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Turning up the Heat on the Risks for Outdoor Workers Print E-mail
Written by Philip Marchion   
Saturday, 14 July 2012 15:47

Harry Truman is often quoted with his now famous phrase, “If you can’t take the heat, get out of the kitchen.”  Of course, his reference to heat was pressure and scrutiny.  But the real heat of kitchen workers who work with stoves and ovens and hot food in 100 degree indoor climate is matched and multiplied by outdoor workers, where heat and sunlight combine for serious health concerns. Particularly in Florida, where both winter and summer can be hot and sunny, outdoor laborers such as landscapers and construction workers face significant medical issues.  The fact is, direct exposure to heat and sunlight poses serious health hazards.  

Medical professionals who are seeing a rise in heat-related cases can – and should – provide advice to patients to reduce the possibility of heat incidence – and to spread the word to their employers as well.  Doctors know all too well that heat stroke, severe sun-burn and dehydration are not minor matters.

Physicians who have seen the effects of significant exposure to the sun’s harmful impact may be able to treat the patients who suffer the consequences of being outdoors virtually all day.  But there’s another saying:  An ounce of prevention is worth a pound of cure. Doctors are well-advised to make sure employers are aware of the risks, and signs associated with heat exhaustion and heat stroke.  There are steps that can be taken to help protect employees.  And workers themselves must be vigilant and guard themselves.  

a)     First of all, a rotation of workers can minimize the exposure.  Shorten shifts and make sure there are shaded areas or indoor options for breaks.  Limit time in the worst heat – use non-bankers hours for outdoor workers.  Early morning or evening hours can be much less oppressive and also more productive. 

b)    Maintain hydration.  The basic rule of making plentiful water available cannot be stressed enough.   Doctors must stress how vital this is. 

c)     Protection is key.  Keep eyes and skin covered.  Encourage the use of sunglasses, wide-brim hats, and lightweight long-sleeved shirts.  Skin cancer is not fun.  Sunblock should be applied frequently. 

d)    Be aware of others.   Tell colleagues to look around, check for red skin, unsteadiness, or more serious implications such as lack of coherence, extreme and profuse perspiration (well passed usual sweat). 

e)     Be self-aware.  Doctors must tell workers how to be self-aware – what some of the symptoms are that they might ignore and shouldn’t such as unexpected irritability, wooziness, exhaustion, burning sensations.

f)     Be educated.  Learn the early signs of heat exhaustion, dehydration and skin cancer.  Early detection can prevent the situation from becoming serious.

Although the Occupational Safety and Health Act (OSHA) has not enacted a specific standard focusing solely on employer responsibility where workers are exposed to heat- and sun-related hazards, primary care doctors may want to offer important wisdom before they see a rise in health issues caused by heat and sunlight.     

Doctors in Florida may deal with heat issues year ‘round but despite the perception to the contrary, this state does have seasons – and the heat is worse in the summer.  Doctors who recognize this and keep their patients aware of the right precautions are providing a great benefit – their continued good health. 

Philip Marchion is an attorney with the Fort Lauderdale office of employment law firm Fisher & Phillips.  He can be reached at (954) 847-4723 or
Last Updated on Saturday, 14 July 2012 15:56
Deciphering ACO Exclusivity for Specialist Physicians Print E-mail
Written by Frederick Segal, Stephen Siegel   
Friday, 29 June 2012 08:24

On November 3, 2011, the Centers for Medicare & Medicaid Services (CMS) published the "Final Rule" setting forth the parameters for Accountable Care Organizations (ACOs) to participate in Medicare Shared Savings Program (MSSP). One of the concerns of specialist physicians who are interested in joining an ACO is their ability to participate in more than one ACO. In the Final Rule, CMS included provisions that provide flexibility for specialists to participate in multiple ACOs. However, practically speaking, they may not have as much flexibility as the Final Rule appears to provide. This article discusses a practical problem specialist physicians face if they seek to participate in multiple ACOs.

The Final Rule defines an ACO as a legal entity that has a certain Taxpayer Identification Number (TIN), and which is comprised of one or more "ACO participants". An ACO participant is an individual or group of provider(s)/supplier(s) (e.g. hospitals, physicians, and others involved in patient care) that are identified by a Medicare-enrolled TIN. An ACO provider/supplier is defined as a provider or supplier who is enrolled in the Medicare program and bills on a fee-for-service basis under a billing number assigned to an ACO participant's TIN.

