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Archive for the ‘Physician Practices’ Category

South Shore Physicians Hospital Organization in Kickback Scheme — Did DOJ Get it Wrong?

February 1, 2015 Leave a comment

In its news release on January 20, the U.S. Attorney’s Office for the District of Massachusetts announced that that the South Shore Physician Hospital Organization in South Weymouth has agreed to pay $1.775 million to settle allegations of operating a recruitment grant program through which it paid kickbacks to its physician members in exchange for patient referrals.  The news release talks about false claims as if the care was not given, but the claims were only “false” because of the kickback taint.

There is great pressure on physicians and hospitals to form networks to capture patients, improve care, and reduce costs.

Without knowing, I am guessing that the grant program by SSPHO was intended to build the network and reward physicians who joined (and referrals were probably required to be made to the hospital and other physician network members). I can see how this could be construed to be a kickback, but we need these networks and I suspect that no harm was done to the Medicare or Medicaid programs.

Even if my guess about the SSPHO is wrong, it’s still time that we allowed healthcare innovators and entrepreneurs to act like real business people and recruit and reward participants in a sensible and straightforward manner — without calling it a kickback.

 

CMS launches database of manufacturer and GPO payments to physicians

October 3, 2014 Leave a comment

The following post will also be published today on the Akerman Health Rx blog.

The Affordable Care Act contains a provision known as the Physician Payments Sunshine Act, which requires the Centers for Medicare and Medicaid Services (“CMS”) to establish a national databank containing information on the financial relationships between physicians (which includes dentists, chiropractors, and other physician specialties) and teaching hospitals, applicable manufacturers, and group purchasing organizations (“GPOs”).  CMS launched its Open Payments website on September 30, 2014 , making its database available to the public.

The database is populated by information reported to CMS by applicable manufacturers and GPOs regarding their payments or other transfers of value to physicians and teaching hospitals.  It is important to note that this reported information specifically includes any ownership or investment interest that physicians (and their immediate family members) have in the manufacturers and GPOs.

CMS encourages physicians and teaching hospitals to register with the Open Payments website.  While registration is voluntary, the reported information is made available to registrants before being made public, and registrants are given an opportunity to dispute any reported information.  In fact, there is a mobile app (and other resources) that allows physicians, teaching hospitals, manufacturers, and GPOs to track provider and industry contact details, share information, and track payments and other transfers of value.

According to CMS and as reported, 4.4 Million payments valued at nearly $3.5 billion were made to 546,000 individual physicians and 1,360 teaching hospitals in the last five months of 2013.  The website will provide future reports on an annual basis.  Beginning in June 2015, it is expected to report twelve full months of data.

We know that the public, and in particular the press, will access the Open Payments database, and there will likely be a high level of misunderstanding and misinformation.  One cannot forget the feeding frenzy that arose when CMS released physician Medicare billing data  earlier this year.  Any physician who receives payments from a manufacturer or GPO would presumably want advance notice of any disclosure regarding payments to that physician.   Accordingly, any physician who does receive such payments should register on the Open Payments website and check the accuracy of all information reported about them, and be prepared to answer questions they may be asked.

AMA President-Elect Wakes Up in 21st Century

September 18, 2014 Leave a comment

On Tuesday, the AMA issued a press release “AMA Calls for Design Overhaul of Electronic Health Records to Improve Usability” about its landmark study with the Rand Corporation, “confirming that discontent with electronic health records … is taking a significant toll on physicians.”  Steven J. Stack, president-elect of the AMA was quoted extensively in the release.

One has to wonder whether Steven “Rip Van Winkle” Stack has been sleeping for the past 5 years or was just off visiting relatives on a distant planet.  Same for the Rand Corporation.  One also has to wonder how much the study cost.  One can sure, however, that if the government had done the study, it would have been a clear contender for a Golden Fleece Award.

