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From HMOs to ACOs: Meet the newest model in health care management – TwinCities.com
When critics look at health care in America, many describe a system that’s fragmented, inefficient and burdened with waste.
Doctors and hospitals generally are paid a fee for every service they provide, the critique goes, so they lack financial incentives to effectively coordinate care and make sure patients get only the services they need.
Patients often have a front-row seat on the dysfunction, critics say, as they are shuffled off to specialists without needed paperwork, undergo unnecessary tests or make repeat hospital visits when medical centers don’t get it right the first time.
Enter “accountable care organizations,” a new structure in health management that the federal government, health insurers and some physicians hope will tame the woes. Doctors, hospitals and clinics would be given responsibility to provide care for a group of patients — within a budget. If health care providers better coordinate care to provide good quality for less money, they can share in the savings.
Republicans and Democrats “agree that transitioning from fee for service to global payments in health care will be necessary in order to deal with the budget deficit,” Bottles wrote in an email. “The consolidation of the health care industry will continue no matter which party prevails in the November election.”
This push for accountable care organizations (or “ACOs”) is driving a consolidation trend among health care companies that’s increasingly being felt in Minnesota. The clearest example is a plan announced in August to combine the HealthPartners and Park Nicollet health systems into one of Minnesota’s largest nonprofit health companies, with 20,000 employees, including 1,500 physicians.
See on www.twincities.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.
Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation
Annals of Family Medicine — Sept/Oct 2012 Issue:
Conclusions: If portions of preventive and chronic care services are delegated to nonphysician team members, primary care practices can provide recommended preventive and chronic care with panel sizes that are achievable with the available primary care workforce.
Discussion: Solving the primary care dilemma—excessive panel sizes in an environment of a primary care physician shortage—requires the replacement of physician-only care with team-based care. Such an unprecedented change in both the culture and structure of primary care practice can be accomplished only through a change in clinician mindset, the training of nonclinician team members, the mapping of workflows and tasks, the creation of standing orders that empower nonclinicians to share the care, the education of patients about team-based care, and the reform of primary care payment. Fortunately, all these elements are being implemented in many innovative primary care practices around the United States. These practices point to a future of high-functioning primary care teams that can ensure health care access and quality for the nation’s population with a reasonable work life for physicians and other team members.
See on www.annfammed.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.
Team Models Could Provide Care for Increased Patient Loads | Science Codex
While patient studies show that cancer survivors don’t even want to use a primary care physician for anything more elaborate than shining a light in their ear, service surveys show that doctors are already trying to see too many patients – a problem that will only get worse when the Afforadable Care Act mandates go into force.
Primary care is facing the dilemma of excessive patient pool sizes, authors claim — the average primary care physician’s panel size of 2,300 is too large for delivering good care under the traditional practice model — and we are about to witness an environment of primary care workforce shortage, which means patient panel size will only increase.
Solution: let someone besides doctors handle a lot of stuff that some patients don’t even want their general practitioner handling.
See on www.sciencecodex.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: US Attorney’s Office New Jersey – Fifth New Jersey Health Care Practitioner Pleads Guilty In Cash-For-Patients Scheme
NEWARK, N.J. – Dinesh Patel, a New Jersey doctor practicing in Newark, pleaded guilty today to participating in a cash-for-patients scheme with a diagnostic facility in Orange, N.J., and agreed to pay back thousands of dollars in bribe money he received in the past two years, U.S. Attorney Paul J. Fishman announced.
Patel, 58, of Livingston, N.J., pleaded guilty today before U.S. District Judge Claire C. Cecchi to an Information charging him with one count of violating the federal healthcare program anti-kickback statute. Patel will forfeit $7,600 he received in kickbacks during the years 2010 and 2011.
