Header graphic for print
Physician Law Current news, updates, & useful tips relating to legal issues affecting physicians & non-institutional providers in their personal & professional lives

Category Archives: Health Reform

Subscribe to Health Reform RSS Feed

The Switch to ICD-10

Posted in Billing & Reimbursement, Health Reform, Medicare, Practice Management, Reimbursement

The long-anticipated implementation of ICD-10 coding finally began this past Thursday, October 1, 2015.  As of that date, government and commercial payors ceased to accept claims under the old coding system (ICD-9).  The transition has been five years in the making due to a government delay in 2012. The new system has five times the… Continue Reading

Are the Days of Private Medical Practice Over?

Posted in Health Reform

According to a recent study published by Accenture, only 1 in 3 physicians will be in independent private medical practice by 2016.  What’s killing the private medical office?  No surprise there —  according to the study, physicians cite reimbursement pressure and practice overhead as key factors driving them to hospital employment.  Access the Accenture Report… Continue Reading

Physicians Go On Strike

Posted in Health Reform

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

HHS to Shift 90% of Fee-For Service Payments to Performance-Based Payments by 2018

Posted in Billing & Reimbursement, Health Reform, Medicare

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

Study Finds That Many Hospitals Are Losing Money On Physician Networks

Posted in Health Reform, Practice Management

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

HHS Cost Data Transparency Perhaps Not So Transparent

Posted in Health Reform, Medicare

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

Physicians Can Review and Correct Reported Data under the Sunshine Act

Posted in Health Reform, Medicare

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

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