Mid-Atlantic Health Law TOPICS

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Did You Know? - Fall 2021

Disclosure of Experience: Did you know that providers might need to tell their patients how much experience they have with a particular procedure before performing the procedure? In Alghussein v. Kaan, an appellate court in Hawaii held that it would be reasonable for a jury to decide that a patient needs to know about a doctor’s experience with a proposed procedure as part of the informed consent process. A patient, who allegedly suffered a permanent injury following spinal surgery, filed suit against her doctor. The patient’s claim was, in part, based on the premise that she had not been told the doctor, who usually used a posterior operation approach when performing spinal surgeries, had only performed a particular side technique approach four times prior to her case. While this case is not binding outside of Hawaii, doctors should consider if their experience with a procedure would be relevant in a patient’s decision to move forward with care.

No Surprises Act: Did you know that Department of Health and Human Services has released its first regulation implementing the new “No Surprises Act.” The No Surprises Act, which goes into effect January 1, 2022, prohibits providers from billing patients more than in-network rates when the patient is forced to use out-of-network care either because of an emergency or during a hospital stay. The regulation explains that a Qualifying Payment Amount (QPA) will be used to help determine the patient’s share of the bill. The QPA will be calculated by considering a health plan’s historic median contract rate for similar services, adjusted for geographic difference and the consumer price index.

 

Alexandria K. Montanio
410-576-4278 • amontanio@gfrlaw.com