According to documents filed in this case and statements made in court:
On Dec.13, 2011, Patel was arrested and charged with accepting cash kickback payments from Orange Community MRI (“Orange MRI”), a diagnostic facility, in exchange for his referral of Medicare and Medicaid patients. Also on Dec. 13, 2011, 12 other New Jersey doctors and one nurse practitioner were arrested and charged in separate complaints with accepting similar cash kickback payments from Orange MRI. As revealed in the Complaints, each of the defendants were recorded taking envelopes of cash in exchange for patient referrals. On Dec. 8, 2011, an Orange MRI executive was arrested and charged in a separate Complaint in connection with his participation in the scheme.
Patel is the fifth person arrested in the December 13 takedown to plead guilty. In all, the five defendants who have pleaded guilty thus far accepted nearly $150,000 in illegal kickbacks from Orange MRI.
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.
Prices soar in North Carolina as hospitals purchase oncology practices and dominate cancer market
Large nonprofit hospitals in North Carolina are dramatically inflating prices on chemotherapy drugs at a time when they are cornering more of the market on cancer care, an investigation by the Observer and The News & Observer of Raleigh has found.
The newspapers found hospitals are routinely marking up prices on cancer drugs by two to 10 times over cost. Some markups are far higher.
It’s happening as hospitals increasingly buy the practices of independent oncologists, then charge more – sometimes much more – for the same chemotherapy in the same office.
Asked about the findings, hospital officials said they are relying on a longtime practice of charging more for some services to make up for losses on others. Hospitals have a name for this: cost-shifting. …
Unlike many independent clinics, they say, hospitals suffer losses from treating patients without insurance and patients covered by Medicaid, the government program for the poor and disabled. Some independent oncologists acknowledge that they often refer such patients to hospitals.
Hospital officials say they provide counseling and many other cancer services that insurers don’t cover.
Officials for Carolinas HealthCare and Novant, which runs four Mecklenburg County hospitals, emphasize that they provide free care to many financially needy cancer patients.
See on www.charlotteobserver.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.
AAFP recommends greater role for primary care docs in Medicare | Healthcare Finance News
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.
HCA Probe Spotlights Cardiologists’ ’Irresistible Temptation’ – HealthLeaders Media
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.
Forbes Insights: Getting From Volume to Value in Health Care
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
Legal Implications of Physician Relationships with Medical Supply and Distribution Companies | Physicians News
Increased federal investigation into alleged inappropriate arrangements between the pharmaceutical and medical device industries and physicians has led to significant scrutiny over certain “distribution” arrangements. Most recently, physician-owned distributorships (“PODs”) have come under attack. Inspector General Levinson recently outlined plans for the Office of Inspector General’s (“OIG”) nationwide study to determine the extent to which PODS supply spinal implants to hospitals and will evaluate, among other things, the proliferation of PODs and whether they offer any cost savings to hospitals. Proponents argue that PODs can result in reduced pricing on medical devices to hospitals because of the lower distribution costs and increased quality of products, including customization. Opponents, however, argue that PODs are nothing more than a mechanism used to reward physicians for referrals. PODs are just one of several ventures that have attracted physicians in the medical device supply chain. There are a number of laws and regulations governing these arrangements.
See on www.physiciansnews.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.
Texas Attorney General Indicts Orthodontist for Health Care Law Fraud in State and Federal Probe
Dr. Michael David Goodwin, 63, an orthodontist who practices in Amarillo, Texas, and Crown Point, Indiana, has been charged in a federal indictment with 11 counts of health care fraud, alleging that he defrauded the Texas Medicaid program of approximately $1.5 million, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.
According to the indictment that was returned by a federal grand jury today, approximately 90 to 95 percent of Goodwin’s orthodontics’ patients were Medicaid beneficiaries. The Texas Medicaid program provides orthodontic services for Medicaid beneficiaries who fit the following criteria: 1) children who are 12 years old and older with severe handicapping malocclusions; 2) children who are up to 20 years old with cleft palate; or 3) other special medically necessary circumstances, including crossbite therapy and head injury involving severe traumatic deviation.
See on www.oag.state.tx.us
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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