JillAllison Opell’s Post

And now for some judiciary action: A panel in Illinois is examining the consolidation of providers and payers, raising questions about competition, pricing, and patient access to care. "Judge Matthew Kennelly will manage a barrage of suits over whether how payers decide what to pay is legal." ... "Consolidation can lead to increased pricing power for payers, potentially impacting reimbursement rates for providers and costs for patients." Health care consolidation poses significant challenges for independent #communityoncology providers, impacting their ability to remain independent, their financial sustainability and more. While mega entities often tout that consolidation leads to improved efficiencies, the evidence is light. But there is plenty of evidence it reduces competition and drives up costs. Read more in the piece by Allison Bell in BenefitsPRO at https://lnkd.in/eeyurTDJ

An article released online yesterday (https://lnkd.in/ggURY5jV) by New England Journal of Medicine (NEJM) opened my eye on a decision that did not make the front page but is nevertheless expected to have a lasting effect on how we run business with regulatory agencies of the US in the future. In short, we silently witness a shift of power from the executive to the judiciary. The U.S. Supreme Court has overturned the Chevron doctrine, which allows courts to defer to agency interpretations of ambiguous statutes. This decision reshapes the balance of power among the three branches of government, putting courts at the expense of Congress and administrative agencies. The Loper Bright opinion could have significant implications for scientific and technical agencies within the Department of Health and Human Services, including increased litigation and regulatory uncertainty for the health care industry, diminished expert authority over the regulation of health care products and services, and heightened risks to patient safety and public health. The majority opinion did not specify a replacement for Chevron and was written in general terms, which contrasts with Justice Elena Kagan's dissent. The implications of Loper Bright for health law and policy are uncertain and potentially vast, potentially opening the door to more challenges to actions taken by health agencies like the Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA). The Loper Bright decision by the Supreme Court has increased courts' power and made it easier to challenge agencies' actions, potentially affecting the FDA's new rule regulating laboratory-developed tests (LDTs). The FDA argues that LDTs qualify as devices under the statute and is revisiting this approach due to increasing concerns about patient risks. The trade organization representing clinical laboratories filed a lawsuit challenging the rule, arguing that the FDA's authority to regulate devices covers only physical products and not LDTs. Loper Bright places the resolution of this question solely in the hands of the courts, potentially hamstringing the FDA's ability to regulate the accuracy of tests intended to detect cancers, enable noninvasive prenatal screening, or identify new pandemic pathogens. Challenges to government regulations will operate asymmetrically to benefit opponents of regulation, primarily regulated industries. The net effect of Loper Bright is likely to move regulatory policy in an industry-friendly direction, detrimenting patient welfare, public health, and safety.

The patient/caregiver voice is so important in engagement and health outcomes.

Medical Group Management Association on the Dire Straits of Independent Practices. Health Law article by Lamb McErlane attorneys Vasilios Kalogredis and Sonal Parekh, Esq. On May 23, 2024, the Medical Group Management Association (MGMA) issued a detailed statement to the House Committee on Ways and Means, Subcommittee on Health, in D.C. It examined the current challenges faced by independent physician practices and offered key recommendations to alleviate these burdens. This has caused many physicians to sell to health systems, hospitals, insurers and private equity firms. The MGMA underscored the critical role of independent practices in delivering high-quality care to communities. Read the summary of MGMA’s position and key recommendations; https://lnkd.in/gUMCUuzs #healthlaw #healthlawattorney #physicianattorney #MGMA #healthlawupdate 

Dr. Christensen and I will discuss Caduceus, a support group model for recovering medical professionals. Learn about the program and how to connect with these groups for recovery support. https://zurl.co/rDJD #recovery #sud #caduceus

Yes this: “Because of this lack of access, resources, and representation, and because there is no single senior staff member in the federal government dedicated to ensuring the voice of the patient is represented, the needs and experiences of patients are deprioritized by corporate interests. As noted by Grace Cordovano, PhD, BCPA, a board-certified patient advocate, while speaking during a 2023 Health Datapalooza session on transparency and trust, ‘We hear a lot about provider burnout, but patients are also burnt out, and we need to take that into consideration when developing our policies.’” And while datasets and access to them are critical I’d also argue that part of patient burnout includes not having a sense for what sort of questions to ask. How do you investigate without a querying framework or resource that explains or encourages you to act on your rights? Absolutely correct- well intended policies are nothing without thoughtful and patient-centered (patient-designed!!!) implementation strategies. We can’t assume people know to ask for their data when the culture doesn’t permit or encourage it. Indeed, when corporate actors aren’t incentived to architect their solutions for it. At the very least, just as innovation officers and DEI officers represent an investment in a strategic direction for culture change, a chief patient officer would open space for a whole spectrum of innovation that includes resources for patient-led inquiry that might ameliorate the burnout patients are feeling. Nice article Lisa Bari and Kat McDavitt

Of the Q&As I have done related to my job transition, this may be the most in-depth in detailing both the past and prospective policy work ahead, which is wonderfully representative of Health Access California's great partnership California Health Care Foundation, which I have so appreciated. "Q: What were the key ingredients that made all that progress possible? A: One is forming coalitions to build consumer power. There are a lot of moneyed interests in the Capitol and in our health care system, and it’s not a given that the patient voice is even in the conversation, much less at the center, where it should be. It’s easy to ignore patient voices if they’re not organized — if they’re not unified." Another is persistence. Many reforms that we passed took much longer than a year. The Hospital Fair Pricing Act was a five-year campaign. The Prescription Drug Transparency Act was a three- or four-year campaign. If you don’t give up, you’re never defeated — you’re only delayed."

Pharmacy’s role in health care continues to evolve

Introducing our inaugural company magazine, your exclusive guide to Ascendant Health! Dive into a world of medical and legal insights, meet our dedicated team, and discover how we can assist you. Click the link below to explore. 📖👩⚕️👨⚖️ https://lnkd.in/g6XrSG7G #AscendantHealth #MagazineLaunch #MedicalLegalInsights #NurseCaseManager #Testimonial #PatientStory #NurseCaseManagement #CaseManagement #AutoInjury #MedicalCaseManagement #CareStaff #NurseCaseManagerSuccess #RecoveryStories

More good news for all my healthcare PE folks out there, but still important to remain vigilant with regards to compliance! “Friendly physician arrangements must be carefully structured to ensure clinical decision-making, particularly for the hiring and firing of professional staff, remains with the friendly physician. Those interested in establishing or operating an MSO arrangement with a "friendly PC" should consult sophisticated, experienced legal counsel to help ensure the terms of the arrangement – and the parties' adherence to those terms – comply with California law.”