Physicians in the Middle of the Marijuana Battle

medical marijHow physicians became the gatekeepers between cannabis and the public and how physicians should approach cannabis as a form of treatment

By: Jacqueline Bain

The Federal Government lists marijuana as a “Schedule I” controlled substance, meaning it has a high potential for abuse and no currently accepted medical use.  21 USC § 812(b)(1).  Because there is no current accepted medical use, Federal law prohibits physician from issuing prescriptions for marijuana.  21 CFR § 1306.04(a).  However, the Federal Government has traditionally deferred to the States to prosecute small-scale marijuana violations.  This lack of Federal enforcement has encouraged the States to enact less stringent controls on the marijuana industry.Continue reading

Toxicology Labs Owned by Referral Sources – Is it Really so Wrong?

substance abuse licensing

Notebook and lens concept

By: David Hirshfeld & Jeff Cohen

Lately we’ve noticed an uptick in criticism of toxicology labs that are owned by the substance abuse treatment programs and recovery residences that refer to them.  Sadly, this criticism seems to be coming from within the addiction and recovery industry itself.  In addition to being absolutely necessary for substance abuse treatment, toxicology screens have become a meaningful source of revenue that helps to fund treatment programs and scholarships for those who cannot afford to pay the full cost of treatment.  We cannot understand why the substance abuse treatment industry would want to help pull the rug out from under itself, but that seems to be what is occurring.  Under the current state of Florida law, toxicology labs can be owned by their referral sources without much risk if that arrangement is properly structured.Continue reading

Mega Practices – How Big is Too Big?

mega practicesBy: Jeff Cohen

A January 24, 2014 court ruling in Idaho that will require the unwind of a hospital system’s purchase of a large primary care medical practice will cause mega practices to think twice about their size.  The Idaho court ruled that St. Luke’s Health System’s purchase of the 40 physician Saltzer Medical Practice violated pertinent state and federal antitrust laws because the group had 80% of the primary care physicians in Nampa, Idaho, a city of roughly 85,000.  The suit was brought by two competing hospitals and succeeded, despite St. Luke’s claims that integrating the practice would improve the quality of care. 

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Montana Hospital Fined for Payments to Doctors

300x300_alertThe Justice Department settled a case against a Montana hospital for nearly $4 Million based on allegations that the hospital improperly paid physicians who referred to the hospital.  The allegations arise out of a medical office building project in which the hospital and referring physicians were co-owners.  The particular areas of wrongdoing targeted by the DOJ included below market lease rates.  The case is odd in that (1) it is not the usual “pay for referral” sort of case traditionally pursued against parties, and (2) ensuring fair market value and commercial reasonableness in rental arrangements of healthcare providers is a key element in terms of compliance.

Integrating Clinical Labs Into Substance Abuse Treatment Programs: A Whole Lot of Fuss Over Pee in a Cup

pee in a cupBy: David Hirshfeld

The recent and drastic cut in reimbursement for point-of-care urinalysis has caused just about all of our substance use treatment program clients to consider integrating clinical laboratories into their enterprise models.  These programs long for a way to restore the revenue stream that urinalysis had generated.  For sober living programs, the lost revenue often means the difference between profitability and breaking even.  For more comprehensive programs, the lost revenue can hinder their ability to expand or provide scholarships to those who could not otherwise afford treatment.  Regardless of their specific goals, our clients are amazed and dismayed at the regulatory minefield that awaits them; especially since their lab consultant (read “reagent salesperson”) makes the process sound so simple.Continue reading

Cutting Patients a Break: Your Financial Hardship Policy

financial hardshipBy David Hirshfeld

with Jean Acevedo, Guest Contributor

As premiums and deductibles rise and coverage shrinks, more and more patients have difficulty paying for their health care.  You can provide financial relief to your patients if you wish, but you should only do so in accordance with a uniform hardship policy.

