Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts

Tuesday, April 07, 2020

COVID-19 Pandemic - West Virginia and Federal Health Care and Legal Resources UPDATED

Prepared and updated by Bob Coffield, Flaherty Sensabaugh Bonasso PLLC
LAST UPDATED: 4/7/2020

We all are working to adapt to the volatile and fluid nature of the changes brought on by the COVID-19 pandemic. I hope this post finds you well, at your home and social distancing. Mountaineers are always free (montani semper liberi), but today and going forward please follow the "stay at home" order issued by the State of West Virginia. Let's bend and flatten this curve West Virginians along with the help of all humans around our globe.

It remains difficult to grasp and stay up to date on the fluid nature of the changing information relevant to our health care and business clients. The legal and regulatory landscape is in constant flux and a lot of questions are arising from our clients. As our health care law team works remotely to stay connected, share information, and attempts to analyze the most recent changes from the various state and federal agencies which regulate and oversee health care providers and the industry, we have pulled together this "resource" page post. We are regularly checking these various aggregation points for new or updated information that are specifically related to West Virginia. We thought it would be valuable to have an access point where not only we can go, but the general public can go, to access the latest information. 

We will be adding and updating these resources as we go forward. If you know of any resource that we have not included, please leave a comment or send us an email. We will assess the information and consider adding it to the resource materials.

