July 2019 > $5
2019 Health Law Issues Crystalizing What to look out for now with 2020 on the horizon By MICHAEL R. LOWE
As we approach the second half of 2019, the biggest health law issues facing health care professionals and providers have crystalized during the first half of this year. With the 2020 elections on the horizon, and nearly every poll listing health care as one of the top three issues on the minds of the American voters, health care professionals and providers must be aware of health law issues which will be driven by and will drive seismic changes in the health care delivery
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and reimbursement systems. We all know that the U.S. health care system is a mess, but most of us don’t fully understand how all of the pieces interact with one another, or the forces which shape the relationships between what I like to refer to as the three Ps, which are patients, providers and payors. Currently, 4 major changes are driving the health care sector and significant trends and changes in health law. Those 4 changes are technology and innovation, health insurance and payment models, alternative therapies, and in particular medical marijuana, and disruption in the health care delivery and payment systems including increasing penetration and ownership by private equity interests and strategic mergers and consolidations such as the Amazon, Berkshire Hathaway and J.P. Morgan Chase joint venture. Here’s a look at the resulting top 10 health law issues fac-
ing providers and professionals as a result of these 4 major factors causing seismic shifts in the health care delivery and reimbursement systems. 1. The Opioid Crisis In 2018 and the beginning of 2019, the opioid epidemic has dominated news headlines and resulted in increasing government fraud and abuse enforcement activities, rapid legislative developments at both the federal and Florida levels, and the formation of a federal Opioid Fraud and Abuse Detection Unit as a new DOJ pilot program. That program utilizes data to identify and prosecute individuals who are contributing to the prescription opioid epidemic, and the pilot program funds 12 experienced Assistant U.S. Attorneys in opioid “hot-spots” for a 3-year term to the end of 2020 to investigate and prosecute health care fraud related to prescription opioids. One of those “hot-spots”
is Florida, and we have seen a significant increase in the investigation and prosecution of prescribing physicians and pharmacies/ pharmacists over the past 12-18 months. And make no mistake, even well-intentioned and honest physicians who prescribe opioids for their patients could be under scrutiny. The collateral effects of these investigation and prosecutions include State licensure investigations, potential medical malpractice lawsuits, peer review actions and third-party payor/managed care company scrutiny. It is critical for Florida prescribing physicians to be aware of and comply with new laws that have gone into effect such as the 3-day limit on opioid prescriptions which went into effect in March 2018. The totality of the new federal and Florida laws and regulations going into effect are too numerous to list in this article, but are certainly something (CONTINUED ON PAGE 5)
HEALTHCARELEADER
Looking Out for the Uninsured
Ryan Schott, OD, contributes to Shepherd’s Hope vision of care “Everyone deserves to see better, and thus live better,” said Ryan Schott, OD. Owner and operator of Kindred Optics in Maitland, he’s also a passionate volunteer for Shepherd’s Hope, providing vision solutions for uninsured and under-insured patients in Central Florida. “Corrected vision and eye health play such a vital role in a person’s ability to function at their best every day,” said Schott. “In 2017, I learned about the incredible collective impact area doctors were making in people’s lives through Shepherd’s Hope and I volunteered immediately. I was surprised when I learned that I was the only optom-
etrist in their Community Referral Provider Program. Alongside general practitioners, specialists in every field can make such a difference in our community by volunteering just one evening a month,” he said. “I grew up abroad, in a US Air Force family. I met so many different people and experienced a lot of different cultures. A common trait I found in so many people the world over is the willingness to help others who need a helping hand. As an optometrist, I can help people see their worlds better,” he said. Schott carries on his family’s tradition of giving back to the community. His
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mother, Michele H. Schott, MSHA, MBA, FACHE, introduced him to Shepherd’s Hope. A retired U.S. Air Force Lt. Colonel and hospital administrator, she began her work with the non-profit as a volunteer; she is now a part-time team member, serving as health information management coordinator at the Longwood Health Center. Dr. Schott sees patients at the Shepherd’s Hope downtown location as well as at his practice in Maitland. He helps patients with primary vision care as well as ocular diseases including dry eye syndrome, glau(CONTINUED ON PAGE 2)
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