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09/11/2020 - 3:43pm

Earlier this summer, the U.S. District Court for the Central District of California issued a temporary restraining order against UCLA preventing clinicians from removing organ-sustaining treatment from 14-year-old Summer Medford.

Summer's parents opposed this plan, because they were pursuing stem cell and exosome regenerative medicine techniques with Dr. Alice Pien. As Dr. Pien explained to the court: "Though conventional understanding might insist that the possibility that these treatments might work for Summer are infinitesimally small, we, as physicians and scientists must always remain humble in the face of unfathomable things that we do not understand and steadfastly advocate for life."...

09/11/2020 - 12:00pm

By Vrushab Gowda

The COVID-19 pandemic has highlighted the value of telehealth as both a tool of necessity (e.g., minimizing infection risk, conserving thinly stretched healthcare resources, reducing cost) as well as of innovation.

Telehealth services have surged in recent months; in April alone, they constituted over 40 percent of primary care visits nationwide and over 73 percent of those in Boston. “Increasing Access to Care: Telehealth during COVID-19,” a recent publication in the Journal of Law and the Biosciences, dissects the issues that have accompanied the growth of telehealth and identifies further areas of potential reform.

Changes to reimbursement

The author of the article, David A. Hoffman, explains that uneven reimbursement patterns have presented a major stumbling block to telehealth initiatives, historically. Without a clear sense of economic gain, health systems lack the incentive to invest in the requisite technologies and implement them at scale.

To this end, the Centers for Medicare and Medicaid Services (CMS) introduced a number of telehealth-specific billing codes in effect for the duration of the pandemic. These cover services including critical care, home and nursing facility visits, observation, and psychological care, among others.

Hoffman writes that CMS can do more to foster the expansion of telehealth in under-resourced areas. For one, it could permit rural health centers and Federally Qualified Health Centers (FQHC) to receive Medicare reimbursement for remote patient monitoring services. Additional administrative guidance should be offered to facilitate billing code entry and claims processing.

Moreover, CMS largely requires a video connection for reimbursement; this may not be feasible in remote or low-income regions with poor internet access. Allowing for audio-based telehealth services would do much to facilitate both access and health equity.

Technological concerns and new flexibilities

Telehealth, as with conventional healthcare delivery, implicates the privacy, security, and storage of protected health information.

The Health Insurance Portability and Accountability Act (HIPAA), HIPAA Privacy Rule, and HIPAA Security Rule continue to govern this province, although the Department of Health and Human Services (HHS) has adopted a more flexible stance in the wake of COVID-19. For one, it will not penalize providers using remote communications technologies which do not fully comply with HIPAA requirements, provided they do so in good faith. This, moreover, extends to all patients, not merely those receiving treatment for COVID.

Artificial intelligence technologies will play an increasingly prominent role in remote patient monitoring, a key component of telehealth.

Generally, the U.S. Food and Drug Administration (FDA) requires premarket notification (colloquially known as “510(k)”) for modifications to approved devices. This process can prove long and complex.

In response to COVID-19, FDA has instead indicated that it will not “object to limited modifications to the indications, claims, functionality, or hardware or software of FDA cleared non-invasive remote monitoring devices that are used to support patient monitoring during the public health emergency…without prior submission of a premarket notification.” This additional flexibility should prompt further innovation in the remote patient monitoring space, which in turn could expand the scope of services offered through telehealth and provide FDA crucial information with which to set permanent policies.

Liability and licensure

Liability and licensure fall largely within the domain of a patchwork of state laws, regulations, and orders.

Two states have liability statutes that speak directly to telehealth initiatives; Hawaii requires malpractice insurance providers to cover telehealth services, and New York has carved out a liability exemption for them (barring cases of gross negligence). Others, however, are silent.

Interstate licensure requirements pose another formidable barrier to telehealth expansion. This is critical, as healthcare providers in states with low COVID burdens may be well-positioned to serve patients in states with higher prevalence.

Some states have taken affirmative steps towards achieving reciprocity. Alaska, Missouri, and Tennessee recognize out-of-state healthcare licenses; Connecticut has altogether dropped its credentialing requirements for telehealth practitioners licensed elsewhere, and New Jersey offers a “fast track” for out-of-state physicians.

