The Impact of the Supreme Court’s Healthcare Ruling on Physicians

The Supreme Court’s ruling recently upholding the constitutionality of the PPACA signals the continuing expansion of the U.S. healthcare system.

The PPACA extends care to approximately 50 million formerly uninsured individuals.  The uninsured currently forgo many, if not all, of the preventative procedures available.  This will surely change as the PPACA is implemented. Although all physicians will likely see an increase in patients, the majority of the demand will be borne by primary care providers (PCPs), likely without the assistance of an increase in physicians providing primary care services.

To meet the increase in demand, physicians should start looking for investments that will increase efficiency.  As time passes, healthcare reform initiatives like EHR, ACOs, and new physician reimbursement models may become more important for physicians trying to keep up with growing demand.  Individuals providing complementary services–nurse practitioners and physicians’ assistants–are also likely to play an increasingly more significant role going forward as providers look to cut costs.

The Department of Health and Human Services (HHS) recognizes the challenges physicians face as implementation of the PPACA progresses. Signaling primary care as a central focus of the legislation, HHS recently proposed increasing Medicaid reimbursements to Medicare levels for PCPs during 2013 and 2014.  The proposal is expected to boost reimbursements by an average of 34%, incentivizing PCPs to begin preparing for the influx of new patients.  The PPACA also seeks to facilitate the expansion of services into underserved areas by increasing payments to rural healthcare providers.

Although some uncertainty still exists, one thing is certain–physicians need to start taking proactive steps to address the significant expansion of demand for their services.

© 2012 Parsonage Vandenack Williams LLC

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Time Limits Set on Board Certification

To prevent physicians’ unlimited use of the term “board-eligible,” all member boards of the American Board of Medical Specialties will limit the amount of time that physicians have to undergo board certification after completing their residencies.  Most of the time limits for the 24 boards range between five and seven years.

Some of the member boards already have certification time limits in place. The rest of the member boards will complete a transition to time limits by January 1, 2019.

© 2012 Parsonage Vandenack Williams LLC

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Reminder that Billing Provider Must Document History of Present Illness

CMS has made clear that the billing provider, and not a medical assistant, must personally document the patient’s history of the present illness (“HPI”).  The HPI includes the quality, severity, duration, timing, context, and associated signs and symptoms of the patient’s current health complaints.  The HPI does not include the patient’s past, family, and social history.  A medical assistant may document the patient’s past, family, and social history as long as the billing provider subsequently reviews such information.

© 2012 Parsonage Vandenack Williams LLC

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Effective Use of QR Codes in Medical Practice

Quick response (“QR”) codes may be an effective way for physicians to market themselves to potential and existing clients.  QR codes are barcode-like images that can store up to fourteen different types of data, including web links and phone numbers.  These images may be placed on nearly anything from advertisements to business cards, and will deliver data encoded in the image to the user’s smartphone when scanned.  Marketing experts suggest that physicians avoid merely using QR codes to provide a link to the practice’s homepage.  Physicians should instead use them in creative ways to provide unique and special content.  Some potential uses include:

  1. Educate patients—prove links to information like health tips, recent medical advances, and other online resources.
  2. Promote services—provide links to information regarding specialty services, seasonal reminders, etc.
  3. Introduce physicians—may be used to link potential patients to website bios, introductory videos, etc.
  4. Invite patients to special events
  5. Make appointments online—can place on appointment reminder cards that provide a link to your online appointment system.
  6. Link to patient testimonials on social media websites

Remember, however, to make sure that your website and other content linked to QR codes is mobile-ready, otherwise users will be unable to use the QR code effectively.

© 2012 Parsonage Vandenack Williams LLC

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Should your Medical Practice Affiliate with a hospital? Considerations

The predicted trend after passage of the health care overhaul bill was that physicians would all sell out to hospitals.  We are not seeing that happen in the manner predicted.  In fact, we are seeing the opposite to some degree.  In considering an affiliation with a hospital, another practice or any type of health care organization, consider the following:  How is practice management affected?  How are patient relationships affected?  Will an affiliation allow us to achieve practice goals that we can’t achieve without the affiliation?  Will an affiliation change the way we deliver care to our patients?  What will happen to our profitability? Will our ability to fund our retirement be affected?

The best answer as to affiliation varies by practice and geographic location.  Evaluate all factors before leaping in any direction.

Be prepared for possible different moves by creating a tax friendly business structure, a recruiting friendly practice and an organization that is equipped to report on quality of care measures.

© 2012 Parsonage Vandenack Williams LLC

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OIG Releases 2012 Work Plan

Among the new areas of focus for the Office of Inspector General (the “OIG”) is increased scrutiny for incident-to services performed by non-physician practitioners.  Specifically, the OIG is planning on investigating whether the non-physician practitioners are qualified to be performing the incident-to services that are being billed by physicians.  This concern and others are highlighted in the recently published 2012 OIG Work Plan.  Your practice can use this Work Plan to help keep your compliance plan current.  Doing so allows your practice to be prepared for any audit or investigation by the OIG.

