Western Pennsylvania Healthcare News

Covering healthcare news in the Pittsburgh region and beyond.

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U.S. Physician Practices Spend Four Times As Much As Payer Administrative Money As Canadian Counterparts

by

Mike Cassidy

A commonwealth fund supported studies reported some key findings:

1. Physician practices in the United States spent $82,975.00 per physician per year interacting with payers compared with $22,205.00 in Canada.

  • If U.S. physicians had similar administrative costs to their Canadian counterparts, the total annual savings would be $27.6 billion dollars.
  • U.S. nurses and medical assistants spent 20.6 hours per week on administrative tasks related to health plans, which is nearly 10 times the 2.5 hours spent by Canadian nursing staff.

I have attached a link with a scan of the highlights of the study.

Healthcare Industry Groups Comment on EHR and Health Reform

by

Mike Cassidy

By Mike Cassidy

In two separate letters, one just by the American Hospital Association and one by a consortium of industry groups, AHA, AMA, AMDIS, CHIME, EHRA, FAH and HIMSS, industry has submitted extensive comments to HHS regarding these issues. Comments focus on five areas of opportunity and challenge:

1. Reduce regulatory complexity;
2. Clarify certification and site certification processes;
3. Address meaningful use issues;
4. Clarify and improve the compliance process; and
5. Evaluate/coordinate the overlapping regulatory time line

Although both letters are instructive, the attachments to the AHA letter provide a useful summary of the issues. Attachment A charts the legal barriers to clinical integration, i.e.

  • Antitrust
  • Stark
  • Anti-Kickback
  • Civil money penalties
  • IRS tax exemption issues

Attachment B indicates the complexity of the overlapping requirements for transition to ICD-10, meaningful use, health reform and HIPAA 5010.

Easier Softer ACOs

by

Mike Cassidy

Although the ink is barely dry on the proposed regulations for Accountable Care Organizations (ACOs), there are already harbingers that ACOs may not be the Health Care Reform savior they were intended to be.

First, a study by the American Hospital Association states that the estimate initially made by CMS for the cost of establishing an ACO, which was $1.8 million, is significantly understated.  The AHA has estimated that a 200 bed single hospital system would need $1.6 to create an ACO and that a five hospital system with 1,200 beds would need $26.1 million to create this larger version of the ACO.

Second, CMS is already offering easier softer versions of ACOs, and have issued a press release announcing the following:

Pioneer ACOs:  The Pioneer ACO process is intended to entice existing integrated systems which have already adopted significant care coordination processes to move further and faster into seamless coordinated care by utilizing the new ACO payment methodology.

  • Advanced Payment ACOs:  This model would give certain ACOs participating in the Medicare Shared Savings program access to their shared savings upfront, which is intended to assist with the now presumably greater investment necessary to establish the ACO.
  • Accelerated Development Learning Sessions:  This initiative is a free program funded by CMS to educate providers regarding the ACO process.

For more information or to contact Mike Cassidy, visit his Featured Thought Leader Page on this site.

ACOs and Anti-Trust

by

Mike Cassidy

By Mike Cassidy

In last month’s post entitled “Reform Redux,” I mentioned that one of the foremost issues for the coming year would be the development of Accountable Care Organizations (ACOs).  The two most troublesome issues in developing ACOs will probably be the Anti-Trust and the Anti-Kickback/Stark issues.  Traditionally, this regulatory structure has made it almost impossible for multiple providers to agree in any joint venture to provide health care services:

  • The Anti-Trust laws basically prohibit agreements (affectionately known as conspiracies) among competitors to fix prices, which is evident by the many enforcement actions taken against IPAs, PHOs, etc.
  • The combination of the Stark law prohibiting referrals to entities with which physicians have financial relationships, the Anti-Kickback statutes prohibiting payment in exchange for referrals, and the Civil Money Penalties statute prohibiting incentives to withhold care, basically eliminate any meaningful opportunities to operate as anything other than an integrated delivery system, which operates as a single entity.

[Read more…]

The Practice of Engagement: How a Health Care Attorney Transformed His Practice Through Social Media

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By Daniel Casciato

In June 2007, health care attorney Mike Cassidy of Pittsburgh-based Tucker Arensberg, P.C. (and chair of its health law practice group) decided that blogging would be a more effective communication tool than a typical law firm newsletter. He could keep current clients informed about legal issues affecting the health care industry as well as cultivate new clients.

Until then, Cassidy used newsletters to keep his physician clients advised as to what was happening, such as the change in the Medicare fee schedule in the late 1980s, Stark Law in 1989, and anti-kickback developments.

“They needed this information and they needed to know that I was an expert in all this,” says Cassidy. “So a newsletter served this function well.”

However, Cassidy soon discovered that producing a newsletter was not very efficient. It took a long time to produce and you had to mail it to everyone. When the Internet became more mainstream, he was able to convert his newsletter into a digital format which made it easier to distribute via email. Despite the convenience of email, Cassidy still had to create and design the newsletter, and the production still took just as long.

Blogging changed all that. Now, Cassidy is able to create shorter articles for his readers, post ongoing, timely information, and produce a new article several times a week on his blog, called MedLawBlog.com.

[Read more…]