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The Money is in the Management Print E-mail
Written by Jeffrey Cohen, Esq.   
Wednesday, 26 October 2011 16:29

Conversation regarding ACOs and even healthcare reform itself is misplaced.  The well established facts are (1) more people will receive health care, and (2) the cost of healthcare will come down.  It does not matter whether the stimulus is a new law or just marketplace reaction.  The fact is that a healthcare system whose players are incentivized to do more with more expensive stuff is not economically sustainable or socially tolerable.

Take a look at our evolving marketplace.  What's the single most distinctive feature in healthcare, aside from inactivity?  Integration.  Larger hospital systems and larger medical practices, typically single specialty.  Good adaptation?  Maybe.  It is in the short run.  Single specialty aggregation is purely defensive though.  It allows groups to maintain market share and to resist price compression better.  But how will that allow providers to do more with less?  How will that stimulate more outcome based, financial risk based care?  It doesn't.  It is well established that cost and quality management demands broad spectrum system awareness....ummmm primary care physicians.  The adaptation of single specialty group integration is short term.  How short?  Who knows?  But it is clearly not as sustainable as one whose preparation for change includes primary care capabilities.

And how do hospital-based physician alliances help physicians survive and thrive?  They don't unless they have a strong primary care base, and even then it is very questionable whether hospitals will be able to utilize their PCPs and specialists in a way that rewards outcomes based, financially smart behavior.  Hospitals have always been sink holes in the landscape of healthcare costs, so why jump in?  Physicians need to make sure that their affiliated hospital systems have clear plans and abilities (e.g. management and good physician billing and collection experience) to deliver outcomes at the right price.  Studies, however, that indicate over sixty percent of Florida hospital admissions are unnecessary are consoling in a fee for service environment, but devastating in a capitated (or other risk based) one.  Physicians have to make sure the ship they book passage on can sail a long way.

And they have to make sure they are part of the right team.  What expertise is there in things like IT, financial management, clinical outcomes management, and risk based contracting?  You're gonna need that!

If one believes that healthcare costs are unsustainable (this guy does) and that our entire payment system is driving that result, then the need for new payment systems is clear.  And the challenge, just in terms of thinking about healthcare differently, is enormous!  How do you go to work and not think "I gotta do a lot, test a lot, do lots of procedures."  How do you begin to shift?  Do you shift?

The compelling answer is "YES."  Why not act now, before any law (even one dumber than the one that passed a year ago) gets passed, before our society calls the issue a failure and politicians and our neighbors demand a single payer-type system?  Isn't there a huge opportunity RIGHT NOW?  You betcha.

So where is it?  It's in management.  The money is in the management.  The data collectors, crunchers and implementers are the new gods in healthcare.  Anyone who can collect data, show what makes clinical and financial sense and then implement it will be more sought after than conflict diamonds.  Show one hospital how to live in that new system, where there are more patients, but less money available, and you retire rich.  Show physicians and other healthcare business people the same thing and lead change.  And since physicians are busy being physicians, except for a handful of physician entrepreneurs, they're best bet is gonna be to find good partners in "business" who embrace change and see opportunity.

ABOUT THE AUTHOR
With over 20 years of healthcare law experience following his position as legal counsel for the Florida Medical Association, Mr. Cohen is board certified by The Florida Bar as a specialist in healthcare law. His practice immerses him in regulatory, contract, corporate, compliance and employment related matters.  Mr. Cohen is the founder of The Florida Healthcare Law Firm. www.floridahealthcarelawfirm.com | 888-455-7702

Last Updated on Thursday, 03 November 2011 08:31
 
Florida's Top Group Practices Print E-mail
Written by Jeffrey Herschler   
Tuesday, 13 September 2011 15:59

According to the South Florida Business Journal, the Top Five Group Practices in the region are Holy Cross Medical Group, Cleveland Clinic Florida, Phoenix Physicians LLC, University of Miami Health System - UHealth and University of Miami Hospital.   The Top 25 list, was published in their annual Guide To Health Care on Aug. 19 and is ranked by number of physicians.  Holy Cross Medical Group (at #5) boasts 135 docs while University of Miami Hospital (at #1) employs a whopping 1300. 

By comparison, Florida Physicians Medical Group (FPMG) claims to be the Orlando area's largest multi-specialty medical group practice with 252 board-certified physicians and surgeons. In Tampa that honor goes to the USF Physicians Group with more than 350 physicians.  Meanwhile,  the University of Florida Physicians (operating in Gainesville and Jacksonville) is a medical group practice comprised of more than 640 doctors.

The South Florida region has long held a reputation for smaller groups, duo's and solo's.  Any Detail Man (or Detail Woman) can tell you that. Often S Florida docs "pose" as groups but are really separate P/A's or LLC's sharing office space.  That said, SFBJ's latest list provides fresh evidence that economic forces, accelerated by HCR, appear to be changing this traditionally small group market. Click to view:  SFBJ's Top Five South Florida Group Practices.

submit a READER RESPONSE for possible publication.