The Work Plan contains 349 new and continuing initiatives.  Others include:

  • Ensuring that physicians who have opted out of Medicare are no longer submitting claims;
  • Reviewing the qualifications to become a critical access hospital;
  • Investigating whether physician’s services were properly coded to the appropriate place of service (i.e. provided in a hospital vs. the physician’s office); and
  • Examining the safety and quality of care for patients having surgeries and procedures in ambulatory surgical centers.

The entire Work Plan can be read at: OIG 2012 Work Plan

© 2011 Parsonage Vandenack Williams LLC

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Records Requests: Know What’s Legal

Mary Vandenack’s client advice regarding the HIPAA rules and medical records requests was recently featured in an article in Physician’s Practice by Keith Martin. 

The full article can be viewed at:

© 2010 Parsonage Vandenack Williams LLC

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Fraud Waste and Abuse Training Requirements Eliminated for Providers

A final rule published in the April 15, 2010 Federal Register makes clear that enrolling in Medicare is considered enough proof that providers know about fraud, waste and abuse issues, and that Medicare Advantage (“MA”) plans do not need to require additional compliance training.

In the 2007 MA regulations, CMS stated that it would hold MA plans and Part D sponsors responsible for fraud and abuse training of first-tier and downstream entities that participate in their plans. This would have included providers who contract with many health plans, which means providers would have had to establish many different training programs.

CMS appeared to back away from the requirement in a proposed regulation posted in October 2009.  This latest final rule, which takes effect June 7, 2010, puts the issue to rest.

CMS listened to providers’ complaints about the burden triggered by training requirements from different MA plans, which essentially amounted to CMS being a tad too extreme in its fraud-fighting efforts. CMS wanted to make sure that plans had good compliance programs and that their downstream contractors, such as providers, had them as well.  But pushing the responsibilities onto providers went a little too far.

To comply with all the idiosyncrasies of each plan’s compliance program would have been a logistical nightmare. Now, with the final rule, an unnecessary and basically impossible standard has been made reasonable and providers will not have to deal with the additional training requirements.

© 2010 Parsonage Vandenack Williams LLC

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How to Control the Costs of Adopting Electronic Medical Records

One of the growing trends for healthcare practices in 2010 is the adoption of electronic medical records (“EMR”).  By managing the selection and adoption of EMR correctly, practices will save money in the long-term. 

Well-researched and efficient management of the selection and adoption process will help a healthcare practice cut costs and reduce frustration.  The following are five key strategies to follow:

  • Make sure you have a full understanding of what an EMR can really be expected to do before you buy a product.
  • Obtain input from all of areas of the practice, including administrative and clinical support staff, regarding what is needed in terms of EMR.
  • Use the opportunity to change workflow rather than try to make the tool work just like the practice.
  • Do not worry about accommodating every single person’s ideas regarding how the software should look and work – focus on the overall picture.
  • Do not try to save money by skimping on training – proper use of EMR is essential for efficiency and cutting costs.

An EMR can be a great tool that improves a healthcare practice’s efficiency, reduces costs, and increases revenue.  By taking the time to make a careful EMR selection and following the above strategies, the practice will greatly benefit from the product.

© 2010 Parsonage Vandenack Williams LLC

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Stricter Self-Referral Rules Under Stark May Bring an End to Some Physician-Hospital Contracts

Major changes to the federal anti-self-referral rules known as the Stark law take effect October 1, 2009.  These changes were approved over a year ago, and could potentially cause many physician-hospital arrangements to fall out of compliance if doctors are not prepared. Lack of knowledge of the Stark law revisions or the structure of a particular agreement will not excuse physicians from liability.

The changes to the Stark law make it much more difficult for physicians and other entities providing designated health services to enter into joint ventures around hospital services. Stark is a strict-liability statute, so even if physicians have innocent intentions, they are still subject to penalties for violating the statute.

The Stark law generally prohibits physicians from referring patients to entities in which they have a financial stake, although there are several exceptions to the rule. In August 2008, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule making broad revisions to the Medicare hospital inpatient prospective payment system that will restrict:

  • So-called “under arrangements,” where hospitals contract with physician-owned entities to provide a broad range of ancillary services, such as clinical labs or imaging services.
  • Per-use or “per-click” payments for equipment and space leases.
  • Compensation deals based on a percentage of revenue generated by space or equipment use.

The changes were delayed one year from the original October 1, 2008, implementation date.

In order to comply with the changes to the Stark law, physicians will need to restructure contracts to narrow the scope of services they perform for a hospital.  For example, a physician-owned entity may need to limit its clinical services but still could conduct billing and management activities.

How Should Physicians Prepare for the Stark Changes?

Here are some steps physicians can take to ensure compliance with the rules taking effect October 1, 2009:

  • Consult an attorney to determine whether current hospital joint ventures or space and equipment leases will continue to be compliant with Stark.
  • Review contracts for clauses that allow parties to amend or dissolve agreements as a result of changes in the law. Be sure to include such clauses in future contracts.
  • Consider restructuring existing deals to limit the scope of services provided or to take advantage of other applicable safe harbors. In some instances, physicians may be forced to unwind the arrangements.
  • Make sure any changes to compensation reflect fair market value.
  • Review any state self-referral laws.
  • Make any changes to agreements in writing.

© 2009 Parsonage Vandenack Williams LLC

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