Monday, September 14, 2009
Free-Standing ERs Licensed in Texas Soon
The 2009 Texas Legislature passed a new law (HB 1357) that will regulate free-standing ERs in Texas. It's hard to tell how many there are, but it appears that there are about 40 free-standing ERs in Texas. Also, it's important to not confuse these with the walk-in retail clinics (CVS, etc.).
The licensing of free-standing ERs in Texas will begin in September 2010. The regulators are in the process of drafting regulatory measures.
Some of the key issues include:
* Whether or not you can have two different types of facilities licensed at the same address (you can't currently do that under Texas law). But there are probably a few health care facilities that would like to add a free-standing ER to their building.
* Another big question is what should the credentials of the physicians at the ERs be. Currently, a physician does not have to have special emergency medicine credentials to work in a free-standing ER (or even in a hospital ER).
* Pediatric credentials for an RN will be a big measure that needs to be addressed. (Should a nurse with pediatric emergency credentials be in the facility at all times?)
* Perhaps the most interesting issue that will have to be addressed involves that of laboratory services. The proposed rules suggest three types of labs: waiver, moderate, and high-end. The latter two require strong credentials for the lab director (MD or PHD and additional training). The question in this case ultimately becomes: What will lab services look like in a few years? Should the government prescribe a lot of standards now and then turn around and those standards will be out-of-date in a few years?
Thursday, September 10, 2009
New Medicare Physician Fee Schedule & Cardiologists
CMS is expected to release its final rule for the 2010 physician fee schedule on November 1, 2009. They gave us a preview of what it could look like earlier this summer. The big story is that it could result in large cuts for specialties and increase payments to primary care physicians.
Those specialties that have a strong emphasis on imaging could see the biggest cuts. In particular, cardiologists could be hit hard.
Here's a look at what the proposed rule could mean for cardiologists:
Practice Expense (PE)
CMS has proposed incorporating the AMA's Physician Practice Information Survey (PPIS) to update the practice expense component of physician fees. This could result in a 10 percent decrease in PE RVU changes (leading to a grand total of a negative 11 percent combined impact on cardiology in the 2010 physician payment fee schedule). Other specialties fare better: anesthesia, family practice and ophthalmology would see increases.
Potential Cuts to Cardiology:
- 42 percent Transthoracic Echo Proposed Cuts
- 24 percent Left Heart Catheterization Proposed Cuts
- 21 percent ECG Payment Proposed Cuts
- 40 percent Technical Component of CT, MR and IMRT Proposed Cuts
- 11 percent Proposed Increase for Office Visits (Level 4 Established Patient Office Visit - 99214)
Consultation Codes
The proposal would stop payments for consultation codes and use existing E/M service codes. CMS claims that the "savings" would be re-distributed to E/M service codes.
Equipment Utilization: 50 percent to 90 percent
CMS proposes to adopt MedPAC's recommendation regarding medical equipment that costs more than $1 million. It would be assumed that the equipment is being used 90 percent of the time that the office is open (as opposed to the current 50 percent).
Other interesting aspects include the idea of separating administered drugs from the physician fee schedule. Physicians will also face a massive cut of over 20 percent if the SGR formula is not updated.
Those specialties that have a strong emphasis on imaging could see the biggest cuts. In particular, cardiologists could be hit hard.
Here's a look at what the proposed rule could mean for cardiologists:
Practice Expense (PE)
CMS has proposed incorporating the AMA's Physician Practice Information Survey (PPIS) to update the practice expense component of physician fees. This could result in a 10 percent decrease in PE RVU changes (leading to a grand total of a negative 11 percent combined impact on cardiology in the 2010 physician payment fee schedule). Other specialties fare better: anesthesia, family practice and ophthalmology would see increases.
