http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 Most Recent Submissions from skern on Modern Medicine Community Fri, 10 Dec 2010 17:50:41 GMT Fri, 10 Dec 2010 17:50:41 GMT modmedadmin@advanstar.com (ModernMedicine) modmedadmin@advanstar.com (ModernMedicine) KickApps Feed Builder 2010-12-10T17:50:41Z 33 http://community.modernmedicine.com/service/searchEverything.kickAction?as=33379&includeVideo=on&includeAudio=on&includePhoto=on&includeBlog=on&sortType=recent 0 http://community.modernmedicine.com/_Sue-The-Bastards/blog/3084310/33379.html High unemployment rates, lethargic recovery, 401(k)’s still down 20%. Sounds dismal? Apparently not for those involved in our nation’s legal system. According to a recent report by the National Center for State Courts, 106 million new cases were filed in state courts in 2008, the last year in which statistics were available, with civil cases increasing by a record 1.3 million or 7%. The increase in civil cases, according to the report, was “likely spurred by the faltering economy.” The report found that the total number of new cases represented a 12% increase over 10 years, with the largest increase in the filing of civil cases—up 29% in 10 years and an astonishing 7.3% between 2007 and 2008 alone. In fact, the civil caseload has increased by an average of over 5% in each of the most recent years reported. In 2005, the rate of incoming civil cases was 5,565 per 100,000 population in the United States. By 2008, that figure rose to over 6,300 per 100,000. The figures offer other revelations. The largest category of cases, by far, is those that produce revenue to states and local governments. Traffic violations represent 54.3% of all cases. Criminal cases, by contrast represent 20.1% of all cases, followed by civil cases at 18.3%, domestic relations at 5.4%, and juvenile at 2.0%. However, a methodological quirk in the way criminal cases are reported may result in double counting many of these cases, which means that civil cases may already exceed the number of criminal defendants being processed in state courts. The tremendous rise in civil cases should not go unnoticed by physicians. While the report does not break down civil cases by category, it is likely that the number of civil cases brought by or against physicians has increased dramatically in the past few years. While physicians generally think about civil cases as those involving personal injury, the largest share of civil cases involve contract disputes. As more and more physicians join group practices, accept employment with hospitals, purchase electronic health record systems, purchase more esoteric medical liability insurance, and lease ever-more expensive equipment, contracts become more a part of the business of medicine. And, just like every other business, these contracts can form the basis of expensive litigation if things don’t go as originally expected. In the not-too-distant past, an employment agreement was little more than a letter inviting a physician to a practice, and setting out salary, vacation, call schedule and when the physician may be eligible for partnership. Today’s employment agreements include critically important restrictive covenants, often reference esoteric medical malpractice policies that place the physician at risk, complicated buy-in provisions, and complex compensation formulas. One bright light in this otherwise gloomy report is that the total number of new tort claims—those involving personal injury, including medical malpractice—continue to fall. While declining only 0.6% between 2007 and 2008, the total caseload fell 25% from 1999 to 2008. In fact, based upon information from seven states, medical malpractice cases represent only 2.8% of all tort cases. Even more encouraging, states like Mississippi, which enacted tort reform in 2003, have realized a 45% reduction in the number of medical malpractice claims filed compared to 1999. New York, by contrast, has seen only a 1% reduction during the same time period. Other states reporting include Arizona (a 22% reduction), Connecticut (a 30% reduction), New Jersey (a 30% reduction), Rhode Island (a 34% reduction), and Oregon (a 42% reduction). Another finding that may affect physicians who purchased homes before the bubble burst, involves the number of mortgage foreclosure cases. Not surprisingly, these cases began to skyrocket in 2008 and will likely continue to challenge our court’s ability to handle them for years to come. Also increasing at staggering amounts are domestic relations cases seeking changes in support (up 28%), while at the same time, the number of divorce filings are down 8%—perhaps due to the increased cost of getting divorced, and the changing economic status of those divorced, as a result of unemployment and other changes in the economy. The clear message from this report is that the economic downturn is causing more and more people to turn to the courts, many to settle economic disputes. One bright light is in the area of tort cases, where reform has stemmed the tide of new personal injury cases. As a result, today’s physician may be more likely to face litigation to settle a contract dispute or a support obligation, than to resolve a malpractice claim. Unfortunately, while malpractice insurance policies protect the physician against the cost of the defending a malpractice case, similar insurance does not exist to pay the costs of litigating these other cases. Steven I. Kern, Esq, is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida. Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast. He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at skern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] High unemployment rates, lethargic recovery, 401(k)’s still down 20%. Sounds dismal? Apparently not for those involved in our nation’s legal system. According to a recent report by the National Center for State Courts, 106 million new cases were filed in state courts in 2008, the last year in which statistics were available, with civil cases increasing by a record 1.3 million or 7%. The increase in civil cases, according to the report, was “likely spurred by the faltering economy.” The report found that the total number of new cases represented a 12% increase over 10 years, with the largest increase in the filing of civil cases—up 29% in 10 years and an astonishing 7.3% between 2007 and 2008 alone. In fact, the civil caseload has increased by an average of over 5% in each of the most recent years reported. In 2005, the rate of incoming civil cases was 5,565 per 100,000 population in the United States. By 2008, that figure rose to over 6,300 per 100,000. The figures offer other revelations. The largest category of cases, by far, is those that produce revenue to states and local governments. Traffic violations represent 54.3% of all cases. Criminal cases, by contrast represent 20.1% of all cases, followed by civil cases at 18.3%, domestic relations at 5.4%, and juvenile at 2.0%. However, a methodological quirk in the way criminal cases are reported may result in double counting many of these cases, which means that civil cases may already exceed the number of criminal defendants being processed in state courts. The tremendous rise in civil cases should not go unnoticed by physicians. While the report does not break down civil cases by category, it is likely that the number of civil cases brought by or against physicians has increased dramatically in the past few years. While physicians generally think about civil cases as those involving personal injury, the largest share of civil cases involve contract disputes. As more and more physicians join group practices, accept employment with hospitals, purchase electronic health record systems, purchase more esoteric medical liability insurance, and lease ever-more expensive equipment, contracts become more a part of the business of medicine. And, just like every other business, these contracts can form the basis of expensive litigation if things don’t go as originally expected. In the not-too-distant past, an employment agreement was little more than a letter inviting a physician to a practice, and setting out salary, vacation, call schedule and when the physician may be eligible for partnership. Today’s employment agreements include critically important restrictive covenants, often reference esoteric medical malpractice policies that place the physician at risk, complicated buy-in provisions, and complex compensation formulas. One bright light in this otherwise gloomy report is that the total number of new tort claims—those involving personal injury, including medical malpractice—continue to fall. While declining only 0.6% between 2007 and 2008, the total caseload fell 25% from 1999 to 2008. In fact, based upon information from seven states, medical malpractice cases represent only 2.8% of all tort cases. Even more encouraging, states like Mississippi, which enacted tort reform in 2003, have realized a 45% reduction in the number of medical malpractice claims filed compared to 1999. New York, by contrast, has seen only a 1% reduction during the same time period. Other states reporting include Arizona (a 22% reduction), Connecticut (a 30% reduction), New Jersey (a 30% reduction), Rhode Island (a 34% reduction), and Oregon (a 42% reduction). Another finding that may affect physicians who purchased homes before the bubble burst, involves the number of mortgage foreclosure cases. Not surprisingly, these cases began to skyrocket in 2008 and will likely continue to challenge our court’s ability to handle them for years to come. Also increasing at staggering amounts are domestic relations cases seeking changes in support (up 28%), while at the same time, the number of divorce filings are down 8%—perhaps due to the increased cost of getting divorced, and the changing economic status of those divorced, as a result of unemployment and other changes in the economy. The clear message from this report is that the economic downturn is causing more and more people to turn to the courts, many to settle economic disputes. One bright light is in the area of tort cases, where reform has stemmed the tide of new personal injury cases. As a result, today’s physician may be more likely to face litigation to settle a contract dispute or a support obligation, than to resolve a malpractice claim. Unfortunately, while malpractice insurance policies protect the physician against the cost of the defending a malpractice case, similar insurance does not exist to pay the costs of litigating these other cases. Steven I. Kern, Esq, is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida. Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast. He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at skern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 10 Dec 2010 17:51:35 GMT http://community.modernmedicine.com/_Sue-The-Bastards/blog/3084310/33379.html skern 2010-12-10T17:50:41Z Malpractice Concerns Modern Medicine Community High unemployment rates, lethargic recovery, 401(k)’s still down 20%. Sounds dismal? Apparently not for those involved in our nation’s legal system. According to a recent report by the National Center for State Courts, 106 million new cases were filed in state courts in 2008, the last year in which statistics were available, with civil cases increasing by a record 1.3 million or 7%. The increase in civil cases, according to the report, was “likely spurred by the faltering economy.” The report found that the total number of new cases represented a 12% increase over 10 years, with the largest increase in the filing of civil cases—up 29% in 10 years and an astonishing 7.3% between 2007 and 2008 alone. In fact, the civil caseload has increased by an average of over 5% in each of the most recent years reported. In 2005, the rate of incoming civil cases was 5,565 per 100,000 population in the United States. By 2008, that figure rose to over 6,300 per 100,000. The figures offer other revelations. The largest category of cases, by far, is those that produce revenue to states and local governments. Traffic violations represent 54.3% of all cases. Criminal cases, by contrast represent 20.1% of all cases, followed by civil cases at 18.3%, domestic relations at 5.4%, and juvenile at 2.0%. However, a methodological quirk in the way criminal cases are reported may result in double counting many of these cases, which means that civil cases may already exceed the number of criminal defendants being processed in state courts. The tremendous rise in civil cases should not go unnoticed by physicians. While the report does not break down civil cases by category, it is likely that the number of civil cases brought by or against physicians has increased dramatically in the past few years. While physicians generally think about civil cases as those involving personal injury, the largest share of civil cases involve contract disputes. As more and more physicians join group practices, accept employment with hospitals, purchase electronic health record systems, purchase more esoteric medical liability insurance, and lease ever-more expensive equipment, contracts become more a part of the business of medicine. And, just like every other business, these contracts can form the basis of expensive litigation if things don’t go as originally expected. In the not-too-distant past, an employment agreement was little more than a letter inviting a physician to a practice, and setting out salary, vacation, call schedule and when the physician may be eligible for partnership. Today’s employment agreements include critically important restrictive covenants, often reference esoteric medical malpractice policies that place the physician at risk, complicated buy-in provisions, and complex compensation formulas. One bright light in this otherwise gloomy report is that the total number of new tort claims—those involving personal injury, including medical malpractice—continue to fall. While declining only 0.6% between 2007 and 2008, the total caseload fell 25% from 1999 to 2008. In fact, based upon information from seven states, medical malpractice cases represent only 2.8% of all tort cases. Even more encouraging, states like Mississippi, which enacted tort reform in 2003, have realized a 45% reduction in the number of medical malpractice claims filed compared to 1999. New York, by contrast, has seen only a 1% reduction during the same time period. Other states reporting include Arizona (a 22% reduction), Connecticut (a 30% reduction), New Jersey (a 30% reduction), Rhode Island (a 34% reduction), and Oregon (a 42% reduction). Another finding that may affect physicians who purchased homes before the bubble burst, involves the number of mortgage foreclosure cases. Not surprisingly, these cases began to skyrocket in 2008 and will likely continue to challenge our court’s ability to handle them for years to come. Also increasing at staggering amounts are domestic relations cases seeking changes in support (up 28%), while at the same time, the number of divorce filings are down 8%—perhaps due to the increased cost of getting divorced, and the changing economic status of those divorced, as a result of unemployment and other changes in the economy. The clear message from this report is that the economic downturn is causing more and more people to turn to the courts, many to settle economic disputes. One bright light is in the area of tort cases, where reform has stemmed the tide of new personal injury cases. As a result, today’s physician may be more likely to face litigation to settle a contract dispute or a support obligation, than to resolve a malpractice claim. Unfortunately, while malpractice insurance policies protect the physician against the cost of the defending a malpractice case, similar insurance does not exist to pay the costs of litigating these other cases. Steven I. Kern, Esq, is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida. Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast. He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at skern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] civil cases, contract disputes, economic, malpractice concerns, mmglobal, personal injury, tort reform nonadult false Sue The Bastards! text blog civil cases,contract disputes,economic,malpractice concerns,mmglobal,personal injury,tort reform 744 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 1 Malpractice Concerns 0 3084310 3407919 Member 0 http://community.modernmedicine.com/_Federal-Court-Upholds-Challenge-to-Obama-Care/blog/2868153/33379.html In a sometimes scathing rebuke to Justice Department Lawyers, a Federal District Court in Florida has denied the federal government’s motion to dismiss a constitutional challenge to the new federal healthcare law, known officially as the Patient Protection and Affordable Care Act (“the Act”). In reaching its decision, the Court began by recognizing that “the Act is a controversial and polarizing law about which reasonable and intelligent people can disagree in good faith, and which some contend was drafted behind closed doors and pushed through Congress by parliamentary tricks, late night weekend votes, and last minute deals among members of Congress who did not read or otherwise know what it was.” Nonetheless, the Court found that it was not within its purview to question or second guess the wisdom, motives, or methods of Congress, but only to decide if the Act is constitutional. If it is, the Court found, it must be upheld—even if it is bad law. Much of the Court’s 65-page decision focused on whether the monetary penalty imposed on those citizens who fail to meet the individual mandate to obtain federally approved health insurance constitutes a “tax” within Congress’ broad taxing power or a “penalty” which can only be imposed by Congress’ much narrower Commerce Clause power. In simple terms, if the cost imposed on those who fail to meet the individual mandate is determined to be a tax, the Act would more likely stand constitutional challenge, because Congress’ authority to tax is very broad. Conversely, if that cost is a penalty, it can only be imposed if it is used to regulate Interstate Commerce under the Constitution’s Commerce Clause. Given the fact that, in all of our nation’s history, no prior act of Congress has sought to use the Commerce Clause to require citizens to purchase something; if the cost is determined to be a penalty rather than a tax, it likely would be unconstitutional. While the Justice Department lawyers insisted that the penalty was, in fact, a tax, the Court rejected that argument and decided that the individual mandate was, rather, a penalty. In doing so, the Court relied on President Obama’s own words during a CNN interview on September 29, 2009, when, confronted with the dictionary definition of a “tax” said “absolutely not a tax” and in fact, “[n]obody considers [it] a tax.” The Court also relied on Congress’ words, finding “Congress did not call it a tax, despite knowing how to do so.” The Court noted that there were several healthcare reform bills introduced and debated during the 111th Congress which unambiguously called the individual mandate a tax. Similarly, a precursor to the Act, which passed the Senate Finance Committee, called the penalty a tax. By contrast, the Act did not call the failure to comply with the individual mandate a tax, but rather a penalty. The Court also noted that the Act imposed a number of taxes in other sections, including an excise tax on medical devices, an excise tax on high-cost employer-sponsored health coverage, an additional hospital insurance tax on high-income taxpayers, and an excise tax on indoor tanning services. In each case Congress specifically referred to these taxes as “taxes” which the Court found “shows, beyond question, that Congress knew how to impose a tax when it meant to do so.” Ironically, the efforts by Congress and President Obama to avoid using the word “tax” for political reasons may ultimately cause one of the most significant laws in our nation’s history to fail Constitutional challenge. The Court also dismissed a number of other efforts by the Justice Department to prevent judicial determination of the constitutionality of the Act. These unsuccessful efforts included a challenge to the standing of the plaintiffs to pursue the lawsuit and a claim that the lawsuit was not yet ripe for adjudication. The Court’s findings move the lawsuit one step closer to what many predict will ultimately be a decision by the United States Supreme Court. Steven I. Kern, Esq, is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at skern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] In a sometimes scathing rebuke to Justice Department Lawyers, a Federal District Court in Florida has denied the federal government’s motion to dismiss a constitutional challenge to the new federal healthcare law, known officially as the Patient Protection and Affordable Care Act (“the Act”). In reaching its decision, the Court began by recognizing that “the Act is a controversial and polarizing law about which reasonable and intelligent people can disagree in good faith, and which some contend was drafted behind closed doors and pushed through Congress by parliamentary tricks, late night weekend votes, and last minute deals among members of Congress who did not read or otherwise know what it was.” Nonetheless, the Court found that it was not within its purview to question or second guess the wisdom, motives, or methods of Congress, but only to decide if the Act is constitutional. If it is, the Court found, it must be upheld—even if it is bad law. Much of the Court’s 65-page decision focused on whether the monetary penalty imposed on those citizens who fail to meet the individual mandate to obtain federally approved health insurance constitutes a “tax” within Congress’ broad taxing power or a “penalty” which can only be imposed by Congress’ much narrower Commerce Clause power. In simple terms, if the cost imposed on those who fail to meet the individual mandate is determined to be a tax, the Act would more likely stand constitutional challenge, because Congress’ authority to tax is very broad. Conversely, if that cost is a penalty, it can only be imposed if it is used to regulate Interstate Commerce under the Constitution’s Commerce Clause. Given the fact that, in all of our nation’s history, no prior act of Congress has sought to use the Commerce Clause to require citizens to purchase something; if the cost is determined to be a penalty rather than a tax, it likely would be unconstitutional. While the Justice Department lawyers insisted that the penalty was, in fact, a tax, the Court rejected that argument and decided that the individual mandate was, rather, a penalty. In doing so, the Court relied on President Obama’s own words during a CNN interview on September 29, 2009, when, confronted with the dictionary definition of a “tax” said “absolutely not a tax” and in fact, “[n]obody considers [it] a tax.” The Court also relied on Congress’ words, finding “Congress did not call it a tax, despite knowing how to do so.” The Court noted that there were several healthcare reform bills introduced and debated during the 111th Congress which unambiguously called the individual mandate a tax. Similarly, a precursor to the Act, which passed the Senate Finance Committee, called the penalty a tax. By contrast, the Act did not call the failure to comply with the individual mandate a tax, but rather a penalty. The Court also noted that the Act imposed a number of taxes in other sections, including an excise tax on medical devices, an excise tax on high-cost employer-sponsored health coverage, an additional hospital insurance tax on high-income taxpayers, and an excise tax on indoor tanning services. In each case Congress specifically referred to these taxes as “taxes” which the Court found “shows, beyond question, that Congress knew how to impose a tax when it meant to do so.” Ironically, the efforts by Congress and President Obama to avoid using the word “tax” for political reasons may ultimately cause one of the most significant laws in our nation’s history to fail Constitutional challenge. The Court also dismissed a number of other efforts by the Justice Department to prevent judicial determination of the constitutionality of the Act. These unsuccessful efforts included a challenge to the standing of the plaintiffs to pursue the lawsuit and a claim that the lawsuit was not yet ripe for adjudication. The Court’s findings move the lawsuit one step closer to what many predict will ultimately be a decision by the United States Supreme Court. Steven I. Kern, Esq, is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at skern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 28 Oct 2010 13:46:09 GMT http://community.modernmedicine.com/_Federal-Court-Upholds-Challenge-to-Obama-Care/blog/2868153/33379.html skern 2010-10-28T13:26:53Z Health Law & Policy Modern Medicine Community In a sometimes scathing rebuke to Justice Department Lawyers, a Federal District Court in Florida has denied the federal government’s motion to dismiss a constitutional challenge to the new federal healthcare law, known officially as the Patient Protection and Affordable Care Act (“the Act”). In reaching its decision, the Court began by recognizing that “the Act is a controversial and polarizing law about which reasonable and intelligent people can disagree in good faith, and which some contend was drafted behind closed doors and pushed through Congress by parliamentary tricks, late night weekend votes, and last minute deals among members of Congress who did not read or otherwise know what it was.” Nonetheless, the Court found that it was not within its purview to question or second guess the wisdom, motives, or methods of Congress, but only to decide if the Act is constitutional. If it is, the Court found, it must be upheld—even if it is bad law. Much of the Court’s 65-page decision focused on whether the monetary penalty imposed on those citizens who fail to meet the individual mandate to obtain federally approved health insurance constitutes a “tax” within Congress’ broad taxing power or a “penalty” which can only be imposed by Congress’ much narrower Commerce Clause power. In simple terms, if the cost imposed on those who fail to meet the individual mandate is determined to be a tax, the Act would more likely stand constitutional challenge, because Congress’ authority to tax is very broad. Conversely, if that cost is a penalty, it can only be imposed if it is used to regulate Interstate Commerce under the Constitution’s Commerce Clause. Given the fact that, in all of our nation’s history, no prior act of Congress has sought to use the Commerce Clause to require citizens to purchase something; if the cost is determined to be a penalty rather than a tax, it likely would be unconstitutional. While the Justice Department lawyers insisted that the penalty was, in fact, a tax, the Court rejected that argument and decided that the individual mandate was, rather, a penalty. In doing so, the Court relied on President Obama’s own words during a CNN interview on September 29, 2009, when, confronted with the dictionary definition of a “tax” said “absolutely not a tax” and in fact, “[n]obody considers [it] a tax.” The Court also relied on Congress’ words, finding “Congress did not call it a tax, despite knowing how to do so.” The Court noted that there were several healthcare reform bills introduced and debated during the 111th Congress which unambiguously called the individual mandate a tax. Similarly, a precursor to the Act, which passed the Senate Finance Committee, called the penalty a tax. By contrast, the Act did not call the failure to comply with the individual mandate a tax, but rather a penalty. The Court also noted that the Act imposed a number of taxes in other sections, including an excise tax on medical devices, an excise tax on high-cost employer-sponsored health coverage, an additional hospital insurance tax on high-income taxpayers, and an excise tax on indoor tanning services. In each case Congress specifically referred to these taxes as “taxes” which the Court found “shows, beyond question, that Congress knew how to impose a tax when it meant to do so.” Ironically, the efforts by Congress and President Obama to avoid using the word “tax” for political reasons may ultimately cause one of the most significant laws in our nation’s history to fail Constitutional challenge. The Court also dismissed a number of other efforts by the Justice Department to prevent judicial determination of the constitutionality of the Act. These unsuccessful efforts included a challenge to the standing of the plaintiffs to pursue the lawsuit and a claim that the lawsuit was not yet ripe for adjudication. The Court’s findings move the lawsuit one step closer to what many predict will ultimately be a decision by the United States Supreme Court. Steven I. Kern, Esq, is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at skern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] act”, affordable, and, care, health law & policy, healthcare, law”, mmglobal, protection, reform, “federal, “patient nonadult false Federal Court Upholds Challenge to Obama-Care text blog act”,affordable,and,care,health law & policy,healthcare,law”,mmglobal,protection,reform,“federal,“patient 682 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 2 Health Law & Policy 0 2868153 3407919 Member 0 http://community.modernmedicine.com/_Save-10000-on-Your-2010-Taxes/blog/2690343/33379.html As a change of pace, I’ve asked one of our tax consultants, David B. Mandell, JD, MBA, to assist in providing some thoughts what you can do now to save on 2010 taxes. Here are some ideas he suggests:1. Maximize the Tax Benefits of Your Qualified Retirement Plan (QRP)Nearly 95% of physicians have some type of QRP in place. These include 401(k)s, profit-sharing plans, money purchase plans, defined benefit plans, 403(b)s, or even SEP or SIMPLE IRAs, for these purposes (technically, IRAs are not QRPs). However, most of these plans are not maximized for deductions for the practice owner(s). The Pension Protection Act of 2006 improved the QRP options for many physicians. In other words, many owners may be using an “outdated” plan and foregoing further contributions and deductions allowed under the most recent rule changes. By maximizing your QRP under the new rules, you could increase your deductions significantly for 2010 and reduce your taxes on April 15, 2011. 2. Implement a Fringe Benefit PlanWhile the vast majority of physicians have QRP’s in place, most have not analyzed, let alone implemented, any other type of benefit plan. Nonqualified plans or fringe benefit plans often enjoy favorable short-term and long-term tax treatment. We will examine 2 types of fringe benefit plans here. One plan has been in the tax code for decades, and the IRS has actually issued “safe harbor” rules so the plan can be implemented simply. This plan is governed under Section 79 of the tax code. Essentially, this plan allows a corporation to provide life insurance benefits to employees--which can be term insurance or permanent life insurance. Since permanent life insurance has an investment portion (called the “cash value”), taxpayers can build up significant values in such plans for retirement. In fact, some clients will accumulate well over $1 million in cash values for their retirement. Other elements of the Section 79 plan include: •    100% tax deduction for contributions to the plan•    Tax free-growth of plan assets•    In many states, the highest level of asset protection for plan funds•    Much higher potential contributions than with profit-sharing plans and 401(k)s•    The ability to carve out a “class” of employees for the plan•    59½ and 70½ age rules for qualified retirement plans do not applyAlso, importantly, this plan can be offered in addition to a qualified retirement plan (like 401(k), profit-sharing plan) or SEP IRA. Thus, if you are already “maxed out” on your qualified retirement plan, the Section 79 plan can be an attractive option.Another fringe benefit plan is the provision of long-term-care insurance coverage for physicians. Again, this can be implemented so that there is choice among the physicians. Depending on the practice’s corporate structure, this plan, in addition to providing an important coverage for the physicians’ family, might reduce a physician-participant’s income taxes by thousands of dollars per year. Essentially, if the doctors may purchase such insurance anyway, why not get a tax break for doing so?If you are interested in reducing your 2010 taxes and have not considered these options, you should do so. These, and other techniques, can help you reduce your taxable income in 2010 significantly…and they can be put into place in a few weeks, so it’s not too late for 2010. Dave Mandell has also offered our readers a free copy of his book, FOR DOCTORS ONLY: A Guide to Working Less & Building More. If you would like a copy, contact David at mandell@ojmgroup.com.Steven I. Kern, Esq, is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida. Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast. He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at skern@drlaw.com.[Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] As a change of pace, I’ve asked one of our tax consultants, David B. Mandell, JD, MBA, to assist in providing some thoughts what you can do now to save on 2010 taxes. Here are some ideas he suggests:1. Maximize the Tax Benefits of Your Qualified Retirement Plan (QRP)Nearly 95% of physicians have some type of QRP in place. These include 401(k)s, profit-sharing plans, money purchase plans, defined benefit plans, 403(b)s, or even SEP or SIMPLE IRAs, for these purposes (technically, IRAs are not QRPs). However, most of these plans are not maximized for deductions for the practice owner(s). The Pension Protection Act of 2006 improved the QRP options for many physicians. In other words, many owners may be using an “outdated” plan and foregoing further contributions and deductions allowed under the most recent rule changes. By maximizing your QRP under the new rules, you could increase your deductions significantly for 2010 and reduce your taxes on April 15, 2011. 2. Implement a Fringe Benefit PlanWhile the vast majority of physicians have QRP’s in place, most have not analyzed, let alone implemented, any other type of benefit plan. Nonqualified plans or fringe benefit plans often enjoy favorable short-term and long-term tax treatment. We will examine 2 types of fringe benefit plans here. One plan has been in the tax code for decades, and the IRS has actually issued “safe harbor” rules so the plan can be implemented simply. This plan is governed under Section 79 of the tax code. Essentially, this plan allows a corporation to provide life insurance benefits to employees--which can be term insurance or permanent life insurance. Since permanent life insurance has an investment portion (called the “cash value”), taxpayers can build up significant values in such plans for retirement. In fact, some clients will accumulate well over $1 million in cash values for their retirement. Other elements of the Section 79 plan include: •    100% tax deduction for contributions to the plan•    Tax free-growth of plan assets•    In many states, the highest level of asset protection for plan funds•    Much higher potential contributions than with profit-sharing plans and 401(k)s•    The ability to carve out a “class” of employees for the plan•    59½ and 70½ age rules for qualified retirement plans do not applyAlso, importantly, this plan can be offered in addition to a qualified retirement plan (like 401(k), profit-sharing plan) or SEP IRA. Thus, if you are already “maxed out” on your qualified retirement plan, the Section 79 plan can be an attractive option.Another fringe benefit plan is the provision of long-term-care insurance coverage for physicians. Again, this can be implemented so that there is choice among the physicians. Depending on the practice’s corporate structure, this plan, in addition to providing an important coverage for the physicians’ family, might reduce a physician-participant’s income taxes by thousands of dollars per year. Essentially, if the doctors may purchase such insurance anyway, why not get a tax break for doing so?If you are interested in reducing your 2010 taxes and have not considered these options, you should do so. These, and other techniques, can help you reduce your taxable income in 2010 significantly…and they can be put into place in a few weeks, so it’s not too late for 2010. Dave Mandell has also offered our readers a free copy of his book, FOR DOCTORS ONLY: A Guide to Working Less & Building More. If you would like a copy, contact David at mandell@ojmgroup.com.Steven I. Kern, Esq, is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida. Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast. He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at skern@drlaw.com.[Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 30 Sep 2010 00:10:43 GMT http://community.modernmedicine.com/_Save-10000-on-Your-2010-Taxes/blog/2690343/33379.html skern 2010-09-29T22:54:13Z Financial Concerns Modern Medicine Community As a change of pace, I’ve asked one of our tax consultants, David B. Mandell, JD, MBA, to assist in providing some thoughts what you can do now to save on 2010 taxes. Here are some ideas he suggests:1. Maximize the Tax Benefits of Your Qualified Retirement Plan (QRP)Nearly 95% of physicians have some type of QRP in place. These include 401(k)s, profit-sharing plans, money purchase plans, defined benefit plans, 403(b)s, or even SEP or SIMPLE IRAs, for these purposes (technically, IRAs are not QRPs). However, most of these plans are not maximized for deductions for the practice owner(s). The Pension Protection Act of 2006 improved the QRP options for many physicians. In other words, many owners may be using an “outdated” plan and foregoing further contributions and deductions allowed under the most recent rule changes. By maximizing your QRP under the new rules, you could increase your deductions significantly for 2010 and reduce your taxes on April 15, 2011. 