Improving Your Practice

Direct Primary Care Practices in Georgia: History, Rules, and Other Considerations

December 9, 2021 | Little Health Law

Direct primary care practices have become popular alternatives to the traditional insurance medical practice model. Direct primary care practices cut out insurance companies from the provider-patient relationship. This post intends to outline the recent history of direct primary care in Georgia and the relevant rules that practices must comply with to establish a direct primary care practice. If you have questions regarding this blog post or migrating to a direct primary care practice, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

History: Senate Bill 18 in 2019

In 2019, Georgia became the 26th state to designate in its insurance code that Direct Primary Care practices are “not insurance” by passing Senate Bill 18. At the time, 3.2 million Georgians were living in areas facing a severe physician shortage. Dubois & Mesa, SB 18 – Direct Primary Care, Ga. St. Univ. L. Rev., Vol. 36:1, p. 136 (2019). In supporting the bill, Senator Kay Kirkpatrick said:

It is a way for people who can’t afford high dollar plans to get the majority of their care handled for a reasonable and predictable amount of money and is also a way for people to keep their primary care doctor if they change plans or if their doctor is not in their insurance network.

Dubois, SB 18 – DIRECT PRIMARY CARE, p. 136. Continue reading ›

3 Considerations Before Opening a Ketamine Clinic in Georgia

November 24, 2021 | Little Health Law

pills-2-300x225 Ketamine is a substance growing in popularity as a treatment for, among other things, depression and pain management. Ketamine clinics are quickly increasing in popularity. Why Ketamine-Assisted Therapy Has Gone Mainstream, Forbes (Oct. 18, 2021). Our healthcare and business law firm assists clients in understanding the rules and requirements around opening and operating Ketamine clinics, understanding the unique issues that face innovative clinics where no clear guidance or oversight has yet been established. With this post, Little Health Law intends to present three considerations for a provider thinking about opening a Ketamine clinic in Georgia. If you have questions regarding this blog post, opening a Ketamine clinic, or operating your existing Ketamine clinic, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

What Physicians at FQHC’s Need to Know About Malpractice Actions

September 29, 2021 | Little Health Law

medical_malpractice_legal_terms-e1632925373696 As a healthcare and business law firm, we work with many physicians employed by Federally Qualified Health Centers, or “FQHCs.” Working at an FQHC offers certain benefits and protections to providers. One such benefit is that individual providers are generally protected from civil malpractice lawsuits. Although our firm does not litigate medical malpractice actions, we work with physicians who are accused of malpractice within an action involving FQHCs to minimize damage to the physician’s reputation and record, particularly regarding reporting to the National Practitioner Data Bank (“NPDB”). This post intends to outline what a physician working at an FQHC needs to know if an individual brings a malpractice action. If you have questions regarding this blog post, the NPDB, or FQHC-related matters, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Suit Against the United States Not Individual Doctors or Practices

The first thing to note is that if you are a physician for most FQHCs and a patient wishes to sue alleging medical malpractice, you—as the physician—and the health center are generally protected from being named in a lawsuit.

Why is that? Continue reading ›

Prescribing Controlled Substances Based on Telemedicine Visits During the COVID-19 Public Health Emergency

September 17, 2021 | Little Health Law

image_4-e1631547014743 Last week, our blog post discussed the general rules permitting telemedicine in Georgia. Often, our healthcare and business law firm’s provider clients who conduct telemedicine also need to understand the requirements around prescribing controlled substances based on telemedicine visits. This post intends to outline some of the relevant prescribing rules in Georgia and the exceptions due to the Public Health Emergency (PHE) created by COVID-19. This post intends to outline some relevant Georgia rules and regulations relating to telemedicine. If you have questions about telemedicine or prescribing rules or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Georgia Rules on Prescribing Controlled Substances via Telemedicine

As discussed in our prior blog post on the general telemedicine rules, we look to the Medical Board’s rules on Unprofessional Conduct, among other rules, to decipher what is allowed in Georgia. Rule 360-3-.02 defines Unprofessional Conduct to include subsection (5), which provides that Unprofessional Conduct could include: “Prescribing controlled substances . . . and/or dangerous drugs . . . for a patient based solely on a consultation via electronic means with the patient, patient’s guardian or patient’s agent.” As such, the general rule prohibits prescribing controlled substances via a telemedicine consult. However, the rule does “not prohibit a licensee from prescribing a dangerous drug for a patient pursuant to a valid physician patient relationship in accordance with O.C.G.A. § 33-24-56.4 or a licensee who is on-call or covering for another licensee from prescribing up to a 30-day supply of medications for a patient of such other licensee nor shall it prohibit a licensee from prescribing medications when documented emergency circumstances exist.” Rule 360-3-.02(5). There are other exceptions related to specific Schedule II controlled substances.