Potential Cuts to Cardiology:
- 42 percent Transthoracic Echo Proposed Cuts
- 24 percent Left Heart Catheterization Proposed Cuts
- 21 percent ECG Payment Proposed Cuts
- 40 percent Technical Component of CT, MR and IMRT Proposed Cuts
- 11 percent Proposed Increase for Office Visits (Level 4 Established Patient Office Visit - 99214)
Consultation Codes
The proposal would stop payments for consultation codes and use existing E/M service codes. CMS claims that the "savings" would be re-distributed to E/M service codes.
Equipment Utilization: 50 percent to 90 percent
CMS proposes to adopt MedPAC's recommendation regarding medical equipment that costs more than $1 million. It would be assumed that the equipment is being used 90 percent of the time that the office is open (as opposed to the current 50 percent).
Other interesting aspects include the idea of separating administered drugs from the physician fee schedule. Physicians will also face a massive cut of over 20 percent if the SGR formula is not updated.
Red Flag Rules Enforcement Pushed Back Again
Red Flag Rules
By Brant Crouch and Jason Lavender
We've all heard a horror story about identity theft - or perhaps you have been a victim yourself. But did you know that you (individually) and your hospital could be found guilty of stealing someone else's identity without even knowing that you did it? You read correctly. Any institution or individual who HANDLES personal non-public information is at risk of breaking new Federal and State Identity Theft Legislation. Non-compliance carries strong consequences such as fines, criminal and civil litigation and up to 10 years in prison.
This article focuses on one particular area known as the Red Flag Regulations. Enforcement has been delayed until May 1, 2009. In late 2007, the Federal Trade Commission ("FTC") issued sweeping regulations aimed at deterring, detecting and preventing identity theft. Under these rules, known as the Red Flag Regulations, 16 C.F.R. § 681.1 et seq. and Final Rule ("Red Flag Regulations") financial institutions and creditors of covered accounts must establish a program to detect, prevent and mitigate identity theft. For more information go to http://www.ftc.gov/bcp/edu/pubs/articles/art11.shtm.
Most health care providers fall under the regulation due to its definition of Creditor. It applies to personal accounts that are paid after the service is rendered or if the service is intended to be paid in installments. Most health care accounts or charges are not paid in advance of service. However, even if a provider generally provides care on a pre-paid basis, accepting patient payments plus insurance payments amounts to a multiple payment account would make the provider subject to the Red Flag regulations. It's important to note that the American Medical Association (AMA) and several other healthcare associations are making efforts to get the FTC to remove health care providers from the definition of Creditor. However, it appears that the FTC will continue to broaden the scope of who will need to comply versus narrowing it. In a February 4, 2009 response to the AMA, the FTC specifically addressed this issue by reinforcing that providers will not be excluded and cites several reasons why. To obtain a copy of this letter or more information you may email the authors of this article.
So now what can health care providers do to get in compliance as quick as possible and most cost effectively? Much of what needs to be done to comply can be done internally using your own staff. Many compliance plan templates are available for free and some at a nominal cost. However, the multiple steps required to comply fully with the regulation involve employee training for ALL staff, third party vendor notification, and possibly more heavy lifting. One option is to utilize an outside resource to assist in providing the employee training. TPHAC has a resource available to all members that provides these services at no cost.
Many medical facilities around the country have taken pro-active measures to ensure that they protect and educate their own staff and the public they serve by enforcing a solid privacy policy as one way to minimize internal risks. One CEO said, "We take pride in the fact that we are taking the reasonable steps necessary to protect our staff, patients and private records. Our employees have found significant value in the Identity Theft awareness training and related employee benefits we now provide."
One of the leading publications for business legal issues, Business & Legal Reports, writes:
"One solution that provides an affirmative defense against potential fines, fees, and lawsuits is to offer some sort of identity theft protection as an employee benefit. An employer can choose whether or not to pay for this benefit. The key is to make the protection available, and have a mandatory employee meeting on identity theft and the protection you are making available, similar to what most employers do for health insurance."
John Gardner, a former member of the South Carolina House of representatives and 23-year veteran attorney explains that, "The government says that an institution must have four things: a written privacy policy, someone to oversee that policy, training for your employees on the true problem of identity theft, and a mitigation plan in place."
