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AHLA Health Law Curriculum Toolkit
The American Health Lawyers Association is devoted to education on the legal issues in the healthcare field. It has over 12,000 members.
The AHLA recently published its Health Law Curriculum Toolkit to address practice readiness of law school grads wanting to practice in the area of healthcare law. The Toolkit is illuminating as to what the field of health law is and the issues and requirements that law schools and employers have in dealing with law students and law graduates interested in the field.
What Providers Need to Know Before They Balance Bill
A very important topic that can get providers into hot water if they do not take the time to understand the requirements of their managed care contracts and Florida law.
By: Karina Gonzalez
Balance billing occurs when a provider collects from a patient the difference between the amount billed for a covered service and the amount paid for that service. Balance billing does not apply when collecting deductibles, copayments or coinsurance.
Under Florida law, a provider may not balance bill a patient for any service, if an HMO is liable and responsible for payment. Contrary to what many people believe, this is true whether you are in-network or out-of-network. Even hospital based out-of-network physicians, such as anesthesiologists, pathologists, radiologists or emergency room physicians cannot balance bill HMO members where the hospital has a contract with the HMO or there was authorization given for an episode of care.
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HFMA Research Report — Value-Focused Acquisition & Affiliation Strategies
A few weeks ago, the Healthcare Financial Management Association (“HFMA”) published a report examining healthcare acquisition and affiliation activity. The report is titled “Acquisition and Affiliation Strategies” and is available as a free download.
There are no surprises in the Report’s so-called “research highlights.” In fact, the highlights are ho-hum obvious:
An emphasis on value-focused strategies. The healthcare organizations interviewed for this report understand that the best way to gain market share is by meeting care purchasers’ demand for high quality, convenient access, and competitive prices. They are seeking acquisition and affiliation partners that will help them achieve these goals.
An understanding that different needs require different approaches. Organizational needs vary greatly depending on local market conditions and the organization’s mission, existing capabilities, and future goals. Organizations are considering a range of partners and partnership opportunities to meet these needs, often pursuing several options simultaneously.
The emergence of new organizational combinations. Healthcare organizations are growing both horizontally (e.g., hospital to hospital) and vertically (e.g., healthcare system to health plan), and different types of organizations are combining forces (e.g., academic medical centers and regional health systems).
A blurring of the lines between competition and collaboration. Market conditions and organizational needs are opening up collaborative possibilities for organizations that may have viewed one another as competitors.
The need to change governance and support structures as organizations change. As organizations grow and gain new capabilities, they are reevaluating and reshaping existing board and management structures, IT systems, financial systems and fund-flow models, and physician relationships to accommodate the changes.
However, the conclusion reached by the Report is very telling:
Few doubt that the forces transforming health care today will lead to further consolidation within the industry. The difference is significant, however, between consolidation that seeks only to increase market power and an acquisition and affiliation strategy that seeks partners who can help produce the cost-efficiencies, gains in clinical quality, and access that care purchasers both need and demand. By taking the latter approach, healthcare organizations will be best-positioned to compete in their markets and win market share by offering patients, employers, and other purchasers a superior value proposition. [emphasis added]
The acquisition/affiliation focus of healthcare organizations has shifted away from market share and toward quality and cost-effective care. That is an important shift. Healthcare organizations that may have looked like good targets in the past may no longer be desirable. If an acquisition or affiliation is the goal, all parties need to make sure that their own healthcare houses are in order. Otherwise, they may be standing at the altar alone.
Hospitals Buy Clinics, Doctors’ Practices; Higher Prices Result
I’m shocked to find that hospital run care is more expensive (with apologies to Casablanca):
For the past four years, Pennsylvania insurance company Highmark has watched its bills for cancer care skyrocket. The increase wasn’t because of new drugs being prescribed or a spike in diagnoses. Instead, the culprit was a change that had nothing to do with care: Previously independent oncology clinics and private practices have been acquired by big hospital systems that charge higher rates, sometimes three times as much, for chemotherapy drugs. “The site of care and the type of service provided does not change at all,” says Tom Fitzpatrick, Highmark’s vice president of contracting. “The only significant difference that we primarily see is the [patient] gets a wristband placed on them.”