2. Implement a Fringe Benefit PlanWhile the vast majority of physicians have QRP’s in place, most have not analyzed, let alone implemented, any other type of benefit plan. Nonqualified plans or fringe benefit plans often enjoy favorable short-term and long-term tax treatment. We will examine 2 types of fringe benefit plans here. One plan has been in the tax code for decades, and the IRS has actually issued “safe harbor” rules so the plan can be implemented simply. This plan is governed under Section 79 of the tax code. Essentially, this plan allows a corporation to provide life insurance benefits to employees--which can be term insurance or permanent life insurance. Since permanent life insurance has an investment portion (called the “cash value”), taxpayers can build up significant values in such plans for retirement. In fact, some clients will accumulate well over $1 million in cash values for their retirement. Other elements of the Section 79 plan include: •    100% tax deduction for contributions to the plan•    Tax free-growth of plan assets•    In many states, the highest level of asset protection for plan funds•    Much higher potential contributions than with profit-sharing plans and 401(k)s•    The ability to carve out a “class” of employees for the plan•    59½ and 70½ age rules for qualified retirement plans do not applyAlso, importantly, this plan can be offered in addition to a qualified retirement plan (like 401(k), profit-sharing plan) or SEP IRA. Thus, if you are already “maxed out” on your qualified retirement plan, the Section 79 plan can be an attractive option.Another fringe benefit plan is the provision of long-term-care insurance coverage for physicians. Again, this can be implemented so that there is choice among the physicians. Depending on the practice’s corporate structure, this plan, in addition to providing an important coverage for the physicians’ family, might reduce a physician-participant’s income taxes by thousands of dollars per year. Essentially, if the doctors may purchase such insurance anyway, why not get a tax break for doing so?If you are interested in reducing your 2010 taxes and have not considered these options, you should do so. These, and other techniques, can help you reduce your taxable income in 2010 significantly…and they can be put into place in a few weeks, so it’s not too late for 2010. Dave Mandell has also offered our readers a free copy of his book, FOR DOCTORS ONLY: A Guide to Working Less & Building More. If you would like a copy, contact David at mandell@ojmgroup.com.Steven I. Kern, Esq, is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida. Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast. He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at skern@drlaw.com.[Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] financial concerns, fringe benefit, mmglobal, nonqualified plans, qrp, qualified retirement plan, safe harbor rules, taxes nonadult false Save $10,000+ on Your 2010 Taxes text blog financial concerns,fringe benefit,mmglobal,nonqualified plans,qrp,qualified retirement plan,safe harbor rules,taxes 1014 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 1 Financial Concerns 1 2690343 3407919 Member 0 http://community.modernmedicine.com/_MACs-RACs-and-Now-ZPICs-The-Feds-are-Closing-In/blog/2577606/33379.html In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA).  Not only did HIPAA lead to the maze of privacy and security regulations that physicians must endure, it established the Medicare Integrity Program which authorized the Centers for Medicare and Medicaid Services (CMS) to contract with Program Safeguard Contractors to identify fraud and improper billing. To further the role of the Program Safeguard Contractors, the Medicare Prescription Drug, Improvement and Modernization Act of 2003 authorized CMS to contract with Medicare Administrative Contractors (MACs) to replace Fiscal Intermediaries and carriers and to consolidate benefit integrity functions to a select few contractors in seven geographical areas or zones. In October 2008, CMS awarded contracts to four Recovery Audit Contractors (RACs) to identify improper Medicare payments and fight fraud, waste, and abuse in the Medicare program.  RAC audits, based upon review of medical data and billing data, using computer analysis of claims and coding practices, began afterward in earnest.  As of March 9, 2010, according to CMS, 598,238 claims from the three-year demonstration project ending in August 2008 were subject to RAC overpayment determinations.  However, of the 76,073 claims appealed, providers were able to overturn the initial RAC audit determination 64.4% of the time.   Fortunately for physicians, although RACs are required to audit both Part A and Part B contractors, they have been focusing more heavily on Part A providers. In 2008, CMS also added to the alphabet soup of contractors focused on identifying and recovering overpayments a more aggressive, and potentially more lethal, weapon against errant billers.  At that time, CMS began the process of consolidating the functions of the Program Safeguard Contractors and the Medicare Prescription Drug Integrity Contractor (charged with combating fraud and abuse in the Part D prescription drug benefit program) into Zone Integrity Contractors (ZPICs). ZPICs have been hired by CMS to identify potential fraud, waste, and abuse using reactive and proactive identification methods.  They are expected to develop cases against providers using data analysis, prepayment and postpayment medical review of claims, evaluation of complaints and fraud detection mechanisms.  They are also expected to work with law enforcement agencies both during investigation and prosecution of healthcare fraud cases, and to refer cases to them for prosecution.  In addition, they are to train MACs to more effectively address fraud, waste, and abuse.  To date, ZPIC contracts have been awarded for three of the seven ZPIC zones.  MACs will continue to interact with Program Safeguard Contractors in those jurisdictions where ZPIC contracts have not been awarded. Unlike RACs, ZPICS are focusing their efforts on physicians, physical therapy providers, skilled nursing facilities, and DME suppliers.  ZPIC audits are based upon a combination of claims data from multiple CMS contractors, to create a complete profile of a beneficiary’s claim history.  This data includes national claims data from the Health Care Customer Information System, CMS Data Center’s Part B Analytics System, and local data compilations.   When a ZPIC identifies overpayments, it refers it to a RAC or a MAC , which then attempts to recoup from the provider.  Unlike other audits, ZPIC medical reviews are not random.  A provider subject to a ZPIC review has almost assuredly been specifically targeted, and the review likely included not only data analytics and claims review, but other investigative techniques. A ZIPC audit is conducted with a higher level of scrutiny and typically focuses on allegations of fraudulent conduct, payment denial, demand for recoupment of alleged overpayments, and even referral to law enforcement.  These referrals can lead to subpoenas, investigation, criminal and civil charges, penalties, incarceration and other sanctions. As such, a ZPIC audit must be treated with urgency, seriousness, and focused attention.  It cannot be treated as simply an ordinary record request.  Experienced legal counsel should be immediately called to oversee the response.  Records submitted should be identified and copies segregated.  Dates of receipt of communications from a ZPIC become critical.  An initial repayment demand letter triggers the time within which to appeal, and failure to file an appeal within 30 days will allow Medicare to begin recoupment on day forty-one. Evaluation of claims under review must begin immediately.  Depending upon the allegations and the scope of the problem, a team approach may be required.  That could include certified billers, coders, and medical professionals to review documentation, coding, and medical necessity.   When demands for overpayment are made, based upon extrapolations, statistical analysis may be necessary to determine whether the extrapolations are valid and reproducible.  As the federal government continues to step up its efforts to reduce fraud, waste, and abuse, physicians are now becoming a greater focus of its efforts.  At the same time, through ZPICs, the government is becoming better able to successfully identify fraud, waste, and abuse, and more effective in successfully prosecuting those at fault.  Any communication from a ZPIC must be viewed as a serious, targeted federal investigation of a provider’s practice, requiring immediate attention and experienced professional assistance. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA).  Not only did HIPAA lead to the maze of privacy and security regulations that physicians must endure, it established the Medicare Integrity Program which authorized the Centers for Medicare and Medicaid Services (CMS) to contract with Program Safeguard Contractors to identify fraud and improper billing. To further the role of the Program Safeguard Contractors, the Medicare Prescription Drug, Improvement and Modernization Act of 2003 authorized CMS to contract with Medicare Administrative Contractors (MACs) to replace Fiscal Intermediaries and carriers and to consolidate benefit integrity functions to a select few contractors in seven geographical areas or zones. In October 2008, CMS awarded contracts to four Recovery Audit Contractors (RACs) to identify improper Medicare payments and fight fraud, waste, and abuse in the Medicare program.  RAC audits, based upon review of medical data and billing data, using computer analysis of claims and coding practices, began afterward in earnest.  As of March 9, 2010, according to CMS, 598,238 claims from the three-year demonstration project ending in August 2008 were subject to RAC overpayment determinations.  However, of the 76,073 claims appealed, providers were able to overturn the initial RAC audit determination 64.4% of the time.   Fortunately for physicians, although RACs are required to audit both Part A and Part B contractors, they have been focusing more heavily on Part A providers. In 2008, CMS also added to the alphabet soup of contractors focused on identifying and recovering overpayments a more aggressive, and potentially more lethal, weapon against errant billers.  At that time, CMS began the process of consolidating the functions of the Program Safeguard Contractors and the Medicare Prescription Drug Integrity Contractor (charged with combating fraud and abuse in the Part D prescription drug benefit program) into Zone Integrity Contractors (ZPICs). ZPICs have been hired by CMS to identify potential fraud, waste, and abuse using reactive and proactive identification methods.  They are expected to develop cases against providers using data analysis, prepayment and postpayment medical review of claims, evaluation of complaints and fraud detection mechanisms.  They are also expected to work with law enforcement agencies both during investigation and prosecution of healthcare fraud cases, and to refer cases to them for prosecution.  In addition, they are to train MACs to more effectively address fraud, waste, and abuse.  To date, ZPIC contracts have been awarded for three of the seven ZPIC zones.  MACs will continue to interact with Program Safeguard Contractors in those jurisdictions where ZPIC contracts have not been awarded. Unlike RACs, ZPICS are focusing their efforts on physicians, physical therapy providers, skilled nursing facilities, and DME suppliers.  ZPIC audits are based upon a combination of claims data from multiple CMS contractors, to create a complete profile of a beneficiary’s claim history.  This data includes national claims data from the Health Care Customer Information System, CMS Data Center’s Part B Analytics System, and local data compilations.   When a ZPIC identifies overpayments, it refers it to a RAC or a MAC , which then attempts to recoup from the provider.  Unlike other audits, ZPIC medical reviews are not random.  A provider subject to a ZPIC review has almost assuredly been specifically targeted, and the review likely included not only data analytics and claims review, but other investigative techniques. A ZIPC audit is conducted with a higher level of scrutiny and typically focuses on allegations of fraudulent conduct, payment denial, demand for recoupment of alleged overpayments, and even referral to law enforcement.  These referrals can lead to subpoenas, investigation, criminal and civil charges, penalties, incarceration and other sanctions. As such, a ZPIC audit must be treated with urgency, seriousness, and focused attention.  It cannot be treated as simply an ordinary record request.  Experienced legal counsel should be immediately called to oversee the response.  Records submitted should be identified and copies segregated.  Dates of receipt of communications from a ZPIC become critical.  An initial repayment demand letter triggers the time within which to appeal, and failure to file an appeal within 30 days will allow Medicare to begin recoupment on day forty-one. Evaluation of claims under review must begin immediately.  Depending upon the allegations and the scope of the problem, a team approach may be required.  That could include certified billers, coders, and medical professionals to review documentation, coding, and medical necessity.   When demands for overpayment are made, based upon extrapolations, statistical analysis may be necessary to determine whether the extrapolations are valid and reproducible.  As the federal government continues to step up its efforts to reduce fraud, waste, and abuse, physicians are now becoming a greater focus of its efforts.  At the same time, through ZPICs, the government is becoming better able to successfully identify fraud, waste, and abuse, and more effective in successfully prosecuting those at fault.  Any communication from a ZPIC must be viewed as a serious, targeted federal investigation of a provider’s practice, requiring immediate attention and experienced professional assistance. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Tue, 24 Aug 2010 19:07:00 GMT http://community.modernmedicine.com/_MACs-RACs-and-Now-ZPICs-The-Feds-are-Closing-In/blog/2577606/33379.html skern 2010-08-24T18:46:04Z Health Law & Policy Modern Medicine Community In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA).  Not only did HIPAA lead to the maze of privacy and security regulations that physicians must endure, it established the Medicare Integrity Program which authorized the Centers for Medicare and Medicaid Services (CMS) to contract with Program Safeguard Contractors to identify fraud and improper billing. To further the role of the Program Safeguard Contractors, the Medicare Prescription Drug, Improvement and Modernization Act of 2003 authorized CMS to contract with Medicare Administrative Contractors (MACs) to replace Fiscal Intermediaries and carriers and to consolidate benefit integrity functions to a select few contractors in seven geographical areas or zones. In October 2008, CMS awarded contracts to four Recovery Audit Contractors (RACs) to identify improper Medicare payments and fight fraud, waste, and abuse in the Medicare program.  RAC audits, based upon review of medical data and billing data, using computer analysis of claims and coding practices, began afterward in earnest.  As of March 9, 2010, according to CMS, 598,238 claims from the three-year demonstration project ending in August 2008 were subject to RAC overpayment determinations.  However, of the 76,073 claims appealed, providers were able to overturn the initial RAC audit determination 64.4% of the time.   Fortunately for physicians, although RACs are required to audit both Part A and Part B contractors, they have been focusing more heavily on Part A providers. In 2008, CMS also added to the alphabet soup of contractors focused on identifying and recovering overpayments a more aggressive, and potentially more lethal, weapon against errant billers.  At that time, CMS began the process of consolidating the functions of the Program Safeguard Contractors and the Medicare Prescription Drug Integrity Contractor (charged with combating fraud and abuse in the Part D prescription drug benefit program) into Zone Integrity Contractors (ZPICs). ZPICs have been hired by CMS to identify potential fraud, waste, and abuse using reactive and proactive identification methods.  They are expected to develop cases against providers using data analysis, prepayment and postpayment medical review of claims, evaluation of complaints and fraud detection mechanisms.  They are also expected to work with law enforcement agencies both during investigation and prosecution of healthcare fraud cases, and to refer cases to them for prosecution.  In addition, they are to train MACs to more effectively address fraud, waste, and abuse.  To date, ZPIC contracts have been awarded for three of the seven ZPIC zones.  MACs will continue to interact with Program Safeguard Contractors in those jurisdictions where ZPIC contracts have not been awarded. Unlike RACs, ZPICS are focusing their efforts on physicians, physical therapy providers, skilled nursing facilities, and DME suppliers.  ZPIC audits are based upon a combination of claims data from multiple CMS contractors, to create a complete profile of a beneficiary’s claim history.  This data includes national claims data from the Health Care Customer Information System, CMS Data Center’s Part B Analytics System, and local data compilations.   When a ZPIC identifies overpayments, it refers it to a RAC or a MAC , which then attempts to recoup from the provider.  Unlike other audits, ZPIC medical reviews are not random.  A provider subject to a ZPIC review has almost assuredly been specifically targeted, and the review likely included not only data analytics and claims review, but other investigative techniques. A ZIPC audit is conducted with a higher level of scrutiny and typically focuses on allegations of fraudulent conduct, payment denial, demand for recoupment of alleged overpayments, and even referral to law enforcement.  These referrals can lead to subpoenas, investigation, criminal and civil charges, penalties, incarceration and other sanctions. As such, a ZPIC audit must be treated with urgency, seriousness, and focused attention.  It cannot be treated as simply an ordinary record request.  Experienced legal counsel should be immediately called to oversee the response.  Records submitted should be identified and copies segregated.  Dates of receipt of communications from a ZPIC become critical.  An initial repayment demand letter triggers the time within which to appeal, and failure to file an appeal within 30 days will allow Medicare to begin recoupment on day forty-one. Evaluation of claims under review must begin immediately.  Depending upon the allegations and the scope of the problem, a team approach may be required.  That could include certified billers, coders, and medical professionals to review documentation, coding, and medical necessity.   When demands for overpayment are made, based upon extrapolations, statistical analysis may be necessary to determine whether the extrapolations are valid and reproducible.  As the federal government continues to step up its efforts to reduce fraud, waste, and abuse, physicians are now becoming a greater focus of its efforts.  At the same time, through ZPICs, the government is becoming better able to successfully identify fraud, waste, and abuse, and more effective in successfully prosecuting those at fault.  Any communication from a ZPIC must be viewed as a serious, targeted federal investigation of a provider’s practice, requiring immediate attention and experienced professional assistance. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] abuse, cms, federal investigation, fraud, health law & policy, medicare administrative, mmglobal, recovery audit contractors, waste, zone integrity nonadult false MACs, RACs, and Now ZPICs: The Feds are Closing In text blog abuse,cms,federal investigation,fraud,health law & policy,medicare administrative,mmglobal,recovery audit contractors,waste,zone integrity 866 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 2 Health Law & Policy 0 2577606 3407919 Member 0 http://community.modernmedicine.com/_More-Stupid-Regulations/blog/2496311/33379.html Just in case physicians didn’t have a large enough target on their backs, the Medical Board of California has painted a larger one.  As of June 27, 2010, physicians in California must inform their patients that they are licensed by the Medical Board of California, and include the Board’s contact information. Under a new California Rule, the information to be conveyed must read as follows: NOTICE TO CONSUMERS Medical doctors are licensed and regulated by the Medical Board of California (800) 633-2322 www.mbc.ca.gov I wonder when California’s patients became “consumers.”  I also wonder why the California Board, in the middle of the greatest budget crisis in the State’s history, has decided that now is the time to churn up more complaints, necessitating more investigators, more bureaucrats, and more imposition on physicians’ time and resources to respond to these complains.   I also wonder how long it will take before other states jump on this bandwagon. Given the fact that the vast majority of “consumer” complaints to medical boards around the nation prove to be without merit, the waste of limited resources seems all the more foolish.  If a state truly wishes to identify bad doctors, there are many better ways than sifting through thousands of letters from consumers, complaining about a doctor’s bedside manner or having to wait too long for an appointment. As with any good bureaucracy, the California Board not only mandates that the information about its existence be provided, but it sets forth exactly how it must be provided, no doubt to assure that its commercial message gain wide distribution, at no cost to the Board. The notice can be provided in one of three ways.  The first is to post it prominently in physician offices, in a place conspicuous to patients, in at least 48-point type in Arial Font.  In that font size, the all caps letters are almost 5/8 inch high. The second method is to include the notice in a written statement, signed and dated by the patient or patient’s representative, and kept in that patient’s file, stating the patient understands the physician is licensed and regulated by the Board.  The third alternative is to include the notice in a statement on letterhead, discharge instructions, or other document given to a patient or the patient’s representative, where the notice is placed immediately above the signature line for the patient, in at least 14-point type. I guess the Board didn’t need to get an environmental impact study of the number of trees that will be have to be cut down to provide the paper for this nonsense.  Nor, I assume, did it do an analysis of the cost to print and store this additional paper, much less the personnel costs involved in having these forms filled out and filed. To assure that its commercial message receives the largest possible audience, the California Board advises that the regulation is designed “to serve a multitude of practice settings, including emergency departments, skilled nursing facilities, and surgical settings.  In every setting where they practice, physicians are responsible for compliance with this regulation, not the facility.” Ironically, the Board states that it expects “a good-faith, common-sense interpretation and compliance with this regulation.”  Perhaps the Board should have used common sense and relied upon the good faith of physicians, rather than imposing upon them an additional, demeaning regulation.  In fact, in announcing the regulation, the Board seems to recognize its absurdity, claiming that it was mandated to pass it by law, and did so only after “deliberating on this issue for a period of years, taking input from the public and the medical profession.”  Imagine if they passed it with only a single year of deliberation! With all of the challenges facing medicine today, not to mention the budgetary challenges faced by California, does the State really have nothing better to do than impose more regulations on physicians?  Of course, California now has an opportunity to reduce the number of unemployed.  It can send SWAT teams throughout the state, looking for posted notices, and measuring font sizes.  One can only wonder what the penalty will be for the poor physician who uses Times New Roman rather Arial font. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at skern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Just in case physicians didn’t have a large enough target on their backs, the Medical Board of California has painted a larger one.  As of June 27, 2010, physicians in California must inform their patients that they are licensed by the Medical Board of California, and include the Board’s contact information. Under a new California Rule, the information to be conveyed must read as follows: NOTICE TO CONSUMERS Medical doctors are licensed and regulated by the Medical Board of California (800) 633-2322 www.mbc.ca.gov I wonder when California’s patients became “consumers.”  I also wonder why the California Board, in the middle of the greatest budget crisis in the State’s history, has decided that now is the time to churn up more complaints, necessitating more investigators, more bureaucrats, and more imposition on physicians’ time and resources to respond to these complains.   I also wonder how long it will take before other states jump on this bandwagon. Given the fact that the vast majority of “consumer” complaints to medical boards around the nation prove to be without merit, the waste of limited resources seems all the more foolish.  If a state truly wishes to identify bad doctors, there are many better ways than sifting through thousands of letters from consumers, complaining about a doctor’s bedside manner or having to wait too long for an appointment. As with any good bureaucracy, the California Board not only mandates that the information about its existence be provided, but it sets forth exactly how it must be provided, no doubt to assure that its commercial message gain wide distribution, at no cost to the Board. The notice can be provided in one of three ways.  The first is to post it prominently in physician offices, in a place conspicuous to patients, in at least 48-point type in Arial Font.  In that font size, the all caps letters are almost 5/8 inch high. The second method is to include the notice in a written statement, signed and dated by the patient or patient’s representative, and kept in that patient’s file, stating the patient understands the physician is licensed and regulated by the Board.  The third alternative is to include the notice in a statement on letterhead, discharge instructions, or other document given to a patient or the patient’s representative, where the notice is placed immediately above the signature line for the patient, in at least 14-point type. I guess the Board didn’t need to get an environmental impact study of the number of trees that will be have to be cut down to provide the paper for this nonsense.  Nor, I assume, did it do an analysis of the cost to print and store this additional paper, much less the personnel costs involved in having these forms filled out and filed. To assure that its commercial message receives the largest possible audience, the California Board advises that the regulation is designed “to serve a multitude of practice settings, including emergency departments, skilled nursing facilities, and surgical settings.  In every setting where they practice, physicians are responsible for compliance with this regulation, not the facility.” Ironically, the Board states that it expects “a good-faith, common-sense interpretation and compliance with this regulation.”  Perhaps the Board should have used common sense and relied upon the good faith of physicians, rather than imposing upon them an additional, demeaning regulation.  In fact, in announcing the regulation, the Board seems to recognize its absurdity, claiming that it was mandated to pass it by law, and did so only after “deliberating on this issue for a period of years, taking input from the public and the medical profession.”  Imagine if they passed it with only a single year of deliberation! With all of the challenges facing medicine today, not to mention the budgetary challenges faced by California, does the State really have nothing better to do than impose more regulations on physicians?  Of course, California now has an opportunity to reduce the number of unemployed.  It can send SWAT teams throughout the state, looking for posted notices, and measuring font sizes.  One can only wonder what the penalty will be for the poor physician who uses Times New Roman rather Arial font. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at skern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 27 Aug 2010 15:13:19 GMT http://community.modernmedicine.com/_More-Stupid-Regulations/blog/2496311/33379.html skern 2010-07-26T19:32:32Z Malpractice Concerns Modern Medicine Community Just in case physicians didn’t have a large enough target on their backs, the Medical Board of California has painted a larger one.  As of June 27, 2010, physicians in California must inform their patients that they are licensed by the Medical Board of California, and include the Board’s contact information. Under a new California Rule, the information to be conveyed must read as follows: NOTICE TO CONSUMERS Medical doctors are licensed and regulated by the Medical Board of California (800) 633-2322 www.mbc.ca.gov I wonder when California’s patients became “consumers.”  I also wonder why the California Board, in the middle of the greatest budget crisis in the State’s history, has decided that now is the time to churn up more complaints, necessitating more investigators, more bureaucrats, and more imposition on physicians’ time and resources to respond to these complains.   I also wonder how long it will take before other states jump on this bandwagon. Given the fact that the vast majority of “consumer” complaints to medical boards around the nation prove to be without merit, the waste of limited resources seems all the more foolish.  If a state truly wishes to identify bad doctors, there are many better ways than sifting through thousands of letters from consumers, complaining about a doctor’s bedside manner or having to wait too long for an appointment. As with any good bureaucracy, the California Board not only mandates that the information about its existence be provided, but it sets forth exactly how it must be provided, no doubt to assure that its commercial message gain wide distribution, at no cost to the Board. The notice can be provided in one of three ways.  The first is to post it prominently in physician offices, in a place conspicuous to patients, in at least 48-point type in Arial Font.  In that font size, the all caps letters are almost 5/8 inch high. The second method is to include the notice in a written statement, signed and dated by the patient or patient’s representative, and kept in that patient’s file, stating the patient understands the physician is licensed and regulated by the Board.  The third alternative is to include the notice in a statement on letterhead, discharge instructions, or other document given to a patient or the patient’s representative, where the notice is placed immediately above the signature line for the patient, in at least 14-point type. I guess the Board didn’t need to get an environmental impact study of the number of trees that will be have to be cut down to provide the paper for this nonsense.  Nor, I assume, did it do an analysis of the cost to print and store this additional paper, much less the personnel costs involved in having these forms filled out and filed. To assure that its commercial message receives the largest possible audience, the California Board advises that the regulation is designed “to serve a multitude of practice settings, including emergency departments, skilled nursing facilities, and surgical settings.  In every setting where they practice, physicians are responsible for compliance with this regulation, not the facility.” Ironically, the Board states that it expects “a good-faith, common-sense interpretation and compliance with this regulation.”  Perhaps the Board should have used common sense and relied upon the good faith of physicians, rather than imposing upon them an additional, demeaning regulation.  In fact, in announcing the regulation, the Board seems to recognize its absurdity, claiming that it was mandated to pass it by law, and did so only after “deliberating on this issue for a period of years, taking input from the public and the medical profession.”  Imagine if they passed it with only a single year of deliberation! With all of the challenges facing medicine today, not to mention the budgetary challenges faced by California, does the State really have nothing better to do than impose more regulations on physicians?  Of course, California now has an opportunity to reduce the number of unemployed.  It can send SWAT teams throughout the state, looking for posted notices, and measuring font sizes.  One can only wonder what the penalty will be for the poor physician who uses Times New Roman rather Arial font. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at skern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] california medical board, complaints, license, malpractice concerns, regulation nonadult false More Stupid Regulations text blog california medical board,complaints,license,malpractice concerns,regulation 788 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 10 Malpractice Concerns 0 2496311 3407919 Member 0 http://community.modernmedicine.com/_Healthcare-Premiums-Up-30/blog/2425366/33379.html Our law firm just received notice of a 30% increase in healthcare premiums from Aetna. The premium is community rated, which means that other businesses have or will soon receive similar notices. After recovering from the initial shock, we looked at premiums from other health insurers for similar plans, and, not surprisingly, found their premium rates nearly identical. So much for the cost savings promised by Obama Care. Instead, it appears that health insurers are padding this year’s premiums to cushion the blow they anticipate when federal mandates kick in, including elimination of existing condition exclusions and mandated coverage of children through age 26. Anecdotal information from Massachusetts, which already has mandated health insurance, may give us some notion of the cost of eliminating pre-existing condition exclusions. Apparently many Massachusetts residents have figured out that the best approach to mandated health insurance is to purchase the least expensive product available, and, if they get seriously ill, then change to a more robust plan. Stories are told of patients and family members on their cell phones changing coverage while being wheeled in for emergency surgery. The cost of covering children through age 26 under family plans will also increase cost, especially given proposed regulations which provides coverage to all such “children” whether single, married, living at home, or living away from home. The increase we recently experienced is more than three times the 9% national increase recently predicted by a Price Waterhouse Coopers study. But even a 9% increase in today’s economy is unacceptable. So much for “bending the cost curve.” It seems like we’ve bent it, only in the wrong direction! For many who have followed the healthcare reform debate, these increases come as no surprise. Economics 101 taught us that we can’t provide more benefits to more people and charge less money. Predictably, employers, faced with these huge increases, are going to look to pass them along to their employees. Increased deductibles, higher employee contributions to premium, or smaller wage increases will be the reaction of many employers, especially in these difficult economic times where price increases to offset increased costs are simply not possible. Of course, physicians are not immune from these increases either. Those who have their own private practices will be confronted with the same hard choices as other small employers. Ironically, they too will be unable to increase their fees to their customers – the very insurance companies that are jacking up premiums by as much as 30%. Employed physicians will find themselves in the same situation as other employees. Higher deductibles, greater contributions, or smaller wage increases. Let’s hope that Congress will not wait too long to see the folly of its ways. Promises of affordable healthcare are quickly becoming victim to reality. We need a real healthcare reform bill, one that eliminates the current reliance on CPT codes, and one that rewards quality and efficiency. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida. Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast. He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Our law firm just received notice of a 30% increase in healthcare premiums from Aetna. The premium is community rated, which means that other businesses have or will soon receive similar notices. After recovering from the initial shock, we looked at premiums from other health insurers for similar plans, and, not surprisingly, found their premium rates nearly identical. So much for the cost savings promised by Obama Care. Instead, it appears that health insurers are padding this year’s premiums to cushion the blow they anticipate when federal mandates kick in, including elimination of existing condition exclusions and mandated coverage of children through age 26. Anecdotal information from Massachusetts, which already has mandated health insurance, may give us some notion of the cost of eliminating pre-existing condition exclusions. Apparently many Massachusetts residents have figured out that the best approach to mandated health insurance is to purchase the least expensive product available, and, if they get seriously ill, then change to a more robust plan. Stories are told of patients and family members on their cell phones changing coverage while being wheeled in for emergency surgery. The cost of covering children through age 26 under family plans will also increase cost, especially given proposed regulations which provides coverage to all such “children” whether single, married, living at home, or living away from home. The increase we recently experienced is more than three times the 9% national increase recently predicted by a Price Waterhouse Coopers study. But even a 9% increase in today’s economy is unacceptable. So much for “bending the cost curve.” It seems like we’ve bent it, only in the wrong direction! For many who have followed the healthcare reform debate, these increases come as no surprise. Economics 101 taught us that we can’t provide more benefits to more people and charge less money. Predictably, employers, faced with these huge increases, are going to look to pass them along to their employees. Increased deductibles, higher employee contributions to premium, or smaller wage increases will be the reaction of many employers, especially in these difficult economic times where price increases to offset increased costs are simply not possible. Of course, physicians are not immune from these increases either. Those who have their own private practices will be confronted with the same hard choices as other small employers. Ironically, they too will be unable to increase their fees to their customers – the very insurance companies that are jacking up premiums by as much as 30%. Employed physicians will find themselves in the same situation as other employees. Higher deductibles, greater contributions, or smaller wage increases. Let’s hope that Congress will not wait too long to see the folly of its ways. Promises of affordable healthcare are quickly becoming victim to reality. We need a real healthcare reform bill, one that eliminates the current reliance on CPT codes, and one that rewards quality and efficiency. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida. Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast. He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 02 Jul 2010 14:26:44 GMT http://community.modernmedicine.com/_Healthcare-Premiums-Up-30/blog/2425366/33379.html skern 2010-07-02T14:25:37Z Health Law & Policy Modern Medicine Community Our law firm just received notice of a 30% increase in healthcare premiums from Aetna. The premium is community rated, which means that other businesses have or will soon receive similar notices. After recovering from the initial shock, we looked at premiums from other health insurers for similar plans, and, not surprisingly, found their premium rates nearly identical. So much for the cost savings promised by Obama Care. Instead, it appears that health insurers are padding this year’s premiums to cushion the blow they anticipate when federal mandates kick in, including elimination of existing condition exclusions and mandated coverage of children through age 26. Anecdotal information from Massachusetts, which already has mandated health insurance, may give us some notion of the cost of eliminating pre-existing condition exclusions. Apparently many Massachusetts residents have figured out that the best approach to mandated health insurance is to purchase the least expensive product available, and, if they get seriously ill, then change to a more robust plan. Stories are told of patients and family members on their cell phones changing coverage while being wheeled in for emergency surgery. The cost of covering children through age 26 under family plans will also increase cost, especially given proposed regulations which provides coverage to all such “children” whether single, married, living at home, or living away from home. The increase we recently experienced is more than three times the 9% national increase recently predicted by a Price Waterhouse Coopers study. But even a 9% increase in today’s economy is unacceptable. So much for “bending the cost curve.” It seems like we’ve bent it, only in the wrong direction! For many who have followed the healthcare reform debate, these increases come as no surprise. Economics 101 taught us that we can’t provide more benefits to more people and charge less money. Predictably, employers, faced with these huge increases, are going to look to pass them along to their employees. Increased deductibles, higher employee contributions to premium, or smaller wage increases will be the reaction of many employers, especially in these difficult economic times where price increases to offset increased costs are simply not possible. Of course, physicians are not immune from these increases either. Those who have their own private practices will be confronted with the same hard choices as other small employers. Ironically, they too will be unable to increase their fees to their customers – the very insurance companies that are jacking up premiums by as much as 30%. Employed physicians will find themselves in the same situation as other employees. Higher deductibles, greater contributions, or smaller wage increases. Let’s hope that Congress will not wait too long to see the folly of its ways. Promises of affordable healthcare are quickly becoming victim to reality. We need a real healthcare reform bill, one that eliminates the current reliance on CPT codes, and one that rewards quality and efficiency. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida. Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast. He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] health care reform, health law & policy, insurance companies nonadult false Healthcare Premiums, Up 30%! text blog health care reform,health law & policy,insurance companies 717 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 5 Health Law & Policy 0 2425366 3407919 Member 0 http://community.modernmedicine.com/_Red-Flags-Rule-The-FTC-Cries-Wolf-Again/blog/2367407/33379.html On the last business day before they were to begin enforcing the Red Flags Rule, the Federal Trade Commission again extended the deadline – this time until December 31, 2010. The Red Flags Rule was promulgated by the FTC to address the risk of identity theft. In announcing the latest delay, FTC Chairman Jon Leibowitz blamed Congress for the uncertainty concerning the Rule. According to Leibowitz: “Congress needs to fix the unintended consequences of the legislation establishing the Red Flags Rule – and to fix this problem quickly. . . . As an agency we’re charged with enforcing the law, and endless extensions delay enforcement.” In blaming Congress, the FTC says it developed the Rule because Congress directed it to develop regulations requiring “creditors” as well as “financial institutions” to address the risk of identity theft when it passed the Fair and Accurate Credit Transactions Act. Because the Act applied to “creditors” the FTC claims it was obligated to include in its Red Flags Rule all entities that have “covered accounts”, including medical practices. Numerous efforts to get the FTC to alter its opinion have proven unsuccessful. When it last delayed enforcement, in October of 2009, the FTC announced that it was doing so to allow Congress time to finalize legislation that would limit the scope of business covered by the Rule. Since then, Congress has failed to act. However, according to the FTC, it has received another request from “certain Members of Congress” for another delay in enforcement of the Rule beyond June 1, 2010. In announcing the latest delay, the FTC urged Congress to act quickly to pass legislation that will resolve any questions as to which entities are covered by the Rule and obviate the need for further enforcement delays. If Congress passes legislation limiting the scope of the Red Flags Rule with an effective date earlier than December 31, 2010, the FTC will begin enforcement as of that effective date to those entities still within the scope of the new legislation. Just one week before the latest announcement the AMA and the American Osteopathic Association filed a lawsuit asking the courts to declare that the legislation which resulted in the Red Flags Rule was not intended to apply to physician offices. However, neither organization asked the courts to immediately enjoin enforcement. Unfortunately, the delay in enforcement by the FTC does not delay numerous state laws which also address identity theft. Some of these state laws are even more burdensome than the federal regulations. It is inexcusable that Congress cannot quickly clarify its intent and, hopefully, remove physician offices from the scope of a law that most observers believe was initially intended only to apply to banks and other financial institutions. While most believe that the FTC has drastically overstepped its bounds in applying the law to physician offices, only Congress or the Courts can eliminate this uncertainty, which has already cost physicians many millions of dollars, and untold lost time. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida. Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast. He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] On the last business day before they were to begin enforcing the Red Flags Rule, the Federal Trade Commission again extended the deadline – this time until December 31, 2010. The Red Flags Rule was promulgated by the FTC to address the risk of identity theft. In announcing the latest delay, FTC Chairman Jon Leibowitz blamed Congress for the uncertainty concerning the Rule. According to Leibowitz: “Congress needs to fix the unintended consequences of the legislation establishing the Red Flags Rule – and to fix this problem quickly. . . . As an agency we’re charged with enforcing the law, and endless extensions delay enforcement.” In blaming Congress, the FTC says it developed the Rule because Congress directed it to develop regulations requiring “creditors” as well as “financial institutions” to address the risk of identity theft when it passed the Fair and Accurate Credit Transactions Act. Because the Act applied to “creditors” the FTC claims it was obligated to include in its Red Flags Rule all entities that have “covered accounts”, including medical practices. Numerous efforts to get the FTC to alter its opinion have proven unsuccessful. When it last delayed enforcement, in October of 2009, the FTC announced that it was doing so to allow Congress time to finalize legislation that would limit the scope of business covered by the Rule. Since then, Congress has failed to act. However, according to the FTC, it has received another request from “certain Members of Congress” for another delay in enforcement of the Rule beyond June 1, 2010. In announcing the latest delay, the FTC urged Congress to act quickly to pass legislation that will resolve any questions as to which entities are covered by the Rule and obviate the need for further enforcement delays. If Congress passes legislation limiting the scope of the Red Flags Rule with an effective date earlier than December 31, 2010, the FTC will begin enforcement as of that effective date to those entities still within the scope of the new legislation. Just one week before the latest announcement the AMA and the American Osteopathic Association filed a lawsuit asking the courts to declare that the legislation which resulted in the Red Flags Rule was not intended to apply to physician offices. However, neither organization asked the courts to immediately enjoin enforcement. Unfortunately, the delay in enforcement by the FTC does not delay numerous state laws which also address identity theft. Some of these state laws are even more burdensome than the federal regulations. It is inexcusable that Congress cannot quickly clarify its intent and, hopefully, remove physician offices from the scope of a law that most observers believe was initially intended only to apply to banks and other financial institutions. While most believe that the FTC has drastically overstepped its bounds in applying the law to physician offices, only Congress or the Courts can eliminate this uncertainty, which has already cost physicians many millions of dollars, and untold lost time. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida. Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast. He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Tue, 01 Jun 2010 14:03:20 GMT http://community.modernmedicine.com/_Red-Flags-Rule-The-FTC-Cries-Wolf-Again/blog/2367407/33379.html skern 2010-06-01T14:00:54Z Health Law & Policy Modern Medicine Community On the last business day before they were to begin enforcing the Red Flags Rule, the Federal Trade Commission again extended the deadline – this time until December 31, 2010. The Red Flags Rule was promulgated by the FTC to address the risk of identity theft. In announcing the latest delay, FTC Chairman Jon Leibowitz blamed Congress for the uncertainty concerning the Rule. According to Leibowitz: “Congress needs to fix the unintended consequences of the legislation establishing the Red Flags Rule – and to fix this problem quickly. . . . As an agency we’re charged with enforcing the law, and endless extensions delay enforcement.” In blaming Congress, the FTC says it developed the Rule because Congress directed it to develop regulations requiring “creditors” as well as “financial institutions” to address the risk of identity theft when it passed the Fair and Accurate Credit Transactions Act. Because the Act applied to “creditors” the FTC claims it was obligated to include in its Red Flags Rule all entities that have “covered accounts”, including medical practices. Numerous efforts to get the FTC to alter its opinion have proven unsuccessful. When it last delayed enforcement, in October of 2009, the FTC announced that it was doing so to allow Congress time to finalize legislation that would limit the scope of business covered by the Rule. Since then, Congress has failed to act. However, according to the FTC, it has received another request from “certain Members of Congress” for another delay in enforcement of the Rule beyond June 1, 2010. In announcing the latest delay, the FTC urged Congress to act quickly to pass legislation that will resolve any questions as to which entities are covered by the Rule and obviate the need for further enforcement delays. If Congress passes legislation limiting the scope of the Red Flags Rule with an effective date earlier than December 31, 2010, the FTC will begin enforcement as of that effective date to those entities still within the scope of the new legislation. Just one week before the latest announcement the AMA and the American Osteopathic Association filed a lawsuit asking the courts to declare that the legislation which resulted in the Red Flags Rule was not intended to apply to physician offices. However, neither organization asked the courts to immediately enjoin enforcement. Unfortunately, the delay in enforcement by the FTC does not delay numerous state laws which also address identity theft. Some of these state laws are even more burdensome than the federal regulations. It is inexcusable that Congress cannot quickly clarify its intent and, hopefully, remove physician offices from the scope of a law that most observers believe was initially intended only to apply to banks and other financial institutions. While most believe that the FTC has drastically overstepped its bounds in applying the law to physician offices, only Congress or the Courts can eliminate this uncertainty, which has already cost physicians many millions of dollars, and untold lost time. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida. Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast. He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] health law & policy, mmglobal nonadult false Red Flags Rule: The FTC Cries Wolf Again text blog health law & policy,mmglobal 646 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 0 Health Law & Policy 0 2367407 3407919 Member 0 http://community.modernmedicine.com/_Medicare-Is-It-Time-To-Opt-Out/blog/2335605/33379.html With the new federal health reform law and recent announcements dramatically increasing the number of audits that Medicare will be conducting through its vigilante “auditors,” is it time to consider opting out of Medicare? To answer that question, you first need to know your options. Most physicians are participating providers with Medicare. That allows them to accept assignment and receive payments directly from Medicare. An alternative is to change to nonparticipating status. The advantage of this is that you can charge your patients additional fees, up to the Medicare limiting charge. However, Medicare will reduce the amount it pays you directly by 5% and, except on a case-by-case basis, you will not be permitted to accept assignment. That means that your patients will receive the check from Medicare for your services, and you will have to rely upon your patients to either endorse the check over to you, or to pay you directly for the care you rendered. For those physicians who believe that changing from participating to nonparticipating status will eliminate the ability of the government to audit your charges, no such luck. As long as your bill is submitted to Medicare, from any source, you are subject to audit. A third option is to completely opt out of Medicare. The rules associated with this process are somewhat complicated. By opting out, neither you nor your patient will receive any Medicare reimbursement. Because no Medicare monies will be involved, there should be no audits, but there can still be compliance issues with respect to whether or not you followed the complicated opt-out requirements. By opting out, a physician is not required to submit claims to Medicare on behalf of patients and is not restricted to the limits on charges for Medicare covered services. However, you cannot opt out selectively. If you opt out, even for one patient, you have elected to completely opt out for 2 years. In order to opt out, you need to enter into private contracts with Medicare beneficiaries. These contracts require Medicare beneficiaries to agree to give up Medicare payments for services furnished by the physician and to pay the physician without regard to any limits that would otherwise apply to what the physician could charge. There are a number of very specific items that these private contracts must include. Among other things, the contracts must Be in writing Clearly state whether the physician is excluded from Medicare under certain provisions of the Social Security Act State that the beneficiary (or his legal representative) accepts full responsibility for payment of the physician’s charges for all services furnished by the physician State that the beneficiary understands that Medicare limiting charges do not apply to what the physician may charge for items or services provided State that the beneficiary agrees not to submit a claim to Medicare or ask the physician to submit a claim to Medicare State the beneficiary understands that Medicare payment will not be made for any items or services furnished by the physician that would have otherwise been covered by Medicare if there were no private contract State that the beneficiary enters into the contract with the knowledge that he has the right to obtain Medicare-covered items and services from physicians who have not opted out of Medicare, and that the beneficiary is not compelled to enter into private contracts that apply to other Medicare-covered services furnished by other physicians or practitioners who have opted out Be signed by the beneficiary and the physician. In addition to entering into a private agreement, the physician must file an affidavit notifying all Medicare carriers to which he would submit claims, advising each that he has opted out of Medicare. Physicians thinking about opting out should first consider the above requirements and weigh the potential benefits of opting out for their practice. If, after careful consideration, the physician decides to pursue opting out, he or she should contact a healthcare attorney to address all of the very specific requirements necessary to effectuate that decision. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] With the new federal health reform law and recent announcements dramatically increasing the number of audits that Medicare will be conducting through its vigilante “auditors,” is it time to consider opting out of Medicare? To answer that question, you first need to know your options. Most physicians are participating providers with Medicare. That allows them to accept assignment and receive payments directly from Medicare. An alternative is to change to nonparticipating status. The advantage of this is that you can charge your patients additional fees, up to the Medicare limiting charge. However, Medicare will reduce the amount it pays you directly by 5% and, except on a case-by-case basis, you will not be permitted to accept assignment. That means that your patients will receive the check from Medicare for your services, and you will have to rely upon your patients to either endorse the check over to you, or to pay you directly for the care you rendered. For those physicians who believe that changing from participating to nonparticipating status will eliminate the ability of the government to audit your charges, no such luck. As long as your bill is submitted to Medicare, from any source, you are subject to audit. A third option is to completely opt out of Medicare. The rules associated with this process are somewhat complicated. By opting out, neither you nor your patient will receive any Medicare reimbursement. Because no Medicare monies will be involved, there should be no audits, but there can still be compliance issues with respect to whether or not you followed the complicated opt-out requirements. By opting out, a physician is not required to submit claims to Medicare on behalf of patients and is not restricted to the limits on charges for Medicare covered services. However, you cannot opt out selectively. If you opt out, even for one patient, you have elected to completely opt out for 2 years. In order to opt out, you need to enter into private contracts with Medicare beneficiaries. These contracts require Medicare beneficiaries to agree to give up Medicare payments for services furnished by the physician and to pay the physician without regard to any limits that would otherwise apply to what the physician could charge. There are a number of very specific items that these private contracts must include. Among other things, the contracts must Be in writing Clearly state whether the physician is excluded from Medicare under certain provisions of the Social Security Act State that the beneficiary (or his legal representative) accepts full responsibility for payment of the physician’s charges for all services furnished by the physician State that the beneficiary understands that Medicare limiting charges do not apply to what the physician may charge for items or services provided State that the beneficiary agrees not to submit a claim to Medicare or ask the physician to submit a claim to Medicare State the beneficiary understands that Medicare payment will not be made for any items or services furnished by the physician that would have otherwise been covered by Medicare if there were no private contract State that the beneficiary enters into the contract with the knowledge that he has the right to obtain Medicare-covered items and services from physicians who have not opted out of Medicare, and that the beneficiary is not compelled to enter into private contracts that apply to other Medicare-covered services furnished by other physicians or practitioners who have opted out Be signed by the beneficiary and the physician. In addition to entering into a private agreement, the physician must file an affidavit notifying all Medicare carriers to which he would submit claims, advising each that he has opted out of Medicare. Physicians thinking about opting out should first consider the above requirements and weigh the potential benefits of opting out for their practice. If, after careful consideration, the physician decides to pursue opting out, he or she should contact a healthcare attorney to address all of the very specific requirements necessary to effectuate that decision. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Wed, 12 May 2010 23:10:19 GMT http://community.modernmedicine.com/_Medicare-Is-It-Time-To-Opt-Out/blog/2335605/33379.html skern 2010-05-12T23:08:22Z Managing Your Practice Modern Medicine Community With the new federal health reform law and recent announcements dramatically increasing the number of audits that Medicare will be conducting through its vigilante “auditors,” is it time to consider opting out of Medicare? To answer that question, you first need to know your options. Most physicians are participating providers with Medicare. That allows them to accept assignment and receive payments directly from Medicare. An alternative is to change to nonparticipating status. The advantage of this is that you can charge your patients additional fees, up to the Medicare limiting charge. However, Medicare will reduce the amount it pays you directly by 5% and, except on a case-by-case basis, you will not be permitted to accept assignment. That means that your patients will receive the check from Medicare for your services, and you will have to rely upon your patients to either endorse the check over to you, or to pay you directly for the care you rendered. For those physicians who believe that changing from participating to nonparticipating status will eliminate the ability of the government to audit your charges, no such luck. As long as your bill is submitted to Medicare, from any source, you are subject to audit. A third option is to completely opt out of Medicare. The rules associated with this process are somewhat complicated. By opting out, neither you nor your patient will receive any Medicare reimbursement. Because no Medicare monies will be involved, there should be no audits, but there can still be compliance issues with respect to whether or not you followed the complicated opt-out requirements. By opting out, a physician is not required to submit claims to Medicare on behalf of patients and is not restricted to the limits on charges for Medicare covered services. However, you cannot opt out selectively. If you opt out, even for one patient, you have elected to completely opt out for 2 years. In order to opt out, you need to enter into private contracts with Medicare beneficiaries. These contracts require Medicare beneficiaries to agree to give up Medicare payments for services furnished by the physician and to pay the physician without regard to any limits that would otherwise apply to what the physician could charge. There are a number of very specific items that these private contracts must include. Among other things, the contracts must Be in writing Clearly state whether the physician is excluded from Medicare under certain provisions of the Social Security Act State that the beneficiary (or his legal representative) accepts full responsibility for payment of the physician’s charges for all services furnished by the physician State that the beneficiary understands that Medicare limiting charges do not apply to what the physician may charge for items or services provided State that the beneficiary agrees not to submit a claim to Medicare or ask the physician to submit a claim to Medicare State the beneficiary understands that Medicare payment will not be made for any items or services furnished by the physician that would have otherwise been covered by Medicare if there were no private contract State that the beneficiary enters into the contract with the knowledge that he has the right to obtain Medicare-covered items and services from physicians who have not opted out of Medicare, and that the beneficiary is not compelled to enter into private contracts that apply to other Medicare-covered services furnished by other physicians or practitioners who have opted out Be signed by the beneficiary and the physician. In addition to entering into a private agreement, the physician must file an affidavit notifying all Medicare carriers to which he would submit claims, advising each that he has opted out of Medicare. Physicians thinking about opting out should first consider the above requirements and weigh the potential benefits of opting out for their practice. If, after careful consideration, the physician decides to pursue opting out, he or she should contact a healthcare attorney to address all of the very specific requirements necessary to effectuate that decision. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] audit, managing your practice, medicare, medicare reimbursement, mmglobal, participating providers nonadult false Medicare: Is It Time To Opt Out? text blog audit,managing your practice,medicare,medicare reimbursement,mmglobal,participating providers 878 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 1 Managing Your Practice 3 2335605 3407919 Member 0 http://community.modernmedicine.com/_Your-Practice-A-New-Revenue-Stream/blog/2277631/33379.html Congratulations! Your practice just became a revenue stream. Unfortunately, not for you, but for the federal government, various state governments, and the bounty hunters they are hiring to recover alleged Medicare and Medicaid overpayments. On March 10th, President Obama issued a directive expanding the use of “payment recapture audits” to identify and recover overpayments. What this means is that companies are being hired to audit your claims and seek return of payments made in excess of the amount the “auditors” decide you should have been paid. The reason for the expansion is simple. The cost of these audits is far less than the money the government realizes from them. In fact, the government can’t lose. They’ve taken a page from the trial lawyers and are paying their “auditors” a percentage of the amount they recover. So much for the fair, unbiased auditor. By calling the companies that audit on a contingency fee “auditors,” the government has turned the definition of an auditor on its head. Auditors are supposed to be independent and not rewarded or penalized depending upon their findings. Imagine the uproar if a bank or a Fortune 500 company paid its auditors based upon how much the audit enhanced the company’s bottom line or increased the value of its stock! Yet, in announcing the expansion of the audit program, the President highlighted Medicare’s Recovery Audit Contractor Program (RAC) as being particularly successful in identifying improper payments, and even boasted that the RACs are compensated on a contingency basis related to the recoveries they obtain. Obama also claimed that the RACs employ accounting specialists and fraud examiners using specialized technology to uncover overpayments. Yet, those of us who have had substantial experience with the RACs have a different perspective. Their “expertise” is often lacking, their objectivity highly questionable-- since they make their money only if they find overpayments--and their tactics often heavy-handed. Dealing with a RAC is not a job for an amateur or the faint of heart. It involves critical deadlines, complex procedures, medical and coding expertise, and a reputation for challenging their often erroneous presumptions and calculations. The amounts in controversy can be very large, and the potential for the audit to turn into a civil or criminal fraud case real. A RAC audit should be treated like an IRS audit. It could result in severe monetary penalties and trigger disciplinary actions and even criminal actions. If you have any doubts about your coding or documentation, get professional help immediately. Like most medicolegal issues, your ability to defend will depend in large part on the quality of your records. If you’ve yet to take the leap into electronic health records, this is yet another reason to do so. One of the advantages of many EHR systems is that they assure that the documentation matches the coding. States are now joining the federal bandwagon. New York State, for example, just increased the maximum civil penalty for persons who receive overpayments or otherwise inappropriate payments from Medicaid. The law now allows for penalties of up to $10,000 for a first offender and $30,000 for repeat offenders—for each item of care, service, or supply! If a Medicaid program audit finds more than 25% of the audited claims resulted in overpayments, the State can recover both civil penalties and the amount of the overpayment. If less than 25%, the State must choose between the amount of the overpayment and the civil penalty. Expect other states to follow with similar legislation. Steven I. Kern has served as Senior Principal with Kern Augustine Conroy & Schoppmann, P.C. (and its predecessor firms) for the last 30 years. In this position, he has provided counsel to physicians, nurses, and other healthcare professionals; numerous hospital medical staffs; state and county medical societies; and physician specialty societies. For the last 10 years, he has been General Counsel to New Jersey Physicians. Mr Kern has gained admission to both the New Jersey and the United States District Court - District of New Jersey bars. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Congratulations! Your practice just became a revenue stream. Unfortunately, not for you, but for the federal government, various state governments, and the bounty hunters they are hiring to recover alleged Medicare and Medicaid overpayments. On March 10th, President Obama issued a directive expanding the use of “payment recapture audits” to identify and recover overpayments. What this means is that companies are being hired to audit your claims and seek return of payments made in excess of the amount the “auditors” decide you should have been paid. The reason for the expansion is simple. The cost of these audits is far less than the money the government realizes from them. In fact, the government can’t lose. They’ve taken a page from the trial lawyers and are paying their “auditors” a percentage of the amount they recover. So much for the fair, unbiased auditor. By calling the companies that audit on a contingency fee “auditors,” the government has turned the definition of an auditor on its head. Auditors are supposed to be independent and not rewarded or penalized depending upon their findings. Imagine the uproar if a bank or a Fortune 500 company paid its auditors based upon how much the audit enhanced the company’s bottom line or increased the value of its stock! Yet, in announcing the expansion of the audit program, the President highlighted Medicare’s Recovery Audit Contractor Program (RAC) as being particularly successful in identifying improper payments, and even boasted that the RACs are compensated on a contingency basis related to the recoveries they obtain. Obama also claimed that the RACs employ accounting specialists and fraud examiners using specialized technology to uncover overpayments. Yet, those of us who have had substantial experience with the RACs have a different perspective. Their “expertise” is often lacking, their objectivity highly questionable-- since they make their money only if they find overpayments--and their tactics often heavy-handed. Dealing with a RAC is not a job for an amateur or the faint of heart. It involves critical deadlines, complex procedures, medical and coding expertise, and a reputation for challenging their often erroneous presumptions and calculations. The amounts in controversy can be very large, and the potential for the audit to turn into a civil or criminal fraud case real. A RAC audit should be treated like an IRS audit. It could result in severe monetary penalties and trigger disciplinary actions and even criminal actions. If you have any doubts about your coding or documentation, get professional help immediately. Like most medicolegal issues, your ability to defend will depend in large part on the quality of your records. If you’ve yet to take the leap into electronic health records, this is yet another reason to do so. One of the advantages of many EHR systems is that they assure that the documentation matches the coding. States are now joining the federal bandwagon. New York State, for example, just increased the maximum civil penalty for persons who receive overpayments or otherwise inappropriate payments from Medicaid. The law now allows for penalties of up to $10,000 for a first offender and $30,000 for repeat offenders—for each item of care, service, or supply! If a Medicaid program audit finds more than 25% of the audited claims resulted in overpayments, the State can recover both civil penalties and the amount of the overpayment. If less than 25%, the State must choose between the amount of the overpayment and the civil penalty. Expect other states to follow with similar legislation. Steven I. Kern has served as Senior Principal with Kern Augustine Conroy & Schoppmann, P.C. (and its predecessor firms) for the last 30 years. In this position, he has provided counsel to physicians, nurses, and other healthcare professionals; numerous hospital medical staffs; state and county medical societies; and physician specialty societies. For the last 10 years, he has been General Counsel to New Jersey Physicians. Mr Kern has gained admission to both the New Jersey and the United States District Court - District of New Jersey bars. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Thu, 01 Apr 2010 20:03:05 GMT http://community.modernmedicine.com/_Your-Practice-A-New-Revenue-Stream/blog/2277631/33379.html skern 2010-04-01T19:51:19Z Health Law & Policy Modern Medicine Community Congratulations! Your practice just became a revenue stream. Unfortunately, not for you, but for the federal government, various state governments, and the bounty hunters they are hiring to recover alleged Medicare and Medicaid overpayments. On March 10th, President Obama issued a directive expanding the use of “payment recapture audits” to identify and recover overpayments. What this means is that companies are being hired to audit your claims and seek return of payments made in excess of the amount the “auditors” decide you should have been paid. The reason for the expansion is simple. The cost of these audits is far less than the money the government realizes from them. In fact, the government can’t lose. They’ve taken a page from the trial lawyers and are paying their “auditors” a percentage of the amount they recover. So much for the fair, unbiased auditor. By calling the companies that audit on a contingency fee “auditors,” the government has turned the definition of an auditor on its head. Auditors are supposed to be independent and not rewarded or penalized depending upon their findings. Imagine the uproar if a bank or a Fortune 500 company paid its auditors based upon how much the audit enhanced the company’s bottom line or increased the value of its stock! Yet, in announcing the expansion of the audit program, the President highlighted Medicare’s Recovery Audit Contractor Program (RAC) as being particularly successful in identifying improper payments, and even boasted that the RACs are compensated on a contingency basis related to the recoveries they obtain. Obama also claimed that the RACs employ accounting specialists and fraud examiners using specialized technology to uncover overpayments. Yet, those of us who have had substantial experience with the RACs have a different perspective. Their “expertise” is often lacking, their objectivity highly questionable-- since they make their money only if they find overpayments--and their tactics often heavy-handed. Dealing with a RAC is not a job for an amateur or the faint of heart. It involves critical deadlines, complex procedures, medical and coding expertise, and a reputation for challenging their often erroneous presumptions and calculations. The amounts in controversy can be very large, and the potential for the audit to turn into a civil or criminal fraud case real. A RAC audit should be treated like an IRS audit. It could result in severe monetary penalties and trigger disciplinary actions and even criminal actions. If you have any doubts about your coding or documentation, get professional help immediately. Like most medicolegal issues, your ability to defend will depend in large part on the quality of your records. If you’ve yet to take the leap into electronic health records, this is yet another reason to do so. One of the advantages of many EHR systems is that they assure that the documentation matches the coding. States are now joining the federal bandwagon. New York State, for example, just increased the maximum civil penalty for persons who receive overpayments or otherwise inappropriate payments from Medicaid. The law now allows for penalties of up to $10,000 for a first offender and $30,000 for repeat offenders—for each item of care, service, or supply! If a Medicaid program audit finds more than 25% of the audited claims resulted in overpayments, the State can recover both civil penalties and the amount of the overpayment. If less than 25%, the State must choose between the amount of the overpayment and the civil penalty. Expect other states to follow with similar legislation. Steven I. Kern has served as Senior Principal with Kern Augustine Conroy & Schoppmann, P.C. (and its predecessor firms) for the last 30 years. In this position, he has provided counsel to physicians, nurses, and other healthcare professionals; numerous hospital medical staffs; state and county medical societies; and physician specialty societies. For the last 10 years, he has been General Counsel to New Jersey Physicians. Mr Kern has gained admission to both the New Jersey and the United States District Court - District of New Jersey bars. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] health law & policy, medical-legal issues, medicare overpayment, mmglobal, recovery audit contractor nonadult false Your Practice: A New Revenue Stream text blog health law & policy,medical-legal issues,medicare overpayment,mmglobal,recovery audit contractor 1330 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 5 Health Law & Policy 3 2277631 3407919 Member 0 http://community.modernmedicine.com/_AMA-Supports-Obamacare-Did-It-Sell-Out-Our-Nations-Physicians/blog/2193855/33379.html The AMA announced today that it is supporting the sweeping $940 billion dollar health care reform bill scheduled for consideration on the House floor this Sunday.  In endorsing the bill, the AMA’s president, J. James Rohack admitted that the bill was “imperfect” and expressed concerns about the bill’s “Independent Payment Advisory Board” which he concedes could result in “misguided payment cuts that undermine access to care and destabilize healthcare delivery.”  Of course, the bill also fails to provide a permanent fix to the ongoing threats to cut Medicare reimbursements by over 21%. Given these facts and polls which show that physicians and other voters overwhelmingly oppose the proposed bill, why did the AMA decide to endorse it? Skeptics will argue that the AMA was forced to endorse the bill, as it previously did over the summer, to maintain its hold on the CPT coding system, which is responsible for an estimated 83% of the AMA’s annual revenues.  Of course, many argue that the reimbursement system based upon CPT codes is responsible for much of what is currently wrong with healthcare and that an overhaul of the reimbursement system, to reward efficient care and good outcomes, could save the system billions.  Even the Mayo Clinic is threatening to completely end its participation with Medicare because it is losing money by providing efficient, outcome based treatment. A continuation of the current reimbursement system is, by just about everyone’s estimates—unsustainable. But, changing that system could cost the AMA its livelihood. Does the AMA’s reliance on CPT code revenues create an insurmountable conflict between its own efforts and the interests of its members?   As one cable news network says “we report—you decide.” Physicians unhappy with the AMA’s decision can contact the AMA at 800-262-3211. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com.  [Editor’s Note: Do you have any thoughts to share on the AMA’s role in the health care reform? Please Log in to use the Comment box below.] The AMA announced today that it is supporting the sweeping $940 billion dollar health care reform bill scheduled for consideration on the House floor this Sunday.  In endorsing the bill, the AMA’s president, J. James Rohack admitted that the bill was “imperfect” and expressed concerns about the bill’s “Independent Payment Advisory Board” which he concedes could result in “misguided payment cuts that undermine access to care and destabilize healthcare delivery.”  Of course, the bill also fails to provide a permanent fix to the ongoing threats to cut Medicare reimbursements by over 21%. Given these facts and polls which show that physicians and other voters overwhelmingly oppose the proposed bill, why did the AMA decide to endorse it? Skeptics will argue that the AMA was forced to endorse the bill, as it previously did over the summer, to maintain its hold on the CPT coding system, which is responsible for an estimated 83% of the AMA’s annual revenues.  Of course, many argue that the reimbursement system based upon CPT codes is responsible for much of what is currently wrong with healthcare and that an overhaul of the reimbursement system, to reward efficient care and good outcomes, could save the system billions.  Even the Mayo Clinic is threatening to completely end its participation with Medicare because it is losing money by providing efficient, outcome based treatment. A continuation of the current reimbursement system is, by just about everyone’s estimates—unsustainable. But, changing that system could cost the AMA its livelihood. Does the AMA’s reliance on CPT code revenues create an insurmountable conflict between its own efforts and the interests of its members?   As one cable news network says “we report—you decide.” Physicians unhappy with the AMA’s decision can contact the AMA at 800-262-3211. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com.  [Editor’s Note: Do you have any thoughts to share on the AMA’s role in the health care reform? Please Log in to use the Comment box below.] Fri, 19 Mar 2010 19:10:28 GMT http://community.modernmedicine.com/_AMA-Supports-Obamacare-Did-It-Sell-Out-Our-Nations-Physicians/blog/2193855/33379.html skern 2010-03-19T19:05:44Z Health Law & Policy Modern Medicine Community The AMA announced today that it is supporting the sweeping $940 billion dollar health care reform bill scheduled for consideration on the House floor this Sunday.  In endorsing the bill, the AMA’s president, J. James Rohack admitted that the bill was “imperfect” and expressed concerns about the bill’s “Independent Payment Advisory Board” which he concedes could result in “misguided payment cuts that undermine access to care and destabilize healthcare delivery.”  Of course, the bill also fails to provide a permanent fix to the ongoing threats to cut Medicare reimbursements by over 21%. Given these facts and polls which show that physicians and other voters overwhelmingly oppose the proposed bill, why did the AMA decide to endorse it? Skeptics will argue that the AMA was forced to endorse the bill, as it previously did over the summer, to maintain its hold on the CPT coding system, which is responsible for an estimated 83% of the AMA’s annual revenues.  Of course, many argue that the reimbursement system based upon CPT codes is responsible for much of what is currently wrong with healthcare and that an overhaul of the reimbursement system, to reward efficient care and good outcomes, could save the system billions.  Even the Mayo Clinic is threatening to completely end its participation with Medicare because it is losing money by providing efficient, outcome based treatment. A continuation of the current reimbursement system is, by just about everyone’s estimates—unsustainable. But, changing that system could cost the AMA its livelihood. Does the AMA’s reliance on CPT code revenues create an insurmountable conflict between its own efforts and the interests of its members?   As one cable news network says “we report—you decide.” Physicians unhappy with the AMA’s decision can contact the AMA at 800-262-3211. Steven I. Kern is a recognized expert on healthcare law and president of Kern Augustine Conroy & Schoppmann, P.C., a healthcare law firm with offices in Bridgewater, NJ, Lake Success, NY, and Philadelphia, Pa, and affiliates in Chicago, Illinois and Altimonti Springs, (Orlando) Florida.  Mr. Kern is a seasoned trial lawyer, having advised and represented thousands of physicians and other healthcare professionals in licensing matters and litigation from coast to coast.  He is a member of the Editorial Advisory Board of ModernMedicine.com and Medical Economics magazine, a member of the Editorial Board of New Jersey Lawyer, and a former Deputy Attorney General for New Jersey. He can be reached at kern@drlaw.com.  [Editor’s Note: Do you have any thoughts to share on the AMA’s role in the health care reform? Please Log in to use the Comment box below.] cpt coding system, health care reform, health law & policy, mmglobal nonadult false AMA Supports Obamacare--Did It Sell Out Our Nation’s Physicians? text blog cpt coding system,health care reform,health law & policy,mmglobal 1596 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 3 Health Law & Policy 0 2193855 3407919 Member 0 http://community.modernmedicine.com/_An-End-to-Tort-Reform/blog/1927361/33379.html The Illinois Supreme Court has recently dealt a fatal blow to meaningful tort reform in that state. Will its decision affect other states, and if so, what is the future of tort reform in America? On February 4, 2010, the Supreme Court of Illinois ruled that an Illinois law capping noneconomic damages in medical malpractice cases was unconstitutional because it violated the separations of powers clause of the Illinois Constitution. The law under review limited noneconomic damages to $1,000,000 against a hospital and its personnel, and $500,000 against a physician, physician practice, or other healthcare professional. The Illinois law, which has been on the books since August of 2005, was based upon legislative findings documenting the fact that increased costs of malpractice insurance on physicians and hospitals were reducing the availability of healthcare in Illinois. The law had been credited with bringing 5,000 more doctors into the state, luring 3 new malpractice insurers into the state, and reducing premiums by 5% to 30%. Given the apparent success of the law, why was it rejected, and what does this decision mean to the 19 states which have similar laws and to efforts in Congress and in other states to impose similar caps? Since the Illinois decision is based upon its own State Constitution, its effect on other states, especially those with existing laws, may not be substantial. This is especially so where the highest courts in those states have already ruled on the constitutionality of these laws. However, in states where the constitutionality of these laws is still under judicial review, the Illinois decision is, at a minimum, likely to be used as part of the trial lawyers’ efforts to strike them down. Moreover, trial lawyers’ lobbyists will now have another quill in their arsenal when lobbying Congress and other state legislatures against meaningful tort reform. Hope that the Illinois Supreme Court decision will have limited impact on other states is founded upon the fact that the decision was based upon the Court’s very broad interpretation of specific language in the Illinois Constitution, rather than upon language in the United States Constitution. The language at issue in the Illinois Constitution involves the ability of the Illinois courts to use a “remittitur”. A “remittitur” allows a court to reduce an excessive jury award, and in the Illinois Constitution, the use of a “remittitur” is a prerogative of the judicial branch of government. The Court simply found that a legislative cap on damages was the equivalent of a legislative “remittitur” and, therefore, determined that the legislature had encroached on the judiciary’s exclusive jurisdiction to reduce jury verdicts. In doing so, it held that the power to reduce jury awards is a traditional power of the judiciary, and the legislature’s mandate to reduce jury awards through caps on noneconomic damages violated the separation of powers clause of the Illinois Constitution. Put another way, since the legislature required courts to enter judgments that differed from a jury’s award which exceeded the limits of the caps, it disregarded the court’s exclusive duty to consider whether a jury’s verdict is excessive as a matter of law. This, according to the Court, made the law unconstitutional. While, short of a state constitutional amendment, the most significant efforts at tort reform are doomed in Illinois, the good news is that similar efforts in other states and in Congress may not be drastically affected by this seemingly anomalous decision. Only time will tell. Steven I. Kern has served as Senior Principal with Kern Augustine Conroy & Schoppmann, P.C. (and its predecessor firms) for the last 30 years. In this position, he has provided counsel to physicians, nurses, and other healthcare professionals; numerous hospital medical staffs; state and county medical societies; and physician specialty societies. For the last 10 years, he has been General Counsel to New Jersey Physicians. Mr Kern has gained admission to both the New Jersey and the United States District Court - District of New Jersey bars. [Editor’s Note: Do you have thoughts to share on medical malpractice? Log in and Comment in the box below.] The Illinois Supreme Court has recently dealt a fatal blow to meaningful tort reform in that state. Will its decision affect other states, and if so, what is the future of tort reform in America? On February 4, 2010, the Supreme Court of Illinois ruled that an Illinois law capping noneconomic damages in medical malpractice cases was unconstitutional because it violated the separations of powers clause of the Illinois Constitution. The law under review limited noneconomic damages to $1,000,000 against a hospital and its personnel, and $500,000 against a physician, physician practice, or other healthcare professional. The Illinois law, which has been on the books since August of 2005, was based upon legislative findings documenting the fact that increased costs of malpractice insurance on physicians and hospitals were reducing the availability of healthcare in Illinois. The law had been credited with bringing 5,000 more doctors into the state, luring 3 new malpractice insurers into the state, and reducing premiums by 5% to 30%. Given the apparent success of the law, why was it rejected, and what does this decision mean to the 19 states which have similar laws and to efforts in Congress and in other states to impose similar caps? Since the Illinois decision is based upon its own State Constitution, its effect on other states, especially those with existing laws, may not be substantial. This is especially so where the highest courts in those states have already ruled on the constitutionality of these laws. However, in states where the constitutionality of these laws is still under judicial review, the Illinois decision is, at a minimum, likely to be used as part of the trial lawyers’ efforts to strike them down. Moreover, trial lawyers’ lobbyists will now have another quill in their arsenal when lobbying Congress and other state legislatures against meaningful tort reform. Hope that the Illinois Supreme Court decision will have limited impact on other states is founded upon the fact that the decision was based upon the Court’s very broad interpretation of specific language in the Illinois Constitution, rather than upon language in the United States Constitution. The language at issue in the Illinois Constitution involves the ability of the Illinois courts to use a “remittitur”. A “remittitur” allows a court to reduce an excessive jury award, and in the Illinois Constitution, the use of a “remittitur” is a prerogative of the judicial branch of government. The Court simply found that a legislative cap on damages was the equivalent of a legislative “remittitur” and, therefore, determined that the legislature had encroached on the judiciary’s exclusive jurisdiction to reduce jury verdicts. In doing so, it held that the power to reduce jury awards is a traditional power of the judiciary, and the legislature’s mandate to reduce jury awards through caps on noneconomic damages violated the separation of powers clause of the Illinois Constitution. Put another way, since the legislature required courts to enter judgments that differed from a jury’s award which exceeded the limits of the caps, it disregarded the court’s exclusive duty to consider whether a jury’s verdict is excessive as a matter of law. This, according to the Court, made the law unconstitutional. While, short of a state constitutional amendment, the most significant efforts at tort reform are doomed in Illinois, the good news is that similar efforts in other states and in Congress may not be drastically affected by this seemingly anomalous decision. Only time will tell. Steven I. Kern has served as Senior Principal with Kern Augustine Conroy & Schoppmann, P.C. (and its predecessor firms) for the last 30 years. In this position, he has provided counsel to physicians, nurses, and other healthcare professionals; numerous hospital medical staffs; state and county medical societies; and physician specialty societies. For the last 10 years, he has been General Counsel to New Jersey Physicians. Mr Kern has gained admission to both the New Jersey and the United States District Court - District of New Jersey bars. [Editor’s Note: Do you have thoughts to share on medical malpractice? Log in and Comment in the box below.] Wed, 03 Mar 2010 00:55:53 GMT http://community.modernmedicine.com/_An-End-to-Tort-Reform/blog/1927361/33379.html skern 2010-03-03T00:52:32Z Health Law & Policy Modern Medicine Community The Illinois Supreme Court has recently dealt a fatal blow to meaningful tort reform in that state. Will its decision affect other states, and if so, what is the future of tort reform in America? On February 4, 2010, the Supreme Court of Illinois ruled that an Illinois law capping noneconomic damages in medical malpractice cases was unconstitutional because it violated the separations of powers clause of the Illinois Constitution. The law under review limited noneconomic damages to $1,000,000 against a hospital and its personnel, and $500,000 against a physician, physician practice, or other healthcare professional. The Illinois law, which has been on the books since August of 2005, was based upon legislative findings documenting the fact that increased costs of malpractice insurance on physicians and hospitals were reducing the availability of healthcare in Illinois. The law had been credited with bringing 5,000 more doctors into the state, luring 3 new malpractice insurers into the state, and reducing premiums by 5% to 30%. Given the apparent success of the law, why was it rejected, and what does this decision mean to the 19 states which have similar laws and to efforts in Congress and in other states to impose similar caps? Since the Illinois decision is based upon its own State Constitution, its effect on other states, especially those with existing laws, may not be substantial. This is especially so where the highest courts in those states have already ruled on the constitutionality of these laws. However, in states where the constitutionality of these laws is still under judicial review, the Illinois decision is, at a minimum, likely to be used as part of the trial lawyers’ efforts to strike them down. Moreover, trial lawyers’ lobbyists will now have another quill in their arsenal when lobbying Congress and other state legislatures against meaningful tort reform. Hope that the Illinois Supreme Court decision will have limited impact on other states is founded upon the fact that the decision was based upon the Court’s very broad interpretation of specific language in the Illinois Constitution, rather than upon language in the United States Constitution. The language at issue in the Illinois Constitution involves the ability of the Illinois courts to use a “remittitur”. A “remittitur” allows a court to reduce an excessive jury award, and in the Illinois Constitution, the use of a “remittitur” is a prerogative of the judicial branch of government. The Court simply found that a legislative cap on damages was the equivalent of a legislative “remittitur” and, therefore, determined that the legislature had encroached on the judiciary’s exclusive jurisdiction to reduce jury verdicts. In doing so, it held that the power to reduce jury awards is a traditional power of the judiciary, and the legislature’s mandate to reduce jury awards through caps on noneconomic damages violated the separation of powers clause of the Illinois Constitution. Put another way, since the legislature required courts to enter judgments that differed from a jury’s award which exceeded the limits of the caps, it disregarded the court’s exclusive duty to consider whether a jury’s verdict is excessive as a matter of law. This, according to the Court, made the law unconstitutional. While, short of a state constitutional amendment, the most significant efforts at tort reform are doomed in Illinois, the good news is that similar efforts in other states and in Congress may not be drastically affected by this seemingly anomalous decision. Only time will tell. Steven I. Kern has served as Senior Principal with Kern Augustine Conroy & Schoppmann, P.C. (and its predecessor firms) for the last 30 years. In this position, he has provided counsel to physicians, nurses, and other healthcare professionals; numerous hospital medical staffs; state and county medical societies; and physician specialty societies. For the last 10 years, he has been General Counsel to New Jersey Physicians. Mr Kern has gained admission to both the New Jersey and the United States District Court - District of New Jersey bars. [Editor’s Note: Do you have thoughts to share on medical malpractice? Log in and Comment in the box below.] cap noneconomic damages, health law & policy, medical malpractice, tort reform nonadult false An End to Tort Reform? text blog cap noneconomic damages,health law & policy,medical malpractice,tort reform 550 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 1 Health Law & Policy 0 1927361 3407919 Member 0 http://community.modernmedicine.com/_Concierge-Medicine-Can-Doctors-Still-Care-for-Patients-After-Health-Care-Reform/blog/1778183/33379.html Do you long to spend more time with your patients, without pressure to generate more billing? If so, concierge medicine may offer the perfect solution. But, can it really work for you? Adding 30 million new insureds to the health care roles and cutting a half billion dollars from Medicare will almost certainly increase pressure on physicians to see even more patients in less time. For those who do not want to practice conveyor belt medicine and believe that good medicine requires time and attention to patients, concierge medicine may offer a highly satisfying alternative to managed care. Unfortunately, federal and state regulators have historically taken a dim view of these practices, arguing that the amenities offered by concierge practices discriminate against those who can’t afford the extra charges, and amount to a surcharge on care that should be covered under a patient’s health care policy. Given this background, it was somewhat surprising to see that the Federal Trade Commission on December 11, 2009, approved the acquisition of a concierge medicine network by consumer and household product giant Procter & Gamble (P&G). P&G will be acquiring complete ownership of MDVIP, Inc, of Boca Raton, Florida. According to its Web site, MDVIP serves over 111,000 patients in 28 states and the District of Columbia through a network of over 310 physicians. P&G previously held a 48% minority stake in MDVIP. According to the company, each physician’s practice case load is limited to a maximum of 600 patients. This allows physicians to provide more timely and customized service to each patient, along with a more comprehensive personal health care plan. Patients who join a concierge practice pay a premium by way of an annual retainer. The fee, a portion of which is apparently shared with MDVIP, Inc., allows patients access to same day appointments, longer patient visits, and home visits--benefits often unavailable in modern primary care practices. Concierge medicine also often provides more health and wellness services and greater assistance to patients who need to navigate the complexities of the health care system. Those who promote concierge medicine claim that physicians enjoy a lighter patient load, more time spent with individual patients, and less administrative paperwork. Often, patients supplement their concierge network with insurance coverage or pay out-of-pocket for these services. While the prospect of working less, enjoying it more, and earning more in the process is hard to ignore, FTC approval does not eliminate the regulatory concerns discussed above. Those interested in concierge medicine need to carefully review their own state laws, federal laws, their existing participating provider agreements, and the effect of concierge practice on their existing patients. In addition, while a concierge practice may be viable in Boca Raton, which is home to one of the nation’s highest net worth populations, a similar practice in an urban center or rural area may face far greater challenges. Like any other business proposition, this one requires substantial due diligence before signing on the dotted line. [Editor’s Note: Do you have any thoughts on this topic? Please Log in and Comment in the box that appears below this blog.] Do you long to spend more time with your patients, without pressure to generate more billing? If so, concierge medicine may offer the perfect solution. But, can it really work for you? Adding 30 million new insureds to the health care roles and cutting a half billion dollars from Medicare will almost certainly increase pressure on physicians to see even more patients in less time. For those who do not want to practice conveyor belt medicine and believe that good medicine requires time and attention to patients, concierge medicine may offer a highly satisfying alternative to managed care. Unfortunately, federal and state regulators have historically taken a dim view of these practices, arguing that the amenities offered by concierge practices discriminate against those who can’t afford the extra charges, and amount to a surcharge on care that should be covered under a patient’s health care policy. Given this background, it was somewhat surprising to see that the Federal Trade Commission on December 11, 2009, approved the acquisition of a concierge medicine network by consumer and household product giant Procter & Gamble (P&G). P&G will be acquiring complete ownership of MDVIP, Inc, of Boca Raton, Florida. According to its Web site, MDVIP serves over 111,000 patients in 28 states and the District of Columbia through a network of over 310 physicians. P&G previously held a 48% minority stake in MDVIP. According to the company, each physician’s practice case load is limited to a maximum of 600 patients. This allows physicians to provide more timely and customized service to each patient, along with a more comprehensive personal health care plan. Patients who join a concierge practice pay a premium by way of an annual retainer. The fee, a portion of which is apparently shared with MDVIP, Inc., allows patients access to same day appointments, longer patient visits, and home visits--benefits often unavailable in modern primary care practices. Concierge medicine also often provides more health and wellness services and greater assistance to patients who need to navigate the complexities of the health care system. Those who promote concierge medicine claim that physicians enjoy a lighter patient load, more time spent with individual patients, and less administrative paperwork. Often, patients supplement their concierge network with insurance coverage or pay out-of-pocket for these services. While the prospect of working less, enjoying it more, and earning more in the process is hard to ignore, FTC approval does not eliminate the regulatory concerns discussed above. Those interested in concierge medicine need to carefully review their own state laws, federal laws, their existing participating provider agreements, and the effect of concierge practice on their existing patients. In addition, while a concierge practice may be viable in Boca Raton, which is home to one of the nation’s highest net worth populations, a similar practice in an urban center or rural area may face far greater challenges. Like any other business proposition, this one requires substantial due diligence before signing on the dotted line. [Editor’s Note: Do you have any thoughts on this topic? Please Log in and Comment in the box that appears below this blog.] Fri, 29 Jan 2010 16:38:48 GMT http://community.modernmedicine.com/_Concierge-Medicine-Can-Doctors-Still-Care-for-Patients-After-Health-Care-Reform/blog/1778183/33379.html skern 2010-01-29T16:30:27Z Health Law & Policy Modern Medicine Community Do you long to spend more time with your patients, without pressure to generate more billing? If so, concierge medicine may offer the perfect solution. But, can it really work for you? Adding 30 million new insureds to the health care roles and cutting a half billion dollars from Medicare will almost certainly increase pressure on physicians to see even more patients in less time. For those who do not want to practice conveyor belt medicine and believe that good medicine requires time and attention to patients, concierge medicine may offer a highly satisfying alternative to managed care. Unfortunately, federal and state regulators have historically taken a dim view of these practices, arguing that the amenities offered by concierge practices discriminate against those who can’t afford the extra charges, and amount to a surcharge on care that should be covered under a patient’s health care policy. Given this background, it was somewhat surprising to see that the Federal Trade Commission on December 11, 2009, approved the acquisition of a concierge medicine network by consumer and household product giant Procter & Gamble (P&G). P&G will be acquiring complete ownership of MDVIP, Inc, of Boca Raton, Florida. According to its Web site, MDVIP serves over 111,000 patients in 28 states and the District of Columbia through a network of over 310 physicians. P&G previously held a 48% minority stake in MDVIP. According to the company, each physician’s practice case load is limited to a maximum of 600 patients. This allows physicians to provide more timely and customized service to each patient, along with a more comprehensive personal health care plan. Patients who join a concierge practice pay a premium by way of an annual retainer. The fee, a portion of which is apparently shared with MDVIP, Inc., allows patients access to same day appointments, longer patient visits, and home visits--benefits often unavailable in modern primary care practices. Concierge medicine also often provides more health and wellness services and greater assistance to patients who need to navigate the complexities of the health care system. Those who promote concierge medicine claim that physicians enjoy a lighter patient load, more time spent with individual patients, and less administrative paperwork. Often, patients supplement their concierge network with insurance coverage or pay out-of-pocket for these services. While the prospect of working less, enjoying it more, and earning more in the process is hard to ignore, FTC approval does not eliminate the regulatory concerns discussed above. Those interested in concierge medicine need to carefully review their own state laws, federal laws, their existing participating provider agreements, and the effect of concierge practice on their existing patients. In addition, while a concierge practice may be viable in Boca Raton, which is home to one of the nation’s highest net worth populations, a similar practice in an urban center or rural area may face far greater challenges. Like any other business proposition, this one requires substantial due diligence before signing on the dotted line. [Editor’s Note: Do you have any thoughts on this topic? Please Log in and Comment in the box that appears below this blog.] concierge practice, health law & policy, mmglobal nonadult false Concierge Medicine? Can Doctors Still Care for Patients After Health Care Reform? text blog concierge practice,health law & policy,mmglobal 737 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 2 Health Law & Policy 0 1778183 3407919 Member 0 http://community.modernmedicine.com/_The-End-of-Out-of-Network-Care/blog/1742898/33379.html Many physicians, unwilling to accept the dramatically reduced payment schedules of managed care companies, practice “out-of-network.”  Out-of-network reimbursement rates are usually based upon the physician’s “usual, customary, and reasonable” fees.  These “UCR” fees are often many times greater than the fees paid to in-network physicians for the same services. Recently, Oxford UnitedHealthcare has announced that, effective January 2010, certain of its insurance products would limit out-of-network benefits to no more than 140% of Medicare rates.   Oxford UnitedHealthcare will effectuate this change by amending language in its insurance policies to no longer pay based upon usual, customary, and reasonable fees.  Rather, those insureds who continue to contract (directly or through their employers) for a policy with out-of-network benefits will receive 140% or less of the Medicare rates when they go out-of-network, less co-payments and deductibles.  Any amounts charged by out-of-network physicians, beyond the 140%, will be the responsibility of the patient. With these changes, individual patients who have health insurance policies with out-of-network benefits will now have to bear a financial burden which will force many of them to in-network physicians.  As a result, the increased premium costs associated with the availability of out-of-network benefits will have far less value.  Given the reduced value, these policies may no longer be perceived as worth the added cost and policies which provide only in-network coverage will become even more attractive. There can be little doubt that this is only the beginning of a trend.  Health insurance companies continue to pressure physicians to go “in-network” and accept the vastly reduced payments associated with being “in-network”.  If Oxford UnitedHealthcare is successful in this effort, it will likely expand its efforts to its other product lines.  Other health insurers will also follow suit.  This change will not only have a substantial effect on out-of-network physicians but will ultimately affect in-network physicians as well.  As more and more physicians decide that they must join managed care networks, the supply of in-network physicians will increase and managed care companies will be able to further reduce reimbursement rates.  Of course, with Congress set to pass a new health reform bill that could provide insurers with an additional 30 million covered lives, insurance companies will have even more influence over the practice of medicine.  With this increased influence, reimbursement rates will, almost certainly, continue to deteriorate. Given the fact that the AMA has already sold out the nation’s physicians, it is highly unlikely that the Federal Government will do anything to alter this trend.  However, insurance companies are regulated by the states.  This provides perhaps one last chance for physicians.  It’s time to work closely with state legislators and insurance regulators to prevent changes in insurance coverage that will diminish patients’ ability to obtain services from physicians of their choice.  Out-of-network plans that protect patients’ choice must be encouraged and protected.  Efforts by insurers to reduce out-of-network benefits to a level that will assure that they are rarely if ever used must be prohibited.  Changes that only benefit insurance companies and their profits, and diminish the right of patients to choose their physicians, must be stopped. Many physicians, unwilling to accept the dramatically reduced payment schedules of managed care companies, practice “out-of-network.”  Out-of-network reimbursement rates are usually based upon the physician’s “usual, customary, and reasonable” fees.  These “UCR” fees are often many times greater than the fees paid to in-network physicians for the same services. Recently, Oxford UnitedHealthcare has announced that, effective January 2010, certain of its insurance products would limit out-of-network benefits to no more than 140% of Medicare rates.   Oxford UnitedHealthcare will effectuate this change by amending language in its insurance policies to no longer pay based upon usual, customary, and reasonable fees.  Rather, those insureds who continue to contract (directly or through their employers) for a policy with out-of-network benefits will receive 140% or less of the Medicare rates when they go out-of-network, less co-payments and deductibles.  Any amounts charged by out-of-network physicians, beyond the 140%, will be the responsibility of the patient. With these changes, individual patients who have health insurance policies with out-of-network benefits will now have to bear a financial burden which will force many of them to in-network physicians.  As a result, the increased premium costs associated with the availability of out-of-network benefits will have far less value.  Given the reduced value, these policies may no longer be perceived as worth the added cost and policies which provide only in-network coverage will become even more attractive. There can be little doubt that this is only the beginning of a trend.  Health insurance companies continue to pressure physicians to go “in-network” and accept the vastly reduced payments associated with being “in-network”.  If Oxford UnitedHealthcare is successful in this effort, it will likely expand its efforts to its other product lines.  Other health insurers will also follow suit.  This change will not only have a substantial effect on out-of-network physicians but will ultimately affect in-network physicians as well.  As more and more physicians decide that they must join managed care networks, the supply of in-network physicians will increase and managed care companies will be able to further reduce reimbursement rates.  Of course, with Congress set to pass a new health reform bill that could provide insurers with an additional 30 million covered lives, insurance companies will have even more influence over the practice of medicine.  With this increased influence, reimbursement rates will, almost certainly, continue to deteriorate. Given the fact that the AMA has already sold out the nation’s physicians, it is highly unlikely that the Federal Government will do anything to alter this trend.  However, insurance companies are regulated by the states.  This provides perhaps one last chance for physicians.  It’s time to work closely with state legislators and insurance regulators to prevent changes in insurance coverage that will diminish patients’ ability to obtain services from physicians of their choice.  