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Where Physician Burnout and Value-Based Care Intersect

This series explores legal issues related to physician burnout and potential solutions, and here we explore the potential impact of value-based care (“VBC”). Our first post addressed how healthcare organizations can foster the psychological safety and emotional well-being of their physicians. Our second post discussed artificial intelligence solutions as a potential way to attract, support and retain overwhelmed clinicians. Here, we explore how VBC can promote physician satisfaction and physician wellness by:
Continue Reading Healing the Healers: Using Value-Based Care Strategies to Mitigate Physician Burnout

In less than two months, Donald Trump will be sworn in as the 47th President of the United States. President-elect Trump has already announced that he will nominate Republican Congresswoman Lori Chavez-DeRemer as his pick to serve as the next Secretary of the Department of Labor (“DOL”). It remains to be seen if the Trump DOL will continue the current administration’s targeting of the healthcare industry.
Continue Reading Will the Trump Labor Department Continue the Current Sharp Focus on the Healthcare Industry?

On September 28, 2024, Governor Gavin Newsom signed into law California Assembly Bill 3030 (“AB 3030”), known as the Artificial Intelligence in Health Care Services Bill. Effective January 1, 2025, AB 3030 is part of a broader effort to mitigate the potential harms of generative artificial intelligence (“GenAI”) in California and introduces new requirements for healthcare providers using the technology.
Continue Reading California Passes Law Regulating Generative AI Use in Healthcare

California is poised to pass a ballot measure aimed at imposing 340B spending restrictions for certain healthcare entities participating in the 340B Program who have historically engaged in spending that is not directly related to patient care and have also owned or operated multifamily dwellings with significant safety issues.
Continue Reading California Votes to Impose 340B Spending Restrictions on Targeted 340B Providers

California Governor Newsom signed Senate Bill 1120 into law, which is known as the Physicians Make Decisions Act. At a high level, the Act aims to safeguard patient access to treatments by mandating a certain level of health care provider oversight when payors use AI to assess the medical necessity of requested medical services, and by extension, coverage for such medical services.
Continue Reading California Limits Health Plan Use of AI in Utilization Management

On October 28, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced the latest states to participate in the voluntary state total cost of care (“TCOC”) model: the All-Payer Health Equity Approaches and Development (“AHEAD”) Model. The initiative aims to curb healthcare costs and improve population health by allowing states to assume responsibility for their own healthcare systems. Specifically, the program holds states accountable for meeting state-specific Medicare targets, reducing cost growth, primary care investment, and advancing health equity principles. As of August 2024, Maryland, Vermont, Connecticut, Hawai’i, Rhode Island, and five downstate counties of New York have been
Continue Reading CMS Continues to Plan AHEAD Amid Rising Healthcare Costs

The Centers for Medicare & Medicaid Services (“CMS”) and its contractor, Wisconsin Physicians Service Insurance Corporation (“WPS”), recently notified over 940,000 Medicare beneficiaries of a data breach that has potentially exposed their protected health information (“PHI”) and personally identifiable information (“PII”). CMS reported on the breach portal of the U.S. Department of Health and Human Services (“HHS”) that the total number of impacted people was 3,112,815 individuals.
Continue Reading Over 940,000 Medicare Beneficiaries Impacted by Data Breach

Over two years into the post-Dobbs era, women’s health is taking center stage in the presidential election. In Dobbs v. Jackson, the Supreme Court overturned protections relating to abortion established in Roe v. Wade. Since then, approximately half of the states across the country have enacted or revived laws that ban or significantly restrict access to abortion. This case and the resulting cascade of legal disputes and legislative battles have created a highly dynamic and precarious legal landscape for women’s health. As a result, providers are left uncertain of their rights and obligations. Women in anti-abortion states face challenges obtaining reproductive
Continue Reading Women’s Health on the Ballot in November: What the Election Could Mean for Reproductive Care and Beyond