Hospitals have long charged more than freestanding medical offices for similar services. It’s part of how they pay for higher operating expenses such as running 24-hour emergency rooms. As the Affordable Care Act attempts to steer people away from pricey inpatient admissions, hospitals have begun buying up doctors’ offices in hopes of increasing their revenue and market share. The number of oncology practices owned by hospitals increased by 24 percent from 2011 to 2012. By turning what used to be independent medical offices into so-called hospital outpatient centers, hospitals are creating networks that, critics say, give them the power to set prices and ultimately raise costs for private insurers and government programs such as Medicare.
From Businessweek: Hospitals Buy Clinics, Doctors’ Practices; Higher Prices Result
Concern mounting over Prime Healthcare pursuit of Bay Area hospitals – San Jose Mercury News
A controversial Southern California-based hospital chain that buys financially struggling hospitals has surfaced as a bidder for the beleaguered Daughters of Charity Health System, which operates four Bay Area hospitals that serve the poor.
But the overture by Prime Healthcare Services isn’t playing well with local hospital employee unions, who say the chain’s checkered history shows it will turn its back on low-income patients and slash workers’ pay and benefits.
Source: www.mercurynews.com
So, we know this is the way that healthcare is going — consolidation into bigger and bigger organizations. In the short run quality should go up and costs should go down. Hopefully. In the long run, I’m not sure bigger is better for anything.
Americans Pay Way More For This Than People In Other Countries
As anyone who’s ever paid a health insurance premium or a hospital bill knows, medical care is expensive. What Americans may not know is that residents of other countries don’t pay nearly as much for the same things.
The latest data from the International Federation of Health Plans, an industry group representing health insurers from 28 countries including the United States, once again illustrates that American patients pay the highest prices in the world for a variety of prescription drugs and common procedures like childbirth and hospital stays.
See on www.huffingtonpost.com
Everyone seems to know this except the Republicans in Congress.
Physician Compensation Strategy
This new infographic from the Healthcare Inteilligence Network is a good summary of the issues to deal with in the physician compensation decision making process:
12 Questions to Guide a Physician Compensation Strategy
A successful physician compensation strategy includes organizational goals, governance and physician engagement, according to Cynthia Kilroy, senior VP of provider strategy and business development, Optum.
This new infographic from the Healthcare Intelligence Network features 12 questions to guide the implementation of a physician compensation strategy for healthcare organizations. Addressing all three areas of the strategy can improve satisfaction while creating an environment and structure that supports transparency and enables quality and efficiency.
Physicians and their Employment Agreements
I have posted in the past on the various issues and minefields facing physicians when getting their employment agreement — especially those physicians newly emerging from residency and fellowship programs and entering the so-called “real” world.
In a post yesterday on the KevinMD.com blog, “Only an attorney can operate on your employment agreement”, the author reminds physicians of the need to have a healthcare lawyer assist them in reviewing any proposed employment agreement.
The AMA has also published materials to assist physicians in reviewing their employment agreements.
As physician practice models continue to evolve, there will be increased pressure on physicians to accept what is offered. However, most of the time, problematic provisions are negotiable. And even when they are not, a lawyer can help the physician understand the risks in “taking or leaving it.”
Just as regular people should not try to evaluate their own health situation without help from a physician, physicians should seek professional advice themselves when presented with legal documents. Contracts have meaning and failing to understand what one is signing is like taking someone else’s medication. Benjamin Franklin’s saying that “an ounce of prevention is worth a pound of cure” applies to legal situations as much as to medical ones.
Medibank Private to push benefits of preventive healthcare
MEDIBANK Private has been given the go-ahead to launch a co-ordinated attack on the costly chronic disease burden by promoting the benefits of user-pays and preventive health schemes that could result in lower premium increases.
Healthcare and controlling healthcare costs have become global concerns for the West. What is going on in the East — is health and healthcare better, or is concern over healthcare an unaffordable luxury for countries whose economies are woefully behind and desperately trying to catch up?
See on www.theaustralian.com.au
New Hopes for Apple’s HealthBook | HL7 Standards
Leonard Kish offers his thoughts on the promise of Apple entering the mHealth arena, which will put a spotlight on squarely on user experience.
There are a zillion health and exercise monitoring apps. All are relatively young, because the smart phone platform is relatively young.
So my question is — are people actually getting healthier? If they are, is the better health the result of the apps or the result of our near obsessive interest (with or without real results) in getting healthier?
See on www.hl7standards.com
Health News Florida
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Physicians Practice
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Joseph Rugg's Health Law Blog 