Out-of-network plans that protect patients’ choice must be encouraged and protected.  Efforts by insurers to reduce out-of-network benefits to a level that will assure that they are rarely if ever used must be prohibited.  Changes that only benefit insurance companies and their profits, and diminish the right of patients to choose their physicians, must be stopped. Tue, 19 Jan 2010 02:17:54 GMT http://community.modernmedicine.com/_The-End-of-Out-of-Network-Care/blog/1742898/33379.html skern 2010-01-19T02:15:42Z Health Law & Policy Modern Medicine Community Many physicians, unwilling to accept the dramatically reduced payment schedules of managed care companies, practice “out-of-network.”  Out-of-network reimbursement rates are usually based upon the physician’s “usual, customary, and reasonable” fees.  These “UCR” fees are often many times greater than the fees paid to in-network physicians for the same services. Recently, Oxford UnitedHealthcare has announced that, effective January 2010, certain of its insurance products would limit out-of-network benefits to no more than 140% of Medicare rates.   Oxford UnitedHealthcare will effectuate this change by amending language in its insurance policies to no longer pay based upon usual, customary, and reasonable fees.  Rather, those insureds who continue to contract (directly or through their employers) for a policy with out-of-network benefits will receive 140% or less of the Medicare rates when they go out-of-network, less co-payments and deductibles.  Any amounts charged by out-of-network physicians, beyond the 140%, will be the responsibility of the patient. With these changes, individual patients who have health insurance policies with out-of-network benefits will now have to bear a financial burden which will force many of them to in-network physicians.  As a result, the increased premium costs associated with the availability of out-of-network benefits will have far less value.  Given the reduced value, these policies may no longer be perceived as worth the added cost and policies which provide only in-network coverage will become even more attractive. There can be little doubt that this is only the beginning of a trend.  Health insurance companies continue to pressure physicians to go “in-network” and accept the vastly reduced payments associated with being “in-network”.  If Oxford UnitedHealthcare is successful in this effort, it will likely expand its efforts to its other product lines.  Other health insurers will also follow suit.  This change will not only have a substantial effect on out-of-network physicians but will ultimately affect in-network physicians as well.  As more and more physicians decide that they must join managed care networks, the supply of in-network physicians will increase and managed care companies will be able to further reduce reimbursement rates.  Of course, with Congress set to pass a new health reform bill that could provide insurers with an additional 30 million covered lives, insurance companies will have even more influence over the practice of medicine.  With this increased influence, reimbursement rates will, almost certainly, continue to deteriorate. Given the fact that the AMA has already sold out the nation’s physicians, it is highly unlikely that the Federal Government will do anything to alter this trend.  However, insurance companies are regulated by the states.  This provides perhaps one last chance for physicians.  It’s time to work closely with state legislators and insurance regulators to prevent changes in insurance coverage that will diminish patients’ ability to obtain services from physicians of their choice.  Out-of-network plans that protect patients’ choice must be encouraged and protected.  Efforts by insurers to reduce out-of-network benefits to a level that will assure that they are rarely if ever used must be prohibited.  Changes that only benefit insurance companies and their profits, and diminish the right of patients to choose their physicians, must be stopped. health law & policy, in-network, insurancement reimbursement, managed care, out-of-network nonadult false The End of Out-of-Network Care? text blog health law & policy,in-network,insurancement reimbursement,managed care,out-of-network 610 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 2 Health Law & Policy 0 1742898 3407919 Member 0 http://community.modernmedicine.com/_Health-Care-Reform-Who-Does-the-AMA-Represent/blog/1533564/33379.html As the health care reform debate now turns to the US Senate, the AMA’s support of the 1990-page House bill has come under increasing attack. The next weeks will be critical to the future of the medical profession, and many wonder if the AMA is up to the task of protecting the nation’s physicians. How could the AMA support a bill which fails to guarantee the restoration of the 21% cut in Medicare reimbursement rates scheduled to begin at year’s end? How could the AMA—which has been a vocal supporter of tort reform, centered around limitations on attorneys’ fees and imposing caps on damages—support a bill which punishes any state that passes these reforms? Yet, the House bill which the AMA supports does not include the “doctor fix” which would eliminate the 21% reimbursement cut. It does, however, include a provision for "incentive payments" to each state which develops an "alternative medical liability law" that encourages "fair resolution" of disputes and "maintains access to affordable liability insurance." Unfortunately, states will not receive these monies if their new laws "limit attorneys' fees or impose caps on damages." So, rather than encouraging meaningful tort reform, the federal government will, essentially, punish states that limit attorneys fees or impose caps on damages, all with the support of the AMA. The medical profession is in crisis. Its future is in the hands of politicians, many of whom believe that paying physicians less can solve the health care problems of the elderly and uninsured. The US Senate has already defeated a bill that would have eliminated the annual threats to reduce physician reimbursements. How has this happened? A recent Wall Street Journal editorial1 reported that, due to the AMA President’s “political gullibility” Democrats won’t give even a passing thought to leaving the AMA behind—especially now, given that the group has shown how cheaply it can be bought.http://online.wsj.com/article/SB10001424052748704013004574518013218640066.html Donald Palmisano, MD, a former President of the AMA, and one who is widely regarded as one of its best presidents, is making the rounds of television talk shows, denouncing the position of the organization he only recently lead. He is now the spokesman for a new, national organization, the Coalition to Protect Patient Rights, which has been established to provide government leaders with a “second opinion” on how best to improve our nation’s health care system. It is clear that physicians, led by the AMA, have lost their influence. It is equally clear that the AMA no longer represents the interests of the vast majority of physicians. Indeed, a recent poll reveals that as many as 45% of our nation’s physicians are considering early retirement or changing professions if health care reform is passed in a form endorsed by the AMA! There may be another reason beyond “political gullibility” to explain the AMA’s seemingly incomprehensible position. One answer may lie in the fact that the AMA receives 83% of its revenues from its publication of CPT Codebooks and related activities. The CPT codes, many believe, are at the very core of the health care crisis. They are the source of a high percentage of miscoding, due to their complexity and subjective criteria. As a result, they expose honest physicians to charges of fraud. They also fail to recognize high quality, efficient, effective care, and they reward overutilization. As Dr Palmisano puts it, they have resulted in government and insurance company price-fixing. Could it be that the AMA is compromising the interests of the nation’s physicians to preserve this highly flawed system? Would you, if 83% of your revenues depended upon it? Reference 1. The AMA Wants a Unicorn, Too: Contrary to the President, most doctors oppose his reforms [Review & Outlook]. The Wall Street Journal. Nov 6, 2009; page A24 As the health care reform debate now turns to the US Senate, the AMA’s support of the 1990-page House bill has come under increasing attack. The next weeks will be critical to the future of the medical profession, and many wonder if the AMA is up to the task of protecting the nation’s physicians. How could the AMA support a bill which fails to guarantee the restoration of the 21% cut in Medicare reimbursement rates scheduled to begin at year’s end? How could the AMA—which has been a vocal supporter of tort reform, centered around limitations on attorneys’ fees and imposing caps on damages—support a bill which punishes any state that passes these reforms? Yet, the House bill which the AMA supports does not include the “doctor fix” which would eliminate the 21% reimbursement cut. It does, however, include a provision for "incentive payments" to each state which develops an "alternative medical liability law" that encourages "fair resolution" of disputes and "maintains access to affordable liability insurance." Unfortunately, states will not receive these monies if their new laws "limit attorneys' fees or impose caps on damages." So, rather than encouraging meaningful tort reform, the federal government will, essentially, punish states that limit attorneys fees or impose caps on damages, all with the support of the AMA. The medical profession is in crisis. Its future is in the hands of politicians, many of whom believe that paying physicians less can solve the health care problems of the elderly and uninsured. The US Senate has already defeated a bill that would have eliminated the annual threats to reduce physician reimbursements. How has this happened? A recent Wall Street Journal editorial1 reported that, due to the AMA President’s “political gullibility” Democrats won’t give even a passing thought to leaving the AMA behind—especially now, given that the group has shown how cheaply it can be bought.http://online.wsj.com/article/SB10001424052748704013004574518013218640066.html Donald Palmisano, MD, a former President of the AMA, and one who is widely regarded as one of its best presidents, is making the rounds of television talk shows, denouncing the position of the organization he only recently lead. He is now the spokesman for a new, national organization, the Coalition to Protect Patient Rights, which has been established to provide government leaders with a “second opinion” on how best to improve our nation’s health care system. It is clear that physicians, led by the AMA, have lost their influence. It is equally clear that the AMA no longer represents the interests of the vast majority of physicians. Indeed, a recent poll reveals that as many as 45% of our nation’s physicians are considering early retirement or changing professions if health care reform is passed in a form endorsed by the AMA! There may be another reason beyond “political gullibility” to explain the AMA’s seemingly incomprehensible position. One answer may lie in the fact that the AMA receives 83% of its revenues from its publication of CPT Codebooks and related activities. The CPT codes, many believe, are at the very core of the health care crisis. They are the source of a high percentage of miscoding, due to their complexity and subjective criteria. As a result, they expose honest physicians to charges of fraud. They also fail to recognize high quality, efficient, effective care, and they reward overutilization. As Dr Palmisano puts it, they have resulted in government and insurance company price-fixing. Could it be that the AMA is compromising the interests of the nation’s physicians to preserve this highly flawed system? Would you, if 83% of your revenues depended upon it? Reference 1. The AMA Wants a Unicorn, Too: Contrary to the President, most doctors oppose his reforms [Review & Outlook]. The Wall Street Journal. Nov 6, 2009; page A24 Tue, 01 Dec 2009 21:27:03 GMT http://community.modernmedicine.com/_Health-Care-Reform-Who-Does-the-AMA-Represent/blog/1533564/33379.html skern 2009-12-01T16:38:48Z Health Law & Policy Modern Medicine Community As the health care reform debate now turns to the US Senate, the AMA’s support of the 1990-page House bill has come under increasing attack. The next weeks will be critical to the future of the medical profession, and many wonder if the AMA is up to the task of protecting the nation’s physicians. How could the AMA support a bill which fails to guarantee the restoration of the 21% cut in Medicare reimbursement rates scheduled to begin at year’s end? How could the AMA—which has been a vocal supporter of tort reform, centered around limitations on attorneys’ fees and imposing caps on damages—support a bill which punishes any state that passes these reforms? Yet, the House bill which the AMA supports does not include the “doctor fix” which would eliminate the 21% reimbursement cut. It does, however, include a provision for "incentive payments" to each state which develops an "alternative medical liability law" that encourages "fair resolution" of disputes and "maintains access to affordable liability insurance." Unfortunately, states will not receive these monies if their new laws "limit attorneys' fees or impose caps on damages." So, rather than encouraging meaningful tort reform, the federal government will, essentially, punish states that limit attorneys fees or impose caps on damages, all with the support of the AMA. The medical profession is in crisis. Its future is in the hands of politicians, many of whom believe that paying physicians less can solve the health care problems of the elderly and uninsured. The US Senate has already defeated a bill that would have eliminated the annual threats to reduce physician reimbursements. How has this happened? A recent Wall Street Journal editorial1 reported that, due to the AMA President’s “political gullibility” Democrats won’t give even a passing thought to leaving the AMA behind—especially now, given that the group has shown how cheaply it can be bought.http://online.wsj.com/article/SB10001424052748704013004574518013218640066.html Donald Palmisano, MD, a former President of the AMA, and one who is widely regarded as one of its best presidents, is making the rounds of television talk shows, denouncing the position of the organization he only recently lead. He is now the spokesman for a new, national organization, the Coalition to Protect Patient Rights, which has been established to provide government leaders with a “second opinion” on how best to improve our nation’s health care system. It is clear that physicians, led by the AMA, have lost their influence. It is equally clear that the AMA no longer represents the interests of the vast majority of physicians. Indeed, a recent poll reveals that as many as 45% of our nation’s physicians are considering early retirement or changing professions if health care reform is passed in a form endorsed by the AMA! There may be another reason beyond “political gullibility” to explain the AMA’s seemingly incomprehensible position. One answer may lie in the fact that the AMA receives 83% of its revenues from its publication of CPT Codebooks and related activities. The CPT codes, many believe, are at the very core of the health care crisis. They are the source of a high percentage of miscoding, due to their complexity and subjective criteria. As a result, they expose honest physicians to charges of fraud. They also fail to recognize high quality, efficient, effective care, and they reward overutilization. As Dr Palmisano puts it, they have resulted in government and insurance company price-fixing. Could it be that the AMA is compromising the interests of the nation’s physicians to preserve this highly flawed system? Would you, if 83% of your revenues depended upon it? Reference 1. The AMA Wants a Unicorn, Too: Contrary to the President, most doctors oppose his reforms [Review & Outlook]. The Wall Street Journal. Nov 6, 2009; page A24 ama position, health care reform, health law & policy, medical tort reform, mmglobal nonadult false Health Care Reform: Who Does the AMA Represent? text blog ama position,health care reform,health law & policy,medical tort reform,mmglobal 1039 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 1 Health Law & Policy 0 1533564 3407919 Member 0 http://community.modernmedicine.com/_YouTube-and-You/blog/1465113/33379.html Should an OB/GYN send his patients a “friend request” to become a friend on his Facebook Page? A Harvard law professor recently reported that one of her friends had received such a request, and it made her extremely uncomfortable. She felt that her relationship with her doctor had been a professional one, not a friendship. Since you are reading about this on a blog, chances are you know about Facebook. For those of you unfamiliar with Facebook and the social networking phenomenon sweeping the country (e.g. those without teenagers), a “friend request” is an e-mail inviting you to access a person’s Facebook page. That page, created by the person asking you to become a “friend” could include information ranging from his baby pictures to his latest article in JAMA. Even though a Facebook page may be completely professional, the notion of being invited to be a “friend” connotes a degree of familiarity that some may consider unprofessional. Certainly, the OB/GYN’s patient did not understand that the term “friend” is a term of art associated with Facebook. Then again, would this patient have felt the same way if the “friend request” had come from her dermatologist or cosmetic surgeon? Would she have felt the same if she were younger and a regular user of the social network? Probably not. Forty years ago, physician advertising was illegal. Then, the US Supreme Court ruled that blanket restrictions on advertising violated the First Amendment. Since that time, advertising by physicians, hospitals, and other health care providers has become pervasive. Social networking, however, will pose new challenges with new rules for physicians and other professionals who embrace this medium. Businesses are making social networking sites and their own YouTube channels part of their core marketing strategy. “Tweeting” one’s daily activities has become part of the daily routine of elected officials, professional athletes, and CEO’s. Yet when physicians use these same tools, they encounter unique challenges, legal issues, and sensitivities. Since patient reaction to social networking efforts may vary dramatically from patient to patient and may also depend upon the specialty of the physician sending the message. Careful thought and some test marketing should precede any social networking activity—be it Facebook, Twitter, or even a practice Web site. Conveying important information to your patients is a service that most patients would appreciate. Letting them know, for example, that you’ve received a supply of flu vaccine and giving them your recommendation as to whether they should receive the vaccine can be a valuable service. Expansion of office hours, the introduction of a new physician, changes in insurance plans with which you participate, and other information concerning your practice can provide patients with information that may make your practice more attractive. Telling patients about what you learned at a recent medical conference can let patients know that you continue to update your knowledge base, that you work hard to stay at the cutting edge of medical knowledge, and that new technologies, new drugs, or new procedures may offer benefits not previously available. The manner in which that information is conveyed, however, is all important. You wouldn’t call a patient at work to chat about your recent medical seminar, no matter how interesting it may have been. Providing that same information through a social network may be viewed as similarly intrusive if not handled appropriately. As such, though the content of a Facebook page may be professional and informative, the very request to join as a “friend” could convey a message which is anything but professional. Often, it’s not what you say, but how you say it. Before you decide to enter the social networking market consider your patient population and your specialty. Ask your patients what they think of the idea. If they are receptive, initially send friend requests to a few select patients who you believe will be open to the idea. Have your office follow-up and see what kind of response you receive. If the response is favorable, consider first sending a note to your remaining patients letting them know that they may receive a friend request. Explain that the request is simply an invitation to access professional information that may be of interest to them, as a “friend of the practice.” By taking the time and effort to explain your purpose, you may avoid unintended negative reaction or even charges of unprofessional conduct. In addition to assuring that your patients are receptive to the idea of having your practice as part of their social network, it is equally important to assure that the content of your communication is appropriate. A number of hospitals, including some of the nation’s most prestigious institutions, have already recognized the benefits of these new methods of communication. Their Web sites include information for patients concerning their areas of specialty, awards they’ve won, and patient information ranging from directions to the hospital to information on cancer and heart disease. However, hospitals also have legal departments that review content before it is distributed through the web. Among the things they watch for is any potential breach of patient confidentiality and videos which may portray their physicians and employees in a less than professional light. For example, videos mocking patients or their complaints, videos of professionals drinking at social events, dressed in costume for a skit, or acting silly may be fine to share among colleagues. However, patients generally do not want to perceive their physicians in this way. Their vision of a physician is that of a consummate professional—a person they can respect, confide in, and trust. They don’t want physicians to be their drinking buddies! Maintaining patient confidentiality is another imperative. Pictures of patients, distributed without their consent, can violate HIPAA. Even pictures of a portion of a patient’s body, which do not readily identify the patient, can cause problems, if the patient realizes that the picture is of his body part, and he has not given his consent to its use. Physicians contemplating using social networks should keep certain guidelines in mind. Do not merge your personal social site with your professional site. Your personal site should be limited to your close friends and not be accessible to patients or others. Even then, remember that today’s friend could be tomorrow’s competitor. Don’t post anything on your personal site that you wouldn’t want your spouse or your employer to see. Your professional site should be just that—professional. Post your vacation photos on your personal site, not your professional site. Limit your professional site to medical and practice information that your patients can use to their benefit. Be sure that the information you provide is accurate and does not breach any patient confidentiality. And, be sure that it is tasteful. Should an OB/GYN send his patients a “friend request” to become a friend on his Facebook Page? A Harvard law professor recently reported that one of her friends had received such a request, and it made her extremely uncomfortable. She felt that her relationship with her doctor had been a professional one, not a friendship. Since you are reading about this on a blog, chances are you know about Facebook. For those of you unfamiliar with Facebook and the social networking phenomenon sweeping the country (e.g. those without teenagers), a “friend request” is an e-mail inviting you to access a person’s Facebook page. That page, created by the person asking you to become a “friend” could include information ranging from his baby pictures to his latest article in JAMA. Even though a Facebook page may be completely professional, the notion of being invited to be a “friend” connotes a degree of familiarity that some may consider unprofessional. Certainly, the OB/GYN’s patient did not understand that the term “friend” is a term of art associated with Facebook. Then again, would this patient have felt the same way if the “friend request” had come from her dermatologist or cosmetic surgeon? Would she have felt the same if she were younger and a regular user of the social network? Probably not. Forty years ago, physician advertising was illegal. Then, the US Supreme Court ruled that blanket restrictions on advertising violated the First Amendment. Since that time, advertising by physicians, hospitals, and other health care providers has become pervasive. Social networking, however, will pose new challenges with new rules for physicians and other professionals who embrace this medium. Businesses are making social networking sites and their own YouTube channels part of their core marketing strategy. “Tweeting” one’s daily activities has become part of the daily routine of elected officials, professional athletes, and CEO’s. Yet when physicians use these same tools, they encounter unique challenges, legal issues, and sensitivities. Since patient reaction to social networking efforts may vary dramatically from patient to patient and may also depend upon the specialty of the physician sending the message. Careful thought and some test marketing should precede any social networking activity—be it Facebook, Twitter, or even a practice Web site. Conveying important information to your patients is a service that most patients would appreciate. Letting them know, for example, that you’ve received a supply of flu vaccine and giving them your recommendation as to whether they should receive the vaccine can be a valuable service. Expansion of office hours, the introduction of a new physician, changes in insurance plans with which you participate, and other information concerning your practice can provide patients with information that may make your practice more attractive. Telling patients about what you learned at a recent medical conference can let patients know that you continue to update your knowledge base, that you work hard to stay at the cutting edge of medical knowledge, and that new technologies, new drugs, or new procedures may offer benefits not previously available. The manner in which that information is conveyed, however, is all important. You wouldn’t call a patient at work to chat about your recent medical seminar, no matter how interesting it may have been. Providing that same information through a social network may be viewed as similarly intrusive if not handled appropriately. As such, though the content of a Facebook page may be professional and informative, the very request to join as a “friend” could convey a message which is anything but professional. Often, it’s not what you say, but how you say it. Before you decide to enter the social networking market consider your patient population and your specialty. Ask your patients what they think of the idea. If they are receptive, initially send friend requests to a few select patients who you believe will be open to the idea. Have your office follow-up and see what kind of response you receive. If the response is favorable, consider first sending a note to your remaining patients letting them know that they may receive a friend request. Explain that the request is simply an invitation to access professional information that may be of interest to them, as a “friend of the practice.” By taking the time and effort to explain your purpose, you may avoid unintended negative reaction or even charges of unprofessional conduct. In addition to assuring that your patients are receptive to the idea of having your practice as part of their social network, it is equally important to assure that the content of your communication is appropriate. A number of hospitals, including some of the nation’s most prestigious institutions, have already recognized the benefits of these new methods of communication. Their Web sites include information for patients concerning their areas of specialty, awards they’ve won, and patient information ranging from directions to the hospital to information on cancer and heart disease. However, hospitals also have legal departments that review content before it is distributed through the web. Among the things they watch for is any potential breach of patient confidentiality and videos which may portray their physicians and employees in a less than professional light. For example, videos mocking patients or their complaints, videos of professionals drinking at social events, dressed in costume for a skit, or acting silly may be fine to share among colleagues. However, patients generally do not want to perceive their physicians in this way. Their vision of a physician is that of a consummate professional—a person they can respect, confide in, and trust. They don’t want physicians to be their drinking buddies! Maintaining patient confidentiality is another imperative. Pictures of patients, distributed without their consent, can violate HIPAA. Even pictures of a portion of a patient’s body, which do not readily identify the patient, can cause problems, if the patient realizes that the picture is of his body part, and he has not given his consent to its use. Physicians contemplating using social networks should keep certain guidelines in mind. Do not merge your personal social site with your professional site. Your personal site should be limited to your close friends and not be accessible to patients or others. Even then, remember that today’s friend could be tomorrow’s competitor. Don’t post anything on your personal site that you wouldn’t want your spouse or your employer to see. Your professional site should be just that—professional. Post your vacation photos on your personal site, not your professional site. Limit your professional site to medical and practice information that your patients can use to their benefit. Be sure that the information you provide is accurate and does not breach any patient confidentiality. And, be sure that it is tasteful. Mon, 09 Nov 2009 21:11:56 GMT http://community.modernmedicine.com/_YouTube-and-You/blog/1465113/33379.html skern 2009-11-06T16:19:19Z Modern Medicine Community Should an OB/GYN send his patients a “friend request” to become a friend on his Facebook Page? A Harvard law professor recently reported that one of her friends had received such a request, and it made her extremely uncomfortable. She felt that her relationship with her doctor had been a professional one, not a friendship. Since you are reading about this on a blog, chances are you know about Facebook. For those of you unfamiliar with Facebook and the social networking phenomenon sweeping the country (e.g. those without teenagers), a “friend request” is an e-mail inviting you to access a person’s Facebook page. That page, created by the person asking you to become a “friend” could include information ranging from his baby pictures to his latest article in JAMA. Even though a Facebook page may be completely professional, the notion of being invited to be a “friend” connotes a degree of familiarity that some may consider unprofessional. Certainly, the OB/GYN’s patient did not understand that the term “friend” is a term of art associated with Facebook. Then again, would this patient have felt the same way if the “friend request” had come from her dermatologist or cosmetic surgeon? Would she have felt the same if she were younger and a regular user of the social network? Probably not. Forty years ago, physician advertising was illegal. Then, the US Supreme Court ruled that blanket restrictions on advertising violated the First Amendment. Since that time, advertising by physicians, hospitals, and other health care providers has become pervasive. Social networking, however, will pose new challenges with new rules for physicians and other professionals who embrace this medium. Businesses are making social networking sites and their own YouTube channels part of their core marketing strategy. “Tweeting” one’s daily activities has become part of the daily routine of elected officials, professional athletes, and CEO’s. Yet when physicians use these same tools, they encounter unique challenges, legal issues, and sensitivities. Since patient reaction to social networking efforts may vary dramatically from patient to patient and may also depend upon the specialty of the physician sending the message. Careful thought and some test marketing should precede any social networking activity—be it Facebook, Twitter, or even a practice Web site. Conveying important information to your patients is a service that most patients would appreciate. Letting them know, for example, that you’ve received a supply of flu vaccine and giving them your recommendation as to whether they should receive the vaccine can be a valuable service. Expansion of office hours, the introduction of a new physician, changes in insurance plans with which you participate, and other information concerning your practice can provide patients with information that may make your practice more attractive. Telling patients about what you learned at a recent medical conference can let patients know that you continue to update your knowledge base, that you work hard to stay at the cutting edge of medical knowledge, and that new technologies, new drugs, or new procedures may offer benefits not previously available. The manner in which that information is conveyed, however, is all important. You wouldn’t call a patient at work to chat about your recent medical seminar, no matter how interesting it may have been. Providing that same information through a social network may be viewed as similarly intrusive if not handled appropriately. As such, though the content of a Facebook page may be professional and informative, the very request to join as a “friend” could convey a message which is anything but professional. Often, it’s not what you say, but how you say it. Before you decide to enter the social networking market consider your patient population and your specialty. Ask your patients what they think of the idea. If they are receptive, initially send friend requests to a few select patients who you believe will be open to the idea. Have your office follow-up and see what kind of response you receive. If the response is favorable, consider first sending a note to your remaining patients letting them know that they may receive a friend request. Explain that the request is simply an invitation to access professional information that may be of interest to them, as a “friend of the practice.” By taking the time and effort to explain your purpose, you may avoid unintended negative reaction or even charges of unprofessional conduct. In addition to assuring that your patients are receptive to the idea of having your practice as part of their social network, it is equally important to assure that the content of your communication is appropriate. A number of hospitals, including some of the nation’s most prestigious institutions, have already recognized the benefits of these new methods of communication. Their Web sites include information for patients concerning their areas of specialty, awards they’ve won, and patient information ranging from directions to the hospital to information on cancer and heart disease. However, hospitals also have legal departments that review content before it is distributed through the web. Among the things they watch for is any potential breach of patient confidentiality and videos which may portray their physicians and employees in a less than professional light. For example, videos mocking patients or their complaints, videos of professionals drinking at social events, dressed in costume for a skit, or acting silly may be fine to share among colleagues. However, patients generally do not want to perceive their physicians in this way. Their vision of a physician is that of a consummate professional—a person they can respect, confide in, and trust. They don’t want physicians to be their drinking buddies! Maintaining patient confidentiality is another imperative. Pictures of patients, distributed without their consent, can violate HIPAA. Even pictures of a portion of a patient’s body, which do not readily identify the patient, can cause problems, if the patient realizes that the picture is of his body part, and he has not given his consent to its use. Physicians contemplating using social networks should keep certain guidelines in mind. Do not merge your personal social site with your professional site. Your personal site should be limited to your close friends and not be accessible to patients or others. Even then, remember that today’s friend could be tomorrow’s competitor. Don’t post anything on your personal site that you wouldn’t want your spouse or your employer to see. Your professional site should be just that—professional. Post your vacation photos on your personal site, not your professional site. Limit your professional site to medical and practice information that your patients can use to their benefit. Be sure that the information you provide is accurate and does not breach any patient confidentiality. And, be sure that it is tasteful. medical practice on internet, mmglobal, social networking nonadult false YouTube and You text blog medical practice on internet,mmglobal,social networking 548 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 0 0 1465113 3407919 Member 0 http://community.modernmedicine.com/_Supply-Demand-and-the-AMA/blog/868007/33379.html The August 24, 2009, edition of Modern Health [registration required] care rates the 100 most powerful people in health care. The president of the American Medical Association rates 95th and its Executive Vice President, 96th. No other representatives of the AMA are listed. By contrast, Andy Stern, the president of the Service Employees International Union ranks 10th and Steve Burd, the president of Safeway stores, 17th. How has organized medicine found its way to the bottom of the heap during the most significant effort to reform health care in decades? In the opinion of this writer, the AMA lost its influence years ago when it capitulated to government demands to remove the practice of medicine from the basic rules of the marketplace. The practice of medicine was removed from market forces when the federal government, in conjunction with the AMA, created the current reimbursement system used by Medicare and most third party payors. This system removes from consideration the quality of care rendered, the training and experience of the physician providing care, the efficiency of the care