2010 Akerman Senterfitt All rights reserved Prior results do not guara - PDF document

1 2010 Akerman Senterfitt. All rights rese
2010 Akerman Senterfitt. All rights reserved. Prior results do not guarantee a similar outcome. akerman.com {M2917467;1} 2010 Akerman Senterfitt. All rights reserved. Prior results do not guarantee a similar outcome. akerman.com Responding to Reduced Reimbursement How to Combat Industry Changes and Reductions in Medicare Reimbursement For further information please contact: Marshall R. Burack, Shareholder, Healthcare Practice 305.982.5603 tel marshall.burack@akerman.com email 5 Sell practice and/or become an emFind other sources of revenueApply for stimulus money for electronic health recordsForm or join a large

2 practice groupContract with managed car
practice groupContract with managed care orgaEstablish a concierge practiceForm or join an Independent Practice Association ("IPA") 4 with requests from Medicare, Medicaid and managed care organizations (e.g. demand for recordsAdditional staff required to deal with payors (e.g. pre-authorizations, wait times and special requests)Increase in costs of regulatory compliance (e.g. fraud and abuseand Stark)Increased cost of living affectinbenefits and malpractice)Costs for technology initiatives(e.g.electronic health records, insurance verification via the web, and other e-initiatives) 3 Patients deferring routine medical care Decrease in ele

3 ctive proceduresDecrease in patients wit
ctive proceduresDecrease in patients with insurance Slower collection of monies due from patientstion resulting in overall reduction in provider reimbursement 2 Medicare and Medicaidcare physician reimbursementMedicaid reform and elimination of MediPassManaged Care Organizations, Health Insurers and other Third Party ted to reductions in Medicare Increase in co-pays and deductibles payments if physicians do notconvert to electronic and portable health care records within 5 years Current State of the MarketJ. Everett Wilson akerman.com 10 JACKSONVILLELOS ANGELESMADISONNEW YORKTALLAHASSEETYSONS CORNER 9 ITS A NEW WORLD!Questions? I But wh

4 at is it going to cost me to get my cost
at is it going to cost me to get my cost me to get my Stimulus Money?Stimulus Money? I need I need incentivesincentivesto go digital!to go digital!RalphLosey@Akerman.com 8 Medicare Pays 75% Premium Until Yearly Cap is ReachedITS A NEW WORLD! $44,000 Per Professional$18,000 + $12,000 + $8,000 + $4,000 + $2,000 7 Bill at least $25,000 per yearMedicare or Medicaid Providers. defined as physicians, dentists, Includes physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, clinical social workers, psychologists, registered dietitians or 6 Penalties begin in 2015 Certified as meaningf

5 ul usersŽeven if they have purchased cer
ul usersŽeven if they have purchased certified software/hardware. 5 HITECHAct: IncentivesProfessionals can earn up to $44,000 from Medicare, or $64,000 from Medicaid, over Stimulus Payments begin in 2011, but requires planning now. MEANINGFUL USEŽCertification Criteria will be a rising tideŽafter 2012.Draft Regulations for Meaningful Use certifications are 556 pagesFYI -Hospitals can earn from $5 Million to First Adopters Will Benefit The Most (Sliding 4 +$2.0 billion-$18.5 billion=$19.5 billionPhysician and Hospital IncentivesBonuses from Medicare/Medicaid For Meaningful Use of EHRSavings Through Improved Efficiencies, Tax Revenues

6 , and Health Information Technology for
, and Health Information Technology for Economic and Clinical Health Act HITECH ACTPart of the Economic Stimulus Plan: American Recovery and Reinvestment Act of 2009 (A.R.R.A) $787 BillionAlso includes HIPAA-2 provisions 3 DO NOTHING and make even less money in CHANGE YOUR PRACTICE to stop taking any Medicare or Medicaid.PROCRASTINATE until 2015, and if it is still START TO CHANGE NOW and qualify for Government Incentive Paymentsunder less stringent standards. 2 It is now government policy for all health care records to be computerized and portable in If you do not comply, then by law in 2015 your Medicare and Medicaid payments will IT