Seventeen states have adopted a variant of the Uniform Emergency Volunteer Health Practitioner Act (UEVHPA), permitting out-of-state license recognition during emergencies. HHS can play a key role in encouraging these reciprocal arrangements. It should assist state leadership in creating Emergency Management Assistance Compacts (EMACs) with telehealth provisions, thereby establishing a safety valve for states in crisis and furthering the development of a national telehealth market. Further, HHS can increase its funding for Telehealth Resource Centers, training growing cohorts of providers and laying the infrastructure necessary for continued expansion.

Although it remains to be determined whether the recent regulatory flexibilities will be locked in, it is clear that parity, promotion, and coordination among disparate state frameworks are essential to growth. Telehealth is flourishing amid COVID-19, but its potential to revolutionize the delivery of care could outlast the pandemic.

The post Telehealth Policy Brought to the Fore in the COVID-19 Pandemic appeared first on Bill of Health.

09/11/2020 - 7:00am

By Jenna Becker

Telehealth can and should be used in an intentional effort to reduce health disparities.

Increased COVID-19 mortality rates in communities of color have been a constant, tragic reminder of the ways in which systemic racism causes poor health outcomes in the United States. Immigrants are facing an increased risk of illness and limited access to care. Rural Americans may face an increased risk of serious illness.

Telehealth can reduce barriers to care that these groups face, such as lack of access to transportation, culturally-competent providers, and childcare.

The last six months have seen rapid growth in the use of telemedicine in response to the COVID-19 pandemic. In response to urgent need, regulatory agencies and private insurance companies have loosened requirements that previously inhibited the use of telehealth.

The expansion of telehealth and removal of traditional barriers to care may lead to more equitable health outcomes.

Impact of telehealth on health disparities

Telehealth has the potential to significantly increase health care access and reduce health disparities.

For example, transportation barriers are more likely found among Black, Indigenous, and Latinx individuals. For appointments that can be conducted online, telemedicine eliminates these barriers. Virtual appointments can similarly reduce burdens on low-income patients, like lost wages and the cost of childcare.

Proximity to specialists and culturally-competent providers presents another barrier to quality health care. A 2015 survey of transgender people in the U.S. found that nearly 30% of respondents needed to travel over 25 miles to receive transition-related care, with 15% of respondents traveling over 50 miles. Telehealth can be used to expand access to care for people with trans experience.

However, telehealth requires that patients have access to technology and the internet, as well as technological literacy. This creates a digital divide, which disproportionately disadvantages Black and Latinx individuals, elderly people, rural populations, and people with limited English proficiency. This digital divide has the potential to increase health disparities with the increased use of telemedicine. Reducing health disparities using telehealth will require a coordinated effort to both expand coverage of telehealth services and close the digital divide.

Telehealth reimbursement policies

Before the COVID-19 pandemic, regulatory hurdles were a key factor limiting the expansion of telehealth services. In March, the Centers for Medicare and Medicaid Services (CMS) announced significantly expanded telemedicine coverage for Medicare beneficiaries. All states have expanded telehealth access for Medicaid beneficiaries. Private insurers have followed suit.

Unfortunately, the Medicare telehealth expansion is likely temporary, reverting at the end of this public health emergency. With the declining use of televisits over the summer, some private insurers already have begun rolling back their coverage of telemedicine.

A number of bills have been introduced by both Democrats and Republicans in Congress to permanently expand CMS telemedicine coverage. Some states, like New Hampshire, are moving to permanently expand coverage for telemedicine. Such changes would increase the availability of virtual appointments, which in turn would help reduce barriers to care for at-risk individuals.

Expanding access to telehealth

In addition to solidifying telehealth reimbursement, lawmakers and health care providers will need to work together to make televisits accessible and reduce the digital divide.

State and federal lawmakers and agencies have increasingly prioritized making affordable broadband access widely available. However, with at least 19 million Americans lacking access to broadband, there is still a way to go.

State and federal governments have a number of tools at their disposal to close this gap. States can allocate funding towards developing broadband infrastructure and providing digital technology to households in need. As suggested in a recent Health Affairs article, the federal government may be able to require all internet providers to provide low-cost internet plans using the Defense Production Act.

Although health systems may not be equipped to provide internet access to their patients, they still can facilitate access in important ways. Health care providers can identify patients who face increased barriers to in-person visits, and prioritize setting them up for tele-visits. They can also institute programs to improve technological literacy among their patients.

A number of health care systems and local health departments have announced a commitment to reducing health disparities within their own patient populations. Providence, a large, multi-state health system, recently committed $50 million to address racial disparities in health care. Such health care organizations could additionally assist in procuring devices for their patients who need them.

