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In this issue
Physician Shortage Series Part I of III:
U.S. Primary Care Shortage Continues
The first installment of this three-part Health Capital Topics series examines the potential reasons behind the increasingly serious shortage of primary care physicians, including the aging baby boomer population; newly insured Americans entering the healthcare marketplace; a bottleneck in the availability of medical residency slots; and, the aging primary care physician population. Additionally, potential solutions to this troubling trend are discussed. The subsequent articles in this series will examine the potential physician shortages in surgical and non-surgical medical specialties in an era of reform in the U.S. healthcare industry.

PDF Icon Small U.S. Primary Care Shortage Continues
Since 2006, the U.S. healthcare market has noted an increasingly serious shortage of primary care physicians. With an influx of consumers expected to flood the U.S. healthcare market due to an aging baby boomer population and the implementation of healthcare reform, the primary care physician shortage in the U.S. has become more critical than ever. The causes of this ongoing and worsening shortage appear to be multifactorial, though the most oft-cited reason for this is the lack of growth in government subsidies for residency training positions. Other possible reasons include the aging baby boomer population; newly insured Americans entering the healthcare marketplace; and, the aging primary care physician population. A potential option to help solve the shortage crisis may be to rely on other allied health professions and non-physician (midlevel) providers to better supplement or replace some tasks that physicians now typically handle. (Read more...)

PDF Icon Brief Review of Healthcare Fraud & Abuse Prosecutions
In the first installment of this three-part Health Capital Topics Series, the framework of current healthcare fraud and abuse laws, namely: (1) the Anti-Kickback Statute; (2) the Stark Law; and, (3) the False Claims Act, as well as, the regulatory thresholds of Fair Market Value and Commercial Reasonableness, were discussed within the current era of healthcare reform in the U.S. In this second installment of this three-part series, three notable Stark violations prosecuted by the federal government, i.e., (1) United States ex rel. Richard Rauh v. McLeod Regional Medical Center of the Pee Dee; (2) United States ex rel. Kaczmarczyk et al. v. SCCI Health Services Corp. et al.; and, (3) the Covenant Medical Center settlement with the U.S. Department of Justice, will be examined. These cases are illustrative of the government's willingness to utilize the tools Congress has provided to combat healthcare fraud and abuse. (Read more...)

PDF Icon Opposition to the "Two-Midnight" Rule Heating Up
Medicare's Inpatient Prospective Payment System fiscal year 2014 final rule, which was issued on August 2, 2013, included a controversial new regulation that will potentially significantly affect healthcare providers and hospitals that are reimbursed through Medicare. The new regulation, named the "two-midnight" rule, has drawn criticism from lawmakers, healthcare industry groups, and healthcare providers. The most recent criticism was memorialized in a U.S. House of Representatives bill, entitled "Two Midnight Rule Delay Act of 2013." The bill proposes to "delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes." (Read more...)

PDF Icon Hospital Merger Faces Class Action Lawsuit for Price Inflation
Since NorthShore University Health System (NorthShore) was formed from the merger of Evanston Northwestern and Highland Park Hospitals in January 2000, the system has suffered various legal challenges. Most recently, on December 10, 2013, the U.S. District Court for the Northern District of Illinois certified a class action lawsuit against NorthShore for inflated healthcare prices due to market monopoly. The lawsuit alleges that NorthShore charged prices at least 9% higher than normal inflation would allow over the years since the merger for both inpatient and outpatient healthcare services. This case is the first private antitrust class action lawsuit regarding a hospital merger, and monetary damages in the amount of hundreds of millions of dollars could potentially be imposed on the Chicago-area hospital system. (Read more...)

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