7 S A NEW WORLD!Ralph Losey akerman.com 20
S A NEW WORLD!Ralph Losey akerman.com 2009 HITECHStimulus LawShareholder, Chair of Akermans Electronic Discovery and IT Law DepartmentAdjunct Professor, University of Florida, School of LawAuthor of three books and numerous articles on electronic records and e-discovery 7 JACKSONVILLELOS ANGELESMADISONNEW YORKTALLAHASSEETYSONS CORNER 6 Select IT hardware and softwareEngage a qualifiedattorney 5 Regulatory RequirementsBilling under a since with predetermined methodsFurnished or supervised by a member of the groupBilled under the group's billing numberProfits may not be distributed based on referrals 4 INADEQUATE PHYSICIAN LEADERSHIPCost o

8 f regulatory mandates for capitatedpatie
f regulatory mandates for capitatedpatientsFailure to manage costs for capitatedpatientsFailure of other groupsConflicts between primary carINADEQUATE BILLING AND COLLECTION SYSTEMS 3 LEVERAGE WITH HEALTH PLANSLeverage with hospitalsPROFIT FROM ANCILLARY SERVICESQuality of care 2 Nearly 50% of physicians work in a 1 or 2 physician practicepractice with 10 or more physicianstively Recent InnovationMayo Clinic …1880'sMost early group practices in rural areas Formation of a Large Practice GroupMarshall Burack akerman.com 7 JACKSONVILLELOS ANGELESMADISONNEW YORKTALLAHASSEETYSONS CORNER 6 Start Non-Risk Until You Understand the Difference betw

9 een FFS Mentality and Managed Care Menta
een FFS Mentality and Managed Care MentalityMake Sure that You KeepBeware of Reserve Fund AccountingRisk Benefit for Well Managed Practice $50 to $200 PMPM or for Practice with 350 Members $210K to $840K per year. 5 Family Medicine/Primary CareCardiologist 4 Medicare Managed Care FFS (PER PATIENT) MAP (PER PATIENT) INITIAL VISIT REIMBURSEMENT $220 FOLLOW UP VISITS REIMBURSEMENT $60 AVERAGE VISIT PER YEAR 3.5 RSEMENT PER MONTH $100 -$140 TOTAL YEARLY REVENUE PER PATIENT $210 -$430 $1200 -$1680 TOTAL YEARLY REVENUE $150,000 $420,000 -$588,000 3 Must Follow Managed Care Protocols 2 NO COST TO PHYSICIAN (e.g., no or lower copays, no or lower

10 deductibles, wellness, vision, and fitn
deductibles, wellness, vision, and fitness benefits as well as access to discHMO ADMISSION TEAM ACCESSIBLE TO PHYSICIANINCREASED REIMBURSEMENT Medicare Managed CareGary Matzner akerman.com 7 JACKSONVILLELOS ANGELESMADISONNEW YORKTALLAHASSEETYSONS CORNER 6 Concierge Medicine …New TwistsDiscount medical plan (FS 636.202) means in exchange for fees, dues or charges, the plan provides access for members to providers of medical services and the right to receive medical services from those providers at A Physician who provides discounts to his or her own patients isAllows a Physician to provide a combination of non-covered services and concie

11 rge amenities to Physician's own patient
rge amenities to Physician's own patientsScreening Tests, BMR, or CIMT. 5 Concierge Medicine …New TwistsHybrid PlanCombines Concierge and Traditional Into One PracticeContinue to See All Patients …Does not Force Patients to find a new Limit concierge Membership …set aside portion of each day.Example 200 Members @ $1,500 = $300K additional revenue 4 Concierge Medicine …New TwistsMedicareAnti-kickback, can't offer remuneration to induce joining, amenities must be fair market valueBreach of contract which provides that MCOpayment is payment in Providing services for fixed prepaid fee may be considered a Managed 3 Concierge Medicine …New Twi

