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McBrayer Blogs
HOSPITAL PAYMENT FOR PERFORMANCE: DRIVEN BY PHYSICIAN’S QUALITY
As the fate of the Affordable Care Act is being determined by a divisive Supreme Court, the health care industry is being led or possibly dragged by the Department of Health and Human Services (“HHS”) and the Center for Medicare and Medicaid Services (“CMS”) into new payment systems that focus on quality of care, outcomes and individual provider performance rather than the traditional fee for service payment model. Even if the Supreme Court finds the Affordable Care Act to be unconstitutional, the change from a payment system focused upon individual services to payment focused upon the quality of the care and patient outcomes are being woven into the fabric of the Medicare reimbursement system. While change in the system is assured, whether the new models will actually bring about better and more efficient care or just reduce available reimbursement is unknown. Despite the unknown effect of paying for performance based upon quality, CMS is marching on with new programs and payment penalties. Physicians, whether employed by a hospital or in a private practice, should be aware of how quality is beginning to drive hospital reimbursement as well as the importance of the physician’s role in determining the quality of care provided by hospitals. By 2017, 6% of all DRG payments will be subject to quality measures through new CMS payment programs for hospital readmissions, value based purchasing and hospital acquired conditions. With these new programs determining a significant amount of payment, physicians must understand the programs and direct their services accordingly. Likewise, hospitals must develop ways to compensate physicians for providing high quality care in a manner that allows hospitals to earn performance payments. More >
PROPOSED PAIN CLINIC LEGISLATION WILL REQUIRE SIGNIFICANT CHANGES TO PROVIDER OPERATIONS AND INCREASE LEGAL SCRUTINY OF PRESCRIBING PRACTICES
The Kentucky General Assembly is currently considering sweeping legislation to combat prescription drug abuse through increased regulation of pain clinics and greater scrutiny of prescribing practices by various agencies of state government. House Bill 4 and the Free Conference Committee Report proposing to modify House Bill 4, if enacted and signed by Governor Beshear, will place significant limits on ownership of pain clinics and also impose a host of requirements governing the operation of pain clinics in the Commonwealth of Kentucky. More >
Federal Government Fight Against Health Care Fraud
FIFTEEN YEARS - $20.6 BILLION – NOT BAD!! More >
CMS Has Issued Proposed Rule Which Would Force Providers to Report Overpayments in 60 Days
The Centers for Medicare & Medicaid Services (“CMS”) released proposed regulations on Tuesday, February 14, 2012 proposing that providers and suppliers must report any self-identified overpayments within 60 days of the incorrect payment being identified or on the date when a corresponding cost report is due, whichever is the latter. More >
ON THE ENFORCEMENT RADAR: MEDICAID AUDITS AND THE 2012 OIG WORK PLAN
Unlike the Department of Health and Human Services Office of Inspector General (“OIG”) which publishes a Work Plan each year, the Department of Medicaid Services (“Medicaid”) generally does not publish guidance on the areas which it plans to investigate and/or audit. In fact, Medicaid’s website states … “Medicaid does not provide guidance on how companies should bill for services, but will direct you to applicable regulations. If you receive direction from staff about how to bill, the Department will not be bound by such instruction, unless it was given by a Director or Commissioner.” Because the federal integrity programs are now moving through the process, Kentucky Medicaid providers are starting to see lots of audit activities. Unlike the OIG audits, we don’t know the precise subject matter of the Medicaid audits, but the process for appeal is outlined below in addition to the areas announced for review by the OIG. More >
The Physician Employment Trend Continues
As healthcare reform continues to be implemented, the trend toward clinical integration and consolidation also continues and will be a defining characteristic of healthcare delivery in the years ahead. One critical component of clinical integration and consolidation has been health systems employing physicians to form large multi-specialty groups to serve the patient population. Physicians contemplating entering into an employment relationship with a hospital or health system must examine a number of critical issues before entering into an employment agreement. More >
ON THE ENFORCEMENT RADAR: THE 2012 OIG WORK PLAN
The Office of Inspector General of the United States Department of Health and Human Services (OIG) released its Work Plan for fiscal year 2012. At the beginning of each fiscal year, the OIG issues its annual Work Plan, which describes current audit, enforcement and evaluation activities and those the agency plans to initiate in the upcoming year. The Work Plan also provides a general view of the OIG’s investigative, enforcement and compliance activities. Basically, the Work Plan informs health care providers what is on the OIG’s enforcement radar in the coming year. Physicians should know what areas that the OIG is concerned about and review their own practices to ensure compliance with regulatory requirements. The following are some of the highlights from the FY 2012 Work Plan. More >
Courier Journal publishes online prescription database
The Courier Journal recently published an online database allowing the public to search, by prescriber last name or zip code, the number of prescriptions Kentucky doctors and other prescribers wrote between 2001 and 2011 for seven commonly-abused drugs: alprazolam, diazepam, morphine, methadone, fentanyl, oxycodone and hydrocodone. The newspaper accessed information from Kentucky’s Department for Medicaid Services via the Open Records Law, so the database is limited to Medicaid claims data. As Senator Grassley (R-IA) and other senators raise concerns that over-prescribing may constitute fraud and abuse, it is important for Kentucky physicians and prescribers to comply with compliance plans, state and federal laws, as well as Kentucky Board of Medical Licensure guidelines. More >
The Doctor’s Doctor: Professional Courtesy in an Age of Healthcare Regulation
For over 200 years, professional courtesy has been a hallmark of physician practice, a symbol of collegiality among doctors. Historians describe its 18th century beginnings as physicians providing charity care for the families of their deceased colleagues—an early form of health insurance for doctors’ widows and children. Over the years, the concept of collegial care also became the preferred alternative to physicians treating themselves or their own family members. In fact, the American Medical Association’s (“AMA”) first code of medical ethics created an obligation among doctors to reciprocate medical care and to extend the courtesy to physician family members as well. Today, the AMA recognizes professional courtesy as a “long-standing tradition” but not an ethical requirement.[1] The federal government’s commentary about “the provision of free or discounted health care items or services to a physician or his or her immediate family members or office staff,” however, is far more cautious than nostalgic. [2] The Department of Health and Human Services Office of Inspector General’s advice that physicians “consult with an attorney” before extending professional courtesy warns that certain arrangements for free or discounted medical care run afoul of fraud and abuse laws.[3] More >
Electronic Prescribing: A Medicare Cut is Looming for all Physicians in 2012 and 2013
Technology is wonderful! It seems like everyday our lives become easier and more convenient due to the ever changing world of IT. We can do almost anything over the Internet…order tickets, shop, chat, and now…even obtain prescription medications. More >
