According to Health and Human Services Secretary, Kathleen Sebelius, 11,000 seniors are becoming eligible for Medicare each day. As new elements of the Affordable Healthcare Act are introduced, seniors will see changes in their Medicare coverage, out-of-pocket expenses, and even the physicians they see.
Known as Obamacare, the Act reduces payments for those with Medicare and who are enrolled in the Medicare Advantage program.
A significant amount of money to fund Obamacare over the next 10 years is being taken from Medicare coffers.
The Congressional Budget Office (CBO) estimates that reimbursement for Medicare-related services will be cut by approximately $716 billion between 2013 and 2022.
Seniors participating in the Medicare Advantage program will see cuts in that as well.
Seniors will face additional cuts through the creation of the Independent Payment Advisory Board (IPAB), which will have control of the Medicare budget in coming years. Insurance companies will be allowed to continue charging seniors and other groups higher rates for their healthcare.
On the plus side for the 49.5 million seniors on Medicare, Obamacare caps the amount seniors will pay for Medicare premiums. It also expands coverage for prescription medications and some preventative care services.
Reducing Payments to Control Costs
Medicare already pays less for services than many commercial carriers and those amounts will be reduced further in the coming years. Facing the prospect of decreasing Medicare revenues, many clinicians are either selling their practice, retiring early, taking employment at hospitals, or refusing to see Medicare patients at all.
A Deficit of Doctors
According to the Association of American Medical Colleges (AAMC), there will be an estimated deficit of 130,000 physicians by 2025. Fewer clinicians mean less access to healthcare for seniors and a longer wait for appointments.
Seniors could be forced to locate a new practitioner, be limited to clinicians within specific networks, and required to travel further distances to receive healthcare.
Medicare Advantage and Excise Taxes
Changes in Medicare Advantage programs could potentially eliminate or drastically reduce vision and hearing coverage. Obamacare raises taxes on medications and medical equipment. Patients will pay an excise tax on medical devices, ranging from wheelchairs and joint replacements to hearing aids.
Funds collected through the tax increase won’t be used for Medicare. The money is earmarked to pay for and sustain Obamacare programs.
The Act assumes that seniors will use the dollars previously used for Medicare Advantage plans to purchase insurance through commercial companies.
IPAB Controls Future Cuts
Further measures to control costs in the future will be in the hands of the IPAB. The 15-member board will have the power to cut Medicare spending where it sees fit to reach specific spending goals.
Cuts will automatically take effect unless Congress moves to counteract the changes with a super majority vote of three-fifths by the Senate. IPAB members are appointed and can’t be voted out of office.
The board essentially provides protection for Congress, absolving them of any responsibility for Medicare cuts.
IPAB will be charged with setting reimbursement rates for clinicians and deciding which medications, treatments and procedures will be covered.
IPAB will determine the most effective treatments for specific maladies and the cost for each treatment and procedure.
Most people agree that some type of healthcare reform was needed, but seniors fear Obamacare will limit their access to physicians, medications and treatments at a time when they need them most. One thing is certain. Obamacare will definitely impact the financial health of seniors.
HIPAA compliance is the most important consideration for medical billing specialists. Billers work with personal, confidential and sensitive patient information and they’re tasked with protecting that data. In this informative article, Nitin Chhoda shares the 18-point HIPAA protected list and how it affects billers and practices.
EMRs and EDI
The privacy laws encompass the way patient records are stored, disclosed and transmitted according to electronic data interchange (EDI) standards.
To accomplish this, integrated electronic medical record (EMR) software is essential. It contains a myriad of security safeguards, along with the ability to identify potential problems with reimbursement claims.
Practices, billers, clearinghouses and healthcare insurance providers that fail to take appropriate precautions when transmitting claims and working with the information can find themselves facing fines and criminal penalties.
An EMR has the ability to identify security breaches and notify those within the software’s network.
Malpractice Insurance
Disclosing personally identifiable information to any unpermitted outside entity can result in malpractice or negligence litigation. What many in the healthcare industry aren’t aware of is that many standard liability and malpractice insurance policies don’t provide coverage for HIPAA violations. The policies may offer coverage for some risk factors, but few insurers are offering policies that reflect changes in HIPAA privacy laws.
