Product Detail

Concierge Medicine: Legal Issues, Ethical Dilemmas, and Policy Challenges

Robert M. Portman and Kate Romanow

ABSTRACT: The practice of “concierge” or “retainer” medicine is growingly steadily due to economic and legal pressures on physicians. This practice model, which typically involves charging access or subscription fees to a limited pool of patients, raises legal hazards, contractual challenges, and ethical dilemmas for physicians interested in converting to concierge medicine, as well as important health policy questions. This article examines these legal and contractual issues, and discusses some of the ethical and policy implications of this relatively new form of medical practice. The authors conclude that this innovative practice form provides a beneficial alternative for patients seeking more personal, proactive, and/or intensive medical care. As concierge medicine proliferates, a wider range of practice models and fee structures should make this approach more affordable to lower and middle income patients— and help satisfy the need for greater access to preventive healthcare. Health policy makers should take steps to encourage this outcome.

Can Preventing Diversion of Profitable Patients Justify Hospitals’ Economic Credentialing Under the Antitrust Laws?

Mark L. Mattioli

ABSTRACT: Investments by physicians in specialty hospitals, ambulatory surgery centers, and other competing facilities have caused many full-service acute care hospitals a great deal of concern. These full-service hospitals believe they are at a disadvantage in competing against such centers because physician-investors allegedly can “pre-select” profitable patients. Full-service hospitals have reacted in a variety of ways, including adopting economic credentialing policies. Physician-owned centers often view these policies as anti-competitive and seek relief under the antitrust laws. Hospitals attempt to defend these actions on the grounds that they prevent what economists call “free-riding.” A key element of this defense is whether pre-selection is occurring and whether the hospital has sufficient evidence of pre-selection to justify the conduct under the antitrust laws.

HIPAA and Ex Parte Interviews—The Beginning of the End?

Angela T. Burnette and D’Andrea J. Morning

ABSTRACT: For many legal counsel, ex parte interviews with a treating physician have served as a time-honored method of informal discovery. In particular, litigators have used ex parte interviews with a former or current physician to obtain personal health information about a party or witness. Both before and after the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule, privacy concerns developed regarding ex parte interviews. Has HIPAA’s Privacy Rule initiated the beginning of the end for informally obtaining health information? This article examines ex parte interviews before the HIPAA Privacy Rule; how courts have addressed ex parte interviews after the Privacy Rule; conflicting issues physicians face in deciding whether to participate in ex parte interviews; and options for legal counsel to consider.

Home Healthcare Workers and the Fair Labor Standards Act

Rebecca M. Fowler

ABSTRACT: In a major industry shift, long term care is moving from nursing homes and institutions to the private home. This change results from a number of factors, including the lower cost of home-based care. These lower costs can be traced to a number of exemptions from the Fair Labor Standards Act requirements for minimum wage and premium overtime payments which apply to many home healthcare workers. These include the companionship, live-in, and professional exemptions. As the home healthcare industry has grown, home healthcare workers have challenged the applicability of these exemptions. This article will explore the issues reflected in those challenges and their resolution, and provide suggestions to help employers ensure that their employees fall within the exemptions.

Practice Resource
Drafting Arbitration Provisions for Complex Business Litigation in Healthcare

Daniela F. Almeida, Esquire

Practice Resource
State Case Summaries: Patient Arbitration

Adapted from an analysis by the Long Term Care and Healthcare Liability and Litigation Practice Groups of the American Health Lawyers Association

CITATION: AHLA, State Case Summaries: Patient Arbitration, J. Health & Life Sci. L., April 2008, at 159. © 2008 American Health Lawyers Association. All rights reserved. This data was originally published as the Arbitration Case Grid in the Arbitration and Dispute Resolution Toolkit.