Robyn Sztyndor is a managing partner in a reputable Fort Lauderdale legal firm and a founding member of Physicians Law, P.A. She concentrates her practice on civil litigation, focusing on commercial litigation and medical malpractice defense. She is experienced in complex legal matters concerning negligence, product liability, and commercial litigation on the behalf of medical practitioners and healthcare facilities.
As a part of her responsibilities, Robyn Sztyndor must stay abreast of the latest developments in medical malpractice law and litigation. It had come to our attention that numerous recent changes to Federal Healthcare Law have changed the medical industry and are poised to trigger further changes. We asked Robyn to discuss some of the changes she thinks are most significant.
Healthcare professionals enter their field to deliver positive medical outcomes. However, as Robyn Sztyndor explains, the Federal government has a major influence over the ways in which physicians must do their job and how healthcare organizations must be run. Sometimes regulations help practitioners, and sometimes they hinder them. The better physicians and healthcare management understand these changes, the more likely it is they will be able to emerge from legal challenges with their livelihoods intact.
Patient safety initiatives are a Centers for Medicare and Medicaid Services (CMS) program working to enhance care and improve safety. PSIs are usually referenced in worksheets to be completed each week. CMS tracks these reports closely. It is the responsibility of every healthcare facility to complete and submit these forms regularly and on time.
Quality improvement organizations (QIOs) are a support system for CMS to enhance the quality and efficiency of healthcare. These groups analyze patient records and other data in order to generate educational material for medical staff. Their educational sessions and materials may be mandatory, and managerial personnel should know what’s required and when.
Like recidivism in the prison system, readmissions are something the medical industry is expected to work toward reducing. Facilities and practitioners may be graded by their readmissions rates, and these rates can be used to help or hinder them during legal proceedings.
Recovery audit contractors (RACs), work for CMS organizations and examine healthcare records. Their interest is to discover fraudulent insurance claims, and they can be a valuable resource.
Medical necessity regulations dictate that a patient must meet the lowest threshold of medical necessity before insurance can be compelled to compensate. Cases that are not seen as a necessity are not reimbursable.
Insurance companies use “retrospective” and “concurrent” reviews to confirm that a patient actually has a need for the care that they are receiving. Robyn Sztyndor points out that most of these changes affect insurance compensation for physicians, and that this may have a negative effect on what they can and cannot do to benefit a patient.