Some Exceptions
There are exceptions to every rule and HIPAA standards indicate that some information can be disclosed if it’s scrubbed or re-identified of personal data. One exception is in the pursuit of medical research. Patients who may want to participate in such studies must provide written authorization.
Clients must be provided with a complete, written explanation of the parameters, along with the knowledge that they can revoke their authorization and how to do so. Data may also be disclosed for public health reasons once all of the 18 elements have been removed.
HIPAA’s Top 18
HIPAA has a list of 18 identifiers within patient records that must be safeguarded. The following is a list of the 18 elements within client records that are covered under the HIPAA privacy rule:
Names
Addresses and geographic locations
Age and/or date of death
Dates of treatments, hospitalizations and admissions
Social Security number
Phone or cell phone numbers
Fax numbers
Email addresses
Medical record numbers
Beneficiary and account numbers
Driver license numbers
Vehicle and serial numbers
Device identifiers
Website URLs
IP addresses
Biometric identifiers including fingerprints or voiceprints
Photographic and comparable images
Other personally identifiable information unless permitted through re-identification.
An EMR is a digital link to every facet of a client’s healthcare history and can be accessed by multiple healthcare practice management providers, and offers a superior level of security to safeguard the storage and transmittal of patient records.
It’s essential that any individual or facility that handles client records obtain training and have an in-depth understanding of HIPAAregulations to avoid malpractice lawsuits.
As different elements of the Affordable Health Care Act (a.k.a. Obamacare) unfold, it’s emerging that this law has had a radical impact on private practices of all types. In Part 1 of this THREE PART article series, founder and CEO of In Touch EMR, Nitin Chhoda discusses the outlook for physical therapy private practices in the Obamacare economy.
2013 has been a very interesting year, and we still have three months to go.
In the last 8 months, the pressure on private practice owners has increased substantially, in more ways than one.
Regardless of the intentions of the administration, a disturbing result of the legislation is that clinicians are closing their practices and many are joining the ranks of hospital-employed providers.
Physical therapists are spending less time with patients and more with their EMR-enabled devices filling out digital paperwork to satisfy government requirements, all under the guise of improving patient care.
Medicare continues to reduce reimbursement amounts and tighten the nooze on private practices. Functional limitation G code reporting, PQRS reporting and manual medical review are just the tip of the iceberg.
The fact is, practitioners are opting out of insurance programs entirely, instituting cash only clinics, or closing up shop.
Results of a survey by the Doctor Patient Medical Association…
An increasing number of clinicians are selling their practices or joining the ranks of hospital-employed providers to combat their loss of revenues. In a 2012 study by the Doctor Patient Medical Association, ninety percent of practitioners polled indicated that private practice is losing out to the business side of medicine and 83 percent were thinking of leaving the profession.
When asked why; government intervention was cited as the root of the problem.
In a 2013 Deloitte survey, fifty percent of respondents said the practice of medicine is in jeopardy. Sixty-two percent indicated they were going to retire early as a result of Obamacare, and seventy five percent voiced the fear that fewer individuals will pursue a career in medicine in the future.
Athenahealth and Sermo both conducted their own surveys with similar results. Their polls also showed that 93 percent of participants were very concerned that they wouldn’t be adequately compensated for their services and expected their revenues to dip dramatically when Obamacare is fully implemented.
The Winds of Change
There are many factors influencing providers – loss of income, tremendous amounts of documentation and additional compliance based reporting, and the fear that legislation will become the motivating force behind medicine. Under new regulations, special G codes and modifiers aren’t payable and many procedures will be bundled for a flat fee.
Reduced incentive payments and Medicare reimbursements, bundled payments and reimbursements based on metrics, along with more regulatory reporting, disclosure and compliance requirements, are creating an insurmountable force that can make private practice unprofitable for those who do not adapt.
We are living in a new economy, called the ‘post medicare’ or the ‘Obamacare’ economy.
