Law Commons^™

Biting The Hands That Feed “The Alligators”: A Case Study In Morbid Obesity Extremes, End-Of-Life Care, And Prohibitions On Harming And Accelerating The End Of Life, Michael J. Malinowski

Michael J. Malinowski

Obesity, recognized as a disease in the U.S. and at times as a terminal illness due to associated medical complications, is an American epidemic according to the Centers for Disease Control and Prevention (“CDC”), American Heart Association (“AHA”), and other authorities. More than one third of Americans (39.8% of adults and 18.5% of children) are medically obese. This article focuses on cases of “extreme morbid obesity” (“EMO”)—situations in which death is imminent without aggressive medical interventions, and bariatric surgery is the only treatment option with a realistic possibility of success. Bariatric surgeries themselves are very high risk for EMO patients. …

A Brave New Medicare, Craig B. Garner

Craig B. Garner

Next month the Affordable Care Act turns five, and by all accounts the influence of this historic legislation will forever change the landscape of health care in the United States, regardless of its ultimate fate. As each passing year introduces thousands of new regulatory pages to an already expansive body of federal and state law, praise for what has come to be known as health care reform is only rivaled by the relentless partisan calls for its repeal.

Procedural Triage, Matthew Lawrence

Matthew B. Lawrence

The Problem With Value-Based Purchasing, Craig B. Garner

Craig B. Garner

From its inception on October 1, 2012, the Hospital Value-Based Purchasing (“VBP”) Program shifted Medicare’s paradigm to emphasize performance over costs in determining hospital reimbursement. Reducing the overall Medicare reimbursement to hospitals by an estimated $1.4 billion for Fiscal Year (“FY”) 2015, the VBP Program was quick to secure the attention of the nation’s health care providers. Technically “budget neutral,” the VBP Program will return this same $1.4 billion to hospitals the following year in the form of performance incentives. As the Federal Government waits to assess the accuracy of its prediction, the FY 2015 reduction of 1.50% will finally …

Medicare: The Perpetual Balance Between Performance And Preservation, Craig B. Garner

Craig B. Garner

Passed by Congress and signed by President Lyndon Johnson into law in 1965, Medicare has weathered storms from all directions, growing to be the preeminent standard for health insurance in the United States. The idea of losing Medicare as a vital public benefit still remains the single greatest fear with which each passing generation of Americans must contend, and yet, these challenges over the past fifty years, designed to fortify Medicare’s foundation and ensure its longevity, continue to take a toll on the program. The most recent climate of reform includes changes implemented by the Patient Protection and Affordable Care …

Chief Justice Roberts' Individual Mandate: The Lawless Medicine Of Nfib V. Sebelius, Gregory Magarian

Gregory P. Magarian

After the U.S. Supreme Court in National Federation of Independent Business v. Sebelius held nearly all of the Patient Protection and Affordable Care Act constitutional, praise rained down on Chief Justice John Roberts. The Chief Justice’s lead opinion broke with his usual conservative allies on the Court by upholding the Act’s individual mandate under the Taxing Clause. Numerous academic and popular commentators have lauded the Chief Justice for his political courage and institutional pragmatism. In this essay, Professor Magarian challenges the heroic narrative surrounding the Chief Justice’s opinion. The essay contends that the opinion is, in two distinct senses, fundamentally …

Policing Cost Containment: The Medicare Peer Review Organization Program, Timothy Stoltzfus Jost

Timothy S. Jost

This Article will first examine the problem of health care cost inflation and the payment strategies the Medicare program has adopted to address that problem. It will then discuss the perverse incentives that these payment strategies create, and the role of the PRO program in addressing harmful provider behavior encouraged by those perverse incentives. The Article examines evidence on whether the PRO program is succeeding or failing in this mission, and suggests possible means of improving the effectiveness of the PRO program in policing cost containment. Specifically, it recommends clarifying and strengthening the deterrent role of the PROs, crafting PRO …

The Future Of Medicare, Post Great Society And Post Plus-Choice: Legal And Policy Issues--Foreword, Timothy Stoltzfus Jost

Timothy S. Jost

No abstract provided.

