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.
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.
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:
Addresses and geographic locations
Age and/or date of death
Dates of treatments, hospitalizations and admissions
Social Security number
Phone or cell phone numbers
Medical record numbers
Beneficiary and account numbers
Driver license numbers
Vehicle and serial numbers
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.
Scheduling, marketing, documentation and billing are the most important parts of the whole physical therapy business. Nitin Chhoda discusses the flow and importance of this 4-prong approach and how it plays a role in a successful practice.
Many managers find that once they implement and adjust to practice management software, productivity improves, inefficiencies are identified, and the practice becomes more financially stable.
Making sure that the practice functions at it’s best will include integrating the four major systems within the practice: scheduling, documentation, billing, and marketing.
Scheduling and Marketing Integration
Why is it important for healthcare practice management to know how efficient the scheduling system is? When taking the big picture view, which is the responsibility of management, you have to know how things are going on inside the practice to know when to reach out.
Healthcare practice management and marketing is an ongoing job that involves many more subtle things than just advertising, but if you don’t know how well the schedule is being filled, you won’t know if your marketing strategy is doing any good or if it is overwhelming the practice.
The big advantage that an EMR gives to healthcare practice management is reporting capabilities. In terms of scheduling this means that with a few clicks you can find out just how often patients cancel or re-schedule appointments, how often appointments are left open when cancelled, and how many more patients your practice can handle.
Documentation, Scheduling, and Billing Integration
From the documentation standpoint, EMRs present a lot of advantages. No more time will be wasted pulling and re-filing medical records when the healthcare practice management has access from their office or on a tablet computer.
They also have access to their schedule, which means they know exactly what to expect without anyone briefing them on their day or week.
EMRs also leave clinicians to make their notes about each visit in a quick and efficient manner. The previous notes are also viewable in an intuitive format. And most importantly, once the appointment is complete, the billing staff can be alerted automatically to changes to the record and further billing requirements.
Scheduling can be handled in the same way, with the reception or healthcare practice management staff having access to the results of the visit immediately and being able to schedule the next appointment for each patient.
Integration and Reporting
For healthcare practice management, the benefit that has never existed before in a fully integrated EMR, will be reporting capabilities that can transform the practice.
Billing staff can run reports to find out just how often certain insurance companies reject claims.
Healthcare practice management can then determine which insurance companies are worth working with and which should be dropped. Scheduling issues can be identified and rectified, and a marketing plan can be developed for attracting new patients if necessary.
All documentation can be centralized and made conveniently available to the staff members who need the information.
Billers can find the information they need to get claims out the door faster, scheduling can be done to ensure that each patient is back in the healthcare practice management when they need to be, and clinicians can review and edit patient records quickly and simply using an intuitive system.
Nitin Chhoda differentiates between malpractice and negligence. They may seem connected to each other but they can be experienced by the practice individually, and it is important to avoid these two lawsuits from occurring.
Already, there have been significant malpractice and negligence legal cases demonstrating the necessity for a cautious and thorough transition process from paper to electronic medical records.
In the year 2000 in South Carolina, Smith v. United States established that the type of liability a hospital or medical practice can be held accountable for when transitioning to medical records only includes negligence and not malpractice.
However, the point is well taken; your transition to a medical EMR should be done with the utmost care and attention to detail.
Smith v. United States
The legally significant decision in the case of Smith v. United States determined that hospitals can be held liable for malpractice and negligence in the case of mismanaged electronic medical records.
That means that when you transition from paper to electronic records, it is the responsibility of the hospital or practice to ensure the patient information is handled carefully and responsibly.
However, it is unlikely that the mishandling of patient information will be deemed medical malpractice. Malpractice refers to the incorrect treatment of patients by a medical practitioner.
This can be improper, negligent, or illegal professional activity, but it applies to the clinician rather than the hospital or practice, unless the practice is aware of the malpractice and does nothing to stop the clinician.
