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Category Archives: Health Reform

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Healthcare Companies Score Low in Cybersecurity Study

Posted in Health Reform, Practice Management

An article on Businessweek.com today suggests that healthcare companies rank worse than financial institutions, utility companies and even retailers when it comes to cybersecurity.  This is particularly frightening news given the intense focus on healthcare data security under HIPAA for a number of years now.  By now, healthcare companies and providers should be well aware of… Continue Reading

New Tool For HIPAA Security Assessment

Posted in Health Reform, Medicare, Practice Management

This past Friday, the Office of the National Coordinator for Health Information Technology, in collaboration with the HHS Office for Civil Rights and HHS Office of the General Counsel, developed a HIPAA “Security Risk Assessment Tool.”  The Security Risk Assessment Tool is a downloadable program that was developed to assist providers in performing HIPAA security… Continue Reading

Physicians Leaving Private Practice for Hospital Employment but at What Cost?

Posted in Health Reform, Practice Management

There was an interesting article published on nytimes.com over the weekend (see ”New Law’s Demands on Doctors Have Many Seeking a Network“) comparing and contrastng the practice of two primary care physicians, one employed by a hospital and another still in private practice but perhaps concerned about her ability to remain there.   The hospital-employed physician touts the… Continue Reading

Hospital Acquisition of Physician Practices Can Raise Antitrust Concerns

Posted in Health Reform, Practice Management

The recent federal antitrust case of Federal Trade Commission and State of Idaho, Plaintiffs, v. St. Luke’s Health System, Ltd, and Saltzer Medical Group, P.A. highlights an important legal consideration for hospitals looking to acquire medical practices and physicians looking to sell to them.  Notwithstanding arguments of cost savings and increased quality and convenience through… Continue Reading

Medicare Advantage Plans Terminating Physician Participation Without Explanation

Posted in Health Reform, Medicare

In recent months I have had a number of physician clients contact me to tell me that they have unexpectedly been dropped from one or more Medicare Advantage plans with which they have participated with no issue for, in some case, years.  These physicians are left somewhat bewildered because these terminations are being done without cause and without explanation.  A… Continue Reading

Expect System Overload Under Obamacare

Posted in Health Reform

We all witnessed the disastrous rollout of the Healthcare.gov website which crashed almost immediately after going live.  The reason according to the Department of Health and Human Services was the huge demand for access to the insurance exchange.  I expect that the website issues (or many of them anyway) will eventually get fixed, but then… Continue Reading

Consider an Unwind Clause in Hospital-Physician Employment Arrangements

Posted in Health Reform, Practice Management

Hospital-physician acquisition of medical practices continues at a furious pace.  Unfortunately, no one knows for certain whether physician employment by hospitals is the key to better or more cost-effective care.  Moreover, the hospital or the physician in such a transaction may for any number of reasons decide later on that the relationship is less than desirable.  Because… Continue Reading

Physician-Hospital Integration Strategies

Posted in Health Reform, Medicare, Physician Compensation, Practice Management

As the implementation of the federal Affordable Care Act (ACA) continues in fits and starts, healthcare providers are scrambling to best position themselves to accommodate anticipated and developing payment models.  Unfortunately no one really knows what these new payment models will look like or how they will ultimately work.  It is apparent, however, that most… Continue Reading

HIPAA Changes Required by 2013 Omnibus Rule

Posted in Health Reform, Practice Management

Earlier this year, the Department of Health and Human Services (HHS) published the “HIPAA Omnibus Rule,” implementing various provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act as the related to the HIPAA Privacy, Security, and Enforcement Rules.  If you are a “covered entity” or “bsuiness associate” under HIPAA, these new… Continue Reading

FTC Sues to Block Hospital Acquisition of Medical Practice

Posted in Health Reform

Adding an interesting wrinkle to an already complex environment, the Federal Trade Commission filed a suit this month to block an Idaho hospital from acquiring a physician practice.  According to an article on thomsonreuters.com, the FTC and the IDAHO Attorney General have filed an antitrust complaint  seeking to block St. Luke’s Health System’s acquisition of… Continue Reading

Physician Unions – An Unintended Consequence of Health Reform?

Posted in Health Reform

I imagine that few physicians contemplated being part of organized labor when they enrolled in medical school but as more and more physicians make the leap from private practice to hospital employment, perhaps large-scale unionization of the physician workforce could become a reality.  According to an article by David J. Leffell today on WSJ.com, the notion… Continue Reading

The Next Health Care Crisis: Not Enough Physicians

Posted in Health Reform

As the debate regarding healthcare reform rages on, perhaps too often the blame for rising health care costs is pointed at physicians, and as a result, physician reimbursement has historically been an easy target for cost-cutting. Unfortunately, as a recent New York Times article illustrates, in only a few short years, the demand for healthcare… Continue Reading

“Narrow Network” HMOs — An Emerging Trend Worth Watching

Posted in Health Reform

The emergence of narrow network HMO products is a trend worth watching for several reasons: first, it demonstrates that third party payers are aggressively seeking to better manage health care costs and are looking for innovative ways to do so; and, second, it is apparent that as new products are developed, those providers who are integrated (both horizontally and vertically) are most likely to be the players of choice.

Health Insurers Getting into the Doctor Biz

Posted in Health Reform, Practice Management

It’s clear that hospitals and health systems are once again acquiring physician practices in an effort to stabilize their referral networks. However, according to a recent article in the Washington Post, health systems are not the only buyers looking to get into the doctor business. Apparently, a number of large health insurance companies, including United… Continue Reading

October 5, 2010 Accountable Care Organization Workshop Agenda

Posted in Health Reform, Medicare

One of the few true payment reform models built into the health care reform law passed earlier this year is the Accountable Care Organization (ACO). Unfortunately, absent final regulations implementing the ACO model, very little guidance exists for physicians who are interested in pursuing this model. To that end, tomorrow, October 5, 2010, the Federal… Continue Reading

States Look to Expand Role of Nurse Practitioners

Posted in Health Reform

As if physicians didn’t already have enough to worry about, it appears that many states are now contemplating expanding the scope of practice of nurse practitioners.  According to recent AP article, at least 28 states are looking at expanding the scope of services nurse practitioners can provide as a means of addressing the looming shortage of… Continue Reading

The Race to Complete Physician-Owned Hospitals Is On

Posted in Ancillary Services, Health Reform, Medicare

  For physicians in the process of developing physician-owned hospitals, the race is on to get those facilities up and running by December, 2010. The recently enacted “Health Care and Education Affordability Reconciliation Act of 2010” amends the Stark law to once and for all prohibit physician-owned specialty hospitals unless: (1) the hospital has a… Continue Reading

New Requirements on Stark In-Office Ancillary Services

Posted in Ancillary Services, Fraud and Abuse, Health Reform, Medicare

Among its many provisions, the newly signed Patient Protection and Affordable Care Act has imposed a new requirement on physicians who rely on the Stark "In-Office Ancillary Services" exception.  Physicians who refer patients for CT, MRI or PET (or other Stark services as designated by the Secretary of HHS) that will be provided by the referring physician’s practice… Continue Reading

House Quietly Repeals Insurance Anti-trust Exemption

Posted in Health Reform

In what should be welcome news for physicians, yesterday the House of Representatives quietly passed a bill which would repeal a long-standing exemption for insurance companies from federal anti-trust laws.  The exemption left anti-trust enforcement against insurance companies in the hands of the states.  If the Senate approves the legislation, health and malpractice insurance companies… Continue Reading