Archive for February, 2013

Physician Sunshine Act Brings More Transparency

Do you ever wonder what motivates your physician to order certain drugs or use certain devices? The government constantly evaluates what influences drug and device orders as it attempts to reduce the costs to the Medicare and Medicaid Program. One area of focus has always been and will continue to be physician financial relationships with the drug and device manufacturers. In furtherance of this scrutiny and in conformance with the Healthcare Reform Act requirements, on February 8, 2013, the Physician Payment Sunshine Act (“Sunshine Act”) was finalized and published. The Sunshine Act will provide public awareness of physicians’ financial relationships with manufacturers and drug companies.

The Sunshine Act specifically requires manufacturers of certain drugs, devices, as well as biological and medical suppliers to provide an annual report of any direct or indirect payments to physicians. A payment means, a payment that may be in excess of $10.00 and it could include …

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Sequestration Consequences Loom for Healthcare in Georgia

Now that we’ve nosedived from the fiscal cliff, we have the impending sequestration to look forward to. What will these cuts mean for healthcare in Georgia? No matter how you slice and dice the figures, one thing is clear when it comes to sequestration – patients will bear the brunt of cuts made to healthcare programs.

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What Healthcare Delivery Systems should be thinking about next.

As healthcare delivery systems are rapidly moving forward implementing integrated ambulatory and acute care clinical systems, preparing for ICD-10 and meeting meaningful use requirements, the market is evolving. With the front-line personnel of healthcare delivery systems working hard implementing the current initiatives, hospital leaders should be thinking about what is next. A recent article in Healthcare IT News, titled “5 CIOS Imagine Healthcare in 10 Years[1],” reflects the thoughts of the past five CIOs of the year. Below are the trends they have identified in conjunction with other market trends surfacing.

  1. Telemedicine is on the horizon and ready to explode – Broadening acceptance of telemedicine, declining cost of technology and the movement of payers to reimburse for these services is accelerating the delivery of care directly into the patient’s home.
  2. Bundled Payments across the continuum of care – Bundled Payment reimbursement will be the foundation to …

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Individual Insurance Premiums under the Affordable Care Act: up or down?

One of the goals of the Affordable Care Act (ACA) is to stabilize the market making more accessible and affordable for individuals. Many of the proponents of the law argued that by creating a well-regulated insurance market health insurance premiums would fall and stabilize. However, there have been several stories in papers across the country speculating that health insurance premiums for individuals are going to rise as much as 30 percent when the health insurance exchanges and other insurance market regulations go into effect next year.

So what is going to happen to premiums in the individual health insurance market?  Well, in the spirit of Harry Truman who asked for a one-handed economist because he was tired of hearing “on the other hand” the right answer is: it depends. It depends on who is asking the question, where is the question being asked and when is the question being asked. The Georgians who enter the individual health insurance market after ACA is …

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A Good Time for ICD-10?

Is this a good time for ICD-10? Providers are mandated to implement ICD-10 for outpatient diagnosis coding by October 1, 2014. This could not be at a worse time for healthcare organizations especially small practices. ICD-10 diagnosis codes are used by your provider to describe your illness and are submitted to insurance companies for payment. Providers currently use an older version called ICD-9. ICD-10 will increase the number of available diagnosis codes from 13,000 to 68,000. Medical Economic journal recently estimated the cost per practice to be $83,000-$2.7million according to the practice size.

The American Academy of Family Physicians (AAFP) recently indicated that providers should not have to bear the economic burden of upgrading to ICD-10. Upgrading requires practice management IT system changes that can be expensive for providers at a time when they are already spending big bucks to implement and upgrade their electronic health records. Meaningful Use Stage II is …

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A Case for Improving Mental Health Services in Georgia

One of the outcomes of December’s tragic shooting at Sandy Hook Elementary School is a renewed interest in addressing behavioral health problems.  While the state of Connecticut has yet to release information about the shooter’s mental state, it is clear that he suffered from a mental health breakdown.  Half to two-thirds of spree shooters, like Adam Lanza, were formally diagnosed, hospitalized, or had shown rage, aggression, paranoia and/or delusional thinking prior to their attack.