rendered, or the result of the care. As a result, the physician providing high quality, efficient and effective care is likely to receive far less compensation than the physician who provides less efficient and effective care. The AMA is financially wedded to the current reimbursement system. Its publication of the CPT codebooks, the primary reference for physician reimbursement, is responsible for a substantial portion of the AMA’s annual revenues. Yet, to most practicing physicians, the CPT codebook is as confusing and counterproductive as the IRS code. Worse, the Resource Based Relative Value System (RBRVS) upon which it is based not only discourages but punishes efficiency and fails to reward any efforts to reduce cost. Does anyone believe that it is mere coincidence that many medical offices are less computerized than the corner gas station, or that it takes days or weeks for a patient to receive test results in an era of instant e-mail communication? If there were a CPT code for e-mailing test results, with explanation, how many office visits would be eliminated in favor of this more efficient and far less costly method of communication? Yet, with medical offices struggling to survive with lower reimbursement rates, financial considerations drive offices to schedule patients for follow-up appointments simply to receive information which could often be transmitted at far less cost electronically. This is only one example. There are also no incentives for physicians to consider costs of pharmaceuticals, costs of diagnostic tests, or alternative treatments in deciding upon a course of care. Yet, much of the cost of health care costs results from these decisions. How much money would be saved if physicians were provided with cost information and paid to evaluate the need for higher cost care before making these decisions? Unfortunately, all current efforts by Congress and the President to reform health care fail to address this foundational flaw in the health care system and, instead, are focused on ways to reduce the cost of physician care. Yet efforts to reduce costs could be far more successful if physicians were brought into the process rather than further removed from it. Until market forces are returned to health care, costs will continue to increase, efficiencies will continue to yield to the need to optimize reimbursements, and quality and access will continue to suffer. The foundation of a market economy is supply and demand. Current reform efforts will dramatically increase demand by bringing more patients into the marketplace. Basic tenants of economic theory teach us that increased demand would lead to increased prices. Increased prices would then discourage demand and spur additional supply resulting in more people choosing to become physicians and health care workers. Similarly, those treating patients most efficiently would benefit by capitalizing by being able to care for more patients in less time. However, our current reimbursement system eliminates these basic economic forces because reimbursement rates are fixed, and the most effective way to increase profit is to perform more services on each patient, not to treat more patients more efficiently. Without reforming the RBRVS-based reimbursement system, adding more demand without addressing supply will only further exacerbate the myriad problems faced by our health care system. Absent more physician supply, the only way to deal with increased demand is to ration care or to substitute physician care with lesser educated physician extenders. Neither is likely to improve health care. It is time to give physicians the flexibility to move to new economic models. Physicians should be free to charge depending upon supply, demand, efficiency, and effectiveness. Alternative pricing could reward prevention, efficient and effective treatment of chronic conditions, and reduction in redundant or unnecessary testing and treatment. Making physicians stakeholders in the cost of pharmaceuticals could readily result in more careful selection of drugs, with appropriate consideration of price along with efficacy. Unfortunately, the AMA’s financial reliance on the CPT codes and its historic tie to the present reimbursement system make the likelihood of meaningful reform far less likely. Its interest in reform and the interests of the majority in the physician community are not in alignment. Because reliance upon the current CPT-code-driven reimbursement system offers no room for innovation, real reform is unlikely. And until these foundational issues are addressed, meaningful reform will fail. The August 24, 2009, edition of Modern Health [registration required] care rates the 100 most powerful people in health care. The president of the American Medical Association rates 95th and its Executive Vice President, 96th. No other representatives of the AMA are listed. By contrast, Andy Stern, the president of the Service Employees International Union ranks 10th and Steve Burd, the president of Safeway stores, 17th. How has organized medicine found its way to the bottom of the heap during the most significant effort to reform health care in decades? In the opinion of this writer, the AMA lost its influence years ago when it capitulated to government demands to remove the practice of medicine from the basic rules of the marketplace. The practice of medicine was removed from market forces when the federal government, in conjunction with the AMA, created the current reimbursement system used by Medicare and most third party payors. This system removes from consideration the quality of care rendered, the training and experience of the physician providing care, the efficiency of the care rendered, or the result of the care. As a result, the physician providing high quality, efficient and effective care is likely to receive far less compensation than the physician who provides less efficient and effective care. The AMA is financially wedded to the current reimbursement system. Its publication of the CPT codebooks, the primary reference for physician reimbursement, is responsible for a substantial portion of the AMA’s annual revenues. Yet, to most practicing physicians, the CPT codebook is as confusing and counterproductive as the IRS code. Worse, the Resource Based Relative Value System (RBRVS) upon which it is based not only discourages but punishes efficiency and fails to reward any efforts to reduce cost. Does anyone believe that it is mere coincidence that many medical offices are less computerized than the corner gas station, or that it takes days or weeks for a patient to receive test results in an era of instant e-mail communication? If there were a CPT code for e-mailing test results, with explanation, how many office visits would be eliminated in favor of this more efficient and far less costly method of communication? Yet, with medical offices struggling to survive with lower reimbursement rates, financial considerations drive offices to schedule patients for follow-up appointments simply to receive information which could often be transmitted at far less cost electronically. This is only one example. There are also no incentives for physicians to consider costs of pharmaceuticals, costs of diagnostic tests, or alternative treatments in deciding upon a course of care. Yet, much of the cost of health care costs results from these decisions. How much money would be saved if physicians were provided with cost information and paid to evaluate the need for higher cost care before making these decisions? Unfortunately, all current efforts by Congress and the President to reform health care fail to address this foundational flaw in the health care system and, instead, are focused on ways to reduce the cost of physician care. Yet efforts to reduce costs could be far more successful if physicians were brought into the process rather than further removed from it. Until market forces are returned to health care, costs will continue to increase, efficiencies will continue to yield to the need to optimize reimbursements, and quality and access will continue to suffer. The foundation of a market economy is supply and demand. Current reform efforts will dramatically increase demand by bringing more patients into the marketplace. Basic tenants of economic theory teach us that increased demand would lead to increased prices. Increased prices would then discourage demand and spur additional supply resulting in more people choosing to become physicians and health care workers. Similarly, those treating patients most efficiently would benefit by capitalizing by being able to care for more patients in less time. However, our current reimbursement system eliminates these basic economic forces because reimbursement rates are fixed, and the most effective way to increase profit is to perform more services on each patient, not to treat more patients more efficiently. Without reforming the RBRVS-based reimbursement system, adding more demand without addressing supply will only further exacerbate the myriad problems faced by our health care system. Absent more physician supply, the only way to deal with increased demand is to ration care or to substitute physician care with lesser educated physician extenders. Neither is likely to improve health care. It is time to give physicians the flexibility to move to new economic models. Physicians should be free to charge depending upon supply, demand, efficiency, and effectiveness. Alternative pricing could reward prevention, efficient and effective treatment of chronic conditions, and reduction in redundant or unnecessary testing and treatment. Making physicians stakeholders in the cost of pharmaceuticals could readily result in more careful selection of drugs, with appropriate consideration of price along with efficacy. Unfortunately, the AMA’s financial reliance on the CPT codes and its historic tie to the present reimbursement system make the likelihood of meaningful reform far less likely. Its interest in reform and the interests of the majority in the physician community are not in alignment. Because reliance upon the current CPT-code-driven reimbursement system offers no room for innovation, real reform is unlikely. And until these foundational issues are addressed, meaningful reform will fail. Mon, 12 Oct 2009 19:46:38 GMT http://community.modernmedicine.com/_Supply-Demand-and-the-AMA/blog/868007/33379.html skern 2009-09-29T19:12:27Z Health Law & Policy Modern Medicine Community The August 24, 2009, edition of Modern Health [registration required] care rates the 100 most powerful people in health care. The president of the American Medical Association rates 95th and its Executive Vice President, 96th. No other representatives of the AMA are listed. By contrast, Andy Stern, the president of the Service Employees International Union ranks 10th and Steve Burd, the president of Safeway stores, 17th. How has organized medicine found its way to the bottom of the heap during the most significant effort to reform health care in decades? In the opinion of this writer, the AMA lost its influence years ago when it capitulated to government demands to remove the practice of medicine from the basic rules of the marketplace. The practice of medicine was removed from market forces when the federal government, in conjunction with the AMA, created the current reimbursement system used by Medicare and most third party payors. This system removes from consideration the quality of care rendered, the training and experience of the physician providing care, the efficiency of the care rendered, or the result of the care. As a result, the physician providing high quality, efficient and effective care is likely to receive far less compensation than the physician who provides less efficient and effective care. The AMA is financially wedded to the current reimbursement system. Its publication of the CPT codebooks, the primary reference for physician reimbursement, is responsible for a substantial portion of the AMA’s annual revenues. Yet, to most practicing physicians, the CPT codebook is as confusing and counterproductive as the IRS code. Worse, the Resource Based Relative Value System (RBRVS) upon which it is based not only discourages but punishes efficiency and fails to reward any efforts to reduce cost. Does anyone believe that it is mere coincidence that many medical offices are less computerized than the corner gas station, or that it takes days or weeks for a patient to receive test results in an era of instant e-mail communication? If there were a CPT code for e-mailing test results, with explanation, how many office visits would be eliminated in favor of this more efficient and far less costly method of communication? Yet, with medical offices struggling to survive with lower reimbursement rates, financial considerations drive offices to schedule patients for follow-up appointments simply to receive information which could often be transmitted at far less cost electronically. This is only one example. There are also no incentives for physicians to consider costs of pharmaceuticals, costs of diagnostic tests, or alternative treatments in deciding upon a course of care. Yet, much of the cost of health care costs results from these decisions. How much money would be saved if physicians were provided with cost information and paid to evaluate the need for higher cost care before making these decisions? Unfortunately, all current efforts by Congress and the President to reform health care fail to address this foundational flaw in the health care system and, instead, are focused on ways to reduce the cost of physician care. Yet efforts to reduce costs could be far more successful if physicians were brought into the process rather than further removed from it. Until market forces are returned to health care, costs will continue to increase, efficiencies will continue to yield to the need to optimize reimbursements, and quality and access will continue to suffer. The foundation of a market economy is supply and demand. Current reform efforts will dramatically increase demand by bringing more patients into the marketplace. Basic tenants of economic theory teach us that increased demand would lead to increased prices. Increased prices would then discourage demand and spur additional supply resulting in more people choosing to become physicians and health care workers. Similarly, those treating patients most efficiently would benefit by capitalizing by being able to care for more patients in less time. However, our current reimbursement system eliminates these basic economic forces because reimbursement rates are fixed, and the most effective way to increase profit is to perform more services on each patient, not to treat more patients more efficiently. Without reforming the RBRVS-based reimbursement system, adding more demand without addressing supply will only further exacerbate the myriad problems faced by our health care system. Absent more physician supply, the only way to deal with increased demand is to ration care or to substitute physician care with lesser educated physician extenders. Neither is likely to improve health care. It is time to give physicians the flexibility to move to new economic models. Physicians should be free to charge depending upon supply, demand, efficiency, and effectiveness. Alternative pricing could reward prevention, efficient and effective treatment of chronic conditions, and reduction in redundant or unnecessary testing and treatment. Making physicians stakeholders in the cost of pharmaceuticals could readily result in more careful selection of drugs, with appropriate consideration of price along with efficacy. Unfortunately, the AMA’s financial reliance on the CPT codes and its historic tie to the present reimbursement system make the likelihood of meaningful reform far less likely. Its interest in reform and the interests of the majority in the physician community are not in alignment. Because reliance upon the current CPT-code-driven reimbursement system offers no room for innovation, real reform is unlikely. And until these foundational issues are addressed, meaningful reform will fail. medicine and market forces, mmglobal nonadult false Supply & Demand and the AMA text blog medicine and market forces,mmglobal 722 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 1 Health Law & Policy 0 868007 3407919 Member 0 http://community.modernmedicine.com/_The-Heats-Getting-Hotter-Health-Care-Prosecutions-to-Rise-Dramatically/blog/576259/33379.html The Obama Administration is set to dramatically increase the number of health care fraud prosecutions to “add muscle to back up its rhetoric about cracking down on health care and corporate fraud.” According to the National Law Journal, Attorney General Eric Holder, Jr. is adding 10 trial attorneys to the fraud section and looking for a new chief for the section. The Fraud Section is already the largest litigation unit within the Justice Department’s Criminal Division, and Holder has now named prosecution of health care fraud a “top priority.” The Law Journal goes on to report that, since 1997, health care fraud prosecution has been responsible for more than $14 billion in criminal fines and settlements. Many of these prosecutions have resulted from the work of strike force teams sent from the Justice Department to local US Attorney’s offices to assist them in rapidly prosecuting health care fraud cases. But health care defense lawyers are concerned that the heightened attention on health care fraud will not uncover more massive fraud, but rather lead to prosecutions for minor violations. The defense bar raises the concern that adding more prosecutors and launching more strike forces will inevitably mean that Justice starts trying to turn minor, inadvertent violations of complex health laws into major litigation and press-release-worthy settlements. Prosecutors live to prosecute, especially young lawyers told they're bringing "cases of extraordinary importance" aimed at reaping millions for the American taxpayer. So defense lawyers counsel caution. The concern that prosecutions of minor violations will multiply is well founded. Once a bureaucracy is established, the publicity surrounding the “big” cases generates a call for more prosecutions, more staff, bigger budgets and more regulation. At the same time, once word gets out that the government is serious about prosecuting fraud, the level of fraud tends to diminish substantially. This is known in legal parlance as the “deterrent effect.” If government were subject to the same market forces as the private sector, it would cut back or redirect staff and resources as the number of “big” cases decreases. Yet, experience tells us that the government bureaucracy which successfully created the deterrent effect, rather than retreat, continues to grow, based on its past success. Soon there simply aren’t enough big cases to justify the now bloated bureaucracy. Rather than reduce staff and budget—concepts foreign to most government agencies—the bureaucrats concentrate on less important cases to justify their continued existence. Anyone familiar with the growth of health care regulation and prosecution over the past 30 years will readily recognize the trend. Today, state and federal health care regulations rival the Internal Revenue Code in complexity. Thirty years ago, most health care attorneys could readily keep the regulations in their memory. Today, teams of lawyers spend hours each month just keeping current on changes to these regulations. No physician or health care provider can be expected to keep track of all of the regulations and follow them scrupulously. Yet, as prosecutors search for new prosecutions, many well-meaning physicians will likely be caught up in their widening net. Given this reality, physicians must increase their efforts to assure compliance with the law. Any new venture must be carefully reviewed by a health care lawyer. General practitioners are notoriously lacking in knowledge sufficient to adequately advise physicians. The biggest problem is often the fact that they simply do not know what they don’t know. What would appear to be a simple, straightforward transaction in any other context may well impact upon all forms of esoteric health-care-related regulations—regulations of which a general practitioner may be completely unaware. Similarly, billing and collection efforts should be reviewed periodically, preferably with someone intimately familiar with coding requirements, to assure that claim forms are properly coded and that medical records support these codes. Lack of documentation remains the greatest single liability when attempting to defend a payor audit, and payor audits are going to become the most common trigger for health care fraud prosecutions. The Obama Administration is set to dramatically increase the number of health care fraud prosecutions to “add muscle to back up its rhetoric about cracking down on health care and corporate fraud.” According to the National Law Journal, Attorney General Eric Holder, Jr. is adding 10 trial attorneys to the fraud section and looking for a new chief for the section. The Fraud Section is already the largest litigation unit within the Justice Department’s Criminal Division, and Holder has now named prosecution of health care fraud a “top priority.” The Law Journal goes on to report that, since 1997, health care fraud prosecution has been responsible for more than $14 billion in criminal fines and settlements. Many of these prosecutions have resulted from the work of strike force teams sent from the Justice Department to local US Attorney’s offices to assist them in rapidly prosecuting health care fraud cases. But health care defense lawyers are concerned that the heightened attention on health care fraud will not uncover more massive fraud, but rather lead to prosecutions for minor violations. The defense bar raises the concern that adding more prosecutors and launching more strike forces will inevitably mean that Justice starts trying to turn minor, inadvertent violations of complex health laws into major litigation and press-release-worthy settlements. Prosecutors live to prosecute, especially young lawyers told they're bringing "cases of extraordinary importance" aimed at reaping millions for the American taxpayer. So defense lawyers counsel caution. The concern that prosecutions of minor violations will multiply is well founded. Once a bureaucracy is established, the publicity surrounding the “big” cases generates a call for more prosecutions, more staff, bigger budgets and more regulation. At the same time, once word gets out that the government is serious about prosecuting fraud, the level of fraud tends to diminish substantially. This is known in legal parlance as the “deterrent effect.” If government were subject to the same market forces as the private sector, it would cut back or redirect staff and resources as the number of “big” cases decreases. Yet, experience tells us that the government bureaucracy which successfully created the deterrent effect, rather than retreat, continues to grow, based on its past success. Soon there simply aren’t enough big cases to justify the now bloated bureaucracy. Rather than reduce staff and budget—concepts foreign to most government agencies—the bureaucrats concentrate on less important cases to justify their continued existence. Anyone familiar with the growth of health care regulation and prosecution over the past 30 years will readily recognize the trend. Today, state and federal health care regulations rival the Internal Revenue Code in complexity. Thirty years ago, most health care attorneys could readily keep the regulations in their memory. Today, teams of lawyers spend hours each month just keeping current on changes to these regulations. No physician or health care provider can be expected to keep track of all of the regulations and follow them scrupulously. Yet, as prosecutors search for new prosecutions, many well-meaning physicians will likely be caught up in their widening net. Given this reality, physicians must increase their efforts to assure compliance with the law. Any new venture must be carefully reviewed by a health care lawyer. General practitioners are notoriously lacking in knowledge sufficient to adequately advise physicians. The biggest problem is often the fact that they simply do not know what they don’t know. What would appear to be a simple, straightforward transaction in any other context may well impact upon all forms of esoteric health-care-related regulations—regulations of which a general practitioner may be completely unaware. Similarly, billing and collection efforts should be reviewed periodically, preferably with someone intimately familiar with coding requirements, to assure that claim forms are properly coded and that medical records support these codes. Lack of documentation remains the greatest single liability when attempting to defend a payor audit, and payor audits are going to become the most common trigger for health care fraud prosecutions. Tue, 25 Aug 2009 18:59:10 GMT http://community.modernmedicine.com/_The-Heats-Getting-Hotter-Health-Care-Prosecutions-to-Rise-Dramatically/blog/576259/33379.html skern 2009-08-25T18:57:40Z Health Law & Policy Modern Medicine Community The Obama Administration is set to dramatically increase the number of health care fraud prosecutions to “add muscle to back up its rhetoric about cracking down on health care and corporate fraud.” According to the National Law Journal, Attorney General Eric Holder, Jr. is adding 10 trial attorneys to the fraud section and looking for a new chief for the section. The Fraud Section is already the largest litigation unit within the Justice Department’s Criminal Division, and Holder has now named prosecution of health care fraud a “top priority.” The Law Journal goes on to report that, since 1997, health care fraud prosecution has been responsible for more than $14 billion in criminal fines and settlements. Many of these prosecutions have resulted from the work of strike force teams sent from the Justice Department to local US Attorney’s offices to assist them in rapidly prosecuting health care fraud cases. But health care defense lawyers are concerned that the heightened attention on health care fraud will not uncover more massive fraud, but rather lead to prosecutions for minor violations. The defense bar raises the concern that adding more prosecutors and launching more strike forces will inevitably mean that Justice starts trying to turn minor, inadvertent violations of complex health laws into major litigation and press-release-worthy settlements. Prosecutors live to prosecute, especially young lawyers told they're bringing "cases of extraordinary importance" aimed at reaping millions for the American taxpayer. So defense lawyers counsel caution. The concern that prosecutions of minor violations will multiply is well founded. Once a bureaucracy is established, the publicity surrounding the “big” cases generates a call for more prosecutions, more staff, bigger budgets and more regulation. At the same time, once word gets out that the government is serious about prosecuting fraud, the level of fraud tends to diminish substantially. This is known in legal parlance as the “deterrent effect.” If government were subject to the same market forces as the private sector, it would cut back or redirect staff and resources as the number of “big” cases decreases. Yet, experience tells us that the government bureaucracy which successfully created the deterrent effect, rather than retreat, continues to grow, based on its past success. Soon there simply aren’t enough big cases to justify the now bloated bureaucracy. Rather than reduce staff and budget—concepts foreign to most government agencies—the bureaucrats concentrate on less important cases to justify their continued existence. Anyone familiar with the growth of health care regulation and prosecution over the past 30 years will readily recognize the trend. Today, state and federal health care regulations rival the Internal Revenue Code in complexity. Thirty years ago, most health care attorneys could readily keep the regulations in their memory. Today, teams of lawyers spend hours each month just keeping current on changes to these regulations. No physician or health care provider can be expected to keep track of all of the regulations and follow them scrupulously. Yet, as prosecutors search for new prosecutions, many well-meaning physicians will likely be caught up in their widening net. Given this reality, physicians must increase their efforts to assure compliance with the law. Any new venture must be carefully reviewed by a health care lawyer. General practitioners are notoriously lacking in knowledge sufficient to adequately advise physicians. The biggest problem is often the fact that they simply do not know what they don’t know. What would appear to be a simple, straightforward transaction in any other context may well impact upon all forms of esoteric health-care-related regulations—regulations of which a general practitioner may be completely unaware. Similarly, billing and collection efforts should be reviewed periodically, preferably with someone intimately familiar with coding requirements, to assure that claim forms are properly coded and that medical records support these codes. Lack of documentation remains the greatest single liability when attempting to defend a payor audit, and payor audits are going to become the most common trigger for health care fraud prosecutions. health law & policy, healthcare fraud, mmglobal nonadult false The Heat’s Getting Hotter: Health Care Prosecutions to Rise Dramatically text blog health law & policy,healthcare fraud,mmglobal 976 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 1 Health Law & Policy 0 576259 3407919 Member 0 http://community.modernmedicine.com/_The-Government-Does-It-Again-Red-Flag-Rules-Delayed-until-November-1-2009/blog/487301/33379.html Once again, only days before enforcement was to begin, the Federal Trade Commission (FTC) has delayed the enforcement date of the Red Flag Rules. The Red Flag Rules were originally promulgated to require creditors and financial institutions to develop policies to discover identity theft. More recently the FTC has determined that medical practices, law firms, and other small businesses that bill for services rendered are also subject to these rules. Faced with opposition from the medical, legal, and business communities, the FTC first postponed enforcement in April, just one day before enforcement was to begin. Now, two days before the new enforcement date&emdash;August 1, 2009&emdash;the FTC has again delayed implementation until November 1, 2009. Of course, millions of dollars and countless hours have been spent by thousands of medical practices  in anticipation of the FTC's mandate. Rumor has it that the FTC may now be considering less onerous rules for physicians and other professional practices. This could result in the scrapping or modification of existing plans at additional expense to physicians. It's time for the FTC to abandon, once and for all, its ill-conceived efforts to extend the reach of the Red Flag Rules to physician offices. This is yet another example of the waste and absurdity associated with government's involvement in physician practices&emdash;and the government wants to control more of our health care? Once again, only days before enforcement was to begin, the Federal Trade Commission (FTC) has delayed the enforcement date of the Red Flag Rules. The Red Flag Rules were originally promulgated to require creditors and financial institutions to develop policies to discover identity theft. More recently the FTC has determined that medical practices, law firms, and other small businesses that bill for services rendered are also subject to these rules. Faced with opposition from the medical, legal, and business communities, the FTC first postponed enforcement in April, just one day before enforcement was to begin. Now, two days before the new enforcement date&emdash;August 1, 2009&emdash;the FTC has again delayed implementation until November 1, 2009. Of course, millions of dollars and countless hours have been spent by thousands of medical practices  in anticipation of the FTC's mandate. Rumor has it that the FTC may now be considering less onerous rules for physicians and other professional practices. This could result in the scrapping or modification of existing plans at additional expense to physicians. It's time for the FTC to abandon, once and for all, its ill-conceived efforts to extend the reach of the Red Flag Rules to physician offices. This is yet another example of the waste and absurdity associated with government's involvement in physician practices&emdash;and the government wants to control more of our health care? Mon, 10 Aug 2009 16:50:40 GMT http://community.modernmedicine.com/_The-Government-Does-It-Again-Red-Flag-Rules-Delayed-until-November-1-2009/blog/487301/33379.html skern 2009-07-31T13:37:22Z Health Law & Policy Modern Medicine Community Once again, only days before enforcement was to begin, the Federal Trade Commission (FTC) has delayed the enforcement date of the Red Flag Rules. The Red Flag Rules were originally promulgated to require creditors and financial institutions to develop policies to discover identity theft. More recently the FTC has determined that medical practices, law firms, and other small businesses that bill for services rendered are also subject to these rules. Faced with opposition from the medical, legal, and business communities, the FTC first postponed enforcement in April, just one day before enforcement was to begin. Now, two days before the new enforcement date&emdash;August 1, 2009&emdash;the FTC has again delayed implementation until November 1, 2009. Of course, millions of dollars and countless hours have been spent by thousands of medical practices  in anticipation of the FTC's mandate. Rumor has it that the FTC may now be considering less onerous rules for physicians and other professional practices. This could result in the scrapping or modification of existing plans at additional expense to physicians. It's time for the FTC to abandon, once and for all, its ill-conceived efforts to extend the reach of the Red Flag Rules to physician offices. This is yet another example of the waste and absurdity associated with government's involvement in physician practices&emdash;and the government wants to control more of our health care? health law & policy, health law & policy, identity theft, mmglobal, red flag rules nonadult false The Government Does It Again: Red Flag Rules Delayed until November 1, 2009 text blog health law & policy,health law & policy,identity theft,mmglobal,red flag rules 935 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 0 Health Law & Policy 0 487301 3407919 Member 0 http://community.modernmedicine.com/_Whats-the-AMA-Thinking/blog/483320/33379.html Right now in Washington, President Obama and Congress are engaged in a debate about health care reform—a debate with enormous stakes for the medical profession, Americans, and the future of the country. No bill has emerged from either the House or the Senate, no one appears to have read the thousands of pages of various forms of legislation being reviewed and debated, and the nonpartisan Congressional Budget Office has concluded that the House Democrat’s bill will create an additional deficit of over $200 billion while leaving millions of Americans still uninsured. Despite these facts, the American Medical Association has endorsed the House Democrats’ version of the legislation. Just one day after the endorsement, The Mayo Clinic Health Policy Center expressed disappointment with the bill, saying it misses an opportunity to help create higher quality and more affordable health care for patients. In fact, says the Mayo Clinic, it will do the opposite. Ironically, President Obama, himself, has described the Mayo Clinic as a model of how health care can be delivered more effectively. At the same time as the Mayo clinic issued its statement, Donald J. Palmisano, MD, a leading surgeon and highly respected former president of the AMA, expressed serious criticism of the House plan, saying “There’s no need to rush a bill through Congress.” Palmisano said he opposes the plan because patients will no longer be able to properly contract with their doctors. “The government takeover of the practice of medicine,” according to Dr. Palmisano, “will destroy the private health insurance companies and will result in rationing, long lines, and loss of access to physicians in the patient’s hour of need.” It also appears that the AMA’s endorsement did little to quell the Administration’s attacks on our nation’s physicians. In his recent news conference, shortly after the AMA’s endorsement, President Obama gratuitously accused pediatricians of performing unnecessary surgery to further their own financial interests—an absurd conclusion given the fact that pediatricians do not perform surgery. Given the serious questions raised by the House bill—one that appears at this time to have absolutely no chance of passage in its current form—and the continued attack on physicians by the President, one must question the AMA’s rush to endorsement, especially since the bill likely will reduce reimbursement for many of its members, increase their tax liability, and if Dr. Palmisano is correct, result in rationing, long lines, and loss of access. The AMA should be representing the interests of physicians, especially since those interests almost always align with the best interests of patients. The AMA’s close relationship with the government, and the fact that much of its income is derived not from dues income but from outside contracts—many with the government—creates a dangerous conflict of interest. Indeed, cynics may suggest that this conflict explains its current endorsement. It’s time for the AMA’s membership to send a strong message, to represent the interests of physicians and their patients, and not always acquiesce to the last offer on the table. At times, leadership requires a willingness to confront and fight against legislation that will result in further deterioration of the physicians’ role in our healthcare system. Health care reform is simply too complex and important to compromise in the hope that compromise may bring some future good will. Simply going along in the hope that going along will somehow prove beneficial at some future undefined time is a poor trade, certainly when the stakes are as high as they are now. While being at the table can be beneficial, it’s not beneficial if you become the appetizer. Right now in Washington, President Obama and Congress are engaged in a debate about health care reform—a debate with enormous stakes for the medical profession, Americans, and the future of the country. No bill has emerged from either the House or the Senate, no one appears to have read the thousands of pages of various forms of legislation being reviewed and debated, and the nonpartisan Congressional Budget Office has concluded that the House Democrat’s