COVID-19 Data Resources and Real Time Tracking of the COVID-19 Crisis:
  • The COVID Tracking Project - Most Recent Data (by state). The COVID Tracking Project collects information from 50 US states, the District of Columbia, and 5 other US territories to provide the most comprehensive testing data we can collect for the novel coronavirus, SARS-CoV-2. We attempt to report positive and negative results, pending tests, and total people tested for each state or district currently reporting that data.
State of West Virginia Health Care Regulatory Agencies and Departments (including a short description of the scope of each agency/department along with a list of current COVID resources):
  • Office of Health Facility Licensure and Certification (OHFLAC): OHFLAC’s primary functions are processing licensure application and investigating complaints filed against its regulated health care facilities. OHFLAC supervises eight programs: Administration; Behavioral Health Program; Chronic Pain Management Clinic Program; Life Safety Program; Medicare/Hospital Program; Nurse Aide Program; Nursing Home Program; and Assisted Living Program.
    • 3/12/2020 announcement in response to COVID-19, including reporting requirements for all West Virginia providers to report "any postive COVID-19 illness in patients/residents/clients and employees to the local health department and OHFLAC". The notification requirements and information that must be reported are listed on this announcement.
  • Office of the West Virginia Attorney General: The Office of the Attorney General is responsible for prosecuting and defending legal actions on behalf of the State, and for ensuring that the rights of the State and its citizens are protected in matters before the circuit courts of this State, the West Virginia Supreme Court of Appeals, and all federal courts. The Attorney General is entrusted with enforcing the laws of the State as they relate to consumer protection, unfair trade practices, civil rights, and other important areas. 
    • No current information/updates.
  • West Virginia Board of Occupational Therapy: The West Virginia Board of Occupational Therapy regulates and licenses persons providing occupational therapy services to the general public in the State of West Virginia. The Board's purposes are to protect consumers and promote quality of occupational therapy services, and to assure the highest degree of professional care and conduct on the part of occupational therapist and occupational therapist assistants. 
    • West Virginia Board of Physical Therapy: The WVBOPT is a state regulatory board created by the WV Legislature to regulate the practice of physical therapy and athletic training in order to protect the public from the unauthorized, unqualified and unregulated practice of physical therapy. The WVBOPT is a part of the Executive Branch of the Government which enforces laws. 
    • West Virginia Registered Nursing Board: The WV RN Board promotes and protects public health, safety, and welfare through the regulation of registered professional nurses, advance practice registered nurses and dialysis technicians. The WV RN Board also oversees the prescriptive authority privileges through collaborative practice agreements.
      • COVID-19 Information. Per this summary, the West Virginia RN Board by vote, has suspended some rules to expedite licensure. These rule suspensions are TEMPORARY in nature and all suspended requirements will have to be fulfilled after the emergency order is lifted.
        • Bullet Points for Board Voted Suspended Rules On 3/20/2020:
          • A Criminal Background Check (CBC) will still be required. However, if the facility where the applicant would go is closed and there isn’t one within a 50 mile radius then the applicant does NOT have to get the CBC. The applicant would have get the CBC as soon as other fingerprinting resources are available or within 30 days of the lifting of the State of Emergency, whichever comes first.
          • The temporary permit (TP) is extended for more than 90 days. Therefore, the applicant would be able to have a temporary permit for more than 90 days. This applies to both exam applicants and endorsement applicants.
          • Verifications do not have to be requested by applicants through NURSYS. The Board will utilize NURSYS and individual state websites.
          • For limited prescriptive authority, the applicant does not have to provide documentation of pharmacotherapy in the clinical practice.
          • Reinstatement applicants will not have to provide continuing education.
        • Bullet Points from the Governor’s Signed Executive Order on 3/23/2020 (but see Executive Order 12-20 issued 3/26/2020, which rescinded the suspension of certain requirements):
          • If a person is licensed in another state as a RN or APRN a WV license is NOT required to practice in WV as long as disciplinary action hasn’t been taken or there is none pending.
          • There is no renewal of licenses.
          • CRNAs can administer anesthesia without supervision. Suspension Rescinded by Governor 3/26/2020
          • APRNs with prescriptive authority do not need a collaborative physician. Suspension Rescinded by Governor 3/26/2020 
          • No limitation on prescriptive writing privileges for APRNs with prescriptive authority as to prescriptive formulary limitations, prescriptive refill and supply limitations. Suspension Rescinded by Governor 3/26/2020
          • Continuing education not required for APRNs. Suspension Rescinded by Governor 3/26/2020
          • Disciplinary timelines for hearings are waived and may be conducted by telephone at the discretion of the agency.
    • West Virginia State Board of Examiners for Licensed Practical Nurses: The WV LPN Board is a legally constituted agency of State government established by the West Virginia Legislature. The Board promotes and protects the public health, safety and welfare through licensure of practical nurses. 
      • Notice: The West Virginia LPN Board is instituting policies of social distancing to make our workplace as safe as possible. Staff who are able to perform their duties from home are working remotely. For a quicker response please use the message center in the nurse portal.
    • West Virginia State Tax Department: The State Tax Department’s primary mission is to collect and accurately assess taxes due to the State of West Virginia in support of State services and programs.
      • Coronavirus 2019 (COVID 19) Response
      • 3/25/2020 letter by Senate President Carmichael and House Speaker Hanshaw among other West Virginia Legislators requesting Governor Justice to issue an Executive Order extending the deadline for filing state income tax returns in West Virginia from April 15 to July 15. (via @BradMcElhinny tweet).
      • In his press conference held at 3:00 PM, March 25, Governor Jim Justice stated, “I have instructed State Tax Commissioner Dale Steager to extend the West Virginia state tax filing and payment deadline to July 15, 2020, to align with the Federal tax filing deadline.” The Administrative Order will be posted on the State Tax Department’s website at tax.wv.gov by end of day tomorrow, March 26.
    West Virginia Hospitals and Health Care Systems Information: 
    • Charleston Area Medical Center (CAMC): 
    Federal Legislation and Information: 
    • CMS Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (Interim Final Rule with comment period), issued 3/26/2020 and applicable beginning on 3/1/2020. This interim final rule with comment period (IFC) gives individuals and entities that provide services to Medicare beneficiaries needed flexibilities to respond effectively to the serious public health threats posed by the spread of the 2019 Novel Coronavirus (COVID-19). Recognizing the urgency of this situation, and understanding that some pre-existing Medicare payment rules may inhibit innovative uses of technology and capacity that might otherwise be effective in the efforts to mitigate the impact of the pandemic on Medicare beneficiaries and the American public, we are changing Medicare payment rules during the Public Health Emergency (PHE) for the COVID-19 pandemic so that physicians and other practitioners, home health and hospice providers, inpatient rehabilitation facilities, rural health clinics (RHCs), and federally qualified health centers (FQHCs) are allowed broad flexibilities to furnish services using remote communications technology to avoid exposure risks to health care providers, patients, and the community. We are also altering the applicable payment policies to provide specimen collection fees for independent laboratories collecting specimens from beneficiaries who are homebound or inpatients (not in a hospital) for COVID-19 testing. We are also expanding, on an interim basis, the list of destinations for which Medicare covers ambulance transports under Medicare Part B. In addition, we are making programmatic changes to the Medicare Diabetes Prevention Program (MDPP) and the Comprehensive Care for Joint Replacement (CJR) Model in light of the PHE, and program-specific requirements for the Quality Payment Program to avoid inadvertently creating incentives to place cost considerations above patient safety. This IFC will modify the calculation of the 2021 and 2022 Part C and D Star Ratings to address the expected disruption to data collection and measure scores posed by the COVID-19 pandemic and also to avoid inadvertently creating incentives to place cost considerations above patient safety. This rule also amends the Medicaid home health regulations to allow other licensed practitioners to order home health services, for the period of this PHE for the COVID-19 pandemic in accordance with state scope of practice laws. We are also modifying our under arrangements policy during the PHE for the COVID-19 pandemic so that hospitals are allowed broader flexibilities to furnish inpatient services, including routine services outside the hospital.
    • KFF Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19. This page aggregates tracking information on approved Medicaid emergency authorities to address the COVID-19 Coronavirus emergency. We currently include details on Section 1135 waivers and 1915 (c) Waiver Appendix K strategies, but will update soon to add additional emergency authorities.
    Other Guidance, Resources and Information: 
    Posted by Bob Coffield at 12:47 PM 0 comments
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    Tuesday, January 03, 2012

    WVHCA: 2012 CON Capital Expenditure Minimum

    The West Virginia Health Care Authority has announced the 2012 certificate of need capital expenditure minimum threshold of $2,916,104. The new threshold is effective beginning January 1, 2012. The threshold is used as a part of the analysis by health care providers who must determine whether or not a certificate of need is required for a proposed project or health care acquisition. 

