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Archive for August, 2012

AAFP recommends greater role for primary care docs in Medicare | Healthcare Finance News

August 30, 2012 Leave a comment

Congress must repeal the sustainable growth rate formula to stabilize Medicare physician payments, and CMS needs to adopt a series of strategies that would strengthen the Medicare program by enhancing the role of primary care physicians, said the American Academy of Family Physicians in a recent letter to CMS.

See on www.healthcarefinancenews.com

For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.

For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.

Healthcare Business Models Clash with Reforms – HealthLeaders Media

August 30, 2012 Leave a comment

Healthcare executives responding to a survey say the nation will see major changes in the way healthcare is delivered and paid for in the next five years as providers and payers struggle to do more with less.

Most of those executives, however, also believe that the fee-for-service-based business models they’re using now will be at least “somewhat sustainable” or fare even better in the face of new challenges brought on by healthcare reform.

KPMG LLP consultants surveyed more than 200 senior leaders in healthcare and found that 73% of health systems executives, 81% of health plan executives, and 79% of drug makers said their business models were somewhat sustainable or better over the next five years.

See on www.healthleadersmedia.com

For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.

For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.

HCA Probe Spotlights Cardiologists’ ’Irresistible Temptation’ – HealthLeaders Media

August 30, 2012 Leave a comment

Physicians specializing in cardiology coined the term “oculostenotic reflex” over a decade ago. But the phrase has been popping up this month in conversations about accusations that thousands of patients underwent inappropriate heart procedures at HCA hospitals in Florida and in three other states, the subject of a federal probe.

Writing in the journal Circulation in 1995, Eric Topol, MD, and Steven Nissen, MD, described this phenomenon as “an irresistible temptation among some invasive cardiologists to perform angioplasty on any significant residual stenosis after thrombolysis”—that is, after clot-busting medications have been used.

Nissen and Topol wrote that while professional organizations don’t support this practice, “the ritual of reflex angioplasty is exercised thousands of times each year.”

See on www.healthleadersmedia.com

For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.

For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.

USDOJ: Eight Individuals and a Corporation Convicted at Trial in South Florida in $50 Million Medicare Fraud

August 27, 2012 Leave a comment

Eight individuals and a Miami-based corporation were convicted by a federal jury for their participation in a Medicare fraud scheme involving the submission of more than $50 million in fraudulent billings to Medicare, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced today.

Antonio Macli, the owner of Biscayne Milieu Health Center Inc., a mental health care corporation, his son Jorge Macli, Biscayne Milieu’s CEO, and Antonio Macli’s daughter Sandra Huarte, an executive at the company, were each found guilty in U.S. District Court for the Southern District of Florida of one count of conspiracy to commit health care fraud, and one or more substantive counts of health care fraud, conspiracy to commit a health care kickback scheme and conspiracy to commit money laundering and substantive counts of money laundering. Antonio Macli and Jorge Macli were also convicted of substantive kickback counts. Dr. Gary Kushner, the medical director at Biscayne Milieu, was found guilty of conspiracy to commit health care fraud and a substantive count of health care fraud. Rafael Alalu, a therapist, and Jacqueline Moran, who handled Medicare billing for Biscayne Milieu, were each found guilty of conspiracy to commit health care fraud and substantive counts of health care fraud. Anthony Roberts and Derek Alexander, two patient recruiters, were each found guilty of one count of conspiracy to commit a health care kickback scheme, and each was convicted of one health care kickback count.

The defendants were charged in a superseding indictment returned June 5, 2012. Twenty other individuals who worked at Biscayne Milieu have all previously pleaded guilty.

See on www.justice.gov

For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.

For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.

Texas Tribune — Proposed Medicaid Fraud Rules Worry Providers

August 25, 2012 Leave a comment

The state’s Health and Human Services Commission is seeking formal approval for new Medicaid fraud rules that doctors allege deny them due process and expand investigators’ power to halt their funding.

For months, HHSC’s Office of the Inspector General has been increasingly relying on a federal rule — part of President Obama’s health care plan — that allows the agency to freeze financing to any health provider accused of overbilling Medicaid. That means they can halt the flow of funding before they complete a full-fledged investigation, and often, providers say, before doctors are given any chance to defend themselves.

HSC says the new state rules — a rewrite of the existing statute — give investigators the tools to stop the bleeding before bad actors run off with the state’s money. They say fraud investigations aren’t opened without good reason, and the idea that there’s no due process is preposterous.

The agency says the new rules, which must be approved by the executive commissioner, are necessary to bring the state in line with federal health reform and measures passed in the last legislative session. It is “mostly a clean-up of the existing rules,” agency spokeswoman Stephanie Goodman said.

But attorneys for health care providers, who are still trying to parse the rewritten rules, say the language the state is preparing to codify appears to put even more power into investigators’ hands than what they’ve already received from the federal government.

See on www.texastribune.org

For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.

For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.

Forbes Insights: Getting From Volume to Value in Health Care

August 25, 2012 Leave a comment

Download this Forbes Insight Report.  This is the challenge of healthcare reform in this country.

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Value-based purchasing, where cost and quality are each integral parts of the equation, is now widely seen as a replacement for traditional fee-for-service reimbursement. For senior hospital and health system executives, the challenge is getting from the-way-things-have-always-been to the-way-things-will-be without tumbling into a fiscal chasm because of the-way-things-are-now.

Getting From Volume to Value in Health Care: Balancing Challenges & Opportunities examines the issues and concerns vital to chief executive officers, chief financial officers and chief medical officers who are charged with leading their institutions on that quest. While as a group they are cautiously optimistic and endorse the goals that value-based purchasing seeks to achieve, they know that the path is neither straightforward nor obstacle free.

See on www.forbes.com

Are meaningful use incentives worth the hassle?

August 23, 2012 Leave a comment

It’s no secret that hospitals are unlikely to recover much of the money they spend on electronic health record (EHR) implementation through the meaningful use incentive program. But experts say hospitals need to watch out for the long-term costs associated with using EHRs. If technology initiatives are not planned effectively, these expenses may quickly swamp a hospital’s finances and have a much more lasting impact than the up-front money hospitals have to pay to get systems up and running.

Methodist Health System, a Texas group comprised of six hospitals and a network of ambulatory medical offices, has implemented EHRs throughout its system and is currently receiving incentive payments. But Pamela McNutt, the system’s senior vice president and CIO, said these payments only covered a fraction of the up-front implementation costs. When the total cost of ownership of the EHR system is added up, the meaningful use incentives may not actually be all that meaningful for the system’s bottom line.

See on searchhealthit.techtarget.com

For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.

For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.

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