The writing is on the wall. There is a reason that CMS is collecting data with functional limitation G code reporting and PQRS reporting. Physical therapists are concerned that the Centers for Medicare and Medicaid Services will use the information obtained through additional reporting to limit services or not pay for them at all. Payment and services would be based on paperwork and statistics instead of a physical examination.
Clinical Care Driven by Numbers?
For example, there is a distinct possibility that Medicare says “Statistically, an ankle sprain patient improves from severity modifier CI to severity modifier CM in ten visits, based on the data we have collected, and the reporting of the functional limitation G code by clinicians in your area. Therefore, you need to get the patient better in ten visits, and we won’t pay for more than ten visits”.
As clinicians, we know this sounds ridiculous since every single patient is different, and may have different goals and other limitations. No two patients are the same. The question is – will this even matter in the Obamacare economy?
I hope I’m wrong, but this could be where things are headed.
If I’m right, we’re talking about healthcare driven by statistics, not by clinical expertise.
Physical therapists are already feeling the impact of PQRS, Functional Limitation G codes and Multiple Procedure Payment Reduction (MPPR). The APTA has estimated a 6 – 20% reduction in Medicare payments for physical therapists in private practice. In fact, they have indicated that some practices may go out of business with these new changes.
Concerns from Private Practice Owners
Clinicians say there are too few doctors to care for the influx of new patients under Obamacare and this has the potential to eliminate the sanctity, the integrity of the patient-clinician relationship. It has the potential to significantly lower standards of care.
It’s likely that there will be a significant influx of Medicaid patients, with very few clinicians to care for them. Incidentally, Medicaid pays approximately fifty six percent of what commercial carriers reimburse. In addition, some estimate an estimated twenty seven percent reduction in Medicare payments.
An oversight panel has been charged with reducing Medicare costs and determined the most effective treatments. Practitioners say it will place uninformed individuals in charge of dictating patient treatments based on cost rather than need.
Hospital-Employed Physicians and Monopolies
An increasing number of private practice owners are choosing employment in hospitals where they often earn more than in private practice, with no overhead, better hours, greater lifestyle flexibility and less administrative burdens. An article in the New England Journal of Medicine attributed the trend to Obamacare, noting that more than half of all physicians are now employed in hospitals.
Under Obamacare, hospitals typically receive higher reimbursements for specialty services than those in private practice. The end result will be alliances between hospitals and insurance carriers, where hospitals hold a monopoly among payers and offered services. Hospitals and payers who saw the financial potential embraced the new legislation.
Obamacare was never about containing escalating healthcare costs – at least not completely. Insurance companies and hospitals agreed to play the Obamacare game with the Affordable Health Care Act, using it to establish themselves as “too big to fail” in the eyes of the government, thereby obtaining the power to call the shots on how healthcare is delivered and reimbursed. For private practice owners, this was always a tough battle to win, if they continued to do business the same way.
In Touch EMR and In Touch Biller Pro – Your Competitive Options in this New Economy
In this economy, your choice of an EMR and billing software is critical. In fact, never before has it been more critical.
The right system can lower costs, improve efficiency and make you and your staff happy and productive. The wrong one can create a never ending cycle of frustration, pain and agony.
Cost effective systems such as In Touch EMR and In Touch Biller Pro provide solutions that help private practices streamline the before, during and after patient experience by providing the following benefits:
Complete eligibility verification online
Create patient records with one click (auto patient chart creation)
Create custom templates with a point and click template builder
Scrub claims, submit claims automatically with one click (automatic claims batching)
Post ERAs with one click
Generate patient statements automatically and much more…..
The future of medicine, how it’s delivered, and the private practice are imperiled. As more patients enter the system, the number of therapists in private practice will decrease. Patients will have less access to care, a situation Obamacare was supposed to remedy. The bottom line is that socialistic medicine favors conglomerates over small businesses like your own private practice.
The Importance of Live Events and Workshops
Attending live events and workshops like the upcoming Private Practice Retreat in Las Vegas is the best one to stay one step ahead of the curve, and prepare your practice for the ‘Obamacare’ economy.
Further measures to control costs in the future will be in the hands of the IPAB. The 15-member board will have the power to cut Medicare spending where it sees fit to reach specific spending goals.