_________________

Every Picture Tells a Story:   Highest Paying Job in U.S.

You guessed it.  Doctors and Surgeons occupy the number one spot in 2011.  

Presented by MF Healthcare Solutions via CNBC (photo by Getty Images)

Last Updated on Tuesday, 13 September 2011 16:10
 
Many cheap Med Mal offers are coming my way. How can I go wrong when I am saving so much? Print E-mail
Written by Matt Gracey   
Tuesday, 13 September 2011 15:47

MED MAL Q & A

Florida doctors are now enjoying a very "soft" buyer-centered market cycle, although I believe this is close to ending.  Back in 2000 we were in a similar market cycle, which led to many insurers pulling out of the state and the others dramatically increasing their malpractice-insurance rates a year or two later.  My advice as we enter the end of this soft market is to find a stable, well-funded, Florida-committed malpractice insurer so that you will lessen the chances of your coverage being canceled by your insurer when the going gets tough soon. 

When deciding which insurer will handle your coverage, remember that not all malpractice insurers are created equal, by any stretch of the imagination.  This is contrary to what you might read and hear from slick marketing folks and what you might like to believe so you feel can feel more comfortable and secure just price shopping. As with every important purchase decision, a risk/reward calculation is useful.  If a new, unrated insurer is promising great coverage and superb defense against claims, all for a price much below the rest of the marketplace, then there is a very high probability that they are just luring you in with unsustainable marketing promises.  In the last malpractice-insurance crisis of the early 2000s, over 50 insurers stopped insuring Florida doctors and left many facing expensive "tail" purchases, so choose very carefully as we come to the end of this buyers'-market part of the never-ending cycle.

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Matt Gracey is a Medical Malpractice Insurance Specialist in Delray Beach with Danna-Gracey, Inc. He actively lectures and writes educational material to help doctors and legislators around the state understand the malpractice insurance issues facing doctors today. You can reach him at (800) 966-2120 or matt@dannagracey.com

Last Updated on Thursday, 22 September 2011 09:47
 
Revenue Cycle Management: Enhance Cash Flow with Improved Efficiency Print E-mail
Written by Todd D. Demel, MBA   
Wednesday, 24 August 2011 17:45

LOST REVENUE

While healthcare providers typically rely on conventional revenue cycle management methods to ensure financial performance, most are not collecting all of the potential revenue they have earned. Whether due to pricing, charges, or coding, considerable amounts of reimbursement are being lost daily. Today, providers must do more with fewer resources. Therefore, it is critical that practices effectively identify and address the root causes of lost revenue.   

THE BUSINESS OF HEALTHCARE

All of this comes down to establishing a better way of managing the business of providing healthcare. And accomplishing this requires the proper processes, tools, and related expertise. While there has been an increased emphasis placed on technology and automating part of the revenue cycle management process, improved financial performance must also incorporate proper compliance measures and appropriate documentation.

Technology can certainly improve efficiencies and reduce some administrative burdens, but the reimbursement ultimately received by the practice correlates with and is a reflection of the data that was initially entered into the system. Just as important, if a practice is cited for noncompliance due to inappropriate or inaccurate documentation, cash flow could be reduced to the point of devastating a practice due to a review or audit that entails a hold being placed on payments. 

GETTING IT RIGHT THE FIRST TIME

Rather than backend processes, the source of inadequacies is typically people and technology on the front-end. Accounts receivable decreases in value as it ages. Therefore, in cases where a claim is not paid the first time it is submitted, the chances of the practice ever receiving payment drops significantly. This is why it is so important to catch potential denials before claims are submitted.  

Transparency
is also a key factor and therefore staff should be aware of:
 
  • Whether the claim has been transmitted;
  • Where the claim is in the process;
  • Whether the claim is complete;
  • Whether there are any factors that may delay transmission of the claim;
And, when the practice can expect payment to be made.

PATIENT RECEIVABLES

While less emphasis has been placed historically on patient receivables (as opposed to insurance receivables), annual increases in health insurance premiums have caused consumers to search for plans that require higher out-of-pocket responsibility in order to offset costs. Since this trend is likely to continue, equal attention must be given to this area of the revenue cycle as well. 

GOALS

The goals for the practice administrator should include:
  • Increasing the first pass resolution rate;
  • Speeding-up the collections process;
  • Reducing workload and increasing efficiencies of staff;
Other factors to consider include the chargemaster or fee schedule, and payer contract management. Establishing a team environment at the practice where everyone is clear on their functions and responsibilities will go a long way towards creating efficiencies. Work distribution should be well thought out, and staff should be educated on best practices for pricing, charging, and coding. There must also be an awareness of compliance risks, accountability, and the possible consequences of noncompliance. 
ABOUT THE AUTHOR:  Mr. Demel is Senior Executive of Physician Management Services at MF Healthcare Solutions.  Possessing both operational and financial backgrounds, the MF Healthcare Solutions management team has vast experience in a range of healthcare industry settings. Combined expertise enables the firm to offer specialized physician practice managementservices. For more information, please visit: www.mfhealthcare.com or contact Todd Demel at (954) 475-3199.
Last Updated on Wednesday, 31 August 2011 17:26
 
Pay-Per-Call Marketing: Twenty First Century Marketing Programs Impeded by Twentieth Century Rules Print E-mail
Written by Jeffrey Segal, MD, JD and Michael J. Sacopulos, JD   
Wednesday, 17 August 2011 12:53

Remember the days when a doctor took out a half page ad in the Yellow Pages - and we quaintly called that marketing. The world has changed. One 21st century marketing program, pay-per-call, is being embraced by doctors across the country.