Georgia Medical Board June Monthly Meeting Minutes Review

August 3, 2021 | Little Health Law

images Welcome to the second installment of our business and healthcare law firm’s monthly medical board meeting review, focusing on the Georgia Composite Medical Board (“Medical Board” or “GCMB”). As a healthcare law firm with physician clients, it is our duty to stay up to date with the Medical Board’s positions and changes so as to better inform our clients. If you have licensing or other GCMB questions or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

The Medical Board met on June 3, 2021 via video teleconference. The June monthly meeting minutes are available here. The Medical Board also publicly releases public orders and agreements each month.

Meeting Minutes

A main theme during the introductory Executive Director’s Report involved preventing and responding to sexual misconduct in the healthcare field. The Board was presented with an article, “State Medical Board Recommendations for Stronger Approaches to Sexual Misconduct by Physicians,” available here. The Board also discussed House Bill 458, which passed the House and Senate and goes into effect on January 1, 2022. A blog post examining HB 458 in more detail is forthcoming from Little Health Law.

Reducing the Negative Impact of Inaccurate NPDB Reports

July 23, 2021 | Little Health Law

D1432441-e1627053044153 Our healthcare and business law firm consistently works with physicians who are dealing with complications resulting from adverse reporting to the National Practitioner Data Bank (“NPDB”). Certain entities, including medical licensure boards and medical malpractice payers, have a duty to report specific actions or events to the NPDB. Any practitioner who has had the misfortune of having an action reported to the NPDB is likely aware of the negative impact such a report can have on his or her ability to practice. Sometimes, however, the information reported to the NPDB is inaccurate in whole or in part. Inaccurate or incomplete reports can have equally serious adverse impacts on a medical provider’s ability to practice as any correctly submitted NPDB report. This post outlines steps practitioners or counsel can take to help minimize the adverse impact of such inaccurate reports. If you have a question about the NPDB or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw .com. You may also learn more about our law firm by visiting www.littlehealthlaw .com.

Submitting a Statement

The NPDB allows practitioners to submit statements at any time to explain or supplement a report. According to the NPDB, the statement is the provider’s “opportunity to provide additional information [the provider] would like included with the report.” A statement does not correct or void a reporting by a medical board, but it is a useful tool for a provider to explain an adverse licensure action when that is necessary. This is a way to tell the practitioner’s side of events. Although the statement may be limited in its impact, it can be particularly useful to submit a well-drafted statement while waiting for the often-lengthy dispute resolution process to conclude. Statements can also be submitted or edited at any time, so the efficiency of a statement makes it a useful tool.

Disputing the Report

If the practitioner wishes to take the matter beyond submitting an explanatory statement, the practitioner must make an important decision: work through the NPDB or go straight to the source (the reporting organization). In our business and healthcare law firm’s experience, we have had more success working with the reporting entity directly to resolve reporting disputes. In fact, the NPDB directs providers to contact the reporting organization before initiating a formal dispute with the NPDB.

Georgia Medical Board May Monthly Meeting Minutes Review

July 16, 2021 | Little Health Law

iStock_000033418316_Medium-e1626470315777 Welcome to the first installment of our business and healthcare law firm’s monthly medical board meeting review, focusing on the Georgia Composite Medical Board (“GCMB” or “Medical Board”). As a healthcare law firm with many physician clients, it is our duty to stay up to date with the Medical Board’s positions and changes so as to better inform our clients. We hope that by providing a review of the Medical Board’s monthly meeting minutes, our readers and provider clients will be able to better navigate the Medical Board successfully. If you have licensing or other GCMB questions or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

The Medical Board meets once a month to uphold its directives under the Medical Practice Act, which allow the Medical Board to do, among other things, the following: review applications for licensure, interview applicants when necessary or requested, investigate complaints, discuss proposed rules and rule modifications, review and publish public orders, and allow for committee meetings.

May Meeting

The Medical Board met on May 6, 2021 via video teleconference. The May monthly meeting minutes are available here. The Medical Board also publicly releases public orders and agreements each month.