Yet, horrific acts like that at Sandy Hook don’t mean that people with mental health problems are more likely to be violent.  In fact, experts argue that people with mental illnesses are much more likely to be victims of crime than perpetrators.

Few people realize how commonplace mental health problems are in the United States.  It is estimated that approximately one in four adults and one in five children will be challenged with an identifiable behavioral health disorder every year. …

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Will the Health Insurance Mandate really change anything for Hospitals?

Last week CMS and the IRS came out with proposed rules on exemptions to the health insurance mandate. As you know, PPACA requires individuals to purchase health insurance that meets certain minimum criteria. These regulations create hardship exemptions which exempt individuals from paying the fines.
There are three main exemptions: 1) if it is determined that the coverage available through the health insurance exchange in an individual’s state is unaffordable, the individual would not be subject to a fine 2) individuals which would be eligible for Medicaid, but for their state’s refusal to accept Federal funding to expand Medicaid, are not subject to a fine and 3) individuals who are not required to a file a Federal return are also exempt.
Therefore, the Congressional Budget office estimates that only 2% of the population will actually pay the penalty. This means there will still be a lot of individuals without insurance who are not subject to the fines. At the same time, …

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States Debating Innovative Approaches to Medical Malpractice Reform

med mal3From Arizona to Florida, state lawmakers are beginning to address medical malpractice reform. Rather than traditional caps on non-economic (so-called “pain and suffering”) damages, states are getting creative about the way they approach medical professional liability litigation reform.

In Arizona, for example, State Rep. Bob Thorpe of Flagstaff has introduced legislation which would require personal injury lawyers to be certified as a “medical malpractice attorney” before they could file suit against a physician or hospital. “The idea is to try to weed out the difference between good, legitimate attorneys that are practicing in the area of medical malpractice … from the ambulance chasers,” he said. Due to the complexity of the issue, Thorpe’s bill would also require that these cases would only be heard by judges who have been through special training in medical malpractice cases.

In Oregon, Gov. John Kitzhaber has taken an active role in trying to reduce healthcare …

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Billions at Stake in CMS’s Pay-for-Performance Rankings

By Bart Foster, CEO & Founder of SoloHealth


Money is a powerful motivator. Look no further than the sports world for validation. The PGA’s FedEx Cup encourages golfers to earn “points” towards participation in playoffs that offer a big season-ending payoff. Tennis has a similar format with the U.S. Open Series where performance in a series of events equates to a huge prize purse. Both instances use hefty prize money to help ensure the top performers participate and at high levels. The Centers for Medicare and Medicaid Services (CMS) have applied this sports theory to its rankings system of Medicare Advantage (MA) and Prescription Drug Plans (PDP) plans. And there’s billions of dollars up-for-grabs for healthcare plans.

CMS Ups the Ante on Star Ratings
Since 2007 the CMS has posted rankings of MA and PDP plans to give consumers an informational tool when comparing and selecting plans. It was designed to help identify poor-performing plans and provide …

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It Is Here….The HIPAA Omnibus Rule Is Released

In February 2009, the American Recovery and Reinvestment Act (“Stimulus Act”) provided significant financial incentives for healthcare providers to adopt and implement electronic health records. Because healthcare providers were encouraged to electronically store and transmit patient protected health information, patient advocates became concerned about the privacy and security protections for patient information. In order to improve the privacy and security requirements, the Stimulus Act included an entire section that enhanced the security requirements and increased the penalties if the providers failed to comply. This section of the Stimulus Act is the Health Information Technology for Education and Clinical Health Act (“HITECH”) and it modified the Health Insurance Portability and Accountability Act (“HIPAA”). HIPAA created the minimum privacy and security requirements. HITECH takes security and privacy to a new level. Over the last three years, hundreds of …

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