|
 By
David Abromowitz
In the typical gainsharing
arrangement, a hospital and a group of physicians enter
into a written agreement under which the physicians work
with the hospital to identify and then implement specific
cost-saving strategies. As a reward for their efforts to
reduce costs, the hospital pays the physicians a
percentage of any reduction in the hospital’s costs for
patient care that is attributable to the physicians’
efforts.
In July 1999, the Office of the Inspector General of the Department
of Health and Human Services (“OIG”) threw cold water over
gainsharing arrangements when it issued a Special Advisory
Bulletin in which it took the position that gainsharing
arrangements between hospitals and physicians are
impermissible under current federal law.
Specifically, the OIG stated that gainsharing arrangements
constitute a violation of the civil monetary penalty law
(the “CMP”), which prohibits a hospital from making
payments to a physician in an effort to induce reductions
or limitations of patient care services to Medicare or
Medicaid beneficiaries under the physician's direct care.
Additionally, the OIG noted that gainsharing arrangements
may raise concerns under the anti-kickback law.
Earlier this year, the OIG
breathed new life into physician-hospital gainsharing
arrangements, by issuing OIG Advisory Opinion 05-01. The
OIG has since issued five additional advisory opinions
supporting various gainsharing arrangements between
hospitals and physicians. This article, however,
discusses only the first of these OIG advisory opinions.
In Advisory Opinion 05-01, the OIG concluded that it would
not impose sanctions on the requestors under either the
CMP or the Anti-Kickback Statute.
Although the OIG reiterated
its previous concerns regarding the potential adverse
affects of gainsharing on patient care and its potential
for disguising payments for referrals, the OIG approved
this specific and carefully structured cost-sharing
arrangement proposed by the requesting hospital and
physicians (the “requestors”). The Advisory Opinion did
not address the other legal constraints on gainsharing,
including the Stark physician self-referral law or the
prohibitions against private inurement by tax-exempt
hospital organizations.
The Proposed Arrangement
The gainsharing arrangement
discussed in the Advisory Opinion involves an acute care,
non-profit hospital that participates in Medicare and
Medicaid programs, and a professional association composed
exclusively of cardiac surgeons with active medical staff
privileges at the hospital. The hospital proposed to
share with the surgeon group a percentage of the
hospital’s cost savings arising from the surgeons’
implementation of a number of cost-reduction measures in
connection with certain surgical procedures. Their
Proposed Arrangement is discussed in more detail below.
Cost-Saving Actions
A program administrator
engaged by the hospital conducted a study of the past
practices at the hospital’s cardiac surgery department.
The study resulted in 19 recommended cost-saving actions
in the surgeon group’s operating room practices to curb
the inappropriate use or waste of medical supplies. The
recommendations covered the following three areas:
-
Open as needed. Fourteen
recommended actions involved opening only as needed
certain packaged items potentially useful during a
surgical procedure, such as surgical trays.
-
Substitution. Four
recommendations consisted of the substitution, in whole
or in part, of less costly items for the items currently
being used by the surgeons in connection with surgical
procedures.
-
Aprotinin use. The final
suggestion would limit the use of Aprotinin, a
medication currently given to many surgical patients
pre-operatively to prevent hemorrhaging, only to
patients that are at an elevated risk of hemorrhage as
indicated by objective clinical standards.
Payment
The hospital proposed to
pay the surgeon group 50 percent of the cost savings
achieved by implementing the recommendations over a period
of one year. Cost savings would be calculated separately
for each recommendation by subtracting the actual costs
incurred from the costs recorded during an historical base
year.
The hospital proposed to
make an aggregate payment to the surgeon group based on
the cost-savings formula. The surgeon group, in turn, was
to distribute its profits on an individual basis to each
of its member surgeons. Under the Proposed Arrangement,
the following additional limitations were to apply to the
payment to the surgeon group:
-
No additional sharing of
cost savings would accrue if the volume of procedures
payable by a federal health care program in the year
covered by the gainsharing program exceeds the volume of
procedures payable by a federal health care program in
the base year.
