While the Affordable Health Care Act (Obamacare) will extend the availability of healthcare services to millions of uninsured Americans, it imposes a variety of mandates on businesses of all sizes that increases the cost of doing business.
Employers are not happy about Obamacare and many fear the effect on their productivity and profit margins.
Businesses with 50 or more employees, and those with workers who put in 30 or more hours per week, are required by Obamacare to provide their workforce with health insurance or face financial penalties of $2,000 per employee.
Many firms are choosing to pay the fine – it’s cheaper than providing insurance.
The outcry by the business community was so great that President Obama delayed the mandate’s effective date until 2015 to give employers time to prepare for the transition. Companies across the nation are looking at strategies to lighten the financial load when Obamacare is fully operational.
Shrinking Business Growth
According to a survey by the Society for Human Resource Management, 41 percent of participating small business owners indicated they would not be hiring new employees due to Obamacare.
Twenty percent said they were reducing their payroll and expansion projects are being placed on hold.
Some businesses will receive tax breaks to help alleviate the financial pain of health insurance premiums they pay for employees. The tax breaks only apply to companies with 25 employees or less and many entrepreneurs fear financial failure with the full implementation of Obamacare.
Reducing Workers and Hours
To elude the fines of Obamacare, many businesses have chosen to:
reduce their workforce
limit workers to 29 hours per week, and
transition to a four-day work week
All three strategies have a negative impact.
Higher unemployment rates and reduced hours will force individuals to utilize social service agencies to survive. According to the Bureau of Labor Statistics, only one full-time job was created for every four part-time jobs in 2012.
A survey conducted by Mercer found that 12 percent of all U.S. employers planned to reduce hours for full-time and part-time employees.
In a Reuters survey, a number of businesses indicated that they would be hiring more temporary employees.
That policy would allow employees to qualify for government subsidies to purchase their own insurance coverage through state operated marketplaces.
The strategy is being used by businesses of all sizes, along with educational institutions.
Companies that do provide insurance for employees are being forced to reduce covered benefits while increasing the cost to workers. Some are choosing to eliminate coverage for spouses and children. Insurance companies have raised their rates in response to the array of mandated services through Obamacare.
Economic Repercussions
The costs incurred by businesses through Obamacare mandates will be passed on to consumers. Companies will have to raise the prices on their goods to make up for a loss in productivity, fines and other costs associated with the healthcare Act.
The impact will be felt at all levels, from food and clothing to housing and the auto industry.
Fear of Obamacare has resulted in significant changes in the business community. To combat the cost of mandatory healthcare, businesses are being forced to lay off workers, cut hours and modify work weeks. The result is a loss in productivity that affects profits and limits the ability to expand and create jobs now and in the future.
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.
Physical therapy clinics and providers should opt for the right EMR system that serves as the solution for improved management and better delivery of patient care. Nitin Chhoda reminds physical therapy practice owner to always choose the right EMR system to maximize its use and increase profitability.
Individuals in need of physical therapy services will always check on the expertise and capability of the clinic.
This will serve as the deciding factor in figuring out the physical therapy clinic or provider they will choose.
The same degree of professionalism and efficiency is also expected from the office solutions that are being utilized with electronic medical records for physical therapy services.
It is essential for any physical therapy clinic or provider to select the best EMR system or physical therapy documentation software.
Focus on What Your Practice Needs
Due to the wide selection of EMR system for physical therapy services, clinic owners and providers are having a difficult time sifting through the various features and functionality of every EMR system. Finding the right EMR system that fits perfectly with the practice’s needs and preferences are overwhelming.
The navigation and the user interface are the main features being focused on. The ideal EMR system can make the daily tasks a lot easier to handle while at the same time, make the office organized, thus, saving time and money for the practice.
User Interface
With many different EMR systems shown to practice owners, there are certain ways in which a user can interface in order to view and manage the documents online. The user interface is available in various forms.
The files are neatly categorized based on the chosen arrangement. This can greatly help in locating required files for a particular treatment as well as other important files such as the workflow items, insurance files, messages and many more.
Simplify Practice Flow
The right EMR system should involve the review of the workflow processes, particularly repetitive steps undertaken in the office.
EMR system for physical therapy services that meets the needs of physical therapy clinic can greatly help save time and money in the long run.
The EMR system that will be chosen will not only establish how the practice is organized, but also how well the patients are treated.
The professional image of your practice is also greatly affected. As the best solution for better management, workflow and delivering quality patient care, the ideal EMR system for physical therapy services must be chosen.
The management of healthcare can be a tedious task due to the various divisions involved. Nitin Chhoda shares how using physical therapy software or EMR (electronic medical record) can provide several benefits to any healthcare facility, especially in physical therapy businesses all over the world.
Both large-scale and small-scale physical therapy centers will gain an advantage if a physical therapy software is utilized. Physical therapy software offers a number of features that can comply with the different aspects on physical therapy practice.
Reporting Capabilities of the Physical Therapy Software
Proper physical therapy software management is not considered complete without the reporting capabilities offered by the physical therapy EMR. As long as the reporting feature is utilized optimally, the average number of visits for each patient can be monitored easily.
This figure can be linked with referral indicators. Any problems or inadequacies can be recognized in which patients are more likely to self-discharge. Previously, this kind of exhaustive reporting takes a lot of time to gather. With the help of the physical therapy software, needed reports are made in just a matter of minutes.
It is a known fact that medical billing can be a burden together with insurance companies who pay approximately half on all the claims that were submitted. With the help of the EMR physical therapy software, submissions are improved.
Additionally, it eliminate errors, boost the efficiency of the overall process, as well as make the identification process on claims a lot easier. The physical therapy software allows the medical billing staff to access all the required tools to track the insurance companies that deny or reject claims on a regular basis.
Physical Therapy Scheduling Process
Inefficient therapy scheduling process in any physical therapy practice also causes money loss. There are instances that one of the patients might cancel without notice. Some cancelled appointments can be rearranged. But there are patients who do not show up, incurring losses.
Physical therapy software can also provide solutions that deal with physical therapy scheduling issues.
With the benefits offered by an EMR, physical therapy practices will become more efficient in terms of providing services as well as with its management.
A private practice that utilizes physical therapy software is considered more efficient, has an improved insurance claim acceptance rates and can deal with problems that might arise easily.
To elude the fines of Obamacare, many businesses have chosen to:
