Many physicians are aware of the push by the Medicare program to move away from a fee for service physician payment model to one which recognizes higher quality and lower cost care. However, few physicians have a good understanding of how such payment models would work and how their practices would fair under them. This… Continue Reading
According to various news outlets, physicians at the University of California student health centers (as many as 150 physicians in all) went on strike this week in protest of what they believe are unfair labor practices by the University. These physicians are members of the Union of American Physicians and Dentists. The protest stems from… Continue Reading
Yesterday the Secretary of the Department of Health and Human Services (HHS) formally announced HHS’ intention to shift 90% of all traditional Medicare payments from fee-for-service (FFS) to quality or value-based payments by 2018. The secretary announced that HHS’ goal is to have 30% of traditional FFS payments tied to quality or value in 2016,… Continue Reading
In news that may not come as a shock to those of us who have been through the cycle of hospitals purchasing physician practices before, a recent study has found that hospitals are losing considerable amounts of money on acquired physician practices. According to the study, 92% of reporting hospital CEOs state that they are… Continue Reading
Despite the Department of Health and Human Services’ intent to make Medicare healthcare cost data more transparent for the healthcare consumer, according to a recent report by the U.S. Government Accountability Office, current Medicare cost data, and the manner in which it is being provided, are largely ineffective in enabling consumers to make informed healthcare decisions. … Continue Reading
Many physicians recently received a notice from the Centers for Medicare and Medicaid Services (CMS) notifying them of the opportunity to register with the CMS “Open Payments” system and review financial data reported about them by drug and device manufacturers under the federal Physician Payments Sunshine Act (“Sunshine Act”). This had led to some confusion… Continue Reading
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
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
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