-
To minimize the surgeons’
financial incentives to steer more costly patients to
other hospitals, a hospital-surgeon group committee
would monitor the case severity, ages and payors of the
patient population, and could terminate a surgeon from
participation in the Proposed Arrangement for
significant changes from historical patterns.
-
The aggregate payment to
the surgeon group will not exceed 50 percent of the
projected cost savings identified in the study.
OIG Analysis in the Advisory Opinion
As stated above, the CMP
prohibits a hospital from making
payments to a physician in an effort to induce reductions
or limitations of patient care services to Medicare or
Medicaid beneficiaries under the physician's direct care.
Applying the CMP to the Proposed Arrangement, the OIG
reasoned that, the "open as needed" surgical tray
recommendations would not implicate the CMP because those
recommendations would not perceptibly limit or reduce the
provision of items or services to patients.
According to the OIG,
however, recommendations concerning the disposable cell
saver, the substitution of less costly items and the use
of Aprotinin constitute an inducement to reduce or limit
the current medical practice at the hospital. Therefore,
these recommendations do implicate the CMP.
Despite this implication,
the OIG stated that it would not impose sanctions under
the CMP because sufficient safeguards were included in
other aspects of the Proposed Arrangement. To summarize
those safeguards:
-
The cost-saving actions
and resulting savings are clearly and separately
identified, permitting public scrutiny and individual
physician accountability for any adverse effect of the
Proposed Arrangement.
-
The requestors have
credible medical support that the implementation of
their recommendations will not adversely affect patient
care.
-
The payments are based on
all surgeries, regardless of the patients’ insurance
coverage, and are subject to a cap on payment for
federal health care programs.
-
Objective historical and
clinical measures establish thresholds to protect
against inappropriate reductions in service.
-
Patients will receive
written disclosure of the Proposed Arrangement.
-
The financial incentives
are reasonably limited in duration and amount.
-
The surgeon group
distributes its profits to its members on an individual
basis, mitigating any incentive for an individual
surgeon to generate disproportionate cost savings.
The OIG asserted that its
position is an exercise of discretion and is consistent
with its 1999 Special Advisory Bulletin. According to the
Advisory Opinion, the Proposed Arrangement differs from
other gainsharing arrangements that were the subject of
the OIG’s warning in the Special Advisory Bulletin because
the Proposed Arrangement sets out the specific actions to
be taken and ties the remuneration to the actual,
verifiable cost savings attributable to those actions. The
OIG identified the following features of gainsharing plans
which heighten the risk that payments will lead to
inappropriate reductions or limitations of services:
-
No demonstrable direct
connection between individual actions and any reduction
in the hospital’s out-of-pocket costs (and any
corresponding gainsharing payment).
-
No specific
identification of the individual cost-saving actions.
-
Insufficient safeguards
against the risk that other unidentified actions, such
as premature hospital discharges, might actually account
for any savings.
-
Questionable validity and
statistical significance of quality-of-care indicators.
-
No independent
verification of cost savings, quality-of-care
indicators, or other essential aspects of the
arrangement.
The features of the
Proposed Arrangement, the safeguards identified by the OIG,
and the OIG’s enumeration of features that would heighten
the risk of a violation, provide useful guidance for the
structuring of other hospital-physician gainsharing
agreements without sanction under the CMP.
Anti-Kickback Statute Analysis
In analyzing the implications of the Proposed Agreement under the
Anti-Kickback Statute, the OIG cautioned that gainsharing
arrangements could be used to disguise illegal
remuneration from the hospital by encouraging physicians
to admit more federal health care program beneficiaries to
the hospitals. However, despite this potential risk for
illegal remuneration, the OIG declined to impose
administrative sanctions because of several factors that
suggested the risk of fraud or abuse in these gainsharing
arrangements was low.
