late-breaking news from your medical association volume XXI / no. 2 FEBRUARY 2014
state Salary Cap Initiative Moving Forward The SEIU-United Healthcare Workers West have enlisted 500 paid signature gatherers to obtain the necessary 500,000 registered voters’ signatures to put the initiative on the state ballot, which would cap hospital prices and the salaries of their top executives.
national ACA: New Federal Standards to Streamline Electronic Payments New federal standards governing how health insurers conduct electronic transactions with physicians will hopefully help reduce administrative hassles. The new rules require health insurers to standardize business practices for electronic funds transfers and electronic remittance advice. The rules, which took effect on January 1st, make it possible for medical practices to automate the process of manually matching payments from insurers with claims that have been submitted. This is a great opportunity for physicians to begin incorporating electronic payments and remits into their practice. CMS estimates only one-third of claim payments across the U.S. currently are transferred electronically. Medicare rules already require physicians to be paid via electronic fund transfers. AMA has developed a toolkit to help physicians take advantage of these changes. Go to www.ama-assn.org and click “Advocacy” on the main menu. Under the Advocacy menu, click “Advocacy Topics.” Then click “Administrative Simplification Initiatives,” “Moving to Electronic Transactions,” then “Electronic Transactions Toolkit.”
DaVita Nearing $389M Settlement Agreement DaVita Healthcare Partners has reached an agreement with the U.S. government that would settle an investigation into whether its relationships with physicians violated the anti-kickback statute. DaVita stated in a release that it expects to finalize the settlement in the coming months with HHS’ inspector general, which launched its investigation in 2010. The inquiries focused on DaVita’s joint ventures with nephrologists to operate dialysis clinics. In addition to the $389 million settlement, DaVita has agreed to unwind a limited number of joint ventures with physicians, either by buying out or selling its stake at fair market value. The deal will likely cover 11 joint ventures that include 28 clinics. More than 70 percent of the company’s dialysis centers are already wholly owned.
Enrollment in ACA Health Insurance Exchanges Since Inception Nearly 3.3 million people selected exchange plans since inception on October 1, 2013. Of the 3.3 million: 55 percent are female and 45 percent are male; 31 percent are age 34 and under; 25 percent are between the ages of 18 and 34; 62 percent selected a Silver Plan and 19 percent selected Bronze; and 82 percent who selected a plan are eligible for Federal assistance. According to HHS, one in four uninsured individuals who are eligible for HIX coverage nationwide are Latino. The majority (62 percent) live in California, Texas, and Florida, and about half are between the ages of 18 and 35.
national (continued) Small Business and the Cost of Health Care According to the National Small Business Association, only 51 percent of the smallest employers offer health benefits, even though they recognize how important this benefit is for recruiting good employees. Among the 70 percent of small firms overall that do offer health insurance, the majority report paying for more than half of the cost. Today the average monthly per-employee cost of health insurance premiums for a small firm is $1,121. When asked in 2009 for the monthly cost of their health benefits package per employee, it was just $590 per month.
Reducing Non-Urgent Emergency Department Visits Saves $$ During a six-month pilot test, one large central Indiana managed health plan reduced non-urgent Emergency Department visits by 53 percent, among members served by nine participating hospitals. Utilizing an “alert” system to provide timely information as to when and where patients receive care, including the ED, the organizations can take proactive steps to address potential problem areas. They simultaneously increased primary care office visits by 68 percent, saving the health plan an estimated $2 to $4 million over the six-month period. Source: www.innovations.ahrq.gov/content.aspx?id=3988.
CFO Charged with Meaningful Use Fraud Joe White, a CFO in Cameron, Texas, was indicted by a federal grant jury on January 22 and charged with making false statements to CMS and aggravated identity theft. According to the indictment, the CFO falsely attested to CMS that Shelby Regional Medical Center met the meaningful use requirements for the 2012 fiscal year. However, Shelby Regional relied on paper records throughout the fiscal year and only minimally used electronic health records. To give the false appearance that the hospital was actually using certified electronic health record technology, White directed Shelby Regional’s software vendor and hospital employees to manually input data from paper records into the electronic health record software, often months after the patient was discharged. In addition White falsely attested to the meaningful use by using another person’s name without consent. As a result of the false attestation, Shelby Regional received $785,655 from the CMS EHR incentive program for 2011 and 2012. If convicted, White faces up to five years in federal prison for making a false statement and up to two years in federal prison for aggravated identify theft. A special agent in charge of the investigation noted that, “as more and more federal dollars are made available to providers to adopt EHR systems, his office expects to see more cases like this one.”
Physicians’ Lawsuit Against UnitedHealthcare Two county medical associations in Connecticut filed a lawsuit this past fall in federal court against UnitedHealthcare, challenging the insurance company’s decision to remove more than 2,000 providers from its Medicare Advantage networks. A preliminary injunction was issued in December by a federal judge, preventing UnitedHealthcare from dropping the doctors. UnitedHealthcare then filed an appeal with the U.S. Circuit Court of Appeals, which was denied. The case is being closely watched across the country as insurers in many markets are seeking to narrow their networks to cut costs as payments for the private Medicare Advantage program are reduced. There is a similar lawsuit pending in New York. The President of the Fairfield County Medical Association argued that UnitedHealthcare’s attempt to eliminate doctors was a backhanded means of trying to avoid the new ACA prohibition on denying care to individuals with pre-existing conditions.