The Evolving Relationships Between Hospital, Physician And Patient In Modern American Healthcare, Craig B. Garner, David Mccabe

Craig B. Garner

This article investigates the ways in which the relationships between patient, provider and hospital have evolved in the past fifty years, while paying special attention to the influence of modern health care reform on all parties involved. Using Medicare as the primary standard, the nation’s health care system is examined both historically and in light of recent changes that seek to transition its structure from one that is cost based to an approach that emphasizes performance. It is only through understanding the roots of our health care program that we can make informed decisions designed to improve its future impact …

Amicus Brief In Support Of Neither Party In Sebelius V. Auburn Reg. Med. Ctr., No. 11-1231, Scott Dodson

Scott Dodson

This amicus brief in support of neither party in the merits case of Sebelius v. Auburn Regional Medical Center, No. 11-1231, urges the Supreme Court to decide the question presented (whether 42 U.S.C. § 1395oo(a)(3) permits equitable tolling) without resort to jurisdictional labels.

Health Care ‘Freedom’, Medicare ‘Enrollment’ And Other Paralogisms: Hall V Sebelius, Mel Cousins

Mel Cousins

Rather overshadowed by the Supreme Court hearings on the constitutionality of the Patient Protection and Affordable Care Act (PPACA), another case involving a claim for health care ‘freedom’ has recently been dismissed by the DC circuit court of appeals. The case is entirely without any legal interest (or indeed legal merit) and, from a purely legal point of view, is barely worth reporting. Nonetheless from a broader political science perspective, it may be worth noting. From this perspective the ongoing health care litigation (of which Hall v Sebelius is a rather peripheral part) might tend to re-establish a view of …

Bending The Health Cost Curve: The Promise And Peril Of The Independent Payment Advisory Board, Ann Marie Marciarille, James Bradford Delong

Ann Marie Marciarille

Underlying today’s and the future’s health-care reform debate is a consensus that America’s health-care financing system is in a slow-moving but deep crisis: care appears substandard in comparison with other advanced industrial countries, and relative costs are exploding beyond all reasonable measures. The Obama Administration’s Patient Protection and Affordable Care Act (“ACA”) attempts to grapple with both of these problems. One of ACA’s key instrumentalities is the Independent Payment Advisory Board—the IPAB, designed to discover and authorize ways to reduce the rate of growth of Medicare and other categories of health spending. The IPAB is a peril. Expert boards to …

"How's My Doctoring?" Patient Feedback's Role In Physician Assessment, Ann Marie Marciarille

Ann Marie Marciarille

A society-wide consumer revolution is underway with the rise of online user-generated review websites such as Yelp, Angie’s List, and Zagat. Service provider reviews are now available with an intensity and scope that attracts increasing numbers of reviewers and readers. Health care providers are not exempt from this new consumer generated scrutiny though they have arrived relatively late to the party and as somewhat unwilling guests.

The thesis of this article is that online patient feedback on physicians is relevant and valuable even though it is also uncomfortable for health care providers. This is because the modern physician-patient relationship is …

Tracing The Evolution Of American Health Care Through Medicare, Craig B. Garner

Craig B. Garner

With President Obama’s health care reform currently under intense partisan scrutiny in the United States, this article is an objective resource for understanding the ways in which Medicare has historically served as a weather vane for charting the changes to the American health care system. During its nearly fifty-year tenure as the standard for the provision of medical care in the U.S., Medicare has evolved in fits and spurts, with its core structure shifting over time in response to changes brought about by the economic and political climate of each decade. It is only by understanding these past revisions, both …

The Affordable Care Act’S Preventive Services Mandate: Breaking Down The Barriers To Nationwide Access To Preventive Services, John Aloysius Cogan Jr.

John Aloysius Cogan Jr.

Relating Diagnosis-Related Groups: What Germany And The United States Can Learn From Each Other About Aute-Care Payment Systems, Timothy D. Martin

Timothy D Martin

In recent years, several countries have adopted diagnosis-related group (DRG) payment systems modeled after the system Medicare uses to reimburse providers for acute-care inpatient treatment. This paper compares the Medicare DRG system with the German DRG system and suggests improvements that might help both systems. First, Germany should proceed carefully in its attempt to reduce the length of hospital visits because its universal payment mechanism cannot shift costs to the private sector so inadequate payment could degrade the quality of care. Second, because both countries struggle with incorporating new treatments and technologies into their payment systems, they should both consider …