Telehealth on its own will not lead to health equity. Access to in-person visits is only one factor that contributes to health disparities. However, expanded carefully, telehealth could provide a method to reduce disparities in health care access and outcomes.

The post How Telehealth Can Reduce Disparities appeared first on Bill of Health.

09/10/2020 - 4:12pm

Few medical centers have studied potentially inappropriate ICU treatment as much as UCLA. In their latest publication (in Journal of Critical Care) researchers report that "over five years the proportion of patients perceived to be receiving inappropriate critical care dropped by 40%." 

...

09/10/2020 - 11:00am

By Abe Sutton

The Georgia Access Model
Other states can follow Georgia’s lead in pursuing innovative 1332 waivers to encourage choice and competition. “A Pathway to Heaven” by ^riza^ is licensed under CC BY 2.0.

In December 2019, Georgia applied for a state relief and empowerment waiver available under Section 1332 of the Affordable Care Act (ACA).

Section 1332 lets states alter select ACA requirements to find the approach that is right for their state and encourage insurance coverage innovation. Georgia has released two prior versions of this waiver proposal; the state’s most recent revision to its 1332 waiver application offers a new vision for the individual market and a potential roadmap for other states. The innovation, the Georgia Access Model, accompanies the now-traditional reinsurance component included in prior 1332 waivers.

The Georgia Access Model shifts Georgia off of healthcare.gov. It instead opts for a decentralized enrollment system that makes plans available through the commercial market. Georgia argues this will increase individual market enrollment and reduce premiums. In this piece, I address some criticisms of the model and present an argument for approving Georgia’s waiver.

What critics are saying
By presenting alternative options to the centralized health exchanges, Georgia may increase choice and competition and improve the consumer experience. “Obamacare” by ShanMcG213 is licensed under CC BY-SA 2.0.

Incentives to innovate may be lacking

Critics allege that removing the exchange without any new incentives for private entities will not increase competition. However, they fail to consider how removing the public exchange that captures the bulk of the market may incentivize private players to compete. Knowing a large chunk of the market is no longer locked up in a government-run option, it is conceivable that commercial players will invest more heavily to match consumers with health plans.

In some ways, this would parallel how enrollment through the exchanges remained roughly stable even after the federal government curtailed spending on ACA Navigators. Given the shortfall in funding, private entities switched tactics to bridge the gap.

Only time can tell how large of an incentive removing the government-run option will be for private insurers. It is certainly plausible that on its own it will not provide sufficient incentive for new investment and fail to draw in new consumers. But a benefit of 1332 waivers is that they allow for state-level experimentation to discover effective approaches.

Enrollment in non-ACA-compliant plans may surge

Critics also express concern that consumer enrollment in non-ACA-compliant plans will increase with the shift to the commercial marketplace. However, if this occurs, it would result from Americans choosing the coverage they prefer. After all, the waiver simply opens more options while maintaining the availability of coverage that resembles existing offerings. This is mandated under the current 1332 guidance, which requires the state to still make available all the plans that would have been on the exchanges. It simply also allows the state to open up more affordable coverage options.

With this waiver, Georgia seems to be welcoming precisely the type of choice and affordability HHS encouraged with the current 1332 guidance. HHS explained that “a major disadvantage of the 2015 interpretation was that it deterred states from providing innovative coverage that, while potentially less comprehensive than coverage established under the PPACA, could have been better suited to consumer needs and potentially more affordable and attractive to a broad range of its residents.” The ACA struck a default balance on these issues, but carefully left space for continued experimentation. After all, the ACA was a result of a state-level experiment.

The future of 1332 Waivers

With the goal of encouraging state-level innovation to promote choice and competition in mind, Georgia’s experience could offer important lessons for the federal government, other states, and the private sector.

Federal

Currently, the 1332 guidance requires coverage losses to not exceed gains within each year of the waiver. The federal government should revise the current 1332 guidance to allow coverage losses to not exceed gains over the life of a waiver. Critics have highlighted that Georgia may have struggled to make the math work for the current, annual requirement. But this requirement discourages innovations that may take longer than a year to have an impact. The ACA itself took multiple years to stabilize.

State

Other states should consider submitting similar waivers if Georgia’s waiver is approved. They also should develop further-reaching waivers along the lines of the waiver concepts released by the federal government. States can be confident that if they develop waivers along the lines of one of the waiver concepts, they would have a good chance of approval in a second Trump term. After all, the federal government releasing waiver concepts seems indicative of a desire to approve similar waivers.

