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AMA Writes to Speaker Boehner, Recommends a Stop to ICD-10 Implementation Print E-mail
Written by Jeffrey Herschler   
Friday, 03 February 2012 10:59

"The implementation...will create significant burdens on the practice of medicine with no direct benefit to individual patient care..."

James L. Madara, MD, Executive VP and CEO of the American Medical Association recently wrote a letter to John Boehner, Speaker of the House, urging him to "put a stop to the Health Insurance Portability and Accountability Act (HIPAA) required implementation of ICD-10". Citing the burden of coping with "with 68,000 codes - a fivefold increase from the current 13,000 codes" and issues in Canada involving "high risk for claims processing and payment disruptions" associated with ICD-10, he recommends a "call on stakeholders to assess an appropriate replacement for ICD-9." Dr. Madara estimates the cost of transitioning to the new coding system as between $83,290 to more than $2.7 million per healthcare practice.

Click HERE to read the letter.
Last Updated on Monday, 06 February 2012 07:49
Best Places to Work Print E-mail
Written by Jeffrey Herschler   
Thursday, 26 January 2012 00:00

Fortune Magazine recently released its list of Best Places to work for 2012. Several healthcare companies made the list including Miami based Baptist Health South Florida.  

 #9           CHG Healthcare Services
#35         Millennium: The Takeda Oncology Co.
#36         Southern Ohio Medical Center
#39         St. Jude Children's Research Hospital
#42         Baptist Health South Florida
#49         Children's Healthcare of Atlanta
#53         Methodist Hospital
#56         Scripps Health
#65         Atlantic Health
#68         Genentech
#71         Mayo Clinic
#80         Stryker
#87         The Everett Clinic
#88         OhioHealth
#96         Meridian Health

Feds Worked Hard During the Holiday Season Print E-mail
Written by Jeff Cohen, Esq. & Al Meyer Esq.   
Wednesday, 11 January 2012 06:37

2012 OIG Work Plan 

On November 10, 2011, the Office of the Inspector General of the Department of Health and Humans Services (the "OIG") issued their 2012 Work Plan.  The annual Work Plan is designed to give Medicare providers and suppliers notice and information on areas of potential abuse that the OIG intends to address with particular attention.  As we approach a new year, here are some areas that our clients and friends may wish to examine to avoid scrutiny by the OIG.

With regard to Medical Equipment Companies, the OIG has identified three areas where heightened scrutiny will be applied:

  • Enrollment Abuses
  • Payments for High Priced Equipment
  • Diabetic Testing Supplies

On the Physician side, OIG deems the following practices worthy of intense focus:

  • Place-of-Service Errors
  • Incident-To Services
  • E/M Services
  • Payments for Services Ordered or Referred by Excluded Providers
Click HERE to read more.     Comment on this story.

Mr. Cohen is the founder of the
Florida Healthcare Law Firm in Delray Beach.  Mr. Meyer is the firm's Compliance Specialist. 
Last Updated on Monday, 16 January 2012 12:55
The Re-Engineering of the Medical Practice Print E-mail
Written by Lawrence Schimmel, M.D., FACS   
Saturday, 07 January 2012 16:55

It has taken a long time but many physicians today finally realize that their medical practice is a business and that the services they provide is the product. We as physicians feel that what we do is “more than just providing service”; however our ability to practice is determined by the business conditions we face on a day-to-day basis. The issues physicians face can be divided primarily into revenue generation, management of expenses, enhancing market share and improving efficiency while maintaining quality.  Market conditions, technology advances and items outside of our control have a direct impact on how successful the practice can be and directly correlate with the bottom line. Physicians are creatures of habit and change is something that is difficult to embrace; but to run a successful business you must adapt to the changing circumstances affecting the practice of medicine. Simply put, you need to continuously re-engineer your business model (practice) to succeed in the healthcare world we live in.

