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Kaiser Poll Reveals Voters' Healthcare Concerns Print E-mail
Written by Jeffrey Herschler   
Monday, 27 August 2012 06:37

The cost of both healthcare and health insurance, followed by Medicare, are the top healthcare concerns on the minds of Republican voters, according to an August tracking poll from the Kaiser Family Foundation.  According to the Poll's authors: 

"This poll, conducted as the GOP prepares for its national convention, finds that the Affordable Care Act is not the top health care priority among Republicans. While jobs are still the number one issue for Republicans, when asked about the health care issues that will impact their vote this fall, Republicans' top concern was the cost of health care and insurance, named by two-thirds (67%) as either "extremely" or "very important" to their vote in Kaiser's August Health Tracking Poll. Next on the list was Medicare, cited by six in ten Republicans (61%) as being important to their vote, while the 2010 health care law ranked third, at 54 percent.  Most interviews in the August 7-12 poll were conducted before Governor Mitt Romney announced Representative Paul Ryan as his running mate on August 11th, which has led to a greater focus on Medicare in the news."

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Last Updated on Friday, 31 August 2012 07:56
Subpoena Duces What??? Print E-mail
Written by David W. Hirshfeld   
Monday, 27 August 2012 06:35

If you run medical practice, you receive subpoenas. Here are a few tips to help you respond to a common form of subpoena without having to involve your attorney.

The most common form of subpoena is a "Subpoena Duces Tecum." A Subpoena Duces Tecum requires the recipient to provide specific records, and the custodian of the records who can answer a few basic questions at a deposition about how the records are generated and kept by the practice. A deposition is just an interview under oath, conducted by one or more attorneys, that is recorded. The subpoena will set the date for the deposition.

Depositions are inconvenient, as you will have attorneys in your office for all your patients to see and gossip about, and someone on your staff will have to take time to be the subject of the deposition. In the vast majority of cases, the attorneys will accept the records by mail if they are accompanied by a written certification signed before a notary. You see, in order for the records to be useful to the attorneys, they need to know that the records are accurate and complete, were generated and maintained in the ordinary course of the practice's business, and haven't been changed in response to the subpoena; and this is what they intend to learn from the deposition. Most attorneys will accept answers to these questions in a written certification in lieu of an in-person deposition.

When you receive a subpoena duces tecum, you should call the issuing attorney and ask if you can respond to the subpoena via written certification rather than a deposition. You should call the issuing attorney immediately, as subpoenas are time sensitive and often require speedy compliance. In addition, if the subpoena was not accompanied by an authorization for release of records signed by the patient, then you should ask the issuing attorney for that authorization as a condition of your compliance with the subpoena. Never discuss the patient's treatment with the issuing attorney.

Mr. Hirshfeld is an attorney with The Florida Healthcare Law Firm in Delray Beach.  

Last Updated on Friday, 14 September 2012 11:50
July 2012 Readers' Poll Results Print E-mail
Written by Jeffrey Herschler   
Monday, 20 August 2012 08:11

The FHIcommunications Readers' Poll for July was conducted in partnership with Marcum Healthcare. We asked:

Now that SCOTUS has ruled on the ACA, what will small employers do with regard to health benefits?

There were a total of 175 participants in the poll. 31% believe small employers will not provide health benefits and therefore pay a fine.  Reflecting a concern voiced by many on both sides of the aisle, just 7% of subscribers feel undersized firms will continue to offer health benefits as before, understanding premiums are expected to keep rising. The majority of participants (56%) are of the opinion that companies will opt to offer reduced health benefits that still meet ACA criteria (i.e. much larger family and individual deductibles). As always we encouraged readers to write in their own answers. Some suggested firms will reduce workforce to below fifty full time employees to avoid a fine. Other, more optimistic participants suggested that companies will look at products on the Insurance Exchange