Physicians in this country have been abandoned and left alone to deal with the thousands of software charlatans selling inadequate EHR products.   Many physicians are on their second EHR system, and some are still looking for something that works.

EHRs and the data that they can produce are critical in dealing with questions of population health and focusing on prevention rather than procedures, all of which will promote more cost-effective health care.

Hopefully, now that the AMA in on task, something useful can be derived from the desolate software environment.

Vascular Access Centers: A Complex Picture

September 18, 2014 Leave a comment

Physicians are under a lot of pressure to improve their bottom line. In office procedures as described in this blog, as well as investments in surgery centers and other business ventures, all bring levels of needed regulatory compliance and increased regulatory scrutiny. From the business side, there are many stories of corporate partners from Hell! Before getting involved in any of these “opportunities,” physicians should work closely with their legal and financial advisors.  An ounce of legal prevention is worth a pound of very expensive legal cure.

Florida Healthcare Law Firm Blog

bcbs lawsuitBy: Jeff Cohen

Vascular access centers are a common ancillary service offered by a variety of physicians, mostly nephrologists.  They provide a unique setting for patients requiring interventional vascular services in connection with things like oncology, dialysis, nutritional delivery, wound healing, pain management and more.  Unlike many surgical services, however, they are typically not provided via a surgery center, but rather as part of (and inside) the physician’s practices.

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Charlotte’s Tangled Web — Florida’s New Law on Medical Marijuana

August 24, 2014 Leave a comment

 

Stetson

USF Health

I invite you to register for this timely and lively program, “Charlotte’s Tangled Web – Considerations for How Doctors and Lawyers Might Avoid the Legal Entanglements of Medical Marijuana in Florida.”

It is being sponsored by Stetson University College of Law and USF Health.  I will be one of the speakers.

Legal and medical continuing education credit has been applied for.

Ohio Cardiologist Indicted for Performing Unnecessay Medical Procedures

August 24, 2014 Leave a comment

“The charges in this case are deeply troubling,” U.S. Attorney Dettelbach said. “Inflating Medicare billings alone would be bad enough. Falsifying cardiac care records, making an unnecessary referral for open heart surgery and performing needless and sometimes invasive heart tests and procedures is inconsistent with not only federal law but a doctor’s basic duty to his patients.”

“This doctor violated the sacred trust between doctor and patient by ordering unnecessary tests, procedures and surgeries to line his pockets,” Special Agent Anthony said. “He ripped off taxpayers and put patients’ lives at risk.”

Just another case where greed coupled with disregard for his patients’ welfare led a physician to commit fraud on the government and commercial insurers and to forsake his Hippocratic oath to do no harm.  Here, the physician not only ordered unnecessary and more invasive procedures than the patient needed but also falsified nuclear test results to justify the unnecessary procedures.

While there is no way to prevent greed like this (other than locking the bastards up), I have predicted in other posts that the migration of medical reimbursement from procedure based to quality of care of the patient will reduce the incentive to perform unnecessary tests and hopefully reduce this kind of fraudulent activity.

What Providers Need to Know Before They Balance Bill

August 16, 2014 1 comment

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.

Florida Healthcare Law Firm Blog

ACO-Payment-300x225

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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12 Questions to Guide Physician Compensation Strategy

August 9, 2014 Leave a comment

From Healthcare Intelligence Network — essentially a sales promo for their book.  According to HIN, a successful physician compensation strategy includes organizational goals, governance, and physician engagement.  This is slanted from the healthcare organization viewpoint.

Nevertheless, still worth a look.

 


9 Measures of ACO Success

Via: Healthcare Intelligence Network

HFMA Research Report — Value-Focused Acquisition & Affiliation Strategies

July 26, 2014 Leave a comment

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.

Tele-ICU connects rural patients

July 26, 2014 Leave a comment

As hospitals are closed and patients need access to physicians who may be far away, telemedicine is one answer.

This YouTube video provides a good insight on tele-ICU and the value it brings to rural patient care.

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