    Pursuant to W.Va. Code 16-2D-2(h) and (s), the Authority is required to adjust the expenditure minimum annually and publish an update of the amount on or before December 31 of each year. The expenditure minimum adjustment isbased on the DRI inflation index published in the Global Insight DRI/WEFA Health Care Cost Review. The DRI inflation index as of December 31, 2011 is 2.9%.
    Posted by Bob Coffield at 10:31 AM 0 comments
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    Thursday, November 24, 2011

    Thanksgiving 2011: Occupy The Dinner Table and Engage With Grace

    The Engage with Grace Project is an effort to raise awareness of the importance of end of life care planning and discussing your wishes with your family and friends.

    Dr. Bryan Vartabedian captures the simplicity of the project in his post, "It began with a simple idea: Create a tool to get people talking. Their tool is a slide with five questions designed to initiate dialog about our end-of-life preferences."  Take time during the Thanksgiving weekend to "occupy the dinner table" with your family and friends. Discuss the 5 questions below and share your thoughts and feelings.
     
    This is my 4th year participating in the Engage With Grace Project. What prompted me to start participating? It was having the opportunity to watch Alexander Drane tell Za's story at the 2008 Health 2.0 Conference. Her story personally connected as I shared in my 2008 blog post.

    West Virginia is often negatively portrayed nationally at the bottom or top in national health rankings. However, it is great to see West Virginia leading the way on end of life care planning. 49% of West Virginians have filled out at least one advance directive -- the highest among all states reporting these statistics. However, this statistic shows how few of us actually take the time and effort to document our wishes. More than 1/2 of the population have left these difficult decisions to be made by their family and health care providers. This statistic shows the importance of the Engage With Grace message.

    For West Virginia readers who want to learn more about end of life care check out the resources provided by the West Virginia Center for End of Life Care. There is valuable information for health care professionals to "Why and how to have end-of-life discussions with your patients", "Accessing Decision Making Capacity", and POST (Physicians Order for Scope of Treatment) Forms.  The website also provides FAQs, educational videos, and forms, including the standard West Virginia Advanced Directive Forms.

    West Virginia is also creating the e-Directive Registry in conjunction with the West Virginia Health Information Network (WVHIN), West Virginia's health information exchange (HIE). The e-registry will store advance directive forms, Physicians Orders for Scope of Treatment forms, and do not resuscitate cards. The registry will allow treating health care providers to access the stored information 24/7 from around the state through the WVHIN. Most importantly, the registry will be accessible by you and I as health care consumers to verify the accuracy of our wishes. 

    Following is the 2011 blog post by the Engage With Grace Team -- Occupy With Grace. Help spread the word this Thanksgiving weekend by telling your end of life care story and posting the message below. You can get the HTML to post here.
     
    Occupy With Grace
     
    Once again, this Thanksgiving we are grateful to all the people who keep this mission alive day after day: to ensure that each and every one of us understands, communicates, and has honored their end of life wishes.
    Seems almost more fitting than usual this year, the year of making change happen. 2011 gave us the Arab Spring, people on the ground using social media to organize a real political revolution. And now, love it or hate it - it's the Occupy Wall Street movement that's got people talking.
    Smart people (like our good friend Susannah Fox) have made the point that unlike those political and economic movements, our mission isn't an issue we need to raise our fists about - it's an issue we have the luxury of being able to hold hands about.
    occupy_with_grace_logo
    It's a mission that's driven by all the personal stories we've heard of people who've seen their loved ones suffer unnecessarily at the end of their lives.

    It's driven by that ripping-off-the-band-aid feeling of relief you get when you've finally broached the subject of end of life wishes with your family, free from the burden of just not knowing what they'd want for themselves, and knowing you could advocate for these wishes if your loved one weren't able to speak up for themselves.

    And it's driven by knowing that this is a conversation that needs to happen early, and often. One of the greatest gifts you can give the ones you love is making sure you're all on the same page. In the words of the amazing Atul Gawande, you only die once! Die the way you want. Make sure your loved ones get that same gift. And there is a way to engage in this topic with grace!

    Here are the five questions, read them, consider them, answer them (you can securely save your answers at the Engage with Grace site), share your answers with your loved ones. It doesn't matter what your answers are, it just matters that you know them for yourself, and for your loved ones. And they for you.

    theoneslide

    We all know the power of a group that decides to assemble. In fact, we recently spent an amazing couple days with the members of the Coalition to Transform Advanced Care, or C-TAC, working together to channel so much of the extraordinary work that organizations are already doing to improve the quality of care for our country's sickest and most vulnerable.

    Noted journalist Eleanor Clift gave an amazing talk, finding a way to weave humor and joy into her telling of the story she shared in this Health Affairs article. She elegantly sums up (as only she can) the reason that we have this blog rally every year:
    For too many physicians, that conversation is hard to have, and families, too, are reluctant to initiate a discussion about what Mom or Dad might want until they're in a crisis, which isn't the best time to make these kinds of decisions. Ideally, that conversation should begin at the kitchen table with family members, rather than in a doctor's office.
    It's a conversation you need to have wherever and whenever you can, and the more people you can rope into it, the better! Make this conversation a part of your Thanksgiving weekend, there will be a right moment, you just might not realize how right it was until you begin the conversation.
    This is a time to be inspired, informed - to tackle our challenges in real, substantive, and scalable ways. Participating in this blog rally is just one small, yet huge, way that we can each keep that fire burning in our bellies, long after the turkey dinner is gone.
    Wishing you and yours a happy and healthy holiday season. Let's Engage with Grace together.