bill will create an additional deficit of over $200 billion while leaving millions of Americans still uninsured. Despite these facts, the American Medical Association has endorsed the House Democrats’ version of the legislation. Just one day after the endorsement, The Mayo Clinic Health Policy Center expressed disappointment with the bill, saying it misses an opportunity to help create higher quality and more affordable health care for patients. In fact, says the Mayo Clinic, it will do the opposite. Ironically, President Obama, himself, has described the Mayo Clinic as a model of how health care can be delivered more effectively. At the same time as the Mayo clinic issued its statement, Donald J. Palmisano, MD, a leading surgeon and highly respected former president of the AMA, expressed serious criticism of the House plan, saying “There’s no need to rush a bill through Congress.” Palmisano said he opposes the plan because patients will no longer be able to properly contract with their doctors. “The government takeover of the practice of medicine,” according to Dr. Palmisano, “will destroy the private health insurance companies and will result in rationing, long lines, and loss of access to physicians in the patient’s hour of need.” It also appears that the AMA’s endorsement did little to quell the Administration’s attacks on our nation’s physicians. In his recent news conference, shortly after the AMA’s endorsement, President Obama gratuitously accused pediatricians of performing unnecessary surgery to further their own financial interests—an absurd conclusion given the fact that pediatricians do not perform surgery. Given the serious questions raised by the House bill—one that appears at this time to have absolutely no chance of passage in its current form—and the continued attack on physicians by the President, one must question the AMA’s rush to endorsement, especially since the bill likely will reduce reimbursement for many of its members, increase their tax liability, and if Dr. Palmisano is correct, result in rationing, long lines, and loss of access. The AMA should be representing the interests of physicians, especially since those interests almost always align with the best interests of patients. The AMA’s close relationship with the government, and the fact that much of its income is derived not from dues income but from outside contracts—many with the government—creates a dangerous conflict of interest. Indeed, cynics may suggest that this conflict explains its current endorsement. It’s time for the AMA’s membership to send a strong message, to represent the interests of physicians and their patients, and not always acquiesce to the last offer on the table. At times, leadership requires a willingness to confront and fight against legislation that will result in further deterioration of the physicians’ role in our healthcare system. Health care reform is simply too complex and important to compromise in the hope that compromise may bring some future good will. Simply going along in the hope that going along will somehow prove beneficial at some future undefined time is a poor trade, certainly when the stakes are as high as they are now. While being at the table can be beneficial, it’s not beneficial if you become the appetizer. Mon, 10 Aug 2009 20:51:07 GMT http://community.modernmedicine.com/_Whats-the-AMA-Thinking/blog/483320/33379.html skern 2009-07-29T18:48:58Z Health Law & Policy Modern Medicine Community Right now in Washington, President Obama and Congress are engaged in a debate about health care reform—a debate with enormous stakes for the medical profession, Americans, and the future of the country. No bill has emerged from either the House or the Senate, no one appears to have read the thousands of pages of various forms of legislation being reviewed and debated, and the nonpartisan Congressional Budget Office has concluded that the House Democrat’s bill will create an additional deficit of over $200 billion while leaving millions of Americans still uninsured. Despite these facts, the American Medical Association has endorsed the House Democrats’ version of the legislation. Just one day after the endorsement, The Mayo Clinic Health Policy Center expressed disappointment with the bill, saying it misses an opportunity to help create higher quality and more affordable health care for patients. In fact, says the Mayo Clinic, it will do the opposite. Ironically, President Obama, himself, has described the Mayo Clinic as a model of how health care can be delivered more effectively. At the same time as the Mayo clinic issued its statement, Donald J. Palmisano, MD, a leading surgeon and highly respected former president of the AMA, expressed serious criticism of the House plan, saying “There’s no need to rush a bill through Congress.” Palmisano said he opposes the plan because patients will no longer be able to properly contract with their doctors. “The government takeover of the practice of medicine,” according to Dr. Palmisano, “will destroy the private health insurance companies and will result in rationing, long lines, and loss of access to physicians in the patient’s hour of need.” It also appears that the AMA’s endorsement did little to quell the Administration’s attacks on our nation’s physicians. In his recent news conference, shortly after the AMA’s endorsement, President Obama gratuitously accused pediatricians of performing unnecessary surgery to further their own financial interests—an absurd conclusion given the fact that pediatricians do not perform surgery. Given the serious questions raised by the House bill—one that appears at this time to have absolutely no chance of passage in its current form—and the continued attack on physicians by the President, one must question the AMA’s rush to endorsement, especially since the bill likely will reduce reimbursement for many of its members, increase their tax liability, and if Dr. Palmisano is correct, result in rationing, long lines, and loss of access. The AMA should be representing the interests of physicians, especially since those interests almost always align with the best interests of patients. The AMA’s close relationship with the government, and the fact that much of its income is derived not from dues income but from outside contracts—many with the government—creates a dangerous conflict of interest. Indeed, cynics may suggest that this conflict explains its current endorsement. It’s time for the AMA’s membership to send a strong message, to represent the interests of physicians and their patients, and not always acquiesce to the last offer on the table. At times, leadership requires a willingness to confront and fight against legislation that will result in further deterioration of the physicians’ role in our healthcare system. Health care reform is simply too complex and important to compromise in the hope that compromise may bring some future good will. Simply going along in the hope that going along will somehow prove beneficial at some future undefined time is a poor trade, certainly when the stakes are as high as they are now. While being at the table can be beneficial, it’s not beneficial if you become the appetizer. health law & policy, health law & policy, mmglobal nonadult false What's the AMA Thinking? text blog health law & policy,health law & policy,mmglobal 730 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 0 Health Law & Policy 0 483320 3407919 Member 0 http://community.modernmedicine.com/_Michael-Jacksons-DoctorsCaregivers-or-Gravediggers/blog/465801/33379.html The death of Michael Jackson has focused attention on physicians who prescribe controlled dangerous substances (CDS) to patients over extended periods of time. As part of the focus, media have repeatedly shown Jackson rehearsing for his London tour and questioned how he could be have the physical stamina to perform if he were, in fact, addicted to controlled substances. The talking heads seem to suggest that since he didn’t look like an addict, there must be some other explanation. What many do not realize is that those who are addicted to CDS rarely look like “drug addicts.” They often hold high level jobs, are well dressed, well nourished, and well spoken. They present as anything but the stereotypical street addict. They are lawyers, doctors, business executives and, yes, entertainers, and they come in with complaints which often justify judicious use of controlled drugs. This creates an enormous dilemma for physicians who are asked to treat complaints that legitimately may require the use of CDS. Often these complaints cannot be objectively assessed, and the physician must rely upon the truthfulness of the patient. When the patient doesn’t meet the stereotype of an addict, the physician is often likely to accept the patient at his word. Since privacy laws make it difficult to know if a patient is obtaining prescriptions from multiple sources, physicians rarely know if a patient is dangerously exceeding the amounts of medication prescribed, through the use of multiple physicians. The proper response by a physician asked to treat patients who need medication to control pain, to aid in sleep, or to relieve anxiety has been the subject of debate for at least the last 30 years when the State of New Jersey put together a taskforce to eliminate the most serious abuses by physicians. As a Deputy Attorney General for the New Jersey, I was responsible for prosecuting and revoking the licenses of over a hundred physicians involved in the indiscriminate prescribing of CDS. Most often, these physicians were simply selling pills or prescriptions out of their offices--mostly amphetamines and barbiturates. We sent undercover agents into their offices, posing as patients. These “patients” had no legitimate medical condition warranting the prescription of CDS. They often went to the doctor’s office wearing a wire, and the taped conversations made the case. The prosecutions were quick and easy. Of course, it didn’t take long before word spread and the blatant indiscriminate prescribing came to a screeching halt. Fortunately, the worst actors were soon either removed from practice or changed their ways. Unfortunately, the success of the program created a bureaucracy and, once created, like any good bureaucracy, needed a reason to continue. So, with the help of a number of self-proclaimed “experts” in the field, the “standards” for prescribing controlled substances for extended use tightened. Physicians were no longer to trust patients who came to them complaining of pain. Rather, they were told that they must act as detectives rather than caregivers. Soon reports of underprescribing became common, and a debate followed as to what constituted proper use of these drugs. Good and honest physicians, sympathetic to their patients’ complaints and perhaps naïve to the manipulative abilities of their drug dependent patients, suddenly found themselves targets of license revocation proceedings, proceedings often fueled by self-proclaimed experts who had their own narrow views of when and in what quantities a physician could legitimately prescribe. Over time, the pendulum has swung back to a more reasonable place. Licensing boards have recognized that underprescribing controlled substances to those in need is at least as inappropriate as overprescribing and that patients in true need of these drugs should receive them. While there is still no recognized standard of care for prescribing controlled substances, it is certainly accepted that the prescription of medications to control pain, reduce anxiety, or assist in sleep is often appropriate and medically indicated. Patients are entitled to be relieved of their pain, even if it requires the use of highly addictive controlled drugs. A physician must try to balance the risks of prescribing for a patient who is seeking to use the physician to maintain an addiction against the risks of denying a patient a needed medication for a justified medical purpose. It is this balance that California will have to consider in deciding whether to prosecute Jackson’s physicians or seek to revoke their medical licenses. If the physicians appropriately considered Jackson’s condition and complaints and justifiably determined that he required the drugs they prescribed, they should have no problem defending their care, especially if they were unaware of prescriptions issued by other physicians. If not, they may face serious jeopardy. The death of Michael Jackson has focused attention on physicians who prescribe controlled dangerous substances (CDS) to patients over extended periods of time. As part of the focus, media have repeatedly shown Jackson rehearsing for his London tour and questioned how he could be have the physical stamina to perform if he were, in fact, addicted to controlled substances. The talking heads seem to suggest that since he didn’t look like an addict, there must be some other explanation. What many do not realize is that those who are addicted to CDS rarely look like “drug addicts.” They often hold high level jobs, are well dressed, well nourished, and well spoken. They present as anything but the stereotypical street addict. They are lawyers, doctors, business executives and, yes, entertainers, and they come in with complaints which often justify judicious use of controlled drugs. This creates an enormous dilemma for physicians who are asked to treat complaints that legitimately may require the use of CDS. Often these complaints cannot be objectively assessed, and the physician must rely upon the truthfulness of the patient. When the patient doesn’t meet the stereotype of an addict, the physician is often likely to accept the patient at his word. Since privacy laws make it difficult to know if a patient is obtaining prescriptions from multiple sources, physicians rarely know if a patient is dangerously exceeding the amounts of medication prescribed, through the use of multiple physicians. The proper response by a physician asked to treat patients who need medication to control pain, to aid in sleep, or to relieve anxiety has been the subject of debate for at least the last 30 years when the State of New Jersey put together a taskforce to eliminate the most serious abuses by physicians. As a Deputy Attorney General for the New Jersey, I was responsible for prosecuting and revoking the licenses of over a hundred physicians involved in the indiscriminate prescribing of CDS. Most often, these physicians were simply selling pills or prescriptions out of their offices--mostly amphetamines and barbiturates. We sent undercover agents into their offices, posing as patients. These “patients” had no legitimate medical condition warranting the prescription of CDS. They often went to the doctor’s office wearing a wire, and the taped conversations made the case. The prosecutions were quick and easy. Of course, it didn’t take long before word spread and the blatant indiscriminate prescribing came to a screeching halt. Fortunately, the worst actors were soon either removed from practice or changed their ways. Unfortunately, the success of the program created a bureaucracy and, once created, like any good bureaucracy, needed a reason to continue. So, with the help of a number of self-proclaimed “experts” in the field, the “standards” for prescribing controlled substances for extended use tightened. Physicians were no longer to trust patients who came to them complaining of pain. Rather, they were told that they must act as detectives rather than caregivers. Soon reports of underprescribing became common, and a debate followed as to what constituted proper use of these drugs. Good and honest physicians, sympathetic to their patients’ complaints and perhaps naïve to the manipulative abilities of their drug dependent patients, suddenly found themselves targets of license revocation proceedings, proceedings often fueled by self-proclaimed experts who had their own narrow views of when and in what quantities a physician could legitimately prescribe. Over time, the pendulum has swung back to a more reasonable place. Licensing boards have recognized that underprescribing controlled substances to those in need is at least as inappropriate as overprescribing and that patients in true need of these drugs should receive them. While there is still no recognized standard of care for prescribing controlled substances, it is certainly accepted that the prescription of medications to control pain, reduce anxiety, or assist in sleep is often appropriate and medically indicated. Patients are entitled to be relieved of their pain, even if it requires the use of highly addictive controlled drugs. A physician must try to balance the risks of prescribing for a patient who is seeking to use the physician to maintain an addiction against the risks of denying a patient a needed medication for a justified medical purpose. It is this balance that California will have to consider in deciding whether to prosecute Jackson’s physicians or seek to revoke their medical licenses. If the physicians appropriately considered Jackson’s condition and complaints and justifiably determined that he required the drugs they prescribed, they should have no problem defending their care, especially if they were unaware of prescriptions issued by other physicians. If not, they may face serious jeopardy. Mon, 10 Aug 2009 17:03:44 GMT http://community.modernmedicine.com/_Michael-Jacksons-DoctorsCaregivers-or-Gravediggers/blog/465801/33379.html skern 2009-07-22T15:13:17Z Patient Care Modern Medicine Community The death of Michael Jackson has focused attention on physicians who prescribe controlled dangerous substances (CDS) to patients over extended periods of time. As part of the focus, media have repeatedly shown Jackson rehearsing for his London tour and questioned how he could be have the physical stamina to perform if he were, in fact, addicted to controlled substances. The talking heads seem to suggest that since he didn’t look like an addict, there must be some other explanation. What many do not realize is that those who are addicted to CDS rarely look like “drug addicts.” They often hold high level jobs, are well dressed, well nourished, and well spoken. They present as anything but the stereotypical street addict. They are lawyers, doctors, business executives and, yes, entertainers, and they come in with complaints which often justify judicious use of controlled drugs. This creates an enormous dilemma for physicians who are asked to treat complaints that legitimately may require the use of CDS. Often these complaints cannot be objectively assessed, and the physician must rely upon the truthfulness of the patient. When the patient doesn’t meet the stereotype of an addict, the physician is often likely to accept the patient at his word. Since privacy laws make it difficult to know if a patient is obtaining prescriptions from multiple sources, physicians rarely know if a patient is dangerously exceeding the amounts of medication prescribed, through the use of multiple physicians. The proper response by a physician asked to treat patients who need medication to control pain, to aid in sleep, or to relieve anxiety has been the subject of debate for at least the last 30 years when the State of New Jersey put together a taskforce to eliminate the most serious abuses by physicians. As a Deputy Attorney General for the New Jersey, I was responsible for prosecuting and revoking the licenses of over a hundred physicians involved in the indiscriminate prescribing of CDS. Most often, these physicians were simply selling pills or prescriptions out of their offices--mostly amphetamines and barbiturates. We sent undercover agents into their offices, posing as patients. These “patients” had no legitimate medical condition warranting the prescription of CDS. They often went to the doctor’s office wearing a wire, and the taped conversations made the case. The prosecutions were quick and easy. Of course, it didn’t take long before word spread and the blatant indiscriminate prescribing came to a screeching halt. Fortunately, the worst actors were soon either removed from practice or changed their ways. Unfortunately, the success of the program created a bureaucracy and, once created, like any good bureaucracy, needed a reason to continue. So, with the help of a number of self-proclaimed “experts” in the field, the “standards” for prescribing controlled substances for extended use tightened. Physicians were no longer to trust patients who came to them complaining of pain. Rather, they were told that they must act as detectives rather than caregivers. Soon reports of underprescribing became common, and a debate followed as to what constituted proper use of these drugs. Good and honest physicians, sympathetic to their patients’ complaints and perhaps naïve to the manipulative abilities of their drug dependent patients, suddenly found themselves targets of license revocation proceedings, proceedings often fueled by self-proclaimed experts who had their own narrow views of when and in what quantities a physician could legitimately prescribe. Over time, the pendulum has swung back to a more reasonable place. Licensing boards have recognized that underprescribing controlled substances to those in need is at least as inappropriate as overprescribing and that patients in true need of these drugs should receive them. While there is still no recognized standard of care for prescribing controlled substances, it is certainly accepted that the prescription of medications to control pain, reduce anxiety, or assist in sleep is often appropriate and medically indicated. Patients are entitled to be relieved of their pain, even if it requires the use of highly addictive controlled drugs. A physician must try to balance the risks of prescribing for a patient who is seeking to use the physician to maintain an addiction against the risks of denying a patient a needed medication for a justified medical purpose. It is this balance that California will have to consider in deciding whether to prosecute Jackson’s physicians or seek to revoke their medical licenses. If the physicians appropriately considered Jackson’s condition and complaints and justifiably determined that he required the drugs they prescribed, they should have no problem defending their care, especially if they were unaware of prescriptions issued by other physicians. If not, they may face serious jeopardy. cdss”, drugs”, jackson”, malpractice, medication”, mmglobal, patient care, “controlled, “michael, “pain, “prescribing nonadult false Michael Jackson’s Doctors…Caregivers or Gravediggers? text blog cdss”,drugs”,jackson”,malpractice,medication”,mmglobal,patient care,“controlled,“michael,“pain,“prescribing 2428 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 3 Patient Care 0 465801 3407919 Member 0 http://community.modernmedicine.com/_OIG-Rules-Hospitals-Can-Pay-Physicians-for-On-Call-Services/blog/405733/33379.html A recent opinion by the Office of Inspector General (OIG) of the Department of Health and Human Services is likely to place hospitals and their medical staffs at opposite ends of the bargaining table when it comes to paying for care for the uninsured and indigent. The OIG, in its second ruling on the subject in a year and a half, has ruled that hospitals can not only compensate physicians for on-call services performed on behalf of their uninsured patients on a per diem basis but can also do so on a fee-for-service basis. This ruling should help end years of efforts by some hospitals to hide behind concerns that compensating physicians for treating indigent patients could violate the Federal anti-kickback statute. The OIG’s opinion addressed a common situation where a hospital’s medical staff bylaws require all members of its active medical staff to provide on-call coverage for its emergency department (ED) and care for patients referred to them while they are providing ED coverage. The hospital under review, like many other hospitals, did not compensate its physicians for on-call service they render to ED patients who are indigent and uninsured. Often, however, hospitals receive government subsidies for caring for the indigent--subsidies not shared with the medical staff. Of note in the OIG opinion is the candid finding that most physicians dislike the duty of performing on-call coverage for the ED because telephone calls requesting the physician to respond come at all hours, disrupting their professional and personal lives. In addition, the opinion recognizes that the on-call obligation creates additional medical liability for care rendered to persons with whom there is often no previously established patient-physician relationship, increasing the risk of claims of medical malpractice. Due to the disruption, increased liability, and the lack of compensation, physicians only provide the minimum emergency coverage required under the hospital bylaws. The “historic sense of duty” to their profession that led physicians to provide this care in the past is, to quote the OIG, a “sentiment . . . no longer shared by all.” Rather, physicians commonly view on-call coverage as an unwanted obligation, jeopardizing the hospital’s ability to serve patients. Under the plan approved by the OIG, physicians at the hospital which requested the opinion will be compensated at a rate of $100 flat fee for emergency consultations on an eligible patient, $300 per admission to a physician’s service for inpatient care and management, $350 flat fee for the primary surgeon of record performing a surgical procedure on a patient admitted from the ED, and $150 for an endoscopic procedure performed on an eligible patient admitted from the ED. According to the hospital, these fees are within the range of fair market value for the services rendered, and the payments are made without regard to referrals or any other business generated between the hospital and the physicians. In approving the plan, the OIG opined that the key inquiry is whether the compensation is Fair market value in an arm’s-length transaction for actual and necessary items or services and Not determined in any manner that takes into account the volume or value of referrals or other business generated between the parties. If these key factors are met, the anti-kickback statute neither compels hospitals to pay for on-call services, nor compels physicians to provide on-call services without compensation. The American Medical Association and other physician organizations have, for years, advised physicians that their medical staffs should not be represented by hospital counsel but should have their own separate counsel. Now that the OIG has made it clear that medical staff members can be paid for their ED coverage, yet another reason exists for independent medical staff counsel. Millions of dollars in fees lie in the balance. A recent opinion by the Office of Inspector General (OIG) of the Department of Health and Human Services is likely to place hospitals and their medical staffs at opposite ends of the bargaining table when it comes to paying for care for the uninsured and indigent. The OIG, in its second ruling on the subject in a year and a half, has ruled that hospitals can not only compensate physicians for on-call services performed on behalf of their uninsured patients on a per diem basis but can also do so on a fee-for-service basis. This ruling should help end years of efforts by some hospitals to hide behind concerns that compensating physicians for treating indigent patients could violate the Federal anti-kickback statute. The OIG’s opinion addressed a common situation where a hospital’s medical staff bylaws require all members of its active medical staff to provide on-call coverage for its emergency department (ED) and care for patients referred to them while they are providing ED coverage. The hospital under review, like many other hospitals, did not compensate its physicians for on-call service they render to ED patients who are indigent and uninsured. Often, however, hospitals receive government subsidies for caring for the indigent--subsidies not shared with the medical staff. Of note in the OIG opinion is the candid finding that most physicians dislike the duty of performing on-call coverage for the ED because telephone calls requesting the physician to respond come at all hours, disrupting their professional and personal lives. In addition, the opinion recognizes that the on-call obligation creates additional medical liability for care rendered to persons with whom there is often no previously established patient-physician relationship, increasing the risk of claims of medical malpractice. Due to the disruption, increased liability, and the lack of compensation, physicians only provide the minimum emergency coverage required under the hospital bylaws. The “historic sense of duty” to their profession that led physicians to provide this care in the past is, to quote the OIG, a “sentiment . . . no longer shared by all.” Rather, physicians commonly view on-call coverage as an unwanted obligation, jeopardizing the hospital’s ability to serve patients. Under the plan approved by the OIG, physicians at the hospital which requested the opinion will be compensated at a rate of $100 flat fee for emergency consultations on an eligible patient, $300 per admission to a physician’s service for inpatient care and management, $350 flat fee for the primary surgeon of record performing a surgical procedure on a patient admitted from the ED, and $150 for an endoscopic procedure performed on an eligible patient admitted from the ED. According to the hospital, these fees are within the range of fair market value for the services rendered, and the payments are made without regard to referrals or any other business generated between the hospital and the physicians. In approving the plan, the OIG opined that the key inquiry is whether the compensation is Fair market value in an arm’s-length transaction for actual and necessary items or services and Not determined in any manner that takes into account the volume or value of referrals or other business generated between the parties. If these key factors are met, the anti-kickback statute neither compels hospitals to pay for on-call services, nor compels physicians to provide on-call services without compensation. The American Medical Association and other physician organizations have, for years, advised physicians that their medical staffs should not be represented by hospital counsel but should have their own separate counsel. Now that the OIG has made it clear that medical staff members can be paid for their ED coverage, yet another reason exists for independent medical staff counsel. Millions of dollars in fees lie in the balance. Tue, 11 Aug 2009 19:27:56 GMT http://community.modernmedicine.com/_OIG-Rules-Hospitals-Can-Pay-Physicians-for-On-Call-Services/blog/405733/33379.html skern 2009-06-24T23:21:57Z Health Law & Policy Modern Medicine Community A recent opinion by the Office of Inspector General (OIG) of the Department of Health and Human Services is likely to place hospitals and their medical staffs at opposite ends of the bargaining table when it comes to paying for care for the uninsured and indigent. The OIG, in its second ruling on the subject in a year and a half, has ruled that hospitals can not only compensate physicians for on-call services performed on behalf of their uninsured patients on a per diem basis but can also do so on a fee-for-service basis. This ruling should help end years of efforts by some hospitals to hide behind concerns that compensating physicians for treating indigent patients could violate the Federal anti-kickback statute. The OIG’s opinion addressed a common situation where a hospital’s medical staff bylaws require all members of its active medical staff to provide on-call coverage for its emergency department (ED) and care for patients referred to them while they are providing ED coverage. The hospital under review, like many other hospitals, did not compensate its physicians for on-call service they render to ED patients who are indigent and uninsured. Often, however, hospitals receive government subsidies for caring for the indigent--subsidies not shared with the medical staff. Of note in the OIG opinion is the candid finding that most physicians dislike the duty of performing on-call coverage for the ED because telephone calls requesting the physician to respond come at all hours, disrupting their professional and personal lives. In addition, the opinion recognizes that the on-call obligation creates additional medical liability for care rendered to persons with whom there is often no previously established patient-physician relationship, increasing the risk of claims of medical malpractice. Due to the disruption, increased liability, and the lack of compensation, physicians only provide the minimum emergency coverage required under the hospital bylaws. The “historic sense of duty” to their profession that led physicians to provide this care in the past is, to quote the OIG, a “sentiment . . . no longer shared by all.” Rather, physicians commonly view on-call coverage as an unwanted obligation, jeopardizing the hospital’s ability to serve patients. Under the plan approved by the OIG, physicians at the hospital which requested the opinion will be compensated at a rate of $100 flat fee for emergency consultations on an eligible patient, $300 per admission to a physician’s service for inpatient care and management, $350 flat fee for the primary surgeon of record performing a surgical procedure on a patient admitted from the ED, and $150 for an endoscopic procedure performed on an eligible patient admitted from the ED. According to the hospital, these fees are within the range of fair market value for the services rendered, and the payments are made without regard to referrals or any other business generated between the hospital and the physicians. In approving the plan, the OIG opined that the key inquiry is whether the compensation is Fair market value in an arm’s-length transaction for actual and necessary items or services and Not determined in any manner that takes into account the volume or value of referrals or other business generated between the parties. If these key factors are met, the anti-kickback statute neither compels hospitals to pay for on-call services, nor compels physicians to provide on-call services without compensation. The American Medical Association and other physician organizations have, for years, advised physicians that their medical staffs should not be represented by hospital counsel but should have their own separate counsel. Now that the OIG has made it clear that medical staff members can be paid for their ED coverage, yet another reason exists for independent medical staff counsel. Millions of dollars in fees lie in the balance. health law & policy, malpractice concerns, mmglobal nonadult false OIG Rules Hospitals Can Pay Physicians for On-Call Services text blog health law & policy,malpractice concerns,mmglobal 1749 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 0 Health Law & Policy 0 405733 3407919 Member 0 http://community.modernmedicine.com/_Red-Flag-Rules-Redux/blog/277922/33379.html Now that physicians have spent an estimated $50 to $100 million to implement the Red Flag Rules to identify and prevent identity theft, the Federal Trade Commission (FTC) has announced that it is delaying the implementation deadline from May 31 until August 1, 2009. Worse, the FTC has announced that it may, yet again, alter the rules to allow low risk business such as medical offices to maintain less cumbersome policies. So, after conscientious physicians throughout the country have spent money on lawyers, seminars, and staff training, on the very day before implementation, the government tells us that they may alter the rules. It is one thing to issue a mandate to the medical community, and it is another to require that the mandate be followed, without funding its cost. It is, however, the height of arrogance and irresponsibility to delay, and possibly reverse the course of that mandate only a few hours before every medical office in the nation was required to be in compliance. One can only imagine the repercussions if a physician suddenly announced to his patient the day before urgent surgery, after all of the pretesting was done and arrangements made for hospitalization, that he changed his mind and would no longer accept her insurance. Yet, the government can engage in similarly irresponsible conduct without penalty. To make matters worse, the greatest cost associated with the Red Flag Rules is in the initial setup. Once the policy is in place and the office staff appropriately trained, the ongoing costs will, generally, be minimal. So, every physician who diligently followed the law, spent the time and the money, and did what should have been done is effectively penalized. What will happen the next time the government issues a mandate? Will physicians act equally responsibly knowing that the government may change its mind at the last minute, and all of their time, efforts, and money will be wasted? Or, will they delay implementation until after the effective date and risk sanctions to avoid the risk of the government changing its mind? The FTC should never have subjected medical practices to a law that was clearly intended for financial institutions and other entities involved in extending credit as their core business. Yet, despite the efforts of the AMA and others to reason with the FTC, the agency refused to yield. Now, only after the cow left the proverbial barn for most physicians, is the FTC rethinking its position. The only solace physicians may take is that, even if the FTC changes its mandate, plans that have already been established to meet the Red Flag Rules should not need modification. At least we can hope. Now that physicians have spent an estimated $50 to $100 million to implement the Red Flag Rules to identify and prevent identity theft, the Federal Trade Commission (FTC) has announced that it is delaying the implementation deadline from May 31 until August 1, 2009. Worse, the FTC has announced that it may, yet again, alter the rules to allow low risk business such as medical offices to maintain less cumbersome policies. So, after conscientious physicians throughout the country have spent money on lawyers, seminars, and staff training, on the very day before implementation, the government tells us that they may alter the rules. It is one thing to issue a mandate to the medical community, and it is another to require that the mandate be followed, without funding its cost. It is, however, the height of arrogance and irresponsibility to delay, and possibly reverse the course of that mandate only a few hours before every medical office in the nation was required to be in compliance. One can only imagine the repercussions if a physician suddenly announced to his patient the day before urgent surgery, after all of the pretesting was done and arrangements made for hospitalization, that he changed his mind and would no longer accept her insurance. Yet, the government can engage in similarly irresponsible