Responsibility for Patient Information
Electronically stored information is already fairly standard in most medical practices. Even without an EMR, it is likely that you keep all client details on a computer and even use the system for scheduling and other routine tasks.
However, it is also likely that the program and system that the information is stored on is not accessible from the Internet. The difference with most modern and effective EMR systems is that you will be able to access sensitive patient information from anywhere, as long as you have a mobile device and an Internet connection.
It is the responsibility of the practice to protect delicate and personal patient information. If that information is stolen or accessible by individuals who are not authorized to view patient information, the practice must demonstrate that all reasonable precautions were taken to avoid the problem or they will be liable for negligence.
Malpractice and Negligence
If a clinician willfully misuses the EMR, it may be considered malpractice and negligence and if practice management are aware of the misuse, the practice may also be liable for malpractice.
However, the primary concern for clinicians as well as practice management is the potential formalpractice and negligence within the new system and during the process of transitioning from paper to electronic medical records.
Not only are the clinicians and practice liable for negligence if there is a leak of information, but they are also responsible for providing the necessary documentation to determine guilt or innocence.
If the practice believes that necessary malpractice and negligence precautions were taken, they must also demonstrate that those precautions were taken. It is on the charged party to prove there is no cause for a legal suit.
Nitin Chhoda explains how insurance and healthcare in the United States differ from other countries. He discusses how healthcare is tied to insurance in order for Americans to afford proper healthcare.
Healthcare and Insurance in Other Places
In some countries, the price of healthcare itself is affordable to residents. For example, in Thailand the need for healthcare and insurance is negligible, especially if a patient is earning a first world level salary.
If you need to go to the doctor, you can afford to go. If you need surgery, it will cost you a lot of money, but it will not cost you even close to the amount you’d pay if you were in the United States.
Another example is the healthcare and insurance system in Norway. Rather than have health insurance, the government uses taxes to subsidize healthcare.
That means that when a Norwegian needs to go to the doctor, they pay an affordable rate, but the doctor also gets paid a good salary because an extra fee is added that is paid by the government. Even for expensive things, if you need healthcare you can get it and at the same time, everyone makes a really good salary.
Our Healthcare and Insurance System
In the United States, the system of a healthcare practice management is very different. The cost of healthcare and insurance is so high that it is unaffordable for most Americans. Especially if a serious accident happens or an illness is diagnosed, uninsured Americans will be responsible for paying all of the costs – hundreds of thousands of dollars.
Because the prices are so high and nobody can afford to pay for surgery in the U.S., instead we buy healthcare and insurance, just in case something bad happens.
Healthcare and insurance work similarly to car insurance. Most of the time you pay your monthly premium, or you pay it up front for the year or the quarterly price each quarter.
Your plan may include co-pays, which are the amounts that you pay when you go to the doctor for certain types of visits. It may also include a deductible, which is the amount you pay each year before you start to redeem your healthcare and insurance.
But if you get into a car accident, your insurance is meant to pay for the amount that you cannot pay. The damage to the other car, medical costs of people in the cars, and damage to your car and your medical expenses can all be covered by car insurance, depending on your policy.
The same is true of healthcare and insurance. If you are diagnosed with cancer, your insurance policy should cover the high costs of treatment.
Healthy or Not
If you are healthy, you don’t use your insurance for healthcare. But once something happens, you cannot get healthcare and insurance because no insurance company will accept you as a client if you are going to be expensive.
This is why healthcare and insurance are so intimately tied together in the U.S. Without insurance, you cannot afford healthcare when you need it.
Sadly, these days healthcare and insurance companies are largely unregulated and can charge incredible premiums for insurance.
That means that even if people want healthcare and insurance, they can’t afford to get it.
If you stop paying your insurance bills, you are no longer covered. That means that healthcare and insurance are unaffordable. In that situation, Americans do not have many options besides medical bankruptcy.