Private sector

Finally, private sector players should spot an investment opportunity to help consumers enroll in the plan that is right for them. This is particularly true if this model spreads to other states. Startups like Stride and HealthSherpa should keep an eye on this waiver.

The post Third Time’s a Charm: Georgia’s 1332 Waiver Application appeared first on Bill of Health.

09/10/2020 - 7:00am

(Clockwise from top left: Jenna Becker, Sravya Chary, Vrushab Gowda, Abe Sutton, Sunnie Ning, Laura Karas)

We are so excited to welcome a new group of Student Fellows to the Petrie-Flom Center family. These six students are a fantastic cohort of health law policy, biotechnology, and bioethics scholars who join us from Harvard Law School and the HMS Center for Bioethics. While we cannot physically welcome our fellows this year, we are excited to provide them with a robust virtual fellowship.

They each will undertake a year-long research project with mentorship from Center faculty and affiliates, and also will blog here at Bill of Health regularly. Keep an eye out for their bylines!

Jenna Becker is a second year law student. Her research interests include the regulation of medical software and technologies. Prior to law school, Jenna worked as a technical analyst for a healthcare software company, advising healthcare systems around the U.S. on their implementation and use of electronic medical records. She engaged in computational biophysics research while at the University of Wisconsin. Her research project will focus on regulation and governance of healthcare artificial intelligence outside of the FDA’s authority.

Sravya Chary joins the Petrie-Flom Center at Harvard Law School from the graduate program in bioethics at Harvard Medical School. She has worked in the pharmaceutical industry for the past two years. Sravya is currently a Data Architect supporting the finance and market access teams. Her research interests include Medicaid and Medicare reimbursement models, commercial formulary strategy, healthcare finance, and research ethics. Her research project will evaluate hydroxychloroquine as a case study for establishing new risk/benefit guidelines for revoking emergency use authorizations.

Vrushab Gowda is a third year law student, as well as an MD candidate at University of North Carolina. He has previously served on the masthead of Harvard Journal of Law and Technology, and has been published in medical literature. His scholarly interests include the legal, regulatory, and ethical dimensions of digital health. His research project will focus on obstacles to telemedicine, which have been brought to light during the COVID-19 pandemic.

Laura Karas is a second year law student and a licensed physician. Laura conducted health policy research with the team of Professor Gerard Anderson at the Johns Hopkins Bloomberg School of Public Health. At HLS, Laura serves as an editor of the Harvard Law Review and has been published in scholarly journals. Her research interests include healthcare antitrust, conflict of interest management within the medical profession, and balancing individual rights and the public good in measures designed to foster public health. Laura’s research project will explore the impact of HIPAA authorizations in patient support program enrollment on patients and drug makers.

Sunnie Ning is a third year law student. Sunnie’s academic interests include patent law, IP and innovation policy, and genetic privacy. Her research project aims to compare and contrast different solutions to solving the problem posed by the patent system, such as licensing and patent pooling, in the context of COVID-19.

Abraham Sutton is a second year law student. He is interested in policy shifts that empower and incentivize the private sector to improve health outcomes and lower costs. Specifically, Abe is interested in the shift to paying-for-value within Medicare and broader changes to increase choice and competition in health care markets to place Americans in control of their own care. He has co-authored op-eds in The Hill and RealClear Politics, in addition to co-authoring white papers for The Cicero Institute and Day One Project. His research project will focus on understanding the statutory limits on organ procurement.

The post Petrie-Flom Welcomes 2020-2021 Student Fellows appeared first on Bill of Health.

09/09/2020 - 8:49am

The Association for the Study of Death and Society (ASDS) will hold the 15th International Conference on the Social Context of Death, Dying and Disposal in Manchester from September 1-4, 2021. 

09/09/2020 - 7:00am

By James W. Lytle 

While New York State has generally earned high marks for its response to the COVID-19 pandemic, nagging questions continue over whether more might have been done to protect patients in nursing homes and other congregate settings — and whether some of the state’s policies even may have made matters worse.

Lessons from the New York State experience may prove helpful to those regions that have displaced New York as the epicenter of the American pandemic, and may help ensure that adequate steps are taken to protect the most frail and vulnerable among us from any resurgence of COVID-19 or from some future disease.

