quality or cost mitigation strengths to grab a piece of the health care reform pie. Look for large reference lab companies to run labs in hospitals, outpatient facilities and large specialty practices, because these entities focus on core practice issues yet shed responsibility for services that can be better managed by business associates. Skilled nursing facilities will bond together to manage patients who do not meet acuity standards to remain hospitalized. The new focus will be on how to manage outcomes in the most cost-effective manner, which creates limitless opportunities for health care providers that are determined to be part of the solution to managing care outcomes, not just charging per service.
CPA Practice Opportunities
While the aforementioned seems daunting, there are numerous opportunities for health care accountants to assist their clients in developing relationships, staying compliant with current laws and regulations, and advising them on business development initiatives. Key opportunities include: • Fraud prevention and forensic services engagements will continue to increase as government and commercial payors continue to develop medical necessity and billing audits. CPAs can work on both sides of this transaction.
NJ Physician Age Breakdown Under 35........................ 5% 35-44...........................26% 45-54...........................33% 55-64........................... 24% 65+...............................12%
However, be wary if you’re engaged in compliance testing on behalf of a government program or other payors, as it may harm your relationships with the provider community. In these instances, a firm with a large provider clientele may seek to perform compliance testing on behalf of the provider community only. The ACA has bulked up pre-existing compliance requirements. Your health care clients certainly don’t need treble damages, nonparticipation in insurance programs and potential severe penalties. Accountants have the computerized audit tools to evaluate billing pattern trends that can help clients maintain an effective compliance program. Also, protect your work with the attorney-client privilege. • Information technology (IT) is a huge growth market for firms with an IT assurance practice. Meaningful use payments have been used by the government as an incentive to deploy electronic medical records and billing systems. The first hurdle of meaningful use was easy to clear, the following ones not so much. The downside is that if any provider certifies it met those hurdles and has not, it is subject to incentive payment recoupment. Many providers will be looking for external validation that their incentives are earned and, conversely, the federal government will be looking for external audit sources to assure the same. • Another key IT opportunity exists for those firms that have experience in system intrusion and security N E W J E R S E Y C P A • j u ly • a u g u s t 2 0 1 4
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engagements. HIPAA privacy and security regulations provide for heavy fines and mitigation costs of improper disclosure of personal health or financial information. Since many providers have both of these exposures, it would help them sleep better at night knowing that an external source has tested both personnel and system issues related to data safeguards. • Consulting services will continue to abound as providers transition into health care reform. While some services might require firms to partner with outside experts, such as coders, billing experts, actuaries and lawyers, many will not. Expect clients to be nervous about bottom-line buying decisions related to diagnostic service equipment purchases, outsourcing of non-key services and other cost drivers that encourage more frugal use of care. Modeling of acuity changes and practice variations and estimating their impacts will be key to those charged with governance. The preceding ideas are certainly not exhaustive. Stay on top of the Office of Inspector General’s Work Plan and other key information sources to keep your firm positioned for new developments in the rapidly changing health care environment. Lewis D. Bivona Jr., CPA, AFE, is president of Professional Medical Management Consultants. He is a member of the New Jersey Society of CPAs Health Care Interest Group. Contact him at lewcpa@gmail.com.