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Three Things MGMA Urges You to do to Help Avert the 29.5% Medicare Payment Cut
In its Washington Connexion email a few minutes ago, MGMA is asking for your help to stop the 29.5% payment cut scheduled to go into effect on January 1, 2012 (less than 100 days from now).
Healthcare providers, and the rest of us who care about healthcare, need to keep pressure on Congress to address this issue. MGMA suggests doing the following three things:
- Understand the impact the payment cut will have on your practice.
- Sign a petition and ask others to do the same and make your opinion known.
- Urge your elected representative to repeal the sustainable growth rate requirements that are causing these cuts.
I will add two other things that you can do:
- Express yourself to your national and state professional associations. They have lobbyists and need your support.
- Enlist the assistance of your vendors and advisors and ask them to voice their support against this scheduled cut.
Do not wait for others to act.
Physician – Hospital Co-Management Arrangements
My partner, Marshall Burack, authored an Akerman Practice Update for our Healthcare Practice Group on physician-hospital co-management arrangements.
I have previously written that co-management arrangements are one important alternative for physicians to consider as they explore workable and financially viable opportunities in this new era of healthcare delivery. So, I think you will find Marshall’s Practice Update to be very timely. This is something that we are currently assisting physician and hospital clients on.
If you do not have time to read the entire article, here is a quick summary from Marshall’s concluding paragraphs:
A physician-hospital co-management arrangement permits a hospital to provide financial incentives for physician members of the medical staff to assist the hospital in improving the quality and reducing the cost of providing patient care. A co-management arrangement can be an attractive alternative to direct hospital employment of physicians, both for hospitals which do not want to assume the financial and administrative burden of owning and operating a large physician practice, and for physicians who wish to maintain their independence rather than becoming hospital employees.
Because a co-management arrangement involves the payment of compensation to physicians who refer patients to the hospital, the arrangement must be structured properly in order to avoid violation of applicable health care statutes and regulations. Hospitals which are considering entering into a co-management arrangement with members of the hospital’s medical staff should engage knowledgeable health care counsel, as well as experienced consultants who will help structure and monitor the arrangement and who will confirm that compensation amounts reflect the fair market value of the management services provided. If a hospital ensures that the co-management arrangement is structured properly, the arrangement should prove to be beneficial for the hospital, the physicians, and most significantly, for hospital patients who will receive higher quality care.
Medicare Fraud Enforcement Continues in Florida
You cannot overlook the seriousness of the government’s continuing efforts to root out healthcare fraud. Just last week, 10 Miami residents pleaded guilty to being part of a $25 million Medicare fraud conspiracy.
The fraud was in connection with home health care and physical therapy services — two frequent areas of fraudulent activity. The defendants included “patient recruiters” nurses, and facility administrators.
Providers must exercise caution in healthcare activities that are so competitive that aggressive and dishonest patient marketing activities are required. Home health, physical therapy, diagnostic services, and DME are several activities that are being seriously scrutinized.
Compliance plans should be put in place by all healthcare providers. Internal audits should be performed. Deficiencies should be addressed. Training is a must if an environment of compliance is desired.
MSOs — Important Again for Physician Practices
Management service organizations have been around for a while providing management to physician practices, ranging from billing and collection to complete turnkey operations. In this regard, they have always been important.
However, MSOs have become increasingly critical to help physicians navigate the unique problems and opportunities facing them in this era of healthcare reform — ACOs, practice acquisitions and consolidations, and reimbursement cuts. Physicians in solo or small practices cannot practice quality medicine, deal with compliance issues, handle employees, negotiate managed care contracts, control expenses, and maximize revenues. Maybe once they could, but no longer.
The goal of contracting with a quality MSO is to allow physicians to practice medicine again without being distracted by all the back office business details.
MSOs come in many shapes and sizes, and one size clearly does not fit all. The physician must decide what it is that he needs and wants. Does he want an MSO that will provide a limited range of services for a limited price or does he want something much more extensive and expensive? The physician should discuss the alternatives with his legal and financial advisors. They will need to assist him in selecting the prospective MSOs and doing due diligence on them.
There are many issues to consider. I will discuss those in subsequent posts.
Predictive Modeling Technology from HHS Could Enhance Payor Compliance Programs
My partner, Rob Slavkin, recently authored an Akerman Healthcare Practice Update about the Department of Health and Human Services’ “introduction of predictive modeling technology as part of the government’s fraud investigation arsenal, as well as a new collaborative tool that enables private payors to enhance their own monitoring and auditing programs.” The Practice Update can be found here.
This is part of the government’s ongoing efforts to root out healthcare fraud.
For a reminder at how serious the government is about this, look at what the OIG has been posting on its website.
The adoption and implementation of compliance programs continue to be one of the most valuable tools to protect healthcare providers, including medical billing companies and DME suppliers, from purposeful or accidental employee activities that may cause exposure to fines, penalties, or possible exclusion from the Medicare and Medicaid programs. Having and following a compliance can also mitigate criminal penalties.
There is much enforcement activity going on, and it too late to adopt a compliance program when the barbarians are at the gate.
Social Media and Physican Practices
As is so often the case, MGMA has provided some excellent information for physicians to consider when exploring the social media as a method to interact with their patients. Read this MGMA article for some good points: “Social media do’s and don’ts for your practice.”
It is very important to design (and implement) a social media policy for your office that clearly sets forth what is and is not permissible.
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