The Money Is In The Management

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.


Appeals Court Strikes Down Individual Mandate in Reform Law

Via Modern Healthcare, Joe Carlson

In a 304-page opinion, the 11th U.S. Circuit Court of Appeals in Atlanta on Friday struck down the individual insurance mandate in the Patient Protection and Affordable Care Act, but allowed the rest of the sweeping law to stand.

In its decision, a divided three-judge panel of the federal appeals court ruled in favor of 26 states that had joined a lawsuit in Pensacola, Fla., which argued the reform law should be struck down because it relies on an unconstitutional expansion of federal power.

The ruling means that the Supreme Court will now have the classic split in the circuit courts that it often relies on when deciding whether to take on a case. The 6th Circuit Court of Appeals upheld the law in June, and the losers in that case filed for permission last month to have their case heard by the Supreme Court.

Read more: http://www.modernhealthcare.com/article/20110812/NEWS/308119930#ixzz1VCtydEqc
?trk=tynt


Marketing: Boldly Going Where No Practice Has Gone Before

By now, every physician has learned about ACOs, Super Groups, IPAs and the like. Virtually every “new” acronym and idea has revealed itself as a retread old one, so at least physicians are getting more comfortable with the new language of healthcare reform. And they are accepting that no one really knows what’s going to happen and how medical practice will ultimately be years from now.
Nearly every physician has asked in the past year or so “What do I do now?” And they have heard responses from every vendor which translates into “Buy my stuff.” Ask an IT person what to do…”Buy my stuff.” Ask an EMR person what to do…”Buy my stuff.” Ask a lawyer….ok enough.

What to do and when to do it in light of feared changes in healthcare is anyone’s guess. There is, however, one remarkably overlooked area of business which physicians have traditionally neglected and which they must focus on now more than ever—marketing.

Do you have a website? Do you know what SEO is and how it works? Do you believe that patients buy what you do and not just who you are? In the internet age when people buy mattresses online, sight unseen, physicians have to begin to learn about marketing.

Though years ago, practicing medicine was clearly a profession, it is now big business. And physicians who thrive will be those who embrace business practices, including marketing. This takes a huge shift in perception since most physicians look at marketing as an expense, not as a good investment.

If you were told that every dollar invested in marketing will yield five dollars in new business would you spend the money? If you were told that buying a stock will result in a five-fold yield over twelve months, would you invest? Physicians have to look as marketing as a good investment rather than simply as a cost. And those that do will likely grow and thrive.


Norton and Humana Commercial ACO Moving Forward

Jim Molpus, for HealthLeaders Media, August 8, 2011

“In its most simplified form, the idea behind accountable care organizations was to get the healthcare providers and payers in a community to work together to improve care while also reducing its cost. Much of that purity has been lost in the noise of the ACO movement, but in Louisville, KY, Norton Healthcare and Humana are continuing the journey.

Norton, with five hospitals and more than 2,000 physicians, and health plan Humana, headquartered in Louisville but with 10 million members nationwide, began discussions of forming an ACO in 2009, “when we had no idea what an ACO really was,” says Steven Hester, MD, Norton’s chief medical officer.”

Read More


Medical Practice Healthcare Legal Audit

The Florida Healthcare Law Firm is proud to offer to our latest service – The Medical Practice Healthcare Legal Audit

Why have an audit?

State and federal regulators are investing billions to enforce even the most benign violations. We have seen what appears to be an honest, simple mistake lead to investigations by regulatory agencies and the imposition of monetary fines and penalties. The sting of any regulatory sanction is further compounded due to lost patient revenues from your practice because of the time and worry dedicated to dealing with government regulators. The end result is the need to spend tens of thousands of dollars, or more, of attorney fees and consulting fees to help undo the damage. Prevention is better than cure!

How it works:

Our Medical Practice Healthcare Legal Audit is comprehensive and can be performed on site at your facility for your convenience. We will conduct interviews with key staff and take a complete top-to-bottom look at your practice to determine if there are any issues that may cause exposure to actions by various regulatory bodies. In addition to identifying risk areas, we will also look for missed revenue opportunities that you may not be taking advantage of if you are unaware of certain key terms in an agreement. Depending on your individual situation our review can cover the following issues:

State licensing boards
Employment contracts
Managed Care Contracts
Medicare
Medicaid
State and Federal fraud and abuse laws
Vendor agreements
Equipment leases
Employment Practices to include: wage and hour compliance (overtime); eeoc compliance; employee handbook; proper classification of employees (exempt vs non-exempt); hiring and termination of employees
OHSA
DEA
Other applicable regulatory issues

What you get:

Once our review is completed we will provide you with a written report of our findings and suggest an action plan for correcting any items that we think may expose your practice. Additionally we can develop for your practice a complete compliance program; your guide to ensuring continued compliance. Did you know that having a written compliance program can be a mitigating factor in the assessment of fines and penalties by many regulatory agencies?

Call now to discuss how our Medical Practice Healthcare Legal Audit can help steer your practice in the right direction. We can tailor the audit to meet your specific needs and provide it at a convenient and reasonable flat rate.


Clinical Research Organizations (CROs) and Referring Physicians

The two business drivers of CROs are (1) pharmaceutical companies that want studies, and (2) referring physicians.  Though CROs will enter into advertising programs designed to educate and attract study participants (often paid for by Pharma), CROs are often frustrated in generating community physician referrals.  One of the main obstacles is the federal Anti Kickback Statute (AKS), which forbids payment of any kind in exchange for patient referrals.  CROs will be glad to know, however, that one of the AKS regulatory exceptions (Safe Harbors) in particular, the “Personal Services Exception” does allow CROs to enter into compensation arrangements with referring physicians.  Though the purpose cannot be to induce patient referrals, if the Safe Harbor is complied with, the CRO can have a compensation arrangement with a physician who refers.

The Safe Harbor essentially requires the following:

  1. That the arrangement be for necessary services (not some cloaked way to pay for patient referrals);
  2. The doctor’s duties have to be in writing;
  3. There has to be a written agreement between the parties;
  4. The agreement must have a 12 month term (though it could be terminated within that period of time);
  5. Compensation must be set in advance, be consistent with fair market value and not vary based on the value or volume of business between the CRO and the referring doctor.


Doctors, Take a Lesson from Lawyers: CYA

Lawyers are trained to document every conversation and communication in writing.  In its dimmest light, it is simple CYA.  More generously, putting things in writing ensures that everyone is on the same page and that time and faulty memory doesn’t distort things. It’s hard enough to communicate let alone remember communication!  Doctors have to learn to put things in writing more.

Admittedly, putting things in writing takes time and can be viewed as hostile.  Culturally, while lawyers are used to putting things in writing and don’t take that personally, the same may not be true in the world of healthcare.  Still, documenting in writing conversations and agreements between people can go a long way to avoid liability and conflict.

Continue reading

Plan B Makes Sense In Terminating Employment

Employers who want to terminate physician employees (who have a contract) usually see two scenarios: terminate without cause, or terminate for cause. Because of complications associated with each of those options, many employers (and employees) prefer another way out.

First of all, having a written contract is nearly always in everyone’s best interest. They describe duties, expectations and responsibilities. And they contain protective devices like noncompete, non solicitation and confidentiality provisions.Continue reading