Although New York was among the hardest hit states, with the highest number of deaths thus far (over 32,000, more than twice as many as California), the aggressive steps taken by Governor Andrew Cuomo and his administration have been widely credited with reducing the spread of the disease in the State.

But a key, sustained criticism of the Governor’s handling of the pandemic focuses on the state’s nursing homes.

To be fair, New York has not been the only state singled out for its COVID-related nursing home experience. Similar concerns have been raised elsewhere, including in New Jersey, where more than 6,700 nursing home residents died from COVID-19, and Massachusetts, where over 64% of the Commonwealth’s COVID deaths are connected to nursing homes and 76 veterans died of COVID-19 in a single soldier’s home. Eighteen states have reported that more than half of their COVID deaths were in long term care facilities and, in three states (New Hampshire, Rhode Island, and Minnesota), nursing home residents have accounted for more than 75% of COVID deaths.

Indeed, from the very beginning of the pandemic, residents of nursing homes have been among the most vulnerable: The Life Care Center at Kirkland in suburban Seattle was the poster child when the pandemic first struck the United States, with 81 of its residents – two-thirds of its population – contracting the virus, and at least 37 dying from it.

The fact that nursing home residents have been so vulnerable to COVID-19 is not surprising: the advanced age of the residents, their co-morbidities, and the very nature of congregate care place nursing home residents at extreme risk. Nevertheless, it is fair to ask whether more could have been done to slow the spread of the virus within long-term care facilities—and whether some steps taken by New York and other states exacerbated risks to nursing home residents.

During the early stages of the pandemic, news reports focused on nursing homes, including a single nursing home in Brooklyn that reported 55 deaths, and widespread complaints from nursing homes that lacked sufficient Personal Protective Equipment (PPE) to protect their workers and their patients. Governor Cuomo insisted that it’s “not our job” to ensure that the nursing homes had adequate PPE.

As concern over the safety of nursing home residents continued to escalate, the Governor responded by announcing that the State Department of Health, along with the State’s Attorney General, would undertake an investigation of nursing homes “to make sure they’re following the rules.” (Neither the Governor nor the Attorney General have spoken much further about the “investigation,” and a nursing home industry news service reported that he had reconsidered that approach within a month of announcing it.)

Even the most basic information relating to the nursing home experience in New York is either disputed or unknown — including the baseline question of how many nursing home deaths actually occurred in the state.

New York State officials assert that approximately 6,400 nursing home residents died in the pandemic, an absolute amount that was second only to New Jersey, but a total that represents only about one in five of the overall death toll from COVID in New York. However, the New York tally only counts those individuals who actually died in the nursing home — and excludes those who may have contracted the disease in the long-term care facility, but died elsewhere — contrary to how most other states have reported COVID-19 deaths.

Beyond the dispute over the numbers, critics have focused upon a policy directive from the New York State Department of Health when the crisis was at its worst. The directive, issued on March 25, 2020, highlighted the “urgent need to expand hospital capacity in New York State to be able to meet the demand for patients with COVID-19 requiring acute care.” The key message of the directive was as follows:

No resident shall be denied re-admission or admission to the NH [nursing home] solely based on a confirmed or suspected diagnosis of COVID-19. NHs are prohibited from requiring a hospitalized resident who is determined medically stable to be tested for COVID-19 prior to admission or readmission.

In an understandable effort to ensure that hospital capacity would be sufficient to meet the surge of COVID patients requiring acute care, the policy was intended to make sure that hospitals could expeditiously transfer patients back to nursing homes. Whether the policy may have inadvertently resulted in accelerating the spread of COVID-19 in long-term care facilities by multiplying the exposure of nursing home residents to COVID-19 patients has been the subject of a prolonged and still unsettled debate.

In the policy’s aftermath, the Governor asserted that nursing homes had the prerogative, and even the obligation, to decline admission of patients if they were not able to care for them — a position that seemed inconsistent with the terms and the spirit of the directive. On May 10th, two months after the controversial policy was put in place, the directive was rescinded and new policies were instituted, including a prohibition on the discharge of COVID-positive patients to nursing homes, and a mandate of regular testing of nursing home staff.

Even after it was rescinded, the policy remained a source of controversy. Ten Republican members of the House of Representatives wrote to the NYS Attorney General, Letitia James, to urge her to “formally review the impact of this deadly policy and make your findings available to the citizens of New York and families of those who lost loved ones as a result of this deadly policy.” State legislators from both parties joined in criticizing the policy and have joined in calls for new policies governing COVID-19 in nursing homes.

