By Martin J. Hagan

People are living longer, and with longevity comes the risk of dementia that as it progresses will render its victims incapable of making their own health care decisions. Alzheimer’s disease is estimated to be the cause of at least half of all dementia cases.

The progression of Alzheimer’s disease from mild to severe stages is irreversible, at least with present treatment options. The only realistic hope is to slow and perhaps stop the progression of the disease, but not to cure it or reverse its effects.

When discussing health care decision-making concerns with individuals who are exhibiting signs of Alzheimer’s disease, the first response should be to assure them that they can continue making their own treatment decisions for as long as they are able.

But since the progressive nature of Alzheimer’s disease makes their ongoing ability to make such decisions unpredictable, it is also essential they have legally effective documents that will keep their voice alive regarding their medical treatment choices, and appoint persons of their own choosing to be their advocates. [Read more…]

By Sean Audley

If you are a Pennsylvania Certified Trauma facility, you are invariably familiar with the significant difference in reimbursement for non-trauma workers’ compensation cases versus trauma cases. The Pennsylvania State Workers’ Compensation fee schedule carves out an exemption for treatment provided to seriously injured workers at hospitals with certified level I or II Trauma Centers or American Burn Association certified Burn Units. The workers’ compensation exemption states that in such matters hospitals are to be paid its “usual and customary charge”. For more than 22 years, this meant that the hospital was paid its full billed charges. That may be changing and it is important for trauma and burn unit hospitals to be prepared to react to the changing rules regarding such payments.

In 2015, one of Pennsylvania’s largest providers of workers’ compensation coverage began to pay trauma claims at less than the provider’s billed charges. Using a Bureau of Workers’ Compensation (BWC) “Statement of Policy” on a wholly unrelated matter, they determined that trauma and burn claims should only be paid in accordance with a usual and customary fee schedule put out by Fair Health, a New York based non-profit that studies medical payments. Where applied, this database has resulted in payments on trauma and burn claims being reduced by 25 to 33 %.

Several cases challenging this made it to the Commonwealth Court in 2016. In the initial decisions, involving challenges brought by Geisinger Medical Center, the Court questioned the use of the Fair Health Database but affirmed the reduced payment. [Read more…]

John K. Heisey, Esquire, a shareholder with the Pittsburgh-based law firm of Thomson, Rhodes & Cowie, P.C., was selected by his peers to be included in the 2017 Edition of The Best Lawyers in America®. 

Best Lawyers is the oldest and most respected peer-review publication in the legal profession, and has earned the respect of the profession, the media, and the public, as the most reliable, unbiased source of legal referrals anywhere. Heisey is also a Fellow of the Academy of Trial Lawyers of Allegheny County, a Pennsylvania Super Lawyer, and has an AV rating, which is Martindale Hubbell’s highest honor awarded for ethical standards and legal ability.

Heisey concentrates his practice defending healthcare providers.  He has successfully tried numerous cases to verdict, including wrongful death claims and those involving catastrophic injuries.

By Antoinette Oliver and Elaina Smiley

The recent $1.35 million settlement that Princeton HealthCare System must pay to former employees should cause all health care employers to consider re-examining their employee medical leave policies.

Princeton HealthCare System (PHCS) had a maximum leave policy that allowed employees to take no more than 12 weeks of leave for medical reasons within a 12 month period.  The PHCS policy was in line with the Family Medical Leave Act (FMLA), which allows qualified employees to take unpaid, job-protected leave for specific family or medical reasons, such as the birth of a child, a serious health condition or to care for a sick family member.  Employees who qualify for FMLA leave can take up to 12 weeks of leave within a 12-month period, either intermittently or all at one time.

PHCS fired any FMLA eligible employee who took more than 12 weeks of medical leave.  It also fired those employees who were not eligible for FMLA leave after their being absent for only a short time.  The EEOC filed suit on behalf of the 23 affected employees, arguing that PHCS’ policy failed to consider leave as a reasonable accommodation under the Americans with Disabilities Act (ADA).  The ADA requires employers to make reasonable accommodations for any employee who has a qualifying disability.  A disability is defined as a physical or mental impairment that substantially limits one or more major life activities.  Under the ADA, employers must work with employees on a case-by-case basis to determine what reasonable accommodations are necessary, depending on the employee’s specific disability and the particular circumstances of the job. 

[Read more…]