Understanding the Laws of Medicine

Oil is to water as cats are to dogs as lawyers are to doctors. So the stereotypical reasoning goes.

American medicine is a highly regulated, bureaucratic practice environment. The regulation is the purview of lawyers, businessmen, and legislators -- certainly not of physicians or other healthcare providers traditionally. Throw into that system the antagonistic medical malpractice environment and it isn't hard to see why some physicians view lawyers' role in US healthcare as antithetical to everything they're trying to achieve.

But that's a counterproductive view, as David Harlow can attest. As a lawyer and consultant specializing in health law, and as a former deputy general counsel to the Massachusetts Department of Public Health, he has seen the healthcare system from myriad angles.

At HealthBlawg, David comments on a host of issues that touch on both law and health, such as mandated health insurance, a feature of many proposals to reform the healthcare system. He offers both expert insights and easy-to-understand analysis. Consider, for example, his recent post on San Francisco's municipal mandate requiring all employers to provide health insurance for their workers:

The 9th Circuit Court of Appeals upheld the mandate in September...and the local restaurant association has taken the fight to the Supremes. The association suffered a setback this week, as the high court refused to enjoin enforcement of the law pending appeal. We'll see this fall whether the Supremes will hear the case. The program has extended health benefits to tens of thousands of folks, and is set to underwrite some new clinics as well.

As I've observed before, the fact that a...challenge has not been brought in Massachusetts is a testament to the coalition-building that went on across all sorts of lines before the Massachusetts plan was enacted. For all its faults, the Massachusetts experience -- like the San Francisco experience -- serves as a laboratory environment in which experimentation is taking place. Here's hoping that a workable national health care reform plan -- backed by a solid coalition -- comes out of all these experiments and the continuing national discourse on the subject.

In another recent post, he managed to boil down the 608-page federal government rules and rates for hospital reimbursements into a few paragraphs of highlights:

First and foremost: Acute care hospitals will enjoy just a 0.2% increase in DRG payments for the year beginning October 1, 2009. The rule provides for a 2.1% adjustment for all hospitals reporting RHQPAPU measures (which is virtually everyone); 0.5% if not reporting. The sucker punch: a 1.9% negative adjustment to adjust for the shift to the severity-adjusted MS-DRG system in FY 2008-09 and the concomitant attention to reporting, which the federales say resulted in higher reimbursements without a change in acuity. There is a total 8.5% negative adjustment to be made which CMS is deferring so as not to whack the industry excessively just now. Congress has come to the rescue once, reducing the cuts and deferring the day of reckoning, but that day has now come. It remains to be seen whether Congress will seek to defeat or defer these cuts again (and again) a la the SGR. Comments are invited; the AHA and others are already steamed.

One bright spot: orthopedic MS-DRG codes are bucking the trend and see a more significant increase.

This week, David Harlow takes a break from his legal commentary to present Grand Rounds, the weekly collection of health blog highlights. Take this opportunity to sample the blogosphere and to familiarize yourself with HealthBlawg.

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Cite this: Colin T. Son. Understanding the Laws of Medicine - Medscape - Jun 02, 2009.