Wednesday, March 11, 2015

Kentucky’s Evolving Behavioral Health Providers

One of the most important effects of the Patient Protection and Affordable Care Act (“ACA”) is the profound change in the coverage of behavioral health services.

Building on the Mental Health Parity and Addiction Equity Act of 2008, the ACA requires both Medicaid and Medicare to provide far more robust behavioral health benefits, especially in the area of substance abuse. This expansion of benefits is not without growing pains – health care providers are waking up to the new reality of a vastly expanded need for substance abuse and other mental health services as well as providers. As state Medicaid programs struggle to finance these new benefits, the need for behavioral health care providers and clinicians has become acute.  This is especially true in Kentucky, where access to substance abuse care is crucial due to the epidemic of prescription drug and heroin addictions.  Fortunately, however, the Cabinet for Health and Family Services has taken proactive steps to strengthen and expand behavioral health infrastructure to meet the ACA’s directives.

Hospital Mergers and Antitrust Laws

The rapidly-evolving field of health care has been moving lately towards a single-minded goal – coordination of patient care in the name of efficiency and efficacy. Hospital systems are more and more often merging with other medical practices to better achieve the standards and goals of the Patient Protection and Affordable Care Act (“ACA”). The Ninth Circuit Court of Appeals, however, recently provided a stark reminder that the ACA isn’t the only law hospitals need to consider compliance with in these mergers.

Saltzer Medical Group in Nampa, Idaho, had been seeking to make a change from fee-for-service to risk-based reimbursement and approached St. Luke’s Health System in Boise in 2012about a formal partnership. They entered into a five-year professional service agreement that contained language about wanting to move away from fee-for-service reimbursement but without any clear language on making that change. Saltzer received a $9 million payment on the deal. Other hospital systems in the area, the FTC, and the Idaho Attorney General all filed suit to enjoin the merger.

Friday, March 6, 2015

Are Medical Staff By-laws Contracts?
Minnesota Supreme Court Says, “Yes”

That sound you just heard was the simultaneous gasp of hospital boards of directors throughout the state of Minnesota.  In Medical Staff of Avera Marshall Regional Medical Center v. Avera Marshall, Minnesota’s highest court made two holdings that strengthened the autonomy of physicians and may shed light as to how courts may interpret medical staff by-laws in the future.

In the case at hand, the medical staff by-laws of Avera Marshall Regional Medical Center (“Avera Marshall”) included a provision that required a two-thirds vote of the eligible voting members (which included the medical staff) to revise or repeal the medical staff by-laws. Any changes to the by-laws approved by vote of the medical staff were still subject to the approval of the Board of Directors (“board”).  The by-laws were silent, however, on whether actions of the board concerning revision of the by-laws required approval by the other voting members.