12 sts…Florida BasedExecutive Physical, Acc
sts…Florida BasedExecutive Physical, Access to Top MDs and Hospitals around the country, Quick Access 600 patients per MD…Seattle Based …Original Concierge companyPCP …50 families per PhysicianNo Insurance accepted …Same day appointments …Spa-type amenities. Annual fee range $14-20KFranchise for $75K + 5% licensing/royalty 2 Concierge Medicine …New Twistscine or Retainer PracticePatients pay Physician annual retainer fees of $50 to $20,000, Typical In exchange for guaranteed heightened access to health care services May include: Executive Physical, 24/7 Access to Pager, Cell, or to Physician on secure website, Next day appointments, Exte

13 nded time with Limited number of patient
nded time with Limited number of patients ConciergeNew TwistsGary Matzner akerman.com 10 JACKSONVILLELOS ANGELESMADISONNEW YORKTALLAHASSEETYSONS CORNER 9 IPAs are a friendly and unobtrusive way for physicians and physician groups to explore the benefits of a larger organization to improve contracts with MCOs and to increase reimbursement rates. Many MCOs desire the efficiencies of being able to contract withmany physicians Through their group purchasing power, IPAs can be used to provide other benefits better rates for malpractThere are cons to IPAs: the Antitrust Laws and limitations to the messenger model; no control over physician me

14 mbers; no structure and limited leadersh
mbers; no structure and limited leadership; limited staff and professional assistance; free riders; competition with othermembers; members d members contracting separately from the IPA.IPAs can be an initial step in a physician's exploration of establishing or joining a large fully integrated group practice. 8 Many IPAs neither share financial risk nor are clinically integrated. Nonintegrated/non ate price terms directly with MCOs."Messenger Model" provides an alternative methodology for these IPAs to deal with IPAs can engage a messenger (unaffiliated with any member physician) who will distribute to all members information from an MCO.

15 The Messenger can gather fee requirement
The Messenger can gather fee requirements from members (cannot disclose to other IPA members) and share requirements with MCOs and the number of providers available at a certain rates.The Messenger can negotiate rates with MCOs but can disclose to members the revised contract rates from the MCO and certain other information. The Messenger, under certain circumstances, can be empowered to sign on behalf of members who accept the MCO's rates/contracts. 7 IPAs That Share Financial Risk Or Are Clinically Integrated WillIPAs can share financial risk by providing services at a capitated rate or at a By providing financial incentives (and disi

16 ncentives) to their members based on qua
ncentives) to their members based on quality, utilization, and cost containment goals.By providing complex or extended treatment regimens that requiresubstantial fee or all inclusive rate.The physician members can share with each other specific rate and procedure Based on this information and the shared financial risk, the IPAcan negotiate directly with the MCO on behalf of its physician members to achieve uniform contractual reimbursement rates. 6 DOJ and FTC understand the imbalance in the bargaining power Os and agree that certain pro- with a more level playing field. The DOJ and FTC have published certain guidelines or "Statements" i

17 n order, among other things, to help gui
n order, among other things, to help guide the operations of IPAs to avoid violating the Antitrust Laws. What are the pro-and anAre the anti-competitive effects ba 5 THERE ARE SEVERE CRIMINAL AND CIVIL PENALTIES FOR VIOLATING THE of the complaint of an MCO, where agents from the DOJ and FTC have investigated an IPA and interviewed its 4 The Antitrust Laws have many layers and are quite complicated, but the basic thing to remember is that they prohibit competitors from agreeing to fix prices, to divide up the market they compete in,to Because IPAs are formed to facilitate contractual relationships between their physician members and MCO

18 s, they are subject to the Antitrust Law
s, they are subject to the Antitrust Laws. How the Antitrust Laws apply to an IPA depend in part on the characteristics of the IPA (e.g., how independent and non-integrated are its members, is the IPA exclusive or non-exclusive, do members In most cases, the Antitrust Laws will impose significant limitations 3 An IPA provides a platform for combining a number of independentphysicians and tiate more effectively with MCOs. In an IPA, there is the very limited inteices of its members.An IPA represents its physician members in dealing with MCOs, while its members maintain their practice independence, and the IPA exerts little or no control