conduct without penalty. To make matters worse, the greatest cost associated with the Red Flag Rules is in the initial setup. Once the policy is in place and the office staff appropriately trained, the ongoing costs will, generally, be minimal. So, every physician who diligently followed the law, spent the time and the money, and did what should have been done is effectively penalized. What will happen the next time the government issues a mandate? Will physicians act equally responsibly knowing that the government may change its mind at the last minute, and all of their time, efforts, and money will be wasted? Or, will they delay implementation until after the effective date and risk sanctions to avoid the risk of the government changing its mind? The FTC should never have subjected medical practices to a law that was clearly intended for financial institutions and other entities involved in extending credit as their core business. Yet, despite the efforts of the AMA and others to reason with the FTC, the agency refused to yield. Now, only after the cow left the proverbial barn for most physicians, is the FTC rethinking its position. The only solace physicians may take is that, even if the FTC changes its mandate, plans that have already been established to meet the Red Flag Rules should not need modification. At least we can hope. Thu, 14 May 2009 22:21:45 GMT http://community.modernmedicine.com/_Red-Flag-Rules-Redux/blog/277922/33379.html skern 2009-05-14T22:18:02Z Malpractice Modern Medicine Community Now that physicians have spent an estimated $50 to $100 million to implement the Red Flag Rules to identify and prevent identity theft, the Federal Trade Commission (FTC) has announced that it is delaying the implementation deadline from May 31 until August 1, 2009. Worse, the FTC has announced that it may, yet again, alter the rules to allow low risk business such as medical offices to maintain less cumbersome policies. So, after conscientious physicians throughout the country have spent money on lawyers, seminars, and staff training, on the very day before implementation, the government tells us that they may alter the rules. It is one thing to issue a mandate to the medical community, and it is another to require that the mandate be followed, without funding its cost. It is, however, the height of arrogance and irresponsibility to delay, and possibly reverse the course of that mandate only a few hours before every medical office in the nation was required to be in compliance. One can only imagine the repercussions if a physician suddenly announced to his patient the day before urgent surgery, after all of the pretesting was done and arrangements made for hospitalization, that he changed his mind and would no longer accept her insurance. Yet, the government can engage in similarly irresponsible conduct without penalty. To make matters worse, the greatest cost associated with the Red Flag Rules is in the initial setup. Once the policy is in place and the office staff appropriately trained, the ongoing costs will, generally, be minimal. So, every physician who diligently followed the law, spent the time and the money, and did what should have been done is effectively penalized. What will happen the next time the government issues a mandate? Will physicians act equally responsibly knowing that the government may change its mind at the last minute, and all of their time, efforts, and money will be wasted? Or, will they delay implementation until after the effective date and risk sanctions to avoid the risk of the government changing its mind? The FTC should never have subjected medical practices to a law that was clearly intended for financial institutions and other entities involved in extending credit as their core business. Yet, despite the efforts of the AMA and others to reason with the FTC, the agency refused to yield. Now, only after the cow left the proverbial barn for most physicians, is the FTC rethinking its position. The only solace physicians may take is that, even if the FTC changes its mandate, plans that have already been established to meet the Red Flag Rules should not need modification. At least we can hope. identity theft, malpractice, red flag rules nonadult false Red Flag Rules Redux text blog identity theft,malpractice,red flag rules 983 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 0 Malpractice 0 277922 3407919 Member 0 http://community.modernmedicine.com/_Court-Says-Hospital-Should-Pay-Private-Physicians-Fees/blog/254390/33379.html As our nation’s banks are beginning to realize, government subsidies can come at a big price. With national health care again poised to take center stage on our national political agenda, a recent decision by a lower New Jersey Court may prove a harbinger of things to come. New Jersey has long required that hospitals accept and treat all patients, regardless of their ability to pay. In return it provides subsidies to private hospitals to compensate them for providing indigent care. The State provides no subsidy, however, to private physicians who, as a condition of membership on hospital staffs, are required to treat indigent patients, free of charge. Using the obligation of hospitals to accept and treat all patients, one court has now taken this duty to a new and unexpected level. The court held that an insured patient, who was not indigent, didn’t need to pay the surgeon who removed her kidney stone because the surgeon did not accept her insurance. Rather, since the hospital accepted her insurance and didn’t explicitly tell the patient that the doctor did not, it was the hospital’s responsibility to pay the surgeon. Why? Because the hospital “is better able to bear the cost of the surgeon’s services than the patient.” In its holding the Court found that since the patient was not explicitly told that her surgeon was not employed by the hospital, did not accept her insurance and would bill separately for his services, it was reasonable for her to conclude that the services she receives from an independent doctor were performed on behalf of the hospital and that she would not be liable for payment of his services. While one might see the merit of this argument if we were dealing with a government-owned and -operated hospital and an indigent patient, the hospital at issue was a private, not-for-profit institution, and the patient was not indigent. Hospitals are facing burgeoning budget challenges as the number of uninsured patients increases. Physicians are under greater economic pressure as reimbursement rates continue to decline. Yet, at least one court has now determined that a patient’s obligation to pay is not a function of ability but a function of her insurance coverage. Is this court’s decision to shift the burden of payment from the patient to the hospital or to the physician a sign of things to come? Should a patient’s obligation to pay for health care depend upon her insurance coverage, rather than her ability to pay? Is there an inherent “entitlement” which allows government to demand that private hospitals and independent physicians provide their services without compensation? These are but some of the many questions that will be debated in the months to come. For those providing health care services, these will, no doubt, be interesting times. As our nation’s banks are beginning to realize, government subsidies can come at a big price. With national health care again poised to take center stage on our national political agenda, a recent decision by a lower New Jersey Court may prove a harbinger of things to come. New Jersey has long required that hospitals accept and treat all patients, regardless of their ability to pay. In return it provides subsidies to private hospitals to compensate them for providing indigent care. The State provides no subsidy, however, to private physicians who, as a condition of membership on hospital staffs, are required to treat indigent patients, free of charge. Using the obligation of hospitals to accept and treat all patients, one court has now taken this duty to a new and unexpected level. The court held that an insured patient, who was not indigent, didn’t need to pay the surgeon who removed her kidney stone because the surgeon did not accept her insurance. Rather, since the hospital accepted her insurance and didn’t explicitly tell the patient that the doctor did not, it was the hospital’s responsibility to pay the surgeon. Why? Because the hospital “is better able to bear the cost of the surgeon’s services than the patient.” In its holding the Court found that since the patient was not explicitly told that her surgeon was not employed by the hospital, did not accept her insurance and would bill separately for his services, it was reasonable for her to conclude that the services she receives from an independent doctor were performed on behalf of the hospital and that she would not be liable for payment of his services. While one might see the merit of this argument if we were dealing with a government-owned and -operated hospital and an indigent patient, the hospital at issue was a private, not-for-profit institution, and the patient was not indigent. Hospitals are facing burgeoning budget challenges as the number of uninsured patients increases. Physicians are under greater economic pressure as reimbursement rates continue to decline. Yet, at least one court has now determined that a patient’s obligation to pay is not a function of ability but a function of her insurance coverage. Is this court’s decision to shift the burden of payment from the patient to the hospital or to the physician a sign of things to come? Should a patient’s obligation to pay for health care depend upon her insurance coverage, rather than her ability to pay? Is there an inherent “entitlement” which allows government to demand that private hospitals and independent physicians provide their services without compensation? These are but some of the many questions that will be debated in the months to come. For those providing health care services, these will, no doubt, be interesting times. Thu, 23 Apr 2009 16:36:36 GMT http://community.modernmedicine.com/_Court-Says-Hospital-Should-Pay-Private-Physicians-Fees/blog/254390/33379.html skern 2009-04-23T16:18:02Z Malpractice Modern Medicine Community As our nation’s banks are beginning to realize, government subsidies can come at a big price. With national health care again poised to take center stage on our national political agenda, a recent decision by a lower New Jersey Court may prove a harbinger of things to come. New Jersey has long required that hospitals accept and treat all patients, regardless of their ability to pay. In return it provides subsidies to private hospitals to compensate them for providing indigent care. The State provides no subsidy, however, to private physicians who, as a condition of membership on hospital staffs, are required to treat indigent patients, free of charge. Using the obligation of hospitals to accept and treat all patients, one court has now taken this duty to a new and unexpected level. The court held that an insured patient, who was not indigent, didn’t need to pay the surgeon who removed her kidney stone because the surgeon did not accept her insurance. Rather, since the hospital accepted her insurance and didn’t explicitly tell the patient that the doctor did not, it was the hospital’s responsibility to pay the surgeon. Why? Because the hospital “is better able to bear the cost of the surgeon’s services than the patient.” In its holding the Court found that since the patient was not explicitly told that her surgeon was not employed by the hospital, did not accept her insurance and would bill separately for his services, it was reasonable for her to conclude that the services she receives from an independent doctor were performed on behalf of the hospital and that she would not be liable for payment of his services. While one might see the merit of this argument if we were dealing with a government-owned and -operated hospital and an indigent patient, the hospital at issue was a private, not-for-profit institution, and the patient was not indigent. Hospitals are facing burgeoning budget challenges as the number of uninsured patients increases. Physicians are under greater economic pressure as reimbursement rates continue to decline. Yet, at least one court has now determined that a patient’s obligation to pay is not a function of ability but a function of her insurance coverage. Is this court’s decision to shift the burden of payment from the patient to the hospital or to the physician a sign of things to come? Should a patient’s obligation to pay for health care depend upon her insurance coverage, rather than her ability to pay? Is there an inherent “entitlement” which allows government to demand that private hospitals and independent physicians provide their services without compensation? These are but some of the many questions that will be debated in the months to come. For those providing health care services, these will, no doubt, be interesting times. malpractice nonadult false Court Says Hospital Should Pay Private Physician’s Fees text blog malpractice 690 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 0 Malpractice 0 254390 3407919 Member 0 http://community.modernmedicine.com/_New-Red-Flag-Rules-Apply-to-Physician-Practices/blog/223566/33379.html The Federal Trade Commission (FTC) has promulgated rules requiring physicians to implement written policies to help prevent identity theft. Any physician’s office that extends, renews, or continues credit for a patient (ie, any practice that bills patients for services rendered) is subject to the Red Flag Rules. Although you may first bill an insurance carrier, if you ultimately bill a patient for any portion of a bill, you are considered a creditor subject to the Rules. The Rules will be enforced beginning on May 1, 2009. In order to comply with the Rules, you must develop a program that allows you to 1. Identify relevant Red Flags 2. Detect Red Flags 3. Prevent and mitigate identity theft 4. Update your program periodically Your program must spell out how it will be administered and must be appropriate to the size and complexity of your practice. It must be approved by your Board of Directors, or if your practice does not have a Board, by a senior employee. The health care law firm of Kern Augustine Conroy & Schoppmann, PC has a template available on its website to assist you in developing your own program. It can be found at http://www.drlaw.com/publications/Red_Flag_Rules_Template.pdf. What is a “Red Flag”? A Red Flag is basically something that should alert your practice to suspicious activity that may indicate identity theft. The FTC guidelines identify 5 categories of warning signs that must be identified and addressed: Alerts, notifications, or warnings from a consumer reporting agency or a service provider (a service provider is a person or entity which performs services on your covered accounts) Suspicious documents Suspicious personal identifying information Suspicious activity relating to a covered account Notices from customers, victims of identity theft, law enforcement authorities, or other entities about possible identity theft in connection with covered accounts. How are “Red Flags” Detected? Red Flags may be detected when you verify a patient’s identity, review medical records, verify insurance forms, or receive alerts or information of suspicious activity from outside agencies. How do I Prevent and Mitigate Identity Theft? You must develop a written program to include appropriate responses to Red Flags, in order to prevent and mitigate identity theft. Among the actions you may take are increased monitoring of accounts, contacting the payor, contacting law enforcement agencies, changing account numbers to prevent misuse, or a combination. Preventive action may be also required if there has been a breach or attempted breach of your database. How Often Must I Update My Program? The Rules simply require that you update your program “periodically.” However, your program should specify that it will be updated periodically to reflect changes in risks to patients resulting from changes in the methods used to engage in identity theft. How Must the Program be Administered? Your program must describe how it will be administered, including how you will get the approval of your management, maintain the program, and keep it current. It must also provide that the Board or designated senior employee approve any material changes to the program. The program should include appropriate staff training and a way to monitor staff to assure that they are all following the program. Administration requires continuing oversight of the program, assuring that the program remains current and relevant as methods of identification theft change. Put another way, writing a program and putting it on a shelf to collect dust is not an acceptable program. If you engage another person or entity to perform services on your covered accounts (a service provider), you must also take steps to ensure that their activities are conducted using a reasonable identity theft program. This could be done through a written contract with the service provider or by amending an existing HIPAA Business Associate Agreement. Are There Additional State Laws that Must be Considered? Yes. Many states have their own rules which must also be implemented as part of your identity theft prevention program. You must determine whether your state has such rules and, if so, incorporate them into your identity theft program. What are the Penalties for Noncompliance? A violation of the Red Flags Rule can subject your practice to significant civil monetary penalties. These new Red Flag Rules place yet another burden on medical practices, many of which are already struggling to survive under increased regulatory pressure, reduced reimbursement, and increased costs. Hopefully this guide, and the template available through Kern Augustine Conroy & Schoppmann, PC, will assist physicians in reducing this new burden. The Federal Trade Commission (FTC) has promulgated rules requiring physicians to implement written policies to help prevent identity theft. Any physician’s office that extends, renews, or continues credit for a patient (ie, any practice that bills patients for services rendered) is subject to the Red Flag Rules. Although you may first bill an insurance carrier, if you ultimately bill a patient for any portion of a bill, you are considered a creditor subject to the Rules. The Rules will be enforced beginning on May 1, 2009. In order to comply with the Rules, you must develop a program that allows you to 1. Identify relevant Red Flags 2. Detect Red Flags 3. Prevent and mitigate identity theft 4. Update your program periodically Your program must spell out how it will be administered and must be appropriate to the size and complexity of your practice. It must be approved by your Board of Directors, or if your practice does not have a Board, by a senior employee. The health care law firm of Kern Augustine Conroy & Schoppmann, PC has a template available on its website to assist you in developing your own program. It can be found at http://www.drlaw.com/publications/Red_Flag_Rules_Template.pdf. What is a “Red Flag”? A Red Flag is basically something that should alert your practice to suspicious activity that may indicate identity theft. The FTC guidelines identify 5 categories of warning signs that must be identified and addressed: Alerts, notifications, or warnings from a consumer reporting agency or a service provider (a service provider is a person or entity which performs services on your covered accounts) Suspicious documents Suspicious personal identifying information Suspicious activity relating to a covered account Notices from customers, victims of identity theft, law enforcement authorities, or other entities about possible identity theft in connection with covered accounts. How are “Red Flags” Detected? Red Flags may be detected when you verify a patient’s identity, review medical records, verify insurance forms, or receive alerts or information of suspicious activity from outside agencies. How do I Prevent and Mitigate Identity Theft? You must develop a written program to include appropriate responses to Red Flags, in order to prevent and mitigate identity theft. Among the actions you may take are increased monitoring of accounts, contacting the payor, contacting law enforcement agencies, changing account numbers to prevent misuse, or a combination. Preventive action may be also required if there has been a breach or attempted breach of your database. How Often Must I Update My Program? The Rules simply require that you update your program “periodically.” However, your program should specify that it will be updated periodically to reflect changes in risks to patients resulting from changes in the methods used to engage in identity theft. How Must the Program be Administered? Your program must describe how it will be administered, including how you will get the approval of your management, maintain the program, and keep it current. It must also provide that the Board or designated senior employee approve any material changes to the program. The program should include appropriate staff training and a way to monitor staff to assure that they are all following the program. Administration requires continuing oversight of the program, assuring that the program remains current and relevant as methods of identification theft change. Put another way, writing a program and putting it on a shelf to collect dust is not an acceptable program. If you engage another person or entity to perform services on your covered accounts (a service provider), you must also take steps to ensure that their activities are conducted using a reasonable identity theft program. This could be done through a written contract with the service provider or by amending an existing HIPAA Business Associate Agreement. Are There Additional State Laws that Must be Considered? Yes. Many states have their own rules which must also be implemented as part of your identity theft prevention program. You must determine whether your state has such rules and, if so, incorporate them into your identity theft program. What are the Penalties for Noncompliance? A violation of the Red Flags Rule can subject your practice to significant civil monetary penalties. These new Red Flag Rules place yet another burden on medical practices, many of which are already struggling to survive under increased regulatory pressure, reduced reimbursement, and increased costs. Hopefully this guide, and the template available through Kern Augustine Conroy & Schoppmann, PC, will assist physicians in reducing this new burden. Fri, 27 Mar 2009 19:54:35 GMT http://community.modernmedicine.com/_New-Red-Flag-Rules-Apply-to-Physician-Practices/blog/223566/33379.html skern 2009-03-27T19:53:05Z Malpractice Modern Medicine Community The Federal Trade Commission (FTC) has promulgated rules requiring physicians to implement written policies to help prevent identity theft. Any physician’s office that extends, renews, or continues credit for a patient (ie, any practice that bills patients for services rendered) is subject to the Red Flag Rules. Although you may first bill an insurance carrier, if you ultimately bill a patient for any portion of a bill, you are considered a creditor subject to the Rules. The Rules will be enforced beginning on May 1, 2009. In order to comply with the Rules, you must develop a program that allows you to 1. Identify relevant Red Flags 2. Detect Red Flags 3. Prevent and mitigate identity theft 4. Update your program periodically Your program must spell out how it will be administered and must be appropriate to the size and complexity of your practice. It must be approved by your Board of Directors, or if your practice does not have a Board, by a senior employee. The health care law firm of Kern Augustine Conroy & Schoppmann, PC has a template available on its website to assist you in developing your own program. It can be found at http://www.drlaw.com/publications/Red_Flag_Rules_Template.pdf. What is a “Red Flag”? A Red Flag is basically something that should alert your practice to suspicious activity that may indicate identity theft. The FTC guidelines identify 5 categories of warning signs that must be identified and addressed: Alerts, notifications, or warnings from a consumer reporting agency or a service provider (a service provider is a person or entity which performs services on your covered accounts) Suspicious documents Suspicious personal identifying information Suspicious activity relating to a covered account Notices from customers, victims of identity theft, law enforcement authorities, or other entities about possible identity theft in connection with covered accounts. How are “Red Flags” Detected? Red Flags may be detected when you verify a patient’s identity, review medical records, verify insurance forms, or receive alerts or information of suspicious activity from outside agencies. How do I Prevent and Mitigate Identity Theft? You must develop a written program to include appropriate responses to Red Flags, in order to prevent and mitigate identity theft. Among the actions you may take are increased monitoring of accounts, contacting the payor, contacting law enforcement agencies, changing account numbers to prevent misuse, or a combination. Preventive action may be also required if there has been a breach or attempted breach of your database. How Often Must I Update My Program? The Rules simply require that you update your program “periodically.” However, your program should specify that it will be updated periodically to reflect changes in risks to patients resulting from changes in the methods used to engage in identity theft. How Must the Program be Administered? Your program must describe how it will be administered, including how you will get the approval of your management, maintain the program, and keep it current. It must also provide that the Board or designated senior employee approve any material changes to the program. The program should include appropriate staff training and a way to monitor staff to assure that they are all following the program. Administration requires continuing oversight of the program, assuring that the program remains current and relevant as methods of identification theft change. Put another way, writing a program and putting it on a shelf to collect dust is not an acceptable program. If you engage another person or entity to perform services on your covered accounts (a service provider), you must also take steps to ensure that their activities are conducted using a reasonable identity theft program. This could be done through a written contract with the service provider or by amending an existing HIPAA Business Associate Agreement. Are There Additional State Laws that Must be Considered? Yes. Many states have their own rules which must also be implemented as part of your identity theft prevention program. You must determine whether your state has such rules and, if so, incorporate them into your identity theft program. What are the Penalties for Noncompliance? A violation of the Red Flags Rule can subject your practice to significant civil monetary penalties. These new Red Flag Rules place yet another burden on medical practices, many of which are already struggling to survive under increased regulatory pressure, reduced reimbursement, and increased costs. Hopefully this guide, and the template available through Kern Augustine Conroy & Schoppmann, PC, will assist physicians in reducing this new burden. ftc, identity theft, malpractice, red flag rules nonadult false New "Red Flag Rules" Apply to Physician Practices text blog ftc,identity theft,malpractice,red flag rules 3100 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 0 Malpractice 0 223566 3407919 Member 0 http://community.modernmedicine.com/_Dont-Delay-Implementation-of-Electronic-Health-Records/blog/222546/33379.html In his recent column, Editor-in-Chief Erich Burnett suggested that physicians “pause” before investing in electronic health records (EHR) systems.1 Mr Burnett opines that lack of universal EHR certification standards are causing compliance problems. Yet, if we have learned anything from technology, it is that we will all be too old to use it if we wait for the perfect system. Technology will continue to advance, and prices will continue to drop. Those who wait for the perfect software or the lowest price will still be using paper and pen when they retire. The question each physician must address now is whether implementation of EHR will result in lower cost, higher reimbursement, and greater efficiency today. If the answer to that question is “Yes,” there is no better time to make the investment. We all know that incomplete documentation often leads to undercoding or the inability to justify claims if audited by third-party payers. The costs associated with undercoding often exceed the cost of EHR. With the Federal Government and other third-party payers aggressively auditing patient records, one audit can result in payments far in excess of the cost of an EHR. This alone should justify the decision to invest today. Beyond pure economic considerations, EHR systems will, if properly implemented, improve patient care, reduce overlapping care and testing, lower the risk of medical or medication error, and ultimately enhance our entire system of delivery. Moreover, under the recently passed American Recovery and Reinvestment Act, physicians must be able to demonstrate meaningful use of EHR by 2011 to be eligible for full federal subsidies of up to $44,000 each. By contrast, those who have not implemented EHR by 2014 will be penalized with a reduction in Medicare reimbursement, beginning in 2015. Selecting an EHR system need not be daunting. Among the most important considerations are CCHIT certification, usability, and the financial viability of the EHR vendor. With hundreds of systems on the market, only those with strong financial backing and sound business models are likely to survive and provide the updates that will be required as technology and certification standards change. Another important consideration is ease of use for the physician and staff, and the availability of effective training. When implementation of EHR fails, it is almost always a result of lack of training. A number of independent organizations can provide unbiased assistance to physicians looking for the best EHR for their offices--often free of charge. Of course, price is always a consideration. However, federal law does allow hospitals, laboratories, and others who have a legitimate interest in improving communication with physicians’ offices to subsidize as much as 85% of the cost of EHR software, and group discounts may be available through various physician organizations. State grants may also be available to provide physicians’ staffs with training in the use of EHR with little or no cost. Reference 1. Burnett E. Pressing ‘pause’ on EHR. [From the Editor]. Medical Economics. Feb 6 2009:7. * This blog was co-authored by Steven Kern, Esq, and Michael M. Rothkopf, MD. Dr. Rothkopf is an internist and chair of the Electronic Health Records Section of NJ Physicians, a physician membership organization which has evaluated large numbers of EHR systems, obtained state grants for training physician staffs, and identified sources through which physicians can obtain subsidies when purchasing HER systems.   In his recent column, Editor-in-Chief Erich Burnett suggested that physicians “pause” before investing in electronic health records (EHR) systems.1 Mr Burnett opines that lack of universal EHR certification standards are causing compliance problems. Yet, if we have learned anything from technology, it is that we will all be too old to use it if we wait for the perfect system. Technology will continue to advance, and prices will continue to drop. Those who wait for the perfect software or the lowest price will still be using paper and pen when they retire. The question each physician must address now is whether implementation of EHR will result in lower cost, higher reimbursement, and greater efficiency today. If the answer to that question is “Yes,” there is no better time to make the investment. We all know that incomplete documentation often leads to undercoding or the inability to justify claims if audited by third-party payers. The costs associated with undercoding often exceed the cost of EHR. With the Federal Government and other third-party payers aggressively auditing patient records, one audit can result in payments far in excess of the cost of an EHR. This alone should justify the decision to invest today. Beyond pure economic considerations, EHR systems will, if properly implemented, improve patient care, reduce overlapping care and testing, lower the risk of medical or medication error, and ultimately enhance our entire system of delivery. Moreover, under the recently passed American Recovery and Reinvestment Act, physicians must be able to demonstrate meaningful use of EHR by 2011 to be eligible for full federal subsidies of up to $44,000 each. By contrast, those who have not implemented EHR by 2014 will be penalized with a reduction in Medicare reimbursement, beginning in 2015. Selecting an EHR system need not be daunting. Among the most important considerations are CCHIT certification, usability, and the financial viability of the EHR vendor. With hundreds of systems on the market, only those with strong financial backing and sound business models are likely to survive and provide the updates that will be required as technology and certification standards change. Another important consideration is ease of use for the physician and staff, and the availability of effective training. When implementation of EHR fails, it is almost always a result of lack of training. A number of independent organizations can provide unbiased assistance to physicians looking for the best EHR for their offices--often free of charge. Of course, price is always a consideration. However, federal law does allow hospitals, laboratories, and others who have a legitimate interest in improving communication with physicians’ offices to subsidize as much as 85% of the cost of EHR software, and group discounts may be available through various physician organizations. State grants may also be available to provide physicians’ staffs with training in the use of EHR with little or no cost. Reference 1. Burnett E. Pressing ‘pause’ on EHR. [From the Editor]. Medical Economics. Feb 6 2009:7. * This blog was co-authored by Steven Kern, Esq, and Michael M. Rothkopf, MD. Dr. Rothkopf is an internist and chair of the Electronic Health Records Section of NJ Physicians, a physician membership organization which has evaluated large numbers of EHR systems, obtained state grants for training physician staffs, and identified sources through which physicians can obtain subsidies when purchasing HER systems.   Thu, 26 Mar 2009 20:45:09 GMT http://community.modernmedicine.com/_Dont-Delay-Implementation-of-Electronic-Health-Records/blog/222546/33379.html skern 2009-03-26T20:40:18Z Practice Management Modern Medicine Community In his recent column, Editor-in-Chief Erich Burnett suggested that physicians “pause” before investing in electronic health records (EHR) systems.1 Mr Burnett opines that lack of universal EHR certification standards are causing compliance problems. Yet, if we have learned anything from technology, it is that we will all be too old to use it if we wait for the perfect system. Technology will continue to advance, and prices will continue to drop. Those who wait for the perfect software or the lowest price will still be using paper and pen when they retire. The question each physician must address now is whether implementation of EHR will result in lower cost, higher reimbursement, and greater efficiency today. If the answer to that question is “Yes,” there is no better time to make the investment. We all know that incomplete documentation often leads to undercoding or the inability to justify claims if audited by third-party payers. The costs associated with undercoding often exceed the cost of EHR. With the Federal Government and other third-party payers aggressively auditing patient records, one audit can result in payments far in excess of the cost of an EHR. This alone should justify the decision to invest today. Beyond pure economic considerations, EHR systems will, if properly implemented, improve patient care, reduce overlapping care and testing, lower the risk of medical or medication error, and ultimately enhance our entire system of delivery. Moreover, under the recently passed American Recovery and Reinvestment Act, physicians must be able to demonstrate meaningful use of EHR by 2011 to be eligible for full federal subsidies of up to $44,000 each. By contrast, those who have not implemented EHR by 2014 will be penalized with a reduction in Medicare reimbursement, beginning in 2015. Selecting an EHR system need not be daunting. Among the most important considerations are CCHIT certification, usability, and the financial viability of the EHR vendor. With hundreds of systems on the market, only those with strong financial backing and sound business models are likely to survive and provide the updates that will be required as technology and certification standards change. Another important consideration is ease of use for the physician and staff, and the availability of effective training. When implementation of EHR fails, it is almost always a result of lack of training. A number of independent organizations can provide unbiased assistance to physicians looking for the best EHR for their offices--often free of charge. Of course, price is always a consideration. However, federal law does allow hospitals, laboratories, and others who have a legitimate interest in improving communication with physicians’ offices to subsidize as much as 85% of the cost of EHR software, and group discounts may be available through various physician organizations. State grants may also be available to provide physicians’ staffs with training in the use of EHR with little or no cost. Reference 1. Burnett E. Pressing ‘pause’ on EHR. [From the Editor]. Medical Economics. Feb 6 2009:7. * This blog was co-authored by Steven Kern, Esq, and Michael M. Rothkopf, MD. Dr. Rothkopf is an internist and chair of the Electronic Health Records Section of NJ Physicians, a physician membership organization which has evaluated large numbers of EHR systems, obtained state grants for training physician staffs, and identified sources through which physicians can obtain subsidies when purchasing HER systems.   ehr system, practice management nonadult false Don't Delay Implementation of Electronic Health Records text blog ehr system,practice management 659 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=3407919&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_2089258_33379_3407919_ap_160X120.jpg false 0 Practice Management 0 222546 3407919 Member 0