With the ever-expanding volume of health law, it can be very difficult to keep track of it all. Here are 4 hot topics to watch for in 2014:
1. Roll-Out and Implementation of the Affordable Care Act (ACA) Changing Health Law Landscape
Starting this year, insurance companies are more limited in what exclusions they can attach to health insurance policies. Insurers can no longer deny coverage due to preexisting conditions, establish lifetime limits on coverage, or increase the cost of policies based on a person’s health. On the flip side, individuals are now responsible for complying with the individual mandate to procure health insurance for themselves or they will face an additional tax. The health exchanges are supposed to help people comply with this requirement; and although the initial roll-out was a complete disaster, most sources agree that the number of people enrolling is on the rise. Hardship waivers may allow some people to avoid the individual mandate this year. And as has been widely reported, although the Obama administration assured the public that they would not lose their current health insurance due to the ACA, that is exactly what happened to millions of Americans…whoops. (Truth be told, the actual numbers seem shrouded in politics.)
Also, shifts in Medicare reimbursement may have far-reaching effects. 2014 will begin the implementation of quality-based reimbursements, including an expansion of Value-Based Purchasing and reductions in reimbursement if a patient is readmitted to the hospital within 30 days. Not only will these provisions have trickle-down effects, but private insurers are starting to follow the Center for Medicare and Medicaid Services’ lead.
Finally, in a more general sense, conflicting goals of federal policy could play out in interesting ways. Although the ACA seems to reward (and I daresay almost require) consolidation of healthcare entities to capture efficiencies in providing care, the Department of Justice is watching the rise of healthcare mergers and consolidations carefully – anti-trust law still applies. Similarly, while the ACA requires a push towards the digitization of medical records, HIPAA and the protection of personal health information is more important than ever, which brings us to topic #2.
2. Rising Risk of Data & Security Breach
Enforcement actions under HIPAA/HITECH are on the rise and protecting personal health information is more complex than it has ever been. HIPAA is not your only concern if you digitally store personal health information – the FTC must now be fully complied with as well. Last year, 4 of 5 Office for Civil Rights (OCR) enforcement actions resulted from data breaches. While most of these were related to the physical loss of data – such as the loss of a hard drive – data stored on the cloud is emerging as a new concern.
Stolen electronic health records command a premium on the black market. These records contain so many overlapping pieces of personal data that stealing someone’s identity becomes a very easy task. Due to the high risk associated with security breaches, companies should revisit their data security policies and protocols. It is amazing how many surprising sources of potential data breaches may be hiding in your office at this very moment. For additional information on this hot topic, see the following article authored by Tammy Scelfo: The Hidden Potential HIPAA Violation…Your Digital Copier!
3. Increasing Fraud & Abuse Enforcement
Fraud and abuse enforcement actions resulted in the Department of Justice recovering $2.6 billion and the Office of the Inspector General recovering $5.8 billion. With the onslaught of positive press releases and ever-increasing regulation, it is reasonable to expect that enforcement actions will continue to be a major concern in 2014. Particular areas for healthcare practitioners and entities to track are actions related to marketing prescription medications for off-label uses and the changing landscape of Stark and Anti-Kickback actions. For additional information on this hot topic, see the following article authored by Tammy Scelfo: Enforcement Actions Recap Significant Recoveries in 2013.
4. Expansion of Telemedicine
Telemedicine is the long-distance practice of medicine via telecommunications. Here in Acadiana, we are fortunate enough to already have a robust telemedicine presence at work. Employees at some of our major local employers can already teleconference with a physician at their workplace. Telemedicine offers a new and uniquely efficient way to provide medical services to more people.
Expect to see the increasing use of telemedicine, particularly for providing specialty medical services in previously underserved locations. As reimbursements for telemedicine continue to expand, the services will grow in use; however, factors such as state licensing, peer review, and patient privacy could continue to have a limiting effect.
2014 promises to be an interesting year in health law with many new regulations expected to come out and go into effect. Businesses should regularly evaluate their policies, procedures, and protocols to make sure they are up to date on the latest changes.
Allen & Gooch is providing this legal update for informational purposes only. This article should not be construed as legal advice or a legal opinion as to any specific facts or circumstances. You should consult your own attorney concerning your particular situation and any specific legal questions you may have.