As a general rule, the practice should not routinely waive co-pays or deductibles, or offer discounts based on a patient’s statement that the patient is suffering from financial hardship.  If the practice does routinely offer discounts or waivers of deductibles without properly investigating a patient’s financial wherewithal, the practice runs the risk of violating its payor contracts, being accused of committing insurance fraud, and/or paying an illegal kickback to induce patients to come to the practice.  Some payor contracts require the practice to bill the payor the lowest rate that the practice bills any of its patients, a so-called “most favored nation provision.”  Typical Medicare participation agreements are subject to this type of provision.  If the practice waives deductibles or co-pays, then insurers often take the position that the amount being billed by the practice to the insurer ought to be reduced by the amount waived.  In addition, a regulator could conceivably accuse the practice of waiving co-pays and deductibles as a means of inducing patients to seek treatment from the practice in violation of anti-kickback laws.Continue reading

Kill H.R. 2914

Background

H.R. 2914 is a bill filed by Congresswoman Speier that is intended (among other things) to prohibit medical practices providing the following sorts of medical services (“Non-ancillary Services”) to their own patients—

*The technical or professional component of (i) surgical pathology, (ii) cytopathology, (iii) hematology, (iv) blood banking, or (v) pathology consultation and clinical lab interpretation services

*Radiation therapy services and supplies

*Advanced diagnostic imaging studies (which include for instance MR and CT)

*Physical therapy services

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FY 2014 Budget Recommends Removing Therapy From In-office Ancillary Services

via apta.org – – – APTA is highly encouraged by the proposal within President Obama’s fiscal year 2014 budget, released yesterday, to exclude therapy services, including physical therapy, along with radiation therapy and advanced imaging from the in-office ancillary services (IOAS) exception of the Stark self-referral laws.

The Office of Management and Budget concluded that closing the loophole for these services would provide a savings of $6.1 billion over the standard 10-year budget window, providing further evidence that these self-referral arrangements lead to overutilization of Medicare services and should be addressed by Congress.

On its own for many years and more recently as part of the Alliance for Integrity in Medicare (AIM) coalition of medical specialty, laboratory, radiation oncology, and medical imaging groups, APTA has long advocated for exclusion of physical therapy from the IOAS exception. APTA agrees with the Administration’s proposal on physician self-referral and believes this issue should be addressed as part of any fundamental delivery system reform.

APTA and its AIM partners continue to be gravely concerned about the ongoing misapplication of the IOAS exception to the physician self-referral law, believing this loophole results in increased spending, unnecessary use of medical services, and potentially compromised patient choice and care. Studies published by the New England Journal of Medicine, Health Affairs, and the Government Accountability Office, among others, have highlighted abuses that result from physician self referral. These ongoing issues serve only to erode the integrity of the Medicare program and undermine patient care.

APTA and AIM now strongly urge the 113th Congress to follow the recommendations of the Administration budget and pass legislation to remove physical therapy, advanced diagnostic imaging, anatomic pathology, and radiation therapy from the IOAS exception.

 

Why Compliance Plans Make Sense

Clipboard with Checklist and Red PenHas your practice implemented a compliance program or considered improving an existing one?  Is it really necessary?  Prior to the Patient Protection and Affordable Care Act (ACA), the necessity for physician practices to develop compliance plans was merely voluntary.  However, the ACA will now require physician practices to have a fraud and abuse compliance plan in place as a condition of continuing to participate in Medicare or Medicaid programs.  Because the government first published guidelines in the year 2000 for the voluntary use of compliance plans in physician practices and has subsequently enacted a mandate in the ACA for compliance plans, many physician practices are proactively implementing them.  While this compliance plan mandate may be viewed by physicians as yet another administrative burden and expense to the practice, it can have many benefits as well.  Implementing an effective compliance program can have the result of not only reducing liability risks, but can also allow a practice to reap monetary benefits.  In fact, it could be more costly for the practice not to have one!Continue reading