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
The drive for reduced costs and increased quality in the delivery of healthcare is an almost universally held goal among those in the industry. However, there seems to be little consensus and much confusion over the best model for achieving these improvements. One model believed by some to be able to address both of these… Continue Reading
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
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
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
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
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
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
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
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
Concierge medical practice
With the emphasis placed on primary care under the federal Affordable Care Act, what will the federal government need to do to entice the best and the brightest to go into primary care?
It is apparent from recent enforcement activity that the Federal Trade Commission (FTC) is keeping a wary eye on physician/hospital integration.
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
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.
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
The health reform law (PPACA) requires referring physicians who provide in-office MRI, CT or PET services to inform a patient in writing at the time of the referral that the patient may obtain the service from an alternative source and provide a list of suppliers who furnish the service in the area in which the patient… Continue Reading
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
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
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
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
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
In anticipation of a much publicized bipartisan meeting with representatives of Congress, President Obama released today a comprehensive health plan which seeks to combine the House and the Senate health care bills. The President’s proposal, which can be read on the Whitehouse.gov website, would not include a public option but would include, among a lot… Continue Reading
In a 2008 report, the the Congressional Budget Office estimated that the savings from tort reform would amount to only about $4 Billion over the period from 2010 to 2019. However, acording to a letter dated December 10, 2009 to Senator Rockefeller, the CBO’s original estimate failed to take into consideration that tort reform would result in… Continue Reading