Ethical hackers are becoming crucial allies in the battle against healthcare data breaches and ransomware attacks. In the twelfth episode of Sheppard Mullin’s Health-e Law Podcast, Ilona Cohen, Chief Legal Officer and Chief Policy Officer of HackerOne, delved into the pressing issue of cybersecurity in the healthcare sector and the pivotal role that ethical hacking may play, with Sheppard Mullin’s Phil Kim, Sara Shanti, and Michael Sutton.
Continue Reading Healthcare Needs More Hackers: A Discussion with Ilona Cohen

On September 28, 2024, Governor Newsom vetoed Assembly Bill No. 3129 (AB 3129), which would have required private equity groups and hedge funds to obtain the Attorney General’s written consent at least 90 days prior to acquisitions or changes of control of certain health care facilities, provider groups, and other providers. More information on the background, evolution, and projected impact of AB 3129 is available at our AB 3129 blog series.[1]
Continue Reading Update: Governor Newsom Vetoes California’s AB 3129 Targeting Healthcare Private Equity Deals

CMS recently published the First Annual Evaluation Report (the “Report”) highlighting its most significant observations in the first year following implementation of the Kidney Care Choices Model (the “KCC Model”). By way of background, the KCC Model is a payment model which creates certain incentives for providers that are intended to improve care management for Medicare patients with chronic kidney disease (“CKD”) (Stage 4 or 5) or end-stage renal disease (“ESRD”). The KCC Model is intended to, among other things, delay the dialysis progression and increase use of home dialysis, while also aiming to reduce the cost of care and
Continue Reading CMS Releases First Annual Evaluation Report for Kidney Care Choices Model

This series explores legal issues related to physician burnout and potential solutions. Our first post addressed how healthcare organizations can foster the psychological safety and emotional wellbeing of their physicians. Clients regularly report that charting and documenting, and communicating with patients via EMR is a substantial contributor to physician burnout. Here, we discuss artificial intelligence as a potential way to attract, support and retain clinicians overwhelmed by ever-growing to-do lists, allowing them to focus on delivering clinical care.
Continue Reading Solving for Physician Burnout: How Organizations Can Deploy AI Solutions to Effectively Support Physician Workloads and Avoid Legal Pitfalls

On July 31, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued its proposed rule (“Proposed Rule”) for the 2025 Medicare Physician Fee Schedule, which includes implications for telehealth services reimbursable by Medicare. Although the majority of telehealth waivers enacted during the COVID-19 public health emergency (the “PHE”) are set to expire at the end of 2024 in the absence of legislative action, CMS has proposed to leave certain key flexibilities in place, including the allowance for physicians and other practitioners to furnish remote “direct supervision” through their immediate availability via audio-video technology.
Continue Reading Key Telehealth Updates in the CY 2025 Physician Fee Schedule Proposed Rule

The U.S. has long had a shortage of physicians in various practice areas. The shortage is even more pronounced in rural areas. International medical graduates (IMG’s) who come to the U.S. to complete a residency in a specialty area primarily come to the U.S. on J-1 visas. By statute, any physician who enters the U.S. on a J-1 must return home for 2 years before applying for H-1B status or permanent residency.
Continue Reading Having Trouble Recruiting Physicians? The Conrad 30 Window is Opening Soon

In an era where artificial intelligence (AI) is reshaping landscapes in the healthcare industry and beyond, understanding the governance of AI technologies is paramount for organizations seeking to utilize AI systems and tools. AI governance encompasses the policies, practices, and frameworks that guide the responsible development, deployment, and operation of AI systems and tools within an organization. By adhering to established governance principles and frameworks, organizations can ensure their AI initiatives align with ethical standards and applicable law, respect human rights, and contribute positively to society. Various international organizations have set forth AI governance principles that provide organizations with a
Continue Reading Navigating the Complex Landscape of AI Governance: Principles and Frameworks for Responsible Innovation