Revenue Generation: Traditionally physician revenue was solely derived from the providing of medical services and receiving reimbursement from insurers, the government, or the patient. In a declining reimbursement world, more services are required to maintain the total revenue a practice generates requiring more patients to be seen with less time to see them. The frustration of working harder for the same or less money is very discouraging. Therefore, to succeed additional sources of revenue need to be found. Each specialty has things that can be done to enhance revenue and provide a value added to your patients. Revenue enhancement via pharmacy dispensing services, sale of items that patients traditionally purchase elsewhere, diagnostic testing, and services that are not reimbursed by insurance are items that each practice needs to evaluate as a way of enhancing practice revenue. 

Management of Expenses:  Physicians are creatures of habit but we need to evaluate all aspects of our l practice and adjust to the times. All businesses today are evaluating their space needs as well as their personnel needs. We should have the right amount of space to practice and the right number of employees so that revenue generation per employees is as high as possible. If you find that you have too much space, subleasing to another practice is a smart way to offset your operational costs.

There are additional costs associated with electronic records and if we do not change the way we operate our bottom line will be reduced. There is no question that the staffing needs will change but rather than adding employees, a re-alignment of employees with different skill sets will negate the need for additional employee expense. Physicians are often asked, what is your cost to collect? If you analyze all costs associated with the billing process you will be amazed at what it really costs to bill and collect your funds. Is there a better way to do it?  Businesses hire consultants to evaluate processes, identify inefficiencies, and show them how to increase the bottom line. In this environment, there is no question medical practices should do the same.

Enhancing Market share:
The number of patients you treat is directly related to your gross revenue.  How to enhance the mix of patients will allow you to earn more without having to see additional patients. Every office needs to determine how and if they can increase the number the higher reimbursed patients. All businesses develop a marketing plan to reach their desired goals. For too long, physicians have sat back and just provided service. It makes sense to set up goals for the practice and retain trained professionals to help you implement a strategy that will allow you to enhance your patient mix and subsequently your revenue stream.

Improving Efficiency:
2012 is just the beginning of the changes we will see as the Affordable Care Act is implemented over the next few years. Additionally, market pressure is significant on healthcare businesses/practices. The ability to identify what you want your practice to look like in a year and the ability to set up an implementation plan to do it is critical for the long-term success of the independent medical practice. Your practice should have the right number of employees performing the right tasks at the right time. Historically physicians perform their own billing and collection. Would it make sense to reduce costs by 4-6% if they could be outsourced?  Would you choose a different EHR if cost were not a factor? Should you have an associate or merge with another physician to offset space and personnel costs? Sometimes it takes an outside view by a trained professional to determine how best to run your business. This is an investment that you should not ignore.

A medical practice, like any other business, needs to adapt and change to market conditions. There will be winners and losers in healthcare over the next few years. Which do you want to be?

Dr. Schimmel is a Principal at Marcum Healthcare.  You may contact the author at or 305.995.9801. 

Last Updated on Saturday, 07 January 2012 17:41
Medicare Shared Savings Program Final Rule: Where Do We Go from Here? Print E-mail
Written by   
Thursday, 05 January 2012 06:55

McDermott Will & Emery is pleased to provide this supplemental matrix to its original White Paper summarizing and evaluating the Centers for Medicare & Medicaid Services (CMS) proposed Medicare Shared Savings Program (MSSP) regulations.  As did the original White Paper, the matrix provides both a summary of, and commentary on, CMS's recently published final regulations.  The matrix, which is intended to be read together with the original White Paper, "The Controversial Draft Medicare ACO Regulations: Analysis, Comments and Recommended Action," includes page-by-page cross-references identifying changes between the Proposed Rule and the Final Rule, as well as McDermott commentary and recommended action items.  Readers should consult both the White Paper and the updated matrix when navigating through the Final Rule's requirements.  We hope that you find this update and the original White Paper to be a useful and valuable resource and strategic planning tool as you evaluate your organization's participation in the MSSP.  The authors and editors of these documents, as well as other McDermott lawyers with substantial experience and knowledge in the many issues raised by the MSSP, are available to respond to your questions and to facilitate your consideration and pursuit of shared savings programs.

Access the Supplemental Matrix and original White Paper here

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