Many health care providers either don't know about these laws or falsely believe that they are exempt from them. Some state governments like Texas have taken the aggressive approach of sending investigators out to businesses to look for violations.
"Identity theft is one of the fastest growing crimes in the United States," Attorney General Greg Abbott said. "Texans expect their personal information to be protected. The Office of the Attorney General will take all necessary steps to ensure that consumers are protected from identity thieves." And they have; making examples of many companies from large ones like Radio Shack and EZ Corp, to smaller businesses like modeling agencies and beauty colleges.
While there's no doubt that health care providers simply do not need any more government compliance headaches, it's clear that when it comes to identity theft there will be no letting up. The AMA will continue to contest this issue with the FTC. In the meantime, it is important to take immediate steps regarding compliance and providing identity theft protection to your patients and employees might be the best way to address these challenges.
Brant Couch, CPA and Vice President with HealthSure, Inc. is located in Austin,Texas. He can be reached at 512-292-3315 or brantc@healthsure.com.
Jason Lavender, Managing Partner & Certified Identity Theft Risk Management Specialist with ID Theft Solutions of America, is located in Austin, Texas. He can be reached at 512-514-6598 or jlavender@idtsoa.com.
By Brant Crouch and Jason Lavender
We've all heard a horror story about identity theft - or perhaps you have been a victim yourself. But did you know that you (individually) and your hospital could be found guilty of stealing someone else's identity without even knowing that you did it? You read correctly. Any institution or individual who HANDLES personal non-public information is at risk of breaking new Federal and State Identity Theft Legislation. Non-compliance carries strong consequences such as fines, criminal and civil litigation and up to 10 years in prison.
This article focuses on one particular area known as the Red Flag Regulations. Enforcement has been delayed until May 1, 2009. In late 2007, the Federal Trade Commission ("FTC") issued sweeping regulations aimed at deterring, detecting and preventing identity theft. Under these rules, known as the Red Flag Regulations, 16 C.F.R. § 681.1 et seq. and Final Rule ("Red Flag Regulations") financial institutions and creditors of covered accounts must establish a program to detect, prevent and mitigate identity theft. For more information go to http://www.ftc.gov/bcp/edu/
Most health care providers fall under the regulation due to its definition of Creditor. It applies to personal accounts that are paid after the service is rendered or if the service is intended to be paid in installments. Most health care accounts or charges are not paid in advance of service. However, even if a provider generally provides care on a pre-paid basis, accepting patient payments plus insurance payments amounts to a multiple payment account would make the provider subject to the Red Flag regulations. It's important to note that the American Medical Association (AMA) and several other healthcare associations are making efforts to get the FTC to remove health care providers from the definition of Creditor. However, it appears that the FTC will continue to broaden the scope of who will need to comply versus narrowing it. In a February 4, 2009 response to the AMA, the FTC specifically addressed this issue by reinforcing that providers will not be excluded and cites several reasons why. To obtain a copy of this letter or more information you may email the authors of this article.
So now what can health care providers do to get in compliance as quick as possible and most cost effectively? Much of what needs to be done to comply can be done internally using your own staff. Many compliance plan templates are available for free and some at a nominal cost. However, the multiple steps required to comply fully with the regulation involve employee training for ALL staff, third party vendor notification, and possibly more heavy lifting. One option is to utilize an outside resource to assist in providing the employee training. TPHAC has a resource available to all members that provides these services at no cost.
Many medical facilities around the country have taken pro-active measures to ensure that they protect and educate their own staff and the public they serve by enforcing a solid privacy policy as one way to minimize internal risks. One CEO said, "We take pride in the fact that we are taking the reasonable steps necessary to protect our staff, patients and private records. Our employees have found significant value in the Identity Theft awareness training and related employee benefits we now provide."
One of the leading publications for business legal issues, Business & Legal Reports, writes:
"One solution that provides an affirmative defense against potential fines, fees, and lawsuits is to offer some sort of identity theft protection as an employee benefit. An employer can choose whether or not to pay for this benefit. The key is to make the protection available, and have a mandatory employee meeting on identity theft and the protection you are making available, similar to what most employers do for health insurance."