The NYS Department of Health responded with a report that minimized the impact of the policy on nursing home deaths. The report’s key conclusion was that the disease was spread by infected staff members, not by discharged hospital patients, evidenced by the fact that the bulk of the hospital patient transfers occurred after nursing home mortality reached its peak, “therefore illustrating that nursing home admissions from hospitals were not a driver of nursing home infections or fatalities.” In addition, the report found that most patients admitted to nursing homes from hospitals were no longer contagious at the time of nursing home admission. The report also highlighted the fact that the percentage of total New York COVID-19 deaths that occurred in nursing homes (21%) was among the nation’s lowest.

But the report did little to end the controversy. The Legislature responded by convening a two-day, 22 hour joint hearing of the State Senate and the State Assembly Health Committees. After quoting Governor Cuomo’s comment that the virus could spread “like fire in dry grass” among the elderly, one legislator stated, “It’s now up to the Legislature to determine who lit the match and how and why the fire fanned out.” The Senate Health Committee chair accused the Health Commissioner of deliberately undercounting nursing home deaths “to make you look better.” A conservative health care public policy think tank noted that the State’s assertions of how well it did in comparison to other states was “doubly misleading: first because the state’s count of nursing home deaths is artificially low, and second because its total death count is unusually high.” The Assembly Health Committee chair dismissed the Department’s low nursing home death count as “patently ridiculous.”

State legislation (Senate Bill No. 8756/Assembly Bill No. 10857) has been proposed to create an independent commission to investigate COVID-19 in nursing homes, a proposal that the Governor has already rejected. Meanwhile, the United States Department of Justice requested information from the state, under the Civil Rights of Institutionalized Persons Act (CRIPA), to determine whether it should launch an investigation into the state’s response to COVID-19 in its nursing homes. CRIPA only applies, however, to “public nursing homes” (i.e., those operated by the state and local governments), which represent a very small percentage of the nursing homes in New York.  Finally, the New York State Bar Association named a panel of lawyers to “examine what happened to individuals receiving care in nursing homes and from other long-term care providers” and to identify “what lessons can be learned and whether laws . . . need to be changed to achieve a better outcome.”

While controversies over the mortality statistics and the since-rescinded nursing home admission mandate remain the hottest political issues, the more consequential issues may relate to the overall lack of preparation within the long term care industry for the pandemic — a responsibility that is shared by the facilities and state policymakers. State officials were, perhaps understandably, laser focused on what the hospital sector needed as the crisis unfolded — reflecting both the urgency of the need for acute hospital capacity and the fact that hospitals have traditionally received more attention from decision-makers than long-term care facilities.

While the current debate has been more political and punitive than productive, perhaps the COVID-19 pandemic will prompt a more thoughtful review of the underlying issues contributing to its impact on the nursing home and congregate care sector: the inadequacy of the sector’s financing (which may become even more strained as a result of the State’s pandemic-related budget crisis); its reliance on underpaid staff (who often work at multiple facilities to make a living wage, thereby potentially compounding the spread of the disease); the widespread failure of facilities to maintain adequate infection control; the unavailability of PPE and other protective supplies for nursing homes; and the overall lack of pandemic planning and preparedness by relevant state and local officials. And perhaps this controversy will result in greater transparency by health care policymakers, at least when it comes to reporting on deaths by an infectious disease.

James W. Lytle is Senior Counsel at Manatt, Phelps & Phillips, LLP and a fellow in the Advanced Leadership Initiative at Harvard University.

The post COVID-19 and Nursing Homes: The New York State Experience appeared first on Bill of Health.

09/09/2020 - 3:00am

This virtual symposium on October 3, 2020, is designed to increase awareness of the latest end of life interventions, including medical aid in dying in California, advances in evidence-based prescribing practices and more.

1. Create more awareness among the healthcare community to the variety of aspects related to the End Of Life Option act...

09/08/2020 - 11:48am

Three years ago, I wrote a short article arguing that physicians have a duty to disclose the costs of treatment, especially when those costs are very high. Newer legal developments have made the case even stronger. One example is a new regulation from the Department of Veterans Affairs.

But the VA regulation continues. It states that "appropriate information" includes "tests that yield information that is extremely sensitive or that may have a high risk of significant consequence (e.g., physical, social, psychological, legal, or economic) that a reasonable person would want to know and consider as part of his or her consent decision.)....