CMS’ Interoperability and Patient Access Final Rule Soon to Be Enforced

May 12, 2021 | Little Health Law

On May 1, 2020, the Centers for Medicare and Medicaid Services (“CMS”) published final rule CMS-9115-F known as the Interoperability and Patient Access final rule. “This final rule is the first ehrsiner_770-300x200 phase of policies centrally focused on advancing interoperability and patient access to health information.” 85 Fed. Reg. 25511. CMS states that this rule “puts patients first by giving them access to their health information when they need it most, and in a way they can best use it.” Policies and Technology for Interoperability and Burden Reduction, CMS.gov. The rule requires coordinated communication between patients, providers, and payers. These changes largely require the use of improved and updated technology, and CMS provides implementation support here. Although many of the requirements under the final rule went into effect on January 1, 2021, because of the hardships posed by COVID-19, “CMS will not enforce these requirements until July 1, 2021.” Id.

Payors carry the brunt of this regulatory change. Without detailing all requirements under the rule, a few are as follows. CMS-regulated payors must maintain a secure, standards-based application programming interface (API) that will support the exchange of patient electronic health information (“EHI”). These payers must also maintain a patient-facing API allowing patients to access their EHI, including information about claims and costs, and make provider directory information publicly available through an API. Further, payors are required to implement a process for exchanging data, which is not required until January 1, 2022.

Governed hospitals will soon have a duty to send event notifications of a patient’s hospital “admission, discharge, and/or transfer to another healthcare facility or to another community provider or practitioner” to “improve care coordination.” Interoperability and Patient Access Fact Sheet, CMS.gov (Mar. 9, 2020). CMS-regulated providers are encouraged to register all interoperability digital contact information through the National Plan and Provider Enumeration System (NPPES). A list of providers who fail to do so will be publicly available as a way to incentivize compliance. Landi, H., CMS’ New Interoperability Rule Requires Major Changes for Payers, Hospitals. Here are 6 Key Elements, Fierce Healthcare (Mar. 9, 2020).

Ringing in the New Year in Compliance with the Equal Pay Act

December 31, 2020 | Little Health Law

Welcome to the fifth and final of our business and healthcare law firm’s holiday-themed blog posts. We hope you have enjoyed this holiday season so far and have a great time ringing in the new new-years-eve-hero-300x300 year tonight. Happy 2021!

Many of our healthcare provider and healthcare business clients own their businesses and employ many individuals. Being an employer carries with it numerous statutory and regulatory obligations. As legal counsel, we often take the role of advising our healthcare employer clients on employment matters. Herein, we discuss the requirements placed on employers by the Equal Pay Act (“EPA”), which attempts to eliminate gender discrimination in pay.

At 29 U.S.C. § 206(d)(1), the EPA provides: “No employer having employees subject to any provisions of this section shall discriminate . . . between employees on the basis of sex by paying wages to employees in such establishment at a rate less than the rate at which he pays wages to employees of the opposite sex in such establishment for equal work on jobs the performance of which requires equal skill, effort, and responsibility, and which are performed under similar working conditions.” To avoid violating the EPA, it is useful to analyze what must be proven if an employer is accused of violating the EPA.

“The Theme I’ve Been Waiting for All My Life”: CMS’ Proposed Rule Promoting Electronic Access to Health Information

December 11, 2020 | Little Health Law

Welcome to the third of our business and healthcare law firm’s holiday-themed blog posts. This week’s post is inspired by my favorite holiday movie, A Christmas Story, and the eloquent words websiteshowart15167-300x300 Ralphie wrote: “A Red Ryder BB gun with a compass in the stock, and this thing which tells time.” Analyzing Ralphie’s literary genius, he gave Miss Shields three enticing facts: the main description, a vital component, and an interesting addition. Following suit, I will provide three enticing facts of CMS’ new proposed rule.

First, the shortened name of the rule is: “Reducing Provider and Patient Burden by Improving Prior Authorization Processes and Promoting Patients’ Electronic Access to Health Information.” According to CMS, the purpose of the proposed rule is “[t]o drive interoperability, improve care coordination, reduce burden on providers and payers, and empower patients.” The ingenuity of the proposed rule stems from the fact that it is not only designed to grant patients better access to their records; it is designed to grant all vital parties’ necessary access to records—meaning patients, payors, and providers.

Second, the new rule requires each payer to use an Application Programming Interface (“API”) that allows each payer’s system to communicate with other payers. The new rule also does not require patients to request the transfer of claims data. As such, a patient’s new payer will have access to all of his or her claims data almost immediately upon enrollment. Importantly, on the new API, payers can send “patient claims, encounter data, and clinical data directly to providers[].” Verma, Seema, Reducing Provider and Patient Burden and Promoting Patients’ Electronic Access to Health Information, CMS.gov (Dec. 10, 2020).