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Primary care doctors becoming more involved in mental health care
Don’t be surprised if your family doctor seems as interested in your brain as in your body. (RT @BeneficentGuild: Primary care doctors becoming more involved in mental health care – The Observer-Dispatch, Utica, N.Y. See on www.uticaod.com
This is not a new situation. The AMA reported on this trend in 2010, as resulting largely from increased focus on depressions and other mental health issues and the lack of psychiatrists for treatment.
Can we learn something from America – Accountable Care Organisations
It has become de rigueur on the left to regard the US healthcare system as the very incarnation of evil and therefore a country from which nothing of value can be learned for improving our NHS. This might be about to change. There is now growing interest in the notion of the ‘Accountable Care Organisation’ (ACO) – or as it is tending to be termed over here, the Accountable Integrated Care System.
The Accountable Care Organisation concept is gathering pace in the US following the 2010 Patient Protection and Affordable Care Act, which included a pilot programme to explore ACO structures and processes. Under the new law, an ACO would agree to manage all of the healthcare needs of a minimum of 5,000 Medicare beneficiaries for at least three years. The ACO can gain extra money through sharing savings (with Medicare) resulting from collaborative efforts to provide care cost-effectively. Stringent governance conditions must be met, along with transparency and quality performance – Medicare ACOs will report on 33 different quality metrics.
In his recent ‘Green Paper’ speech on future Labour Party health policy, Andy Burnham spoke of the need for “one service co-ordinating all of one person’s needs“, with the district general hospital “evolving over time into an integrated care provider from home to hospital“. Indeed, he went on to say:
“If we look to the US the best providers are working on that highly integrated basis, co-ordinating physical, mental and social care from home to hospital. We have got to take the best of that approach and universalise it here.” See on www.sochealth.co.uk
From the Socialist Health Association of Scotland. I don’t want to think about the ramifications of having an important part of Obamacare endorsed by a socialist health organization. However, labels aside the ability to provide coordination of care in a private setting is a good thing, which is why ACOs are so critical to meaningful healthcare reform.
Your EHR needs a population health management system
Office-based medical practice is changing fast. The government is providing incentives to those practices that use electronic prescribing and electronic records systems and will soon penalize those that don’t. Health reform will shortly deliver many newly insured patients to your office. A host of new patient care models aimed at making healthcare more team-based are emerging. Reimbursement tied to outcomes will demand a greater level of patient management and engagement in the care process.
Often, though, an EHR alone cannot provide the functionality necessary to manage a specific population of patients.
There are many reasons a practice may need to identify and proactively work with a defined group of patients. Primarily, it’s to insure they are receiving care according to the evidenced-based standards agreed upon by the practice. See on www.kevinmd.com
Many physicians are re-evaluating their first choice of EHR and are changing to others as they learn how they work and what is needed for their medical practices. This is just one more instanceof making saure your EHR is robust enough to add new important components as the need develops.
The New Imperative Of Patient Engagement For Hospitals And Health Systems
Currently, most hospitals and health systems focus on patient engagement because of their mission to deliver patient-centric care. These efforts are pursued despite the neutral or even negative economic consequences to these organizations, which operate within the fragmented, fee-for-service payment system. For example, care coordination attendant to patient engagement efforts will, at times, reduce demand for services and, thereby, reduce fee-for-service payments to providers.
As public and private sector health care purchasers shift payment models towards value and as demographic changes result in more chronically ill patients entering the health care system, patient engagement efforts will become increasingly important to the financial sustainability and clinical success of these hospitals and health systems.
New patient engagement efforts shift focus from the inpatient core of hospitals to ambulatory care settings and to the integration of care into the homes and communities of patients. To succeed at these efforts, organizations must build longitudinal partnerships with patients to drive ongoing management of chronic conditions and utilization of preventive care services to drive long-term quality and cost outcomes.
See more on healthaffairs.org
11th Circuit Upholds Florida’s Patient Self-Referral Act
From Akerman’s Health Law Rx Blog:
POSTED BY JOSEPH W. N. RUGG ON FEBRUARY 4, 2013
Last month, in the case Fresenius Medical Care Holdings, Inc. et al. vs. DVA Renal Healthcare, Inc., the 11th Circuit Court of Appeals upheld the constitutionality of the Florida Patient Self-Referral Act of 1992.
The Florida Legislature modeled the Florida Act after the federal Physician Self-Referral Prohibitions, or Stark law, that was passed in 1989. The Stark law has gone through a number of revisions and clarifications over the last 23 years, but the Florida Legislature has not kept the Florida Act up to date with the many changes in the Stark law. The result is that the Florida Act contains provisions that are either inconsistent with, or in some instances more burdensome than, the Stark law. This makes it difficult for healthcare businesses to operate in Florida, as Fresenius discovered.