Conclusions
The OIG has drawn a distinction between generalized gainsharing
arrangements tied to overall cost savings, which it views
as prohibited, and limited gainsharing arrangements tied
to specific, identifiable, and verifiable cost savings,
which it may permit on a case-by-case basis. While the OIG
has cautioned that its recent advisory opinions on
gainsharing should not be interpreted as throwing open the
door to gainsharing arrangements, it seems likely that
hospitals and physicians will be replicating these
arrangements in the near future.
However, given the relatively narrow scope of these advisory
opinions and particularly the Advisory Opinion discussed
above, all parties must carefully consider whether and how
to implement their own gainsharing arrangements. First,
only requesting parties are protected by advisory
opinions, so all parties debating the implementation of a
gainsharing arrangement should consider obtaining their
own advisory opinions in order to receive approval from
the OIG.
Second, the existing advisory opinions do not address how, or if,
gainsharing arrangements will be permitted under the Stark
physician self-referral law. This omission is not
unexpected given that CMS, not the OIG, has the authority
to interpret the Stark law. Therefore, all parties must
analyze independently whether their gainsharing
arrangements comply with the Stark law.
While the future of gainsharing arrangements has brightened, these
advisory opinions have opened the door only a crack.
Without action by Congress to amend the CMP, hospitals and
physicians will continue to lack the tools they need to
align their economic interests with each other and reduce
hospital costs. Gainsharing arrangements will continue to
be risky and, without approval from the OIG, could subject
the hospital and physicians involved to penalties under
both the CMP and the Anti-Kickback Statute.
______________________________
David Abromowitz
is a Partner of the
Health & Medicine Practice Group. He can be contacted at
dabromowitz@bdblaw.com
or
614.221.1363.
By:
Steven Armatas
 The
American Competitiveness and Corporate Accountability Act
of 2002, more commonly known as Sarbanes-Oxley or “SOX,”
was signed into law by President Bush on July 30, 2002.
Enacted in response to the financial scandals of Enron,
WorldCom, Arthur Andersen and others, SOX constitutes a
far-reaching attempt to restore accountability to the
business sector.
While nearly all of
its provisions currently apply only to publicly-traded
companies, SOX’s tentacles are starting to reach into the
governance of privately-held and non-profit entities,
including hospitals and medical foundations. In September
2004, California adopted the Non-Profit Integrity Act
becoming the first state in the country to extend
Sarbanes-Oxley type reforms to non-profit organizations.
Several other states, including Ohio, are considering
similar legislation. Many health care organizations have
also recently felt pressure from state regulators, the
media, and their own accountants, auditors and banks to
implement SOX-like regulations.
In light of these
developments, the following nine principles of corporate
governance, which have emerged from Sarbanes-Oxley, should
be strongly considered for implementation by every health
care organization (“HCO”):
1. Governing Board. The HCO’s governing board
should not serve in a mere ceremonial or honorary
capacity. Instead, it should play a significant role in
overseeing the HCO’s operations in order to assure
effective and ethical management.
2. Independent Directors. Every HCO should
recruit and retain independent, non-management board
members. The staff of the U.S. Senate Finance Committee
has recommended that at least one-fifth of any board be
independent. An independent board member is someone who
has no prior relationship with the HCO or its management
that may impair or appear to impair his ability to make
independent judgments.
3. Audit Committee. Any HCO with significant
revenues should establish an audit committee with the
power, without needing the consent of the full board, to (i)
retain and assure the independence of the HCO’s external
auditors, (ii) review the HCO’s accounting policies and
decisions, (iii) determine the adequacy of any internal
record-keeping, and (iv) oversee the accuracy of the
organization’s financial statements.
4. Internal Governance. An HCO board should have
sub-committees that focus on (i) the establishment, review
and periodic updating of the organization’s charter
documents; (ii) the criteria, evaluation, selection and
nomination of directors; and (iii) the board’s size,
composition, and committee structure.