    To learn more please go to www.engagewithgrace.org.This post was developed by Alexandra Drane and the Engage With Grace team.
    Posted by Bob Coffield at 8:24 AM 0 comments
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    Friday, August 20, 2010

    FSB: Best Lawyers in America 2011

    This past week I received notice that I was again selected by my peers for inclusion in The Best Lawyers in America® 2011 in the field of "Health Care Law".

    In all, nine lawyers from Flaherty Sensabaugh Bonasso PLLC were selected for inclusion in The Best Lawyers in America® 2011. Congratulations to my partners, David Givens and Mark Robinson, who were selected for the first time this year in the category of "Medical Malpractice".

    Below is a list of all the 2011 FSB honorees:

    Best Lawyers is based on an exhaustive peer-review survey in which more than 39,000 leading attorneys cast almost 3.1 million votes on the legal abilities of other lawyers in their practice areas. Corporate Counsel magazine has called Best Lawyers "the most respected referral list of attorneys in practice."
    Posted by Bob Coffield at 2:33 PM 0 comments
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    Wednesday, March 10, 2010

    AHLA Connections: Legal Implications of Health Care Social Media

    The current issue of the American Health Lawyers Association's Connections magazine features an article I co-authored with fellow AHLA health lawyer, Jody Joiner, on the impact of social media use in health care.

    The article, Risky Business: Treating Tweeting the Symptoms of Social Media (PDF version), is featured in the March 2010 issue of AHLA Connections (Vol.14, No. 3, March 2010), a health lawyer magazine for the health and life sciences law community.

    We provide background context on the use of social media tools by health care providers, address why we think health lawyers need to understand social media, and explore some of the legal implications as social media and the law intersect. The article ends with practical guidance to health care providers and organizations on implementing policies emphasizing the appropriate use of social media.

    You can peruse the complete digital edition of the March 2010 AHLA Connections (Vol. 14, No. 3, March 2010). AHLA members should also check out the article in this issue on the recently launch Health Law Wiki. Great to see AHLA adding a wiki resource for members to share their expertise and experience in the complex and ever changing health care legal and regulatory world.

    Special thanks to the AHLA Connections staff for allowing Jody and I the opportunity to write the article and for their great editorial assistance.
    Posted by Bob Coffield at 2:30 AM 0 comments
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    Monday, March 01, 2010

    HITECH Law Blog

    A warm welcome to fellow AHLA member and health law blogger, Kathie McDonald-McClure.

    I just ran across her blog, HITECH Law Blog. She focuses the blog on health information technology, privacy and security and the blog was named after the HITECH Act. Looks like a great addition to the health law blogosphere.

    Ms. McDonald-McClure is a member of the Health Care Services Team at Wyatt Tarrant & Combs, LLP in Louisville, KY.
    Posted by Bob Coffield at 10:43 AM 0 comments
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    Thursday, January 07, 2010

    2010 AHLA Hospitals and Health Systems Law Institute: Hot 2010 Health Law Legal Topics

    Although it is cold today in West Virginia - I'm hoping it will be hot in Florida in February.

    I thought I would take a moment on this cold wintry day to write about the hot health topics that will be discussed at the American Health Lawyers Association (AHLA) Hospitals and Health Systems Law Institute scheduled for February 25-26, 2010 at the Doral Golf Resort & Spa in Miami, Florida (Conference Brochure PDF).

    I will be speaking at the Hospitals Law Institute along with my colleague, Jody Joiner, Assistant Operations Counsel at Sisters of Charity of Leavenworth Health System. Our topic scheduled for Friday, February 26 is Hospital’s Friend or Foe: The Age of Social Media and Health 2.0 where we plan to cover:
    • The social media technology tools used by health care providers and hospitals
    • Pros/cons and legal implications of social media and health 2.0 services such as blogs, wikis, social networking, podcasting, video sharing, etc.
    • Best practices and development of policies and procedures which address staff and employees using social media
    In addition to our session there will be variety of "hot" health law legal topic covered at the conference that will interest hospital administrators and their legal counsel, including sessions on government data mining to identify hospital compliance, understanding the recent ARRA HITECH developments impacting HIPAA and EHR, hospital/physician collaboration and relationships, best practices in hospital practitioner credentialing, peer review and privileging, voluntary disclosure strategies, hospital clinical research issues, and much more.

    The AHLA Hospital and Health System Law Institute overlaps with the AHLA Physicians and Physician Organizations Law Insitute which will be held on February 24-25.The Physician Law Insitute will include "hot" physician topics on on call payments, Accountability Care Organizations, HITECH, disruptive physician behavior intervention, Stark issues for physicians, hospital/physician mergers, FMV for physician compensation and much more.

