Archive
HealthLeadersMedia’s Top 5 Physician Challenges in 2011
HealthLeadersMedia has identified the “Top 5 Physician Challenges in 2011.”
The author of the article, Joe Cantlupe, describes these challenges as “carry-overs, issues that unfolded in 2010, and will continue to be important for physicians in 2011, whether physicians are changing their practices or cutting back on their hours. These are certainly hot-button issues …”
The five challenges are listed below (linked to some additional explanatory material), but read the entire article for the complete discussion.
1. “Doc Fix”
3. Impact of Primary Care Shortages
CMS EXPANDS HEALTHCARE PROVIDER DIRECTORY
Yesterday, CMS announced its enhancement of its Physician Directory tool, which now will includes new information about physicians and other healthcare workers. The Physician Directory website is now called “Physician Compare.”
The new website, which was required by the Affordable Care Act of 2010, contains information about physicians enrolled in the Medicare program (M.D.s, D.O.s, O.D.s, D.P.M.s, and D.C.s). The site also contains information about other types of health professionals who routinely care for Medicare beneficiaries, such as nurse practitioners, clinical psychologists, registered dietitians, physical therapists, physician assistants, and occupational therapists.
The goal of the new website is to provide more provider-specific information for Medicare beneficiaries and other consumers. Presently, the information on the site includes contact and address information for offices, the professional’s medical specialty, where the professional completed his or her degree as well as residency or other clinical training, whether the professional speaks a foreign language, and the professional’s gender.
Later in 2011, CMS plans a second phase of the “Physician Compare” website which will indicate whether professionals choose to participate in a voluntary effort with CMS to prescribe medicines electronically.
More important, in future years, CMS will expand the “Physician Compare” website to include information about the quality of care Medicare beneficiaries receive from the healthcare professionals profiled on the website. This will include information on quality of care and patient experience. The Affordable Care Act requires CMS to develop a plan to implement this expansion by 2013.
New Disclosure Requirements for In-office Ancillary Services
The Healthcare Reform Act Section 6003 adds an additional requirement to the Medicare in-office ancillary exception under the Stark law and regulations that requires the referring physician to inform the patient in writing that the patient may obtain the specified service (magnetic resonance imaging, computed tomography, and positron emission tomography) from a person other than the referring physician or the referring physician’s group. Although this statutory requirement went into effect on January 1, 2010, CMS stated in its July proposed regulations implementing this requirement that disclosure will only be required for services furnished after the regulation takes effect on January 1, 2011.
The proposed regulation is as follows:
42 CFR 411.355 General exceptions to the referral prohibition related to both ownership/investment and compensation.
* * * * *
(b) * * *
(7) Disclosure requirement for certain imaging services.
(i) With respect to magnetic resonance imaging, computed tomography, and positron emission tomography, the referring physician shall provide written notice to the patient at the time of the referral that the patient may receive the same services from a person other than one described in paragraph (b)(1) of this section. Except as set forth in paragraph (b)(7)(ii) of this section, the written notice shall include a list of at least 10 other suppliers (as defined in Sec. 400.202 of this chapter) that provide the services for which the individual is being referred and which are located within a 25-mile radius of the referring physician’s office location at the time of the referral. The notice should be written in a manner sufficient to be reasonably understood by all patients and should include for each supplier on the list, at a minimum, the supplier’s name, address, telephone number, and distance from the referring physician’s office location. A record of the disclosure notification, signed by the patient, shall be maintained as a part of the patient’s medical record.
(ii) If there are fewer than 10 other suppliers located within a 25-mile radius of the physician’s office location at the time of the referral, the physician shall list all of the other suppliers of the imaging service that are present within a 25-mile radius of the referring physician’s office location, including up to 10 suppliers. Provision of the written list of alternate suppliers will not be required if no other suppliers provide the services for which the individual is being referred within the 25-mile radius.
The government’s commentary on this new regulation can be found here.
Where Are We on Implementing Healthcare Reform?
CMS provides a 38 page pdf on all the provisions in the Healthcare Reform Act and the status of regulations that have proposed or finalized — at least as of September 24, 2010. That pdf can be found and downloaded (including links to regulations) at
CMS Proposed Rule on Health Care Reform Act’s Program Integrity Provisions
Healthcare fraud is a multi-billion dollar problem. The Health Care Reform Act adopts a number of so-called “Transparency and Program Integrity Provisions” to help combat this fraud (Title VI, sections 6001-6703). While it is easy to conclude that these provisions are another example of the government’s overreaction to an actual problem, healthcare providers cannot ignore them.
