taxes or redirection of governmental expenditures, limitation of choice in providers, and perhaps some form of rationing (which in fact already exists, by limiting access of the uninsured and some of the poor). What, then, are the prospects for meaningful national health care reform in the near future? While the answer to this question remains unclear, there is no doubt that providers across the country are likely to face an unprecedented array of state health care initiatives over the next few years, whether or not federal legislation is enacted. To prepare for this upcoming legislative activity, providers must remain aware of state legislative activity as it evolves.