19 over how its An IPA can be open to prima
over how its An IPA can be open to primary care physicians and specialists orits membership can be be competitors of other members.An IPA can have exclusive membership (meaning it does not permitits members to join other IPAs and does not admit everyone who wants to join) or non-exclusive membership (meaning that its admission policies are open and it does not prohibit its members from joining other IPAs).An IPA may or may not impose some financial risk on its members. 2 An IPA is an organization created and owned by independently The IPA does not provide health care services itself; it is IPAs are based on the premise that a group of b

20 etter informed and The primary goal of a
etter informed and The primary goal of an IPA is to assist individual physician practices in leveling the playing field with managed care organizations ("MCOs") in order to get better contracts, increase their patient base, and improve their reimbursement rates while at the same time, Independent Practice Associations ("IPAs")Joseph Rugg akerman.com 10 akerman.com Thank You DALLAS DENVER FT. LAUDERDALE JACKSONVILLE LOS ANGELES MADISON MIAMI NEW YORK ORLANDO TALLAHASSEE TAMPA TYSONS CORNER WASHINGTON, D.C. WEST PALM BEACH 9 ITS A NEW WORLD!Questions? II But what is it going to But what is it going to cost me to get my cost me to ge

21 t my Stimulus Money?Stimulus Money? I ne
t my Stimulus Money?Stimulus Money? I need I need incentivesincentivesto go digital!to go digital! RalphLosey@Akerman.com 8 Medicare Pays 75% Premium Until Yearly Cap is ReachedITS A NEW WORLD! $44,000 Per Professional$18,000 + $12,000 + $8,000 + $4,000 + $2,000 7 Bill at least $25,000 per yearMedicare or Medicaid Providers. defined as physicians, dentists, Includes physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, clinical social workers, psychologists, registered dietitians or 6 Penalties begin in 2015 Certified as meaningful usersŽeven if they have purcha

22 sed certified software/hardware. 5 HITE
sed certified software/hardware. 5 HITECHAct: IncentivesProfessionals can earn up to $44,000 from Medicare, or $64,000 from Medicaid, over requires planning now. MEANINGFUL USEŽCertification Criteria will be a rising tideŽafter 2012.Draft Regulations for Meaningful Use certifications are 556 pagesFYI -Hospitals can earn from $5 Million to First Adopters Will Benefit The Most (Sliding 4 What Kind of Government Incentive Payments?ITS A NEW WORLD! +$2.0 billion-$18.5 billion=$19.5 billion Physician and Hospital IncentivesBonuses from Medicare/Medicaid For Meaningful Use of EHR HHS Discretionary Funds ficienci

23 es, Tax Revenues, and Health Informatio
es, Tax Revenues, and Health Information Technology for Economic and Clinical Health Act HITECH ACT Plan: American Recovery and Reinvestment Act of 2009 (A.R.R.A) $787 BillionAlso includes HIPAA-2 provisions 3 DO NOTHING and make even less money in CHANGE YOUR PRACTICE to stop taking any Medicare or Medicaid.START TO CHANGE NOW and qualify for under less stringent standards. 2 It is now government policy for all health care records to be computerized and portable in If you do not comply, then by law in 2015 your Medicare and Medicaid payments will ITS A NEW WORLD! Ralph Losey akerman.com 2009 HITECHStimulus Law 42 akerman.com Th

24 ank You DALLAS DENVER FT. LAUDERDALE JAC
ank You DALLAS DENVER FT. LAUDERDALE JACKSONVILLE LAS VEGAS LOS ANGELES MADISON MIAMI NEW YORK ORLANDO TALLAHASSEE TAMPA TYSONS CORNER WASHINGTON, D.C. WEST PALM BEACH 41 d unobtrusive way for physicians and physician groups to explore the benefits of a larger organization to improve contracts with MCOsand to increase reimbursement Many MCOs desire the efficiencies of being able to contract withmany physicians through a single entityThrough their group purchasing power, IPAs can be used to provide other benefits for its members, such as better rates foThere are cons to IPAs: the Antitrust Laws and limitations to the messenger model; no co