5. Compensation Committee. A committee of
independent directors should determine the compensation of
key executive officers. Compensation decisions should not
be “automatic” or merely tied to cost-of-living
adjustments, but instead directly reflect the executive’s
performance in meeting set goals and objectives.
6. Disclosure of Financial Information. Any
disclosures regarding assets, activities, liabilities, and
results of operations should be accurate and complete.
CEOs and CFOs should be able to certify the accuracy of
these disclosures and the adequacy of their organizations’
internal controls. The Senate Finance Committee has
recommended that Form 990 include a non-profit’s annual
performance goals and the measurements for meeting same.
7. Codes of Conduct. HCOs should adopt and
implement codes of conduct for their directors and
employees reflecting the organization’s commitment to
operate in strict compliance with applicable law, ethical
business standards, and the entity’s governing documents.
8. Monitoring Compliance. An HCO should establish
procedures to receive internal complaints and foster
confidential and anonymous mechanisms to encourage
employees to report any fraud or irregularity. No
punishment should ever be assessed against
“whistleblowers,” even if their allegations ultimately
prove unfounded.
9. Document Retention. HCOs should have express
document retention policies. For example, financial
records, significant contracts, employment records and
fundraising activities should be archived according to
guidelines established by the organization or the IRS.
Such policies should also include rules for handling
electronic files and voicemail.
In short, the migration of mandatory Sarbanes-Oxley
principles to for-profit and non-profit health care
institutions is inevitable. Those organizations that
await compulsory regulations will find themselves
struggling and possibly unable to meet compliance
deadlines. Self-regulation and proactive behavior in this
field are thus the best course of action.
______________________________
Steven Armatas
is a Partner of the Business Practice Group.
He can be contacted at
sarmatas@bdblaw.com
or
330.491.5216.
 By
Stephen Griffin
It was surprising to
be asked how medical malpractice reform affected defense
attorneys. It reminded me of my Division III college
football career. There was no glory in it and no one
really cared we were playing, other than family and
girlfriends. As an example, I can remember asking a
freshman coed whether she would be attending the game.
Her reply always stuck with me: “I have to clean my dorm
room.” Humbling, but the game was still worth playing
just for the love of it. The point is no one really cares
how a defense attorney feels about medical malpractice
reform, but now that you asked . . .
Every day a medical
defense lawyer protects his client from the pool of
swimming sharks. Those sharks say to the defense lawyer:
“Hey, there’s no money in what you do, why not come swim
with us?” The decision to represent physicians over
plaintiffs is not based on money. Rather, it is a deeply
rooted philosophical difference. It is another game worth
playing.
Unfortunately, there
are enormous negatives attached to being a defense
attorney during this malpractice crisis and the advent of
reform. Philosophically, tort reform was mandatory.
Professionally, tort reform could hurt.
No matter what some
elected officials and the Plaintiff’s Bar say, medical
malpractice reform is worthy. Over the past two years not
a single day passed that my clients didn’t corner me to
share their hardships. The frustration was real to the
point of anger. Exposure to such daily negative energy
coupled with the requisite emotional support clients need
in the midst of a lawsuit places the defense attorney
dangerously close to the edge of burn out.
Despite the beckoning
of Plaintiffs’ Bar, I took a stand for reform. The
warning was that fewer medical malpractice cases meant
fewer cases to defend. Backing reform could cost me my
subspecialty. It also happens to be true that civil
defendants will need an attorney at trial. Since we have
the best civil justice system in the world, my job is not
in jeopardy. I will always be able to make a living at
counsel table. I do not need to perpetuate a fallacy to
preserve my income.
What I found
disconcerting were the accusations that defense attorneys
were part of the problem. I’ve only known one way to
defend cases and I’ve been doing it for seventeen years.