Fresenius and the related appellants are out-of-state corporations that provide renal dialysis services in Florida, both directly and through subsidiary corporations, to patients suffering from end stage renal disease. Fresenius wanted to use a vertically integrated business model in Florida and refer all the patients’ blood work to associated laboratories. Fresenius stated that such a business model would be more efficient and better for patients. However, because the employee-physicians of Fresenius had a financial interest in the associated laboratories, they were prohibited by the Florida Act from referring their patients there for blood work.
Fresenius sued the Secretary of the Florida Department of Health and the members of the Florida Boards of Medicine and Osteopathic Medicine, arguing that the Florida Act is unconstitutional because it is (1) preempted by federal law, (2) violative of the dormant U.S. Constitution’s Commerce Clause, and (3) violative of substantive due process.
The Court of Appeals was not persuaded by any of the legal arguments made by Fresenius and upheld the constitutionality of the Florida Act.
The important take away from this case is that in Florida, as in many states, there are legal restrictions on a physician’s ability to refer patients to entities in which the physician may have an investment interest. Compliance with the Stark law is not enough. The Florida Act is much more restrictive. Moreover, Florida has its own versions of the anti-kickback and the false claims statutes. When physicians do business transactions in Florida, it is critical that all of the relevant statutes are carefully considered.
Akerman’s Health Law Rx Blog
I am pleased to announce my firm’s new health law blog, Health Law Rx Blog.
Akerman’s Health Law Rx Blog provides timely updates on the latest health law issues, keeping the firm’s clients, friends, and readers up to date on pertinent legal developments. Akerman attorneys regularly update the blog with changes in the law and other relevant news. As this is meant to be an interactive site, your comments and contributions are appreciated. I am one of the contributors, so I hope you will visit the blog often and participate in any discussions that interest you. I plan to shadow post articles from the blog that I think you will find interesting.
Content on Akerman’s Health Law Rx Blog is intended to inform you about legal developments, including recent decisions of various courts and administrative bodies. It should not be construed as legal advice or a legal opinion, and you should not act upon the information without seeking the advice of legal counsel.
With more than 550 lawyers and government affairs professionals and a network of 19 offices, Akerman is ranked among the top 100 law firms in the U.S. by The National Law Journal NLJ 250 (2012). The firm’s Healthcare Practice Group includes over twenty attorneys and professionals representing health systems, physicians, health insurers, and other clients in all aspects of healthcare law across Florida and throughout the United States.
Is Concierge Medicine Finally Ready for Takeoff? – HealthLeaders Media
For years observers have been predicting the impending migration of physicians into direct pay or concierge medicine, where no longer will they have to accept low Medicare and Medicaid reimbursements or haggle with private payers.
Has that time finally arrived?
A recent survey of more than 13,500 physicians found that 6.8% of them would “embrace” direct pay or concierge medicine within the next three years. That includes 9.6% of practice owners, 7.7% of primary care physicians, and 6.4% of specialists, according to the survey conducted by physician recruiters Merritt Hawkins for The Physicians Foundation.
See on www.healthleadersmedia.com
Physicians have limited choices in front of them for how they will provide care in the future (and the future is now) — (1) maintain the status quo, (2) combine, merge, or consolidate with, or sell to, with other physicians, (3) sell to, or affiliate with, hospital systems or managed care companies, or (4) become independent of other physicians, of hospitals, and of managed care companies by doing concierge medicine.
Telehealth to Expand in Rural Communities with FCC $400 Million Fund
The FCC has announced $400 million will be made available through a healthcare connect fund to create and expand telehealth networks and services.
See on www.hitechanswers.net
Beth Kassab: Patients lose when hospitals take over doctors
When a big hospital chain buys an independent doctor’s office, we often hear the move will “enhance care”, “integrate care” or “improve health-care efficiency.”
Spare us the euphemisms.
Patients are the losers in these deals.
We pay higher costs. We get fewer choices because doctors are pressured to refer patients only to providers who also work for the hospital. And, because these acquisitions are so common today, an independent doctor’s office is becoming as quaint as the house call.
Unfortunately, this is the entire article and is much too short to discuss a topic full of so many nuances. Tough issues need far more analysis and thought than this. The question to study is, if the goal of physician practice acquisitions is integration of healthcare to enhance and improve the patient experience while reducing costs, then where are the disconnects? Why are hospitals and physicians failing (assuming this “reporter” is correct in her bottom line conclusion)?
See on articles.orlandosentinel.com
Physician groups eye mergers but blindsided by legal fights – amednews.com
Declining payments and increasing financial pressures have led more physicians to become employees of large medical groups and hospitals. At the same time, the Affordable Care Act is prompting smaller practices to consolidate as a way to more easily participate in new health system delivery models such as accountable care organizations.
But as physicians attempt to escape administrative burdens and financial stress, they are encountering another hurdle — legal disputes brought about by mergers.
See on www.ama-assn.org
Joseph Rugg's Health Law Blog 