25 ntrol over physician members; no structu
ntrol over physician members; no structure and limited leadership; limited staff and professional assistance; free riders; competition with other members; membersjoining multiple IPAs; and members contracting separately from the IPAIPAs can be an initial step in a physician's exploration of establishing or joining a large fully IPAs Are Becoming Popular AgainIndependent Practice Associations 40 Many IPAs neither share financial . Nonintegrated/non risk sharing IPAs cannot usually negotiate price terms directly with MCOs."Messenger Model" provides an alternative methodology for these IPAs to deal with MCOs. IPAs can engage a messenger (u

26 naffiliated with any member physician) w
naffiliated with any member physician) who will distribute to all members information from an MCO. The Messenger can gather fee requirements from members (cannot disclose to other IPA d the number of providers available at a The Messenger can negotiate rates with MCOs but can disclose to members the revised contract rates from the MCO and certain other information. d to sign on behalf of members who accept the MCO's rates/contracts. Independent Practice Associations 39 IPAs That Share Financial Risk Or Are Clinically Integrated WillTypically Be Given More Leeway In Dealing With MCOs. providing services at a capitated rate or at a percen

27 tage of By providing financial incentiv
tage of By providing financial incentives (and disincentives) to their members based on quality, utilization, By providing complex or extended treatment regimens that requiresubstantial coordination at a What can these IPAs do? The physician members can share with each other specific rate Based on this information and the shared financial risk, the IPAcan negotiate directly with the MCO on behalf of its physician members to achreimbursement rates Independent Practice Associations 38 Reality And Guidance DOJ and FTC understand the imbalance in the bargaining power between physician practices and MCOs and ag The DOJ and FTC have publish

28 ed certainorder, among other things, to
ed certainorder, among other things, to help guide the operations of IPAs to avoid "rule of reason" analysis: What is the relevant market? What are the pro-and an How are providers included or ex lanced by market efficiencies? Independent Practice Associations 37 from the DOJ and FTC have investigated an 36 and are quite complicated, but the basic thing to remember is that they prprices, to divide up the market they Because IPAs are formed to facilitate physician members and MCOs, they arHow the Antitrust Laws apply to an IPA depend in part on the characteristics IPA exclusive or non-exclusive, do members compete with each other for In

29 most cases, the Antitrust Laws willIPA'
most cases, the Antitrust Laws willIPA's ability to bargain with MCOs 35 g a number of independentphysicians and gotiate more effectively with MCOsIn an IPA, there is the very limited inteices of its membersAn IPA represents its physician members ence, and the IPA exerts little or no control over how its An IPA can be open to primary care physicians and specialists orits membership can be be competitors of other membersmbership (meaning it does not permitits members to join other IPAs and does not admit or non-exclusive membership (meaning that its admission policies are open and it does not prohibit its members from joining other IPAs)

30 An IPA may or may not impose some financ
An IPA may or may not impose some financial risk on its members 34 An IPA is an organization created and owned by independently practicing The IPA does not provide health care services itself; it is practice a group of better informed and more unified physicians will get better managed care contracts The primary goal of an IPA is to assist individual physician practices in leveling the playing field with managed care organizations ("MCOs") in order to get better contracts, increase threimbursement rates while at the same time, maintaining their practice What Is An IPA? Independent Practice Associations Independent Practice Associations

31 ("IPAs") Joseph Rugg akerman.com 32 Co
("IPAs") Joseph Rugg akerman.com 32 Concierge Medicine …New Twists Discount Medical Plan s in exchange for fees, dues or charges, the plan provides access for members to providers of medical A Physician who provides discounts to his or her own patients is Allows a Physician to provide a combination of non-covered services and concierge amenities to Physician's own patients Screening Tests, BMR, or CIMT 31 Concierge Medicine …New Twists New Twists- –Hybrid Plan Combines Concierge and Traditional Into One Practice Continue to See All Patients …Does not Force Patients to find a new Limit concierge Membership …set