Defending malpractice cases requires a prolonged battle
and enormous effort. A professional reputation and a lot
of money are at stake. To wage a half-hearted defense
invites catastrophe. I have never apologized for a bill
and won’t start now. I cannot recall a client telling me
after a verdict that I was over-prepared. Like my
clients, I believe in a thorough workup before surgery.
There have also been
clients along the way implying that financial gain was the
motivating factor. Most of my clients are a lot savvier.
If financial gain was the sole motivating factor, those
clients can be assured that my name would be on the
Complaint not the Answer.
At the core of my
decision to support medical malpractice reform and take an
active role in its passage was my family. It stands to
reason that the finest academic minds should be pursuing
medicine or science. As a father, I want those minds
treating the ailments of my children. As a believer in
the free market, I know the brightest minds will pursue
those opportunities offering the greatest rewards for
sacrifice and accomplishment. Malpractice premiums make
the practice of medicine a bad business decision. Not
even my clients were steering their children towards
medical school. Ultimately, families lose.
I’ve wanted to represent physicians from the earliest
point of my career. Protecting doctors while they care
for their patients felt worthy. The quality of medicine
was being compromised because of shortcomings in the tort
system. Appropriate reform made perfect sense to me. If
it means I have to find some new clients, that’s
acceptable. Occasionally, we all need to find a greater
good than personal gain.
______________________________
Stephen Griffin
is a Shareholder and Co-Chair of the Health & Medicine Practice Group.
He can be contacted at
sgriffin@bdblaw.com or
330.491.5262.
|
|
|
Jeffrey Weinstock is an Associate who works in the
Boca Raton office of Buckingham Doolittle & Burroughs.
In addition to being a member of the Health & Medicine
practice group, he is part of the Firm’s Taxation &
Employee Benefits and Business Law practice groups.
His membership in three practice groups reflects the
breadth of Jeff’s legal knowledge. “I’m a
transactional attorney and deal with transactions
involving businesses in many different fields,” he
explains. “In health care, I work with a broad
range of entities from individual providers to
hospitals to manufacturers of health care products. I
represent them in mergers and acquisitions and all
types of operational issues such as contracting,
transactions, leasing and loans.”
A graduate of the University of Michigan, Jeff earned
his J.D. and master’s in taxation from the University
of Miami School of Law. His interest in the health
care industry began at a young age. “I’ve been
surrounded by physicians since childhood. My
father, both my grandfathers, my brother and several
uncles were physicians. I was exposed to their
practices and concerns, running their practices and
treating their patients. So I guess I’ve seen what
concerns and special problems health care providers
face. My background made me interested in health
care related issues even when I was in law school.”
Before joining the Firm, Jeff served as corporate
counsel to a publicly traded health care company.
“It was a diversified company with a wide array of
activities, everything from operating physical therapy
clinics and an institutional pharmacy to high-tech
medical devices. I gained detailed knowledge of
the unique issues faced in several different areas of
the health care industry.”
Jeff brings his knowledge of the medical world and his
experience in multiple fields of the health care
industry to his practice. “My clients have
included physicians and physician groups, hospitals,
dentists, medical device manufacturers and other types
of health care entities.”
Jeff is also legal editor and occasional columnist for
Ophthalmology Management magazine. “The
topics of the articles that I have written include
issues that every medical practice faces, not just
ophthalmologists; including what to do when records
are subpoenaed, how to protect yourself when an
associate has a judgment against him, and how to
protect intellectual property. These are issues
my clients in all branches of health care need help
with, and I enjoy advising them and giving them the
support they need so that they can concentrate on doing
their job well.” |
Breakthrough
for E-Prescribing
On October 11, 2005, the Centers for Medicare Services
(“CMS”) and the Office of the Inspector General (“OIG”)
proposed a new Stark exception and an Anti-Kickback
Statute safe harbor on e-prescribing. As a result,
physician practices may soon be able to accept financial
and technical aid for e-prescribing without triggering the
Anti-Kickback Statute or Stark.