John Gardner, a former member of the South Carolina House of representatives and 23-year veteran attorney explains that, "The government says that an institution must have four things: a written privacy policy, someone to oversee that policy, training for your employees on the true problem of identity theft, and a mitigation plan in place."
Many health care providers either don't know about these laws or falsely believe that they are exempt from them. Some state governments like Texas have taken the aggressive approach of sending investigators out to businesses to look for violations.
"Identity theft is one of the fastest growing crimes in the United States," Attorney General Greg Abbott said. "Texans expect their personal information to be protected. The Office of the Attorney General will take all necessary steps to ensure that consumers are protected from identity thieves." And they have; making examples of many companies from large ones like Radio Shack and EZ Corp, to smaller businesses like modeling agencies and beauty colleges.
While there's no doubt that health care providers simply do not need any more government compliance headaches, it's clear that when it comes to identity theft there will be no letting up. The AMA will continue to contest this issue with the FTC. In the meantime, it is important to take immediate steps regarding compliance and providing identity theft protection to your patients and employees might be the best way to address these challenges.
Brant Couch, CPA and Vice President with HealthSure, Inc. is located in Austin,Texas. He can be reached at 512-292-3315 or brantc@healthsure.com.
Jason Lavender, Managing Partner & Certified Identity Theft Risk Management Specialist with ID Theft Solutions of America, is located in Austin, Texas. He can be reached at 512-514-6598 or jlavender@idtsoa.com.
Wednesday, September 9, 2009
Hospital-Acquired Infection Policy Change Makes Little Impact on Medicare
CMS recently created a new policy in which it would penalize health care facilities for the extra costs of treating hospital-acquired infections. Today's Wall Street Journal (09/09/09) found that it might not make a difference:
"The government won't save much from Medicare's year-old policy of refusing to pay hospitals' extra costs to treat hospital-acquired infections and injuries such as bedsores, a new study concludes. Medicare adopted the policy last year with the goal of saving lives and cutting costs. Each year, about 1.7 million Americans acquire infections while in the hospital, and 99,000 of them die, according to the federal Centers for Disease Control and Prevention. Medicare . . . stopped paying the extra costs of treating 10 hospital injuries and infections beginning Oct. 1, 2008"
The state of Texas is following Medicare's lead and passed legislation in the 2009 Legislature that would require state-run programs (for example, Medicaid) to adopt a similar policy. However, it is not clear when this will go into effect considering the fact that money was not appropriated to enforce this policy.
"The government won't save much from Medicare's year-old policy of refusing to pay hospitals' extra costs to treat hospital-acquired infections and injuries such as bedsores, a new study concludes. Medicare adopted the policy last year with the goal of saving lives and cutting costs. Each year, about 1.7 million Americans acquire infections while in the hospital, and 99,000 of them die, according to the federal Centers for Disease Control and Prevention. Medicare . . . stopped paying the extra costs of treating 10 hospital injuries and infections beginning Oct. 1, 2008"
The state of Texas is following Medicare's lead and passed legislation in the 2009 Legislature that would require state-run programs (for example, Medicaid) to adopt a similar policy. However, it is not clear when this will go into effect considering the fact that money was not appropriated to enforce this policy.
Friday, September 4, 2009
House Bill 2256 - Facility-Based Physician Disclosure
House Bill 2256 is a new law that requires Texas health care facilities to disclose to their patients that facility-based physicians may be out-of-network. And it also sets up a mediation process as well.
The new law also places the burden on the facility-based physician as well. A facility-based physician who bills a patient covered by a PPO or HMO and does not have a contract with the patient's plan is required to send a notice to the patient regarding the mediation process that is available.
The new law also places the burden on the facility-based physician as well. A facility-based physician who bills a patient covered by a PPO or HMO and does not have a contract with the patient's plan is required to send a notice to the patient regarding the mediation process that is available.
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