As part of its application to CMS, a prospective ACO is required to submit a list of its ACO participants and their associated ACO providers/suppliers, and identify those providers/suppliers who are primary care physicians. Further, the ACO participants and the providers/suppliers are, prior to the filing of the ACO application, required to sign agreements or contracts relating to participation in the ACO. Essential to the successful operation of the MSSP is CMS' ability to gather and analyze claims and other information submitted to CMS by an ACO participant through its billing TIN. This data will be used by CMS to calculate an ACO's shared savings, assign beneficiaries, benchmark, etc. Consequently, CMS has determined that all ACO providers/suppliers associated with each ACO participant TIN must agree to participate in the ACO as a member of that ACO participant. Thus, for example, if a group practice agrees to participate in an ACO, the group practice entity will be designated as an ACO participant and all of the physicians and allied health professionals in the group must agree to participate in that ACO. CMS's "all or none" approach is one reason why physicians and physician group practices may hesitate before agreeing to become either ACO providers/suppliers or ACO participants.

An ACO participant TIN, and its associated physicians "upon which beneficiary assignment is dependent," must be exclusive to one ACO. If beneficiary assignment is not dependent on the ACO participant's TIN, an ACO participant and its associated physicians may participate in multiple ACOs. Thus, the question of how Medicare beneficiaries will be assigned to an ACO becomes a critical step in determining whether a given ACO participant is able to provide services on behalf of multiple ACOs.

The assignment of a Medicare beneficiary to a particular ACO is a two-step process... READ MORE 

Mr. Segal and Mr. Siegel are attorneys at Broad and Cassel in Miami, FL.
Last Updated on Monday, 02 July 2012 10:12
The Top 3 MRA Mistakes Print E-mail
Written by M. Alexandra Johnson, FACHE and Wilma N. Torres, CPC   
Sunday, 24 June 2012 00:00

How Much Are They Costing Your Practice?

When a medical group's risk score is low despite a chronically ill patient population, the culprit is generally one of three very common practitioner habits:

1.       Failure to connect diabetic manifestations

2.       Improper documentation of histories

3.       Un-specific cardiac disease

Let's explore each one...  Click  HERE to finish the blog post.

About the authors: M. Alexandra Johnson, FACHE and Wilma N. Torres, CPC are principals at Coleman Consulting Group. The firm's services include:

·          Risk Adjusted Reimbursement (MRA)
·          Coding & Billing
·          ICD-10-CM Consulting & Training
·          EMR/Meaningful Use Attestation
·          Credentialing & Contracting

For additional information about the firm or to request a complimentary no-obligation consultation, please call 954.578.3331 or email

Last Updated on Monday, 25 June 2012 07:16
Domestic and International Healthcare Arbitrations Print E-mail
Written by   
Thursday, 14 June 2012 00:00

Health care companies are increasingly resorting to arbitration, instead of courtroom litigation, to settle their disputes. Both the number and diversity of matters going to arbitration are on the upswing. From provider-payor issues, to licensing disputes, to M&A deals, sophisticated parties elect arbitration with the expectation that they can resolve their differences in confidence with less expense. This article provides practical advice to health care companies on whether to choose to arbitrate, how to draft arbitration agreements and how to conduct arbitrations. It addresses both U.S. and cross-border arbitrations. This article was featured in the March 25, 2012 issue of Health Lawyers Weekly.

Click here to read the full article.

Last Updated on Friday, 15 June 2012 11:14
Alcohol Abuse vs. Dependence: Is it Fraudulent to Knowingly Soft-Pedal a Diagnosis? Print E-mail
Written by M. Alexandra Johnson, FACHE and Wilma N. Torres, CPC   
Sunday, 03 June 2012 00:00

Do you think a provider would chart heart disease for a patient with - say - hypertrophic cardiomyopathy because it's a 'warmer, fuzzier' diagnosis? Or try to scare a patient with metabolic disorder into losing weight by diagnosing her prematurely with diabetes?  You're probably shaking your head in disbelief, yet some providers do just this when it comes to charting dependence on a substance, such as alcohol or other drugs. Their ambivalence leads to documentation of 'use' or 'abuse' as they fear "stigmatizing" the patient with a diagnosis of addiction, and somehow 'use' and 'abuse' seem less negative. 

Clinicians are ethically mandated to use their medical knowledge and judgment to diagnose a patient's condition and then to chart it completely and accurately.  So if our hypothetical provider charts in this fashion, is he, in a sense, committing fraud?  Fraud has several definitions:  deceit, trickery, sharp practice, or breach of confidence, perpetrated for profit or to gain some unfair or dishonest advantage; any deception, trickery, or humbug.

While soft-pedaling a diagnosis hardly results in profit or gain, it is dishonest, and in keeping with the definition above, deceitful. It begs the question of where exactly is the line between accurate reality and a little white lie. Knowingly charting less than accurately is deceptive and fraudulent.

 Click here to read more.

About the authors:  M. Alexandra Johnson, FACHE and Wilma N. Torres, CPC are principals at Coleman Consulting Group. The firm's services include:

-Risk Adjusted Reimbursement (MRA)             
-Coding & Billing
-ICD-10-CM Consulting & Training                   
-EMR/Meaningful Use Attestation
-Credentialing & Contracting

For additional information about the firm or to request a complimentary no-obligation consultation, please call 954.578.3331 or email

Last Updated on Monday, 04 June 2012 08:51
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