Practically speaking,
this exception and safe harbor would allow hospitals,
group practices, prescription drug plan sponsors and
Medicare Advantage organizations to give physicians the
hardware, software and training they need to receive and
transmit electronic prescription drug orders. It will
allow physicians that cannot afford e-prescribing
technology to get financial help from larger providers so
that these physicians can electronically send
prescriptions to pharmacies.
Physicians should be aware that the exception and safe
harbor apply only to electronic e-prescribing technology
and do not extend to e-prescribing technology that is
bundled with electronic health records technology. It
will not be possible to bundle these technologies together
until CMS and the OIG create additional exceptions and
safe harbors.
____________________________________
Hospitals May Be Immune from
Vicarious Liability
In September, the Supreme Court of Ohio handed down a
decision in Comer v. Risko,
a case that is important to hospitals where doctors work
as independent contractors. The ruling concerned a patient
who was allegedly harmed by an independent contractor, but
who failed to file a primary negligence claim against that
physician within the time allowed. The court said that the
patient may not pursue a lawsuit against the hospital for
secondary or “vicarious” liability for the contractor’s
negligence.
The claim involved an
attempt by the estate of a deceased patient to pursue a
negligence claim against Knox Community Hospital. The
administrator of the estate filed suit against both an
individual physician and the hospital, based on the
failure of two contractor physicians working at the
hospital to detect a cancerous mass when they interpreted
separate chest x-rays of this patient. At a later date,
after the statute of limitations had expired, the
administrator included claims against the two contractor
physicians.
While an employer is
generally liable for injuries to third parties caused by
its employees or agents in the course of their employment,
Ohio law generally does not impose similar liability on a
company or “principal” for negligent acts committed by
independent contractors in the performance of their
contractual duties. The Supreme Court of Ohio decided,
however, to narrow this exception and found that a
hospital could be held liable for negligent acts of
medical professionals working as contractors when:
(1)
the hospital held itself out to the public as a
provider of medical services; and
(2)
in the absence of any notice or knowledge to the
contrary, a patient looked to the hospital, rather than
the individual practitioner, to provide competent medical
care.
In this case, Knox
County Hospital argued that the hospital could be liable
only when its contractors themselves were found to have
acted negligently. Therefore, since the administrator had
not named the contractor physicians within the statute of
limitations, the deceased patient had no legal ground on
which to seek damages from either the hospital or the two
contractor physicians.
After the case had
worked its way through appeals, the Supreme Court of Ohio
accepted Knox County Hospital’s contentions and held that
if the independent contractor is not and cannot be liable
because of the expiration of the statute of limitations,
no potential liability exists to flow through the
secondary party, i.e., the hospital.
On Thursday, June 30, 2005, Governor Taft signed H.B. 66,
the state’s biennial budget bill for fiscal years
2006-2007. The Governor vetoed 27 items in the bill,
including two long-term-care-related items. For a
complete analysis of the long-term care provisions and
related items visit:
www.ohca.org/uploads/news/05budgetanalysis.pdf.
____________________________________
Immunization Requirements
As of October 7, 2005, skilled nursing facilities (SNFs)
serving Medicare and Medicaid beneficiaries are required
to provide immunizations against influenza and
pneumococcal disease to all of their residents. SNFs will
be required to offer the immunizations as a condition of
participation in the two programs.
The rule requires
that each resident be offered timely influenza
immunizations and the lifetime pneumococcal vaccination
unless:
(1)
vaccination was medically contraindicated because
of the resident’s medical condition;
(2)
the resident personally or through a representative
refused the treatment after education and consultation
about the benefits of vaccination; or
(3)
the resident has already been vaccinated.
Before offering the
immunizations, SNFs must ensure that each resident, or the
resident’s legal representative, received education
regarding the benefits and potential side effects of
immunizations. SNFs must also document the administration
of an annual influenza vaccination in each resident’s
medical record.