32 aside portion of each day Example 200 M
aside portion of each day Example 200 Members @ $1,500 = $300K additional revenue 30 Concierge Medicine …New Twists Legal Issues Medicare -Prohibits charging additional fees for Covered Services Anti-kickback, can't offer remuneratmust be fair market value –Managed Care Breach of contract which provides that MCOpayment is payment in –State Insurance Laws Providing services for fixed prepai 29 Concierge Medicine …New Twists Franchise or Do it Yourself …Florida Based Executive Physical, Access to Top MDs and Hospitals around the country, Quick Access 600 patients per MD –$1,500 Annual Fee $1K to MD $500 to MD

33 VIP …Seattle Based …Original C
VIP …Seattle Based …Original Concierge company PCP …50 families per Physician No Insurance accepted …Same day appointments …Spa-type amenities. Annual fee range $14-20K Franchise for $75K + 5% licensing/royalty 28 Concierge Medicine …New Twists Traditional Concierge Concept cine or Retainer Practice Patients pay Physician annual retainer fees of $50 to $20,000, Typical In exchange for guaranteed heightened access to health care services Physical, 24/7 Access to Pager, Cell, or to Physician on secure website, Next da Limited number of patients ConciergeMedicineNew Twists Gary Matzner akerman.com 26 Medic

34 are Managed Care Risk vs Non-Risk Contra
are Managed Care Risk vs Non-Risk Contracting Start Non-Risk Until You Understand the Difference between FFS Mentality and Managed Care Mentality –Look for Opportunities with Smaller Plans Make Sure that You Keep Beware of Reserve Fund Accounting Risk Benefit for Well Managed Practice $50 to $200 PMPM or for Practice with 350 Members $210K to $840K per year. 25 Medicare Managed Care But I'm not a PCP! Who does the patient call when they have the Flu? Family Medicine/Primary Care Cardiologist Internist 24 Medicare Managed Care FFS (PER PATIENT) MAP (PER PATIENT) INITIAL VISIT REIMBURSEMENT $220 FOLLOW UP VISITS REIMBURSEMENT $60 AVERA

35 GE VISIT PER YEAR 3.5 RSEMENT PER MONTH
GE VISIT PER YEAR 3.5 RSEMENT PER MONTH $100 -$140 TOTAL YEARLY R EVENUE PER PATIENT $210 - $430 $1200 - $ 1680 TOTAL YE ARL Y RE V E NU E * 350 PATIENTS $150,000 $420,000 -$588,000 23 Medicare Managed Care Concerns for MAP Physician –Patients Must Use Plan Specialists and Hospitals Must Follow Managed Care Protocols –Risk Contracting Pool Deficits –Control of Patients 22 Medicare Managed Care Summary of Benefits for MAP Physician –NO BILLING –PREDICTABLE MONTHLY INCOME NO COST TO PHYSICIAN (e.g., no or lower copays, no or lower deductibles, wellness, vision, and fitness benefits as well as access to disc HMO AD

36 MISSION TEAM ACCESSIBLE TO PHYSICIAN

MISSION TEAM ACCESSIBLE TO PHYSICIAN –MORE FREE TIME DUE TO HMO SUPPORT INCREASED REIMBURSEMENT Medicare Managed Care Gary Matzner akerman.com 20 Formation of a Large Practice Group Getting Started Identify potential members Select a leadership group Obtain sufficient capital Hire a management consultant Select IT hardware and software Engage a qualified attorney 19 Formation of a Large Practice Group Regulatory Requirements Group Practice –Single legal organization (a unified business with centralized management) Billing under a sin ce with predetermined methods Ancillary Services Furnished or supervised by a member of the gro

37 up Billed under the group's billing numb
up Billed under the group's billing number Profits may not be distributed based on referrals 18 INADEQUATE PHYSICIAN LEADERSHIPCost of regulatory mandates for capitatedpatientsFailure to manage costs for capitatedpatientsFailure of other groupsConflicts between primary carINADEQUATE BILLING AND COLLECTION SYSTEMS 17 LEVERAGE WITH HEALTH PLANSLeverage with hospitalsPROFIT FROM ANCILLARY SERVICESQuality of care 16 Formation of a Large Practice Group Large Group Practices are the Exception; Not the Norm Nearly 50% of physicians work in a 1 or 2 physician practice practice with 10 or more physicians tively Recent Innovation Mayo Clinic …