Here's how it works. Internet marketing companies create a platform which either markets to patients (push) or serves as a magnet for prospective patients (pull). This might include an email blast to a proprietary list. Or a search-engine optimized web site with rich information.  Once a prospect is interested in the services being promoted, the company directs those prospects to healthcare providers participating in a designated geographic area. The provider pays a fee for each substantive lead - the lead being measured as a phone call to the doctor's office lasting longer than a few seconds. It's up to the office staff to convert the phone lead into an office appointment. Sounds great. A lead on the telephone is probably more valuable than an email inquiry. If the phone's ringing, what's not to like?

We hate to be the skunks at the garden party, but legacy statutes are not particularly supportive of 21st century marketing programs. The federal government has laws on its books which prevent "kickbacks" or fee-splitting. These laws predate pay-per-call marketing by many years, but these laws are still valid. The laws say a kickback is a payment designed to induce a referral for health care. On the surface, pay-per-call programs seem to contain the ingredients referenced in anti-kickback statutes.  Fortunately, there are safe harbors which don't trigger enforcement of fee-splitting penalties - such as when a doctor refers to another doctor in his multi-specialty practice - and they are both employees in the same facility. If they split profits at the end of the year, then, in a sense, the referral has generated extra fees split by all. As a safe harbor, this does not trigger any action.

On the other hand, if two unrelated doctors have a handshake agreement whereby referrals will be paid a cool $300 for every surgery - that's likely against the law. No safe harbor there. We should note that the federal anti-kickback rules apply only to Medicare-Medicaid providers. Those physicians they do not participate in Medicare-Medicaid are outside the scope of these laws. Also the laws apply to professional services. It may be possible to structure pay-per-call to fall outside the scope of federal law by limiting the scope of offers to products only. However, as these pay-per-call marketing plans typical operate, they would be in violation of federal law. Many states, though, have parallel statutes affecting fee-splitting; such as California Business and professional Code Section 650 which bars licensed physicians from offering or receiving any form of consideration in return for patient referrals.

WWDHHSD (or What Would Dept. Health and Human Services Do)...The Office of Inspector General for U.S. Dept. Health and Human Services ("OIG") issued an Advisory Opinion on a pay per call program. There, OIG concluded that a pay per lead program did indeed violate the plain language of the Anti-Kickback Statute. And, such a program did not qualify for any statutory safe harbor. That said, OIG concluded they would not enforce the statute against participants in those programs, because such programs did not promote the type of abuse the statute was meant to curtail. The federal government opined pay-per-call, as outlined in the Advisory Opinion, was kosher. 

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(Pay Per Call Mktg:  continued from top of page)  

The policy is similar to choice the federal government exercises to "tolerate" medical marijuana purchases. Medical marijuana is legal under a number of state statutes. But, medical marijuana still violates federal law. Nonetheless, the current federal policy is to look the other way.  While the above is helpful in giving a doctor comfort, a doctor making a decision whether or not to participate in a pay-per-call program must also pay attention to policies of their state professional licensing board. Most licensing boards have explicit prohibitions against "fee splitting."  

It's unclear whether state licensing boards would follow the lead of the federal government, Would they acknowledge, as Dept. H.H.S. does, that such programs violate criminal statutes with no safe harbor - but opt against enforcement? Nobody knows. We can all agree that no physician wants to be the test case. The reality today is that many Board investigations are complaint-driven. So, if patients complain to the Board for any number of reasons, an investigation might broaden to include allegations fee-splitting. Doctors who want to test the waters with pay-per-call programs would be well advised to proactively lobby their licensing bodies to update their decades-old fee-splitting policies. Medical Justice can provide you with a template of model language for revising the policy.                  

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Jeffrey Segal, MD, JD, is founder and CEO of Medical Justice Services. Mike Sacopulos, JD, is general counsel for the organization. Run by physicians for physicians, Medical Justice, is a membership-based organization that offers services and proprietary methods to protect physicians' most valuable assets - their practice and reputation. The company offers proactive services to deter frivolous medical malpractice lawsuits, prevent Internet defamation and provide strategies for successful counterclaim prosecution. Medical Justice works as a supplement to conventional professional liability insurance.

Last Updated on Wednesday, 24 August 2011 17:57
 
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