Managed Care Contracting & Provider Payment

New Hampshire “HIPAA” legislation debated; NH House Bill 580 would replace previous medical records law with broad patient rights.

Current law recognizes that medical records are the property of the patient and allows the patient to obtain a copy of the records.  Current law forbids a provider from disclosing “confidential communications or information” about a patient without patient consent, except as provided for by law or to protect the welfare of the individual or the public interest.  Current law also forbids using any patient identifying information for sales purposes without the patient’s written authorization.  

The proposed legislation would continue these provisions and would recognize a broader right of patients to control access to their information and to be able to find out who has had access to that information. 

1st Circuit Upholds New Hampshire Law Banning Disclosure of Physician Prescribing Information

This past November 18^th, the 1^st Circuit overturned a lower Court decision and held that an “innovative” New Hampshire approach aimed at curbing increasing drug prices was not an un Constitutional abridgement of free speech.  The law prevents companies that mine prescription data from selling it to pharmaceutical companies for use by their drug detailers to attempt to influence prescribing patterns. 

New Hampshire adopts “HealthFirst” Standard Wellness Program for Small Businesses

This past spring, New Hampshire passed a law creating HealthFirst, a health insurance program offering a standardized set of benefits intended to emphasize wellness.   The law is intended to create an affordable form of health insurance for employers with between 1 and 50 employees.  HealthFirst will focus on wellness and the role of the primary care physician in effectively managing care.  The product, which is designed to launch on October 1, 2009 is said to resemble a product offered in Rhode Island, which has saved small employers 15% of premiums.

Quick Post: Connecticut Passes Law Prohibiting “Silent PPOs”

Connecticut joins approximately 12 other states restricting the selling of a physician’s discount.  The law requires any entity contracting with a physician, group, physician network, IPA organization or PHO to disclose the contracting entity’s intent to sell or lease contract rates, including providing a list of potential “customers” on request.  It requires all ID cards to provide a web address or toll free number access to the discount can be verified at the time of service.  It also requires the contracting entity’s right to sell that discount to terminate when the provider contract ends.   

Thank you to Marla Hirsh for passing this information along!

For a link to the bill, Click Pub. L. 08-126

Blue Cross of Massachusetts announces Initiative to Pay Global Capitation

Tuesday’s Boston Globe (01/22/08) contained an announcement that Blue Cross of Massachusetts was launching a program to pay "doctors and hospitals a flat sum per patient each year”.

Battle Over Commercial Use of Prescribing Information Moves to Maine & Vermont

This is a quick update on the issue of whether drug representatives can have access to physician's prescribing data.

Last January 30^th, I posted on a pending lawsuit challenging New Hampshire's law limiting access to information on physician drug prescribing habits. Link to original Post In May, I updated you on the decision striking New Hampshire’s law as an overbroad restriction on speech. Link to 1^st Update.

Doctors Bring Class Action to Stop Ranking System

Following the theme of yesterday's post about the New York AG's attempts to block the launch of UnitedHealth's Premium Program, Tuesday's Hartford Courant ran an article about a class action filed in July by the Fairfield County Medical Association against CIGNA and United HealthCare.

New Hampshire’s Ban on Selling Prescription Information Stricken

Hello,

I’ve been running with several deadlines and have missed some interesting developments. I’ll try to catch up with my posting over the next few days – if that’s possible.

First:
On April 30^th a federal District Court for the district of New Hampshire struck down a New Hampshire law preventing the sale of information about physicians’ prescribing patterns. The court found the law violated the 1^st Amendment.

New Hampshire Department of Insurance Issues Position on Collecting of Up Front Deductibles

On April 4^th, the New Hampshire Department of Insurance issued a Bulletin stating that providers of service cannot collect a deductible from a patient in advance of service unless they have actual knowledge that the patient has not met his / her deductible.

Blue Cross and Blue Shield of Massachusetts surveys Consumers on what they want to know about health providers.

Results focus on quality, not price.

On Monday (April 2, 2007), BCBSMass issued the survey results. The survey results show that Massachusetts adults are “keenly” interested in having more and better information available to them about provider quality and one in four reported that they or someone in their immediate family had experienced a medical error.