EHR Not Effective Communications Tool Says Healthcare Tech Prentice Tom, MD, an ER physician and the lead speaker at the California HIMSS Innovation and Technology Summit, told the audience that EHR are not effective communications tools. He suggests that EHRs are not structured on how physicians think, and that software in built on a medical student learning platform. People believe doctors have to have this enormous amount of documentation to do what doctors need to do, but Dr. Tom does not believe this is true. He cited an often-quoted study stating that the average physician waits 18 seconds before interrupting a patient because most of the information the patient is providing is not necessary. Dr. Tom observed that the emergency physician looking at a patient’s chief complaint knows 95 percent of the time, within 5 to 10 seconds, what the doctor is going to do with that patient. The rest of the time is spent putting in place the documentation that is required of the physician to do what he or she actually knew he or she wanted to do in the first ten seconds. Medical record documentation is primarily for billing and to have a record in the rare event that there is a risk case. Fear of litigation in the real driver for all documentation. Tom cited a January 2014 study that stated that 40 percent of healthcare dollars spent do nothing to improve patient lives.
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HIE Survey Offers Sobering Results on Value A large survey of health care providers and payers during the last six months of 2013 finds a considerable skepticism regarding the future of health information exchanges. A research firm, Black Book Rankings, polled 1,550 providers and 794 payers using HIE, with 95 percent of payers, 83 percent of hospitals, and 70 percent of physicians responding that publicly-funded HIEs are struggling with flawed business models and are not providing meaningful connectivity. Seventy-two percent of respondents believe that by 2017, there could be as few as ten of the currently functioning public HIEs supported by federal grants that are ending, unless they find better business models, improve their processes, and create ways to encourage participation. The HITECH Act funded more than a half-billion dollars for state HIEs, but 94 percent of surveyed payers don’t see the value proposition in these entities. Nearly all of the payer respondents say public HIEs are struggling to exchange data between payers and providers.
Increase in Fraud Prosecutions During fiscal year 2013 the federal government reported 377 new prosecutions for cases with a charge of Health Care Fraud, up 7.7 percent from five years ago, and up 9.9 percent from ten years ago, according to Trac Reports.
Are You Happy in Your Specialty? According to new data from Medscape’s 2014 Physician Lifestyle Report, dermatologists are the happiest physicians at their jobs, with 53 percent reported being “very” or “extremely” happy at work, followed by ophthalmologists, pathologists, and gastroenterologists. At the bottom of the list of 23 specialties are emergency physicians.
Trends and Drivers of Primary Care Physicians’ Use of EHR The Commonwealth Fund recently released key findings of the rate of adoption of electronic medical records by primary care physicians. It is no surprise that solo physicians lag behind larger primary care practices of 20 or more in the adoption of electronic medical records,, and certain functions, such as electronically exchanging information with other physicians, have been adopted by only a minority of providers. Solo or small group practice size is a major determinant to HIT adoption. Half of physicians in solo practices use EHRs, compared with 90 percent of those in practices of 20 or more physicians. From 2009 to 2012, the rate of adoption of EHR by primary care physicians increased by half, from 46 percent to 69 percent. HIT rose particularly in order entry management: the proportion of physicians able to send prescriptions electronically to pharmacies nearly doubled, from 34 percent to 66 percent, and electronic ordering of lab tests grew from 38 percent to 54 percent. In 2012, 33 percent of primary care physicians could exchange clinical summaries with other doctors and 35 percent could share lab or diagnostic tests with doctors outside their practice, yet only a minority of physicians provided electronic access to patients. Fewer than one-third allowed patients to electronically view test results, make appointments, or request prescription refills.
HIPAA Omnibus Final Rule Compliance Deadline By September 23, hospitals and physicians must comply with the HIPAA omnibus final rule, which strengthens patient privacy protections and provides patients with new rights to their protected health information. Here is a sample of some of the things you need to know: 1) the final rule expands patient rights by allowing them to ask for a copy of their electronic medical record in electronic form; 2) when patients pay out of pocket in full, they can instruct their provider to refrain from sharing information about their treatment with their health plan; same is true with Medicare beneficiaries; and 3) business associate agreements and policies and procedures must address the prohibition on the sale of patients’ PHI without permission. Information on this subject is provided in greater detail on SMCMA’s website, www.smcma.org, under the section on Practice Management Resources.
medicare Deadline for Attestations for Medicare Meaningful Use 2013 Extended CMS announced that the original planned date by which all physicians who are attesting for Medicare Meaningful Use in 2013 has been extended from February 28, 2014 to March 31, 2014. CMS delayed the date because the attestation system has been experiencing a number of problems. Physicians who are seeking to attest should visit CMS registration and attestation system at www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html.
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medicare (continued) ICD-10 Costs Higher than Previously Estimated New research by an AMA-funded report updates the widely quoted 2008 cost estimates of $83,290 for small practices, $285,195 for medium-sized practices, and more than $2.7 million for large ones. The new research estimates range from $56,639 to $226,105 for small practices; $213,364 to $824,735 for medium-sized practices; and $2 million to more than $8 million for large practices. A major element in the cost is the vendor/software upgrade category, the authors concluded. Practices fortunate enough to have no cost associated with a software upgrade, perhaps around one-third, will see their costs toward the lower end of the range. The AMA and the Medical Group Managers Association have both been pushing back on the October 1 implementation date, hoping for another delay.
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