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Critical Conversations in Healthcare Print E-mail
Written by Jeffrey Herschler   
Friday, 27 July 2012 10:22

The South Florida Business Journal recently hosted a healthcare panel discussion featuring some of the biggest names in the local healthcare community.

Included on the panel were:
  • Jerry Fedele: President and CEO Boca Raton Regional Hospital
  • Brian E. Keeley: President and CEO Baptist Health South Florida
  • Jeffrey B. Kramer: CPA, Partner Goldstein Schechter Koch
  • Lee F. Lasris: Founding Partner Florida Health Law Center
  • Penny Shaffer: Market President, Florida Blue & immediate Past Chair of the Greater Miami Chamber of Commerce
  • Mike Segal: Partner Broad and Cassel
  • Dr. Fernando Valverde: CEO Florida International University College of Medicine Health Care Network
  • Dr. Steven G. Ullmann: Director of Programs University of Miami Center for Health Sector Management
Not surprisingly the discussion focused on the future of healthcare delivery in the post SCOTUS ACA decision world.  Refreshingly the conversation focused on the policy issues and challenges without overt political partisanship.

Editor's Note:  To save space, initials of panelists are used throughout. 

JF pointed out that there is profound pressure on the health industry regardless of the ACA.  He stated that end of life care is a critical issue left unaddressed by the new health law.  Mr. Fedele predicts "intense" consolidation of providers and insurers.

BK foresees a market-driven solution to the cost crisis, not an ACA solution.  His organization is focusing on four things to prepare for the future:

1.     Physician Integration (i.e. aligning incentives)

2.     Huge Investment in IT

3.     Commitment to Family Medicine

4.     Wellness and Prevention Initiatives  

JK observed that small groups struggle to cope with the rapid pace of change.  He cited as examples EHR adoption, myriad rules and regulations as well as payment reform.  Since solos and small groups can't afford the expertise necessary to affect necessary changes within their practices, they look to be employed or combine to form larger groups. 

LL sees contraction in the healthcare marketplace as well as increased use of physician extenders (nurse practitioners and physician assistants) and changes in physician compensation programs to control cost. 

PS asserted that true healthcare reform would address access, quality and cost.  She laments that the ACA deals with access pretty well but is deficient in solving the quality and cost issues.   

MS emphasized that Fee-for- Service is a thing of the past and solo docs are out of business.  He stated that ACO's are emergent, a "sea-change". Mr. Segal also pointed out that the ACA is only part of the massive transformation going on in the health industry currently. 
 
FV expressed a profound concern for an imminent physician shortage.  He predicts that ARNP's and PA's will assume a huge role in primary care with physicians migrating to the specialties.

SU foresees increased demand for well educated and trained practice and facility administrators.  He warned that Medicare's survival relies on reimbursement cuts that may be draconian. 

Last Updated on Friday, 10 August 2012 10:18
 
CMS names 89 new Medicare accountable care organizations serving beneficiaries in 40 states and the District of Columbia as of July 1 Print E-mail
Written by Jeffrey Herschler   
Friday, 27 July 2012 10:17

Below is a list of the new Florida ACOs:

Accountable Care Coalition of Northwest Florida, LLC, located in Pensacola, Florida, is comprised of networks of individual ACO practices, with 60 physicians. It will serve Medicare beneficiaries in Alabama and Florida.

Accountable Care Partners, LLC, located in Jacksonville, Florida, is comprised of ACO group practices and networks of individual ACO practices, with 65 physicians. It will serve Medicare beneficiaries in Florida and Georgia.

Allcare Options, LLC, located in Parrish, Florida, is comprised of ACO group practices and networks of individual ACO practices, with 198 physicians. It will serve Medicare beneficiaries in Florida.

Florida Medical Clinic ACO, LLC, located in Zephyrhills, Florida, is comprised of networks of individual ACO practices, with 153 physicians. It will serve Medicare beneficiaries in Florida.

FPG Healthcare, LLC, located in Orlando, Florida, is comprised of ACO group practices, with 142 physicians. It will serve Medicare beneficiaries in Florida.

HealthNet LLC, located in Boynton Beach, Florida, is comprised of networks of individual ACO practices, with 55 physicians. It will serve Medicare beneficiaries in Florida.

Integrated Care Alliance, LLC, located in Gainesville, Florida, is comprised of networks of individual ACO practices, with 115 physicians. It will serve Medicare beneficiaries in Florida.

Medical Practitioners for Affordable Care, LLC, located in Melbourne, Florida, is comprised of networks of individual ACO practices, with 126 physicians. It will serve Medicare beneficiaries in Florida.

Palm Beach Accountable Care Organization, LLC, located in West Palm Beach, Florida, is comprised of networks of individual ACO practices, with 337 physicians. It will serve Medicare beneficiaries in Florida.

Reliance Healthcare Management Solutions, LLC, located in Tampa, Florida, is comprised of networks of individual ACO practices, with 36 physicians. It will serve Medicare beneficiaries in Florida.
 