On September 23, CMS published in the Federal Register its proposed rule on “Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers.” The proposed rule is intended to transition CMS’s antifraud activities from “pay and chase” to fraud prevention. The complete proposal can be found at http://tinyurl.com/24cv3lw. Comments have been solicited and must be received no later than November 16, 2010.
Over the next several posts, we will explore the proposed rule and what it means to healthcare providers.
Health Care Reform Act — Where We Are
Politics is not an exact science.
Politics is the art of the possible.
— Otto von Bismarck
On March 23, and March 30, 2010, the President signed into law what is commonly known as the Health Care Reform Act. It is comprised of the Patient Protection and Affordable Care Act of 2010 (“PPACA”) as amended by the Health Care and Education Reconciliation Act of 2010 (“HERA”).
The consolidated Congressional print of the combined Acts takes up 907 pages.
A headline discussing an AP Poll that came out in late September stated that the health care reform law is making us “muddle-minded.” The poll’s questions included a true-or-false quiz asking whether each of 19 different items was (or was not) included as part of the Health Care Reform. Along with their answer to each of the questions, respondents were also asked how confident they felt in their answers. For the most part, majorities picked the right answers. But a sizable number also got things wrong. And right or wrong, people were unsure of their answers. By the way, I looked at the questions, and I’m not sure I could have answered them correctly.
Lawsuits have been filed challenging the constitutionality of those parts of the law that penalize individuals who fail to purchase health insurance, arguing that the federal government cannot tax or otherwise assess an economic penalty over individuals who refuse to participate in economic activity. In response to the government’s motion to dismiss one lawsuit that was filed in the Northern District of Florida, the federal judge ruled that the lawsuit could proceed. On the other hand, in a case filed in the Eastern District of Michigan, another federal judge ruled that “the Commerce Clause affords Congress broad power to regulate even purely local matters that have substantial economic effects,” finding that “by choosing to forgo insurance plaintiffs are making an economic decision to try to pay for healthcare services later, out of pocket, rather than now through the purchase of insurance, collectively shifting billions of dollars, $43 billion in 2008, onto other market participants.” It is expected that the constitutionality of this provision of the law will ultimately be determined by the U.S. Supreme Court.
In the meantime, regardless of the outcome of the court challenges, the law is likely to have a significant effect on healthcare providers as aspects of the law are implemented.
The Health Care Reform Act is comprehensive and affects, or is slated to affect, nearly all parts of the health care insurance and delivery systems. It includes insurance reforms, tax changes, Medicare and Medicaid coverage and payment changes, and establishes a number of entities to conduct demonstration projects on new ways to deliver health care or train those who participate in the health care delivery system.
Rulemaking is just beginning, and a number or proposed and final regulations have already been promulgated. The Health Care Reform Act is to be implemented over the next five years or more. The following is a list of some of what is scheduled to happen and when:
March 23, 2010 (Upon Enactment) — Fraud and abuse provisions are effective, such as overpayments, anti-kickback statute amendments, false claims act amendments, expanded subpoena authority, and Stark law disclosure requirements relating to the in-office ancillary services exception.
June 23, 2010 (90 Days After Enactment) — Temporary retiree reinsurance program and national high risk insurance programs become effective.
September 23, 2010 (6 Months After Enactment) — Coverage for adult children up to age 26, plans prohibited from rescinding coverage, pre-existing conditions prohibited for children under the age of 19, plans prohibited from rescinding coverage.
2011 — Medicare Advantage payment freezes pending restructuring of rates, and prohibition on physician ownership in hospitals.
2012 — Allow providers organized as accountable care organizations to share in cost savings achieved for the Medicare program; excess readmission provision goes into effect, and drug manufacturers must report information relating to drug samples.
2013 — Drug, device and supply manufacturers must begin disclosing payments to physicians and teaching hospitals, and hospital organizations must conduct community needs assessments.
2014 — No pre-existing condition limitations or annual limits on coverage, and the individual mandate begins, Medicaid expands eligibility, and health insurance exchanges commence.
2015 — Independent payment advisory board established to propose changes in Medicare payments.
Joseph Rugg's Health Law Blog 