    You can register for one or both. As an AHLA Member I regularly attend the Physician/Hospital Law Institutes every year or so because of quality and breadth of health law related materials for those who work in the health care industry. More information, along with how to register, can be found at the AHLA website:
    Hospitals and Health Systems Law Institute
    Physicians and Physician Organizations Law Insitute
    Posted by Bob Coffield at 7:48 AM 0 comments
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    Tuesday, December 22, 2009

    Lorman Medical Records Law Seminar: March 18, 2010

    On March 18, 2010 I will be speaking on Medical Records Law at a seminar in Charleston, West Virginia. The seminar is sponsored by Lorman Educational Services. Joining me for the day long seminar will be three very knowledgeable health care colleagues:
    • Michael T. Harmon, MPA, CIPP/G, Compliance Specialist for the West Virginia Mutual Insurance Company, a Medical Professional Liability Insurance Company
    • Sallie H. Milam, J.D., CIPP/G, Executive Director of the West Virginia Health Information Network and Chief Privacy Officer for the West Virginia State Government
    • James W. Thomas, Esq., Manager of the Charleston, West Virginia Business Law Department of Jackson Kelly PLLC whose practice focuses primarily upon health care matters of a business, regulatory and operational nature
    Additional information about the seminar and how to register can be found at Lorman Educational Services. Following is the full seminar agenda:

    8:30 am – 9:00 am

    		Registration




    9:00 am – 9:15 am

    		Overview




    9:15 am – 10:30 am

    		HIPAA Compliance: Reality and Perspective



    		— Michael T. Harmon, MPA, CIPP/G



    • Overview
    • Enforcement
    • Complaints
    • Case Examples
    • Summary of HITECH Changes




    10:30 am – 10:45 am

    		Break




    10:45 am – 12:00 pm

    		HITECH Financial Incentives for Implementation of HIT



    		— James W. Thomas, Esq.



    • Qualifying an Electronic Health Record System
    • Available Financial Incentives




    12:00 pm – 1:00 pm

    		Lunch (On Your Own)




    1:00 pm – 2:00 pm

    		Health Information Exchange in West Virginia: Impact on Patient Records



    		— Sallie H. Milam, J.D., CIPP/G




    2:00 pm – 2:15 pm

    		Break




    2:15 pm – 3:30 pm

    		Consumer Driven Health Care: HITECH, Health 2.0, Social Media and Personal Health Records



    		— Robert L. Coffield, Esq.



    • HITECH Breach Notification Requirements
    • Impact of Health 2.0 and Social Media Technology on the Future of Health Care
    • Development and Adoption of Personal Health Records
    • Discuss the Legal Implications of Emerging Technology




    3:30 pm – 4:30 pm

    		Panel Discussion



    		— Robert L. Coffield, Esq., Michael T. Harmon, MPA, CIPP/G, Sallie H. Milam, J.D., CIPP/G and James W. Thomas, Esq.

    Posted by Bob Coffield at 10:02 AM 0 comments
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    Saturday, August 08, 2009

    Viral Health Effort Via Twitter: Fit West Virginia (#FitWV)

    Dawn Miller of the Charleston Gazette highlights the ongoing Fit West Virginia (#FitWV) effort ongoing via Twitter in her op-ed piece, West Virginians try to tip scales on obesity.

    The idea was born back on West Virginia Day as a result of Jason Keeling asking his blog readers to discuss solutions to West Virginia's problems in a post, West Virginia: Using Social Media for the Mountain State's Betterment. In response, Skip Lineberg of Maple Creative responded with his post, A Fitter West Virginia.

    As a result of that "healthy idea seed" being planted a core group of West Virginia tweeters have been regularly posting on Twitter using the hashtag #FitWV. The effort has created a viral movement of West Virginians supporting other West Virginians in making health choices, exercising regularly, etc. Hopefully, this positive discussion is bringing about positive change and support to those participating.

    As the country discussed health care reform efforts like #FitWV should be made a part of the equation. As Jordan Shlain, MD says in his recent op-ed over at The Health Care Blog:
    . . . Nowhere in this debate is the patient, the consumer, and the citizen: the American! We lack accountability, responsibility and civic sensibility. It is Joe Diabetic that snacks on ice cream, misses appointments and doesn't take his insulin that increases the cost of health care. This diabetic will be admitted to your local ER with diabetic ketoacidosis and have many subsequent hospital admissions at our (read: your) expense, not his. This is a fundamental collective action problem.

    Our town square is so big that we can get away with malfeasance to our village (and our country) with no shame. Yet, the forces of economics do not defy gravity and the cost of health care is now affecting all of us. Those of us that are untethered from the reality of cost are driving our health care 'car' into the ground.     . .
    If you use Twitter -- please join the effort.

    Dawn Miller also provides a link to some great new information from the Centers for Disease Control. The CDC released last month "Recommended Community Strategies and Measurements to Prevent Obesity in the United States."

    Ms. Miller writes:

    The CDC did all the research and evaluation work, so individual communities don't have to. They assembled a group of people with experience in urban planning, nutrition, physical activity, obesity prevention and local government. The group reviewed a couple years' worth of research, evaluated various tactics and settled on 24 recommendations. For each one, the CDC summarizes the evidence behind it and suggests ways to measure progress. Communities should:

    1. Make healthier food and drinks available in public places. Schools are key, but think also of after-school programs, child care centers, parks, playgrounds, swimming pools, city and county buildings, prisons and juvenile detention centers.

    2. Make healthier food more affordable in those public venues. Lower prices, provide discount coupons or offer vouchers for healthy choices.