Special Note:
CMS may exercise its enforcement discretion even if
facilities are out-of-compliance with this requirement
because a vaccine shortage meant they were unable to
obtain vaccine for their residents.
OFFICE OF INSPECTOR
GENERAL UPDATES
Holiday Gifts and Government
Regulations
Gifts to business partners and patients are a festive way
to say thank you and wish them happy holidays, but if the
OIG thinks your gift is an attempt to induce referrals, or
if your gift is too large, you could be spending the new
year battling Anti-Kickback and Stark allegations. There
are, however, several steps that you can take this holiday
season to continue gift giving while avoiding problems.
Stark’s exceptions
for gift giving and receiving: Under Stark’s “de
minimus compensation” exception, hospitals, manufacturers
and other entities can give physicians gifts as long as
they are under $50 each and are not cash or cash
equivalents—such as gift certificates, stocks, or
something the physician needs, like free medical supplies
or equipment. The total value of gifts to or from one
entity cannot exceed $300 per physician each year.
Ensuring gifts
don’t trigger the Anti-Kickback Statute: Unlike
Stark, the Anti-Kickback Statute offers no safe harbors
for holiday gift giving or receiving. Therefore, you must
review each situation and ensure there is no intent to
induce referrals or business. If you suspect that a gift
giver may expect referrals in exchange for a gift,
respectfully return the gift and explain that is it
against your compliance policy to accept gifts that might
compromise your practice’s position.
Gifts to patients: You should also exercise
caution when giving gifts to patients, particularly those
who are Medicare of Medicaid beneficiaries, in order to
avoid the implication that your generosity is an attempt
to influence a beneficiary’s provider or supplier
selection. Gifts and free services to patients should not
cost more than $10 per time and should not exceed $50 per
year, according to the OIG.
_______________________________
November
30, 2005 - David Abromowitz,
Buckingham
ColumbusSM,
will be speaking to the Akron General Hospital Center for
Family Medicine. His topic will be
"Physician Contracts."
_______________________________
 Priya Bathija,
Buckingham
ColumbusSM,
wrote an article for "Briefs," which is a quarterly
publication of the Columbus Bar Association. Her
article is entitled, "An
Overview of Attorney Trust Accounts."
_______________________________
 Joseph Feltes,
Buckingham CantonSM,
wrote an article for the September issue of
Ophthalmology Management. His article is
entitled, "Going Bare?,"
which discusses the consequences of not having medical
malpractice insurance.
_______________________________
 Thomas
W. Hess,
Buckingham
ColumbusSM,and
G.
Brenda Coey,
Buckingham CantonSM,
spoke at the AOPHA Annual Convention. Their
topic was "How to Conduct a
Resident Abuse & Neglect Investigation." Ms.
Coey also gave a presentation to the OHCA on
"Documenting to Minimize
Liability." She will be speaking on
November 4, 2005 on "Legal
Documentation." Mr. Hess also
presented at an Ohio Centers for Assisted Living seminar.
His topic was "Advance
Directive," and he will be making this same
presentation at an Ohio Health Care Association seminar.
_______________________________
 November
17-18, 2005 - Richard Milligan,
Buckingham
CantonSM,will
be presenting to the AultCare Provider Physicians
Conference. The title of the presentations are
"Tort Reform - Is it Making a
Difference?" and
"Understanding and Avoiding Medical
Malpractice Risk."
_______________________________
 Susan Rank,
Buckingham
CantonSM,
wrote an article for the October, 2005 issue of
Employee Benefit Plan Review. The article is
entitled, "Between a Rock and
a Hard Place: Self Audits Under the Fair Labor
Standards Act."
If you are interested in obtaining information on
upcoming seminars or would be interested in having
speakers from BDB make a presentation to your
organization, please contact: Lorna J. Henderson, Client
Relations Administrator, at
800.686.2825 ext. 86473
or
lhenderson@bdblaw.com.
|
