How the Patient Protection and Affordable Care Act affects Texas dentists.

President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law March 23, 2010 (P.L. 111-148), as arguably the most significant legislative health reform since the creation of Medicare and Medicaid in 1965 (1). Several PPACA provisions will impact dentists as both health care providers and small business owners and employers (2). Overall, the law significantly changes health care financing and facilitates competition in the health insurance market place through the creation of health insurance exchanges (HIX).

The redistributional impact of Canada's Employment Insurance Program, 1992­2002.

For a decade or so starting in the early 1990s, Canada's major income support programs underwent substantial reform. Meanwhile, the economy first lingered in a deep recession and then recovered with a period of strong growth. This paper focuses on how the distributional impact of Employment Insurance (EI) evolved during this period. We find that EI was strongly redistributive throughout the whole period with respect to the earnings of individuals, and somewhat less so for family income. But we also show that the distribution of benefits and contributions changed substantially over time, becoming less redistributive. Somewhat counter-intuitively, both the benefit and contribution sides of the program are shown to be redistributive, even though the contribution structure is regressive. These findings are relevant in the current context, as the economy struggles with a combination of high unemployment and fiscal pressures on government spending.

Physician M&As: what you need to know before taking the plunge.

In the current healthcare environment, many physicians are considering merging practices. Increasing costs, decreasing revenues, and changing regulations are obstacles today's physicians face, which has led many to "take the plunge" and merge practices. For a successful merger to occur, many factors must be considered. Advantages and disadvantages exist that must be weighed in order to determine if a merger is the best decision. This article considers the factors associated with merging physician practices to determine the best possible outcome for a physician's practice.

Securing your family's future: the value of estate planning.

BACKGROUND: The authors provide an overview of general estate planning considerations, including minimization of federal estate taxes, estate planning techniques to be used to meet specific goals, and guidelines to ensure a well-drafted and well-organized plan. They also stress the importance of planning for incapacity. CONCLUSIONS: A well-thought-out and sound estate plan protects assets, minimizes estate taxes, ensures appropriate distribution to designated beneficiaries and prepares family members and business partners. In developing an estate plan, dentists should seek professional advice from a qualified attorney and a certified financial planner. Practice Implications. A sound estate plan should address business continuation or disposition with respect to the dental practice.

Reallocation in academic dentistry: a legal and administrative perspective.

Like other elements in higher education, academic dentistry is experiencing financial austerity and must be able to reallocate its resources in order to provide the optimal level of service within a given budget. Continuous, across-the-board budget cuts will only reduce the quality of strong departments to the level of weak ones. Dental college faculty, with guidance and support from administrators, will need to develop procedures and criteria for program restructuring that will increase educational flexibility and link budgeting with planning. Seniority and tenure may be used as criteria for personnel action, but faculty must be aware that tenure is a method to achieve academic freedom and is not a guarantee of perpetual employment. The courts will not substitute their judgment for that of the university authorities in academic or personnel matters unless the institution's action is arbitrary, capricious, or discriminatory.

Court decisions hold implications for managed care plans--Part two.

This article highlights selected legal developments from the past two years that reflect the causes and effects of the competitive environment in which the managed care industry finds itself. Additional cases were discussed in the January-February 1990 issue of the journal. "Health Law" is a regular feature of Physician Executive contributed by Epstein Becker & Green. Douglas Hastings, Esq., a partner in the law firm's Washington, D.C., offices, serves as column editor.

Pitfalls in negotiating hospital-based physician contracts.

The appropriate planning, negotiation and drafting of a hospital-based physician agreement is important to its success. Not only does Mr. Gravely discuss important issues to be covered in the negotiating process, but his experience in this field enables him to share effective negotiating strategies. A reprint from In Touch, this article serves to broaden the radiology manager's understanding of hospital-based physician contracts.

Guidelines for physician contracting with alternative delivery systems.

The rapid proliferation of alternative healthcare delivery systems--particularly health maintenance organizations (HMOs) and preferred provider organizations (PPOs)--means that physicians contemplating participation in one of these entities must obtain, at the least, information about the group's ability to operate efficiently and effectively. For physicians who are contracting directly with a specific HMO, PPO, or independent practice association (IPA), issues that are relevant in all situations include termination, submission of data, discipline procedures, no solicitation covenants, arbitration clauses, rights to discontinue treatment, use of consultants, compliance with state and federal laws, and exclusivity.

Contract law for physicians. The basics.

As part of the Minnesota Medical Association's ongoing contract review process, this article provides information to help educate physicians about the major managed care contracts being offered to them. The information provided is not intended to, nor should it be a substitute for legal advice pertaining to an individual's practice and specific contracts with third parties. The MMA will not be making recommendations regarding the merits of any particular contract. A decision to enter into a contract rests with the physician and his or her clinic in consultation with private legal counsel.

Entity matters. Financial consequences of entity selection for the physician-owned practice.

When a physician-owned medical practice selects a legal structure, it also opts for a set of tax attributes that can have a significant impact on operations and financial decision-making. Whether forming a new practice, contemplating a merger or simply dealing with the tax and operational issues of their current situation, practice executives and physician owners need to understand the tax and financial implications of the different entities.

Firing without fear. Heading off litigation in employee terminations.

Under most state laws, employee handbooks carry the status of employment contracts, or such contracts are implied through various employment conversations. Unlike in the past, when a management decision to discharge an employee could be challenged only for statutory or public policy reasons, today's employer may have to prove that he or she did not violate an employee's contractual right to employment. Employers can reduce the risk of employment liability through practical steps such as careful monitoring and documenting of the hiring, performance appraisal, and disciplinary processes, and a credible grievance procedure. Many employers have found, however, that taking these steps does not always prevent litigation. Certain legal precautions, such as written disclaimers and other handbook revisions, can result in the dismissal of such actions before trial and will deter many plaintiffs' attorneys from taking the case. The strongest legal protection in termination situations is a release of all claims executed by the employee and supported by severance pay or other valuable consideration to which the employee would not be otherwise entitled.

Legal issues in cash balance pension plan conversions.

Replacing a traditional pension with a cash balance plan raises a number of complicated and unsettled legal issues, including the protection of accrued benefits, the rate of benefit accrual, age discrimination and notice requirements. This article discusses those issues and concludes that routine conversions to cash balance plans appear to be legal both currently and into the foreseeable future.

Administration--delayed benefits payment; interest. Fotta v. Trustees of the United Mine Workers of America, Health and Retirement Fund of 1974, 165 F.3d.209 (3rd Cir. 1998).

In a case of first impression, the Third Circuit holds that a beneficiary of an ERISA plan may sue the plan for interest on delayed benefits payments under Section 502(a)(3)(B) regardless of whether he also seeks to recover unpaid benefits. A beneficiary is not made whole when a plan pays benefits after delay since he has lost the time value of the money. Interest for delayed benefits payments is appropriate equitable relief that prevents the plan from being unjustly enriched at the beneficiary's expense. Since interest is money damages that is restitutive in nature, it is a form of equitable relief. Interest is not prohibited as "extracontractual" since it is compensation that is part of the contractual obligation.