    3. Improve the availability of full-service grocery stores in underserved areas. One study of 10,000 people showed that black residents in neighborhoods with at least one supermarket were more likely to consume the recommended amount of fruits and vegetables than those in neighborhoods without supermarkets. Residents consumed 32 percent more fruits and vegetables for each additional supermarket in their census tract.

    More supermarkets also raised real estate values, economic activity and employment and lowered food prices.

    4. Provide incentives to food retailers -- supermarkets, convenience stores, corner stores, street vendors -- to locate in underserved areas or to offer healthier food and drinks. Incentives can be tax benefits and discounts, loans, loan guarantees, start-up grants, investment grants for improved refrigeration, supportive zoning and technical assistance.

    5. Make it easier to buy foods from farms.

    6. Provide incentives for the production, distribution and procurement of foods from local farms.

    Did you know that the United States does not produce enough fruits, vegetables and whole grains for every American to eat the recommended amount of these foods? Dispersing agricultural production throughout the country would increase the amount of available produce, improve economic development and contribute to environmental sustainability.

    7. Restrict availability of less healthy foods and drinks in public places.

    8. Offer smaller portion options in public places.

    9. Limit advertisements of less healthy foods and drinks.

    10. Discourage people from drinking sugar-sweetened beverages.

    11. Support breastfeeding, which appears to provide some protection from obesity later in life.

    12. Require physical education in schools.

    13. Increase the amount of physical activity in school PE programs. Modify games so that more students are moving at all times, or switch to activities in which all students stay active. Improving phys ed improves aerobic fitness among students.

    14. Increase opportunities for extracurricular physical activity.

    15. Reduce screen time in public settings. TV and computer time displaces physical activity, lowers metabolism, increases snacking and exposes children to marketing of fattening foods.

    16. Improve access to outdoor recreational facilities, such as parks, green spaces, outdoor sports fields, walking and biking trails, public pools and community playgrounds. Access also depends on how close such places are to homes and schools, cost and hours of operation.

    17. Support bicycling. Create bike lanes, shared-use paths and routes on existing and new roads. Provide bike racks near commercial areas. Improving bicycling infrastructure can increase how often people bike for utilitarian purposes, such as going to work and school or running errands.

    18. Support walking. Build sidewalks, footpaths, walking trails and pedestrian crossings. Improve street lighting, make crossings safer, use traffic calming approaches. Walking is a regular activity of moderate intensity that a large number of people can do.

    19. Locate schools within easy walking distance of residential areas.

    20. Improve access to public transportation to increase biking and walking to and from transit points.

    21. Zone for mixed-use development, including residential, commercial, institutional and other uses. This cuts the distance between home and shopping, for example, and encourages people to make more trips by foot or bike.

    22. Enhance personal safety in areas where people are or could be physically active.

    23. Enhance traffic safety in areas where people are or could be physically active.

    24. Participate in community coalitions or partnerships.

    Posted by Bob Coffield at 7:31 AM 0 comments
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    Friday, August 07, 2009

    AHLA Public Interest Committee Publishes Stark Law White Paper

    The American Health Lawyers Association's Public Interest Committee recently published a new white paper on on the federal self-referral law also known as the "Stark Law" which looks at and considers what, if any, changes to the Stark Law might be beneficial under the current health care system and the proposed reform efforts.


    The white paper is entitled, A Public Policy Discussion: Taking the Measure of the Stark Law. The white paper was written as a result of the Committee's Convener on Stark Law, held in Washington, DC on April 24 and June 30, 2009.

    Posted by Bob Coffield at 2:02 PM 1 comments
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    Sunday, July 26, 2009

    Technology: Then and Now

    The discussion about health care reform has been front and center lately. Along with the debate comes the discussion and questions about the role technology will (should) play in the reform efforts. I was reminded of a photo I found a few months ago while I was home visiting my dad and looking through some old photo albums with him. 

    Although the technology may have changed some from 1978 to 2008 - human nature hasn't really changed that much. Reforming the health care system involves more than implementing technology. Health information technology will not save the system, make health care cheaper or better without changes to the underlying structure of the system of health that we have built. If we continue our health care system with the fundamental flaws that exist without changing the human/process side - adding technology won't help.

    Below is a photo of me from Christmas 1978 with the Atari 2600. The second photo of my son with the Nintendo Wii in 2008. Has much change in 30 years? 


    Posted by Bob Coffield at 2:21 PM 0 comments
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    Friday, June 26, 2009

    Support the Declaration of Health Data Rights: #MyHealthData

    The Declaration of Health Data Rights collaborative effort was announced this week by setting forth a simple, straightforward framework for health consumers right to their personal health information.

    The social media driven initiative has grown support throughout the week. The effort is being endorsed and supported by a variety of companies/organizations and bloggers. The traditional media has also covered the initiative, including the NYT, "A Push for the Wired Patient's Bill of Rights," Boston Globe, "Health data rights declaration gets push,"and the Huffington Post, "Release 0.9 HealthDataRights Beta Version."

    This evening I formally endorsed the declaration and statement of rights (Endorser #793). Read more about the initiave and consider supporting the effort at HealthDataRights.org. You can also follow the discussion on the declaration via twitter at the tag #myhealthdata.