New State Laws Affect Docs and other Healthcare Pro's Charged in Criminal Matters Print E-mail
Written by Elizabeth Perez   
Friday, 27 July 2012 10:13

The war on health care fraud continues to be front and center in Florida. Effective as of July 1, 2012, laws enacted this legislative session amend the draconian licensure penalties (enacted in 2009) for health care professionals who are convicted of certain criminal charges. Currently, licensing boards within the Department of Health must refuse to issue or renew the license of health care professionals if they have been convicted of certain enumerated crimes within 15 years from the date of application. This change relaxes this penalty, but expands the reach of the criminal convictions to similar laws in other jurisdictions.

Click HERE to read the entire article.

Elizabeth Perez is Of Counsel in the Fort Lauderdale office of the statewide law firm Broad and Cassel. A health law attorney, she is a member of the firm's Commercial Litigation, Health Law and White Collar Criminal and Civil Fraud Defense Practice Groups. She may be reached at (954) 764-7060 or epperez@broadandcassel.com.
Last Updated on Friday, 10 August 2012 10:28
 
Saving the Medicaid Expansion Print E-mail
Written by Paul Gionfriddo   
Sunday, 22 July 2012 10:13

Our Health Policy Matters        
 

A column focusing on federal, state and local health policy  

Within days of the Supreme Court's ACA ruling that made the Medicaid expansion optional, the governors of Florida, South Carolina, Iowa, and Louisiana all announced that they wanted to opt out of it

The governors of six other states were considering the same thing.

However they frame their views for the media, they are in fact an attack on two different constituencies.  The first is lower income uninsured families, elders, and single adults, 17 million of whom expected to become insured as a result of the expansion.  The second is safety net providers - nursing homes, hospitals, community health centers, mental health facilities, and others - who need Medicaid dollars to offset the costs of caring for people who have no insurance.

But there could be a very simple way for the federal government to save the Medicaid expansion in those states - and the Supreme Court hinted at it in its majority decision two weeks ago.  This week's Our Health Policy Matters column, Saving the ACA Medicaid Expansion, explains how. 

Click HERE to read the entire blog post.

Last Updated on Sunday, 22 July 2012 10:15
 
Enjoying the Ride? Print E-mail
Written by Jeffrey Herschler   
Friday, 20 July 2012 08:10

   roller coaster
Med Mal Roller Coaster

The cyclical nature of the medical malpractice insurance industry is well documented. Check out this excerpt from the digital archive at CBS Life & Health Library, just nine years ago, when we were on the other end of the wave:

"Medical malpractice claims have held steady, yet insurance premiums have skyrocketed. This pattern can be attributed to the cyclical nature of the commercial insurance business. We are in the midst of a classic hard insurance cycle. The first such crisis, which was particularly acute in the product liability and medical liability sectors, occurred in the mid-'70s. The second crisis, dramatically detailed in the 1986 Time magazine cover story entitled Sorry, Your Policy Is Cancelled was more..."(click HERE to read more of the 2003 story).

According to Matt Gracey, President of Danna-Gracey, a medical malpractice brokerage firm with offices in Delray Beach and Orlando, the current soft market in medical malpractice is characterized by the following:
  • Low rates: Up to 60% lower than 2005;
  • More choices of insurers; much more competitive climate due to the favorable claims cycle;
  • Loose underwriting; claims are more often overlooked by insurers.  
  • Expanded coverage; lots of bells and whistles on standard policies!
Sounds good! Let the good time roll, right? Not so fast, says Gracey. With a hard market ahead, it makes sense to get ready for the inevitable. And the market might be turning sooner rather than later. 

There are already some ominous signs. For example:
  • Loss ratios are increasing as pricing decreases; many insurers are over or approaching a "combined loss ratio" of over 100%. 
  • Reserve takedowns dwindling; insurers have been using claims reserves to bolster their losses, thus allowing them to keep their pricing as low as possible.   
  • Market shrinking as doctors retire, sell out to hospitals, or go bare.
Meanwhile the 2003 Tort Reform law is being challenged in Florida's Supreme Court and there are serious concerns that the law will be struck down. But they are working on Tort Reform at the national level (see House proposal would reform medical liability), so why worry? Says Gracey, "For years the House has passes great versions of Tort Reform, which all fail to get the 60 votes needed in the Senate. This one will go the same way. This is just election year posturing to show doctors that Republicans are trying and it's the Democrats' fault."

To get ready for the next medical malpractice storm, Gracey recommends the following:
  • Move to high ground! Insure with highly rated, financially solid companies that have a track record of being committed to Florida's doctors in more difficult market conditions. 
  • Plan now to avoid being uninsurable, or not able to afford coverage;
  • Examine coverage options; get an independent expert to review your coverage for gaps. 
  • Examine bare options and reexamine your asset protection plan. 
In closing, Gracey has one last piece of advice: "Enjoy the party while it lasts!"

Last Updated on Friday, 27 July 2012 10:26
 
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