38 ;1880's Most early group practices in ru
;1880's Most early group practices in rural areas Formation of a Large Practice Group Marshall Burack akerman.com 14 ITS A NEW WORLD!Questions? II But what is it going to But what is it going to cost me to get my cost me to get my Stimulus Money?Stimulus Money? I need I need incentivesincentivesto go digital!to go digital! 13 Medicare Pays 75% Premium Until Yearly Cap is ReachedITS A NEW WORLD! $44,000 Per Professional$18,000 + $12,000 + $8,000 + $4,000 + $2,000 12 Bill at least $25,000 per yearMedicare or Medicaid Providers. defined as physicians, dentists, Includes physician assistants, nurse practitioners, clinical nurse sp

39 ecialists, certified registered nurse an
ecialists, certified registered nurse anesthetists, clinical social workers, psychologists, registered dietitians or 11 Penalties begin in 2015 Certified as meaningful usersŽeven if they have purchased certified software/hardware 10 HITECHAct: IncentivesProfessionals can earn up to $44,000 from Medicare, or $64,000 from Medicaid, over requires planning nowMEANINGFUL USEŽCertification Criteria will be a rising tideŽafter 2012Draft Regulations for Meaningful Use certifications are 556 pagesFYI -Hospitals can earn from $5 Million to First Adopters Will Benefit The Most (Sliding 9 What Kind of Government

40 Incentive Payments?ITS A NEW WORL
Incentive Payments?ITS A NEW WORLD! +$2.0 billion-$18.5 billion=$19.5 billion Physician and Hospital IncentivesBonuses from Medicare/Medicaid For Meaningful Use of EHR HHS Discretionary Funds ficiencies, Tax Revenues, and Health Information Technology for Economic and Clinical Health Act HITECH ACT Plan: American Recovery and Reinvestment Act of 2009 (A.R.R.A) $787 BillionAlso includes HIPAA-2 provisions 8 DO NOTHING and make even less money in CHANGE YOUR PRACTICE to stop taking any Medicare or MedicaidSTART TO CHANGE NOW and qualify for under less stringent standards 7 It is now government policy for all health care records to

41 be computerized and portable in If you
be computerized and portable in If you do not comply, then by law in 2015 your Medicare and Medicaid payments will ITS A NEW WORLD! Ralph Losey akerman.com 2009 HITECHStimulus Law 5 Current State of the Market Physician Alternatives and Potential Solutions Sell practice and/or become an em Find other sources of revenue Apply for stimulus money for electronic health records Form or join a large practice group Contract with managed care orga Establish a concierge practice Form or join an Independent Practice Association ("IPA") 4 Current State of the Market Continued Increase in Operational Costs Expenses associated with reimburseme

42 nt: with requests from Medicare, Medicai
nt: with requests from Medicare, Medicaid and managed care organizations (e.g. demand for records Additional staff required to deal with payors (e.g. pre-authorizations, wait times and special requests) Increase in costs of regulatory compliance (e.g. fraud and abuseand Stark) Increased cost of living affectinbenefits and malpractice) Costs for technology initiatives(e.g.electronic health records, insurance verification via the web, and other e-initiatives) 3 Current State of the Market Decrease in Physician Revenues Due to: Economy Patients deferring routine medical care Decrease in elective procedures –Decrease in non-covered proc

43 edures Decrease in patients with insuran
edures Decrease in patients with insurance Slower collection of monies due from patients Health Care Reform tion resulting in overall reduction in provider reimbursement 2 Current State of the Market Decrease in Physician Revenues Due to: Medicare and Medicaid care physician reimbursement Medicaid reform and elimination of MediPass Managed Care Organizations, Health Insurers and other Third Party ted to reductions in Medicare Increase in co-pays and deductibles –Decrease in covered benefits Health Records payments if physicians do notconvert to electronic and portable health care records within 5 years Current State of the Market