    The rights set forth in the declaration are largely supported by existing state and federal law, including changes to be implemented under the new HITECH provisions of the American Recovery and Reinvestment Act of 2009. The declaration serves as a simplified and concise statement of rights that helps to alert and engage patients of the role they need to play as better health consumers. Engaged health consumers play a key role in creating the needed change and improvement in our health care delivery system.


    A Declaration of Health Data Rights

    In an era when technology allows personal health information to be more easily stored, updated, accessed and exchanged, the following rights should be self-evident and inalienable. We the people:
    • Have the right to our own health data
    • Have the right to know the source of each health data element
    • Have the right to take possession of a complete copy of our individual health data, without delay, at minimal or no cost; if data exist in computable form, they must be made available in that form
    • Have the right to share our health data with others as we see fit
    These principles express basic human rights as well as essential elements of health care that is participatory, appropriate and in the interests of each patient. No law or policy should abridge these rights.

    Posted by Bob Coffield at 2:52 AM 1 comments
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    Tuesday, May 26, 2009

    X PRIZE: $10M Incentive to Innovate In Health Care (Reform)

    Scott Shreeve, MD, Senior Health Advisor at the X PRIZE Foundation sent out a call last week to all health care bloggers to participate in a blog rally to promote the idea and effort behind the Healthcare X PRIZE competition. Below is a message from Dr. Sheeve being post around the blogosphere today. Please spread the word via your blog, Facebook, Twitter or the old fashion way -- telling someone face to face.

    We are entering an unprecedented season of change for the United States health care system. Americans are united by their desire to fundamentally reform our current system into one that delivers on the promise of freedom, equity, and best outcomes for best value. In this season of reform, we will see all kinds of ideas presented from all across the political spectrum. Many of these ideas will be prescriptive, and don’t harness the power of innovation to create the dramatic breakthroughs required to create a next generation health system.

    We believe there is a better way.

    This belief is founded in the idea that aligned incentives can be a powerful way to spur innovation and seek breakthrough ideas from the most unlikely sources. Many of the reform ideas being put forward may not include some of the best thinking, the collective experience, and the most meaningful ways to truly implement change. To address this issue, the X PRIZE Foundation, along with WellPoint Inc. and WellPoint Foundation as sponsor, has introduced a $10M prize for health care innovators to implement a new model of health. The focus of the prize is to increase health care value by 50% in a 10,000 person community over a three year period.

    The Healthcare X PRIZE team has released an Initial Prize Design and is actively seeking public comment. We are hoping, and encouraging everyone at every opportunity, to engage in this effort to help design a system of care that can produce dramatic breakthroughs at both an individual vitality and community health level.

    Here is your opportunity to contribute:
    1. Download the Initial Prize Design
    2. Share you comments regarding the prize concept, the measurement framework, and the likelihood of this prize to impact health and health care reform.
    3. Share the Initial Prize Design document with as many of your health, innovation, design, technology, academic, business, political, and patient friends as you can to provide an opportunity for their participation
    We hope this blog rally amplifyies our efforts to solicit feedback from every source possible as we understand that innovation does not always have a corporate address. We hope your engagement starts a viral movement of interest driven by individual people who realize their voice can and must be included. Let’s ensure that all of us - and the people we love - can have a health system that aligns health finance, care delivery, and individual incentives in a way that optimizes individual vitality and community health. Together, we can ensure the best ideas are able to come forward in a transparent competition designed to accelerate health innovation. We look forward to your participation.

    This post was written by Scott Shreeve, MD in behalf of the X PRIZE Foundation.     Special thanks to Paul Levy for both demonstrating the value of collaborative effort and suggesting we utilize a blog rally for this crowdsourcing effort.
    Posted by Bob Coffield at 8:00 AM 0 comments
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    Tuesday, April 14, 2009

    Neurology Today: When Moving Records and Practices, Know Your Legal Obligations.

    I was interviewed for an article appearing in the March 19 2009, edition of Neurology Today. The article, When Moving Records and Practices, Know Your Legal Obligations (pdf version), was written by Elizabeth Stump and discusses the current legal requirements and recommendations regarding medical record retention, release of information, storage and requirements for notification of patients when a physician leaves a practice.
    Posted by Bob Coffield at 4:10 PM 0 comments
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    Monday, March 02, 2009

    WVHCA FY 2007 Annual Report: A Summary of Health Care In West Virginia

    The West Virginia Health Care Authority's 2008 Annual Report for FY 2007 is now available. The report summary was provided to the West Virginia Legislature by Sonia Chambers, Chair of the WVHCA. The report contains significant information about the state of health care in West Virginia.

    The Executive Summary states:
    Hospitals:
    Overall, West Virginia hospitals remained relatively stable, reporting profits of $184.5 million or 4.4% of net patient revenue (NPR), up from $176.7 million (4.5% of NPR) in FY 2006.

    Acute Care Hospitals
    The total profit margin for the 35 general acute care hospitals increased by almost 1%, with profits of $165.7 million (4.4% of NPR), up from $123.8 million (3.5% of NPR) in the prior year.

    Critical Access Hospitals (CAH)
    As a group, the profitability for CAHs continued to improve for the fourth straight year. The aggregate profit was $5.8 million (2.3% of NPR). In FY 2006, profit was $4.3 million (1.8% of NPR).

    Long-term Acute Care Hospitals (LTCH)
    The two facilities in FY 2007 reported a profit of $1.5 million (5.9% of NPR), a decline from the FY 2006 profit of $3.3 million(12.4% of NPR).

    Psychiatric Hospitals
    The psychiatric hospitals had an aggregate loss of $8.3 million(35.8% of NPR), with the two state psychiatric hospitals losing $9.6 million combined and the two private hospitals earning profits of $1.3 million. The prior year’s overall loss was $702,000 (2.0% of NPR).

    Rehabilitation Hospitals
    The five rehabilitation hospitals showed a return to more normal profit levels with aggregate profits of $19.8 million (22.1% of NPR). In FY 2006, these hospitals reported an aggregate profit of $46.0 million (51.7% of NPR) due to the sale of a facility.

    Other Facilities:

    Nursing Homes
    The overall profit margin for the state’s 106 nursing homes increased by 1.5%. Aggregate profits of $44.8 million (6.5% of NPR) were reported, an increase over the $32.6 million (5.0% of NPR) reported in FY 2006.
    Aggregate net patient revenue increased $38.6 million in FY 2007; expenses increased $25.1 million.

    Home Health
    Overall, home health agencies reported total losses of $2.3 million on $84.1 million total revenue; 32 of the 66 agencies were profitable. Eleven home health agencies were acquired during FY 2007.

    Hospice
    Hospice profits for the 19 agencies were $8.3 million, compared to $9.1 million in FY 2006.

    Behavioral Health Facilities
    Eighty-nine behavioral health providers reported aggregate profits of $15.1 million, 2.9% of total revenue; 57 of 89 facilities were profitable.

    Methadone Treatment Facilities
    The aggregate profit for the eight facilities was $6.1 million, 29.7% of total revenue.

    Ambulatory Surgical Centers (ASC)
    Eleven reporting certified ASCs had an aggregate profit of $5.2 million, 21.7% of total revenue.
    Posted by Bob Coffield at 4:59 PM 0 comments
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    Wednesday, February 18, 2009

    World Health Care Congress Consumer Connectivity: Overcoming Legal and Policy Barriers for Health IT Adoption








    Next week I will be speaking at the World Health Care Congress 2nd Annual Leadership Summit on Consumer Connectivity in Carlsbad, CA on February 23-24. I will be co-presenting a session on Overcoming Legal and Policy Barriers for Health IT Adoption with Rod Piechowski, Senior Associate Director for Policy, American Hospital Association and Director, National Assocation of Health Information Technology.
    Our session will examine the following areas:
    • Addressing the need to reform the overall payment system to spur system-wide IT adoption
    • Managing the shift in traditional practice models to meet cross-generational needs – Strategies to change traditional behaviors
    • Evaluating the current legal barriers to utilizing web-based applications and today's PHRs
    • Responding to the shift in medical information ownership – moving from provider-based to patient-centered records
    • Overcoming current concerns of defamation and invasion of personal privacy
    • HIPAA Compliance – Expanding regulations to cover PHRs and other web-based health IT applications
    • Discussing the merger of traditional healthcare with the next generation/Health 2.0 community
    Posted by Bob Coffield at 1:27 AM 1 comments
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    Thursday, January 15, 2009

    American Well: e-House Calls by the Hawaiian Doctor

    Today Hawaii Medical Service Association along with American Well roll out American Well's technology that redesigns the house call -- call it "e-House Call." More about the joint effort and how to log in can be found at HMSA's Online Care For Consumers.

    American Well's technology allows live, face-to-face consultations between physicians and patients. The technology matches up the patient with the physician. Hawaii hope that the project will provide convenient, affordable and better access to health care in a state (not unlike West Virginia) that has remote areas/islands.

    I plan to invite American Well to West Virginia to see whether we might roll out a similar effort in conjunction with the West Virginia Health Information Network or as a part of the innovation community under the Medicaid Transformation Grant program that I am working on through the West Virginia Health Improvement Institute.

    More background information in the AP News article, "The Hawaii doctor is in - online." Also, David Harlow over at HealthBlawg recently examined whether American Well might be the disruptive innovation to unseat retail based health clinics.

    Tip to @jenmccabegorman.
    Posted by Bob Coffield at 10:15 AM 1 comments
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    WVHFMA: Consumer Driven Health Care

    Tomorrow I will be speaking on consumer driven health care at the West Virginia Chapter Healthcare Financial Management Association's Winter Education Conference in Charleston, West Virginia.

    I thought I would post my slides for the presentation titled, Consumer Driven Health Care: The Impact of Social Media and Health 2.0. The presentation is an introduction to the concepts of social media, health 2.0, consumer driven health care and some of the legal implications.

    This past week I ask my social media network on Facebook and Twitter to help develop a list of words and phrases that represent Consumer Driven Health Care. The results are included in the presentation.

    WVHFMA CDHC And Health 2.0 (1 15 09)
    View SlideShare presentation or Upload your own. (tags: driven consumer)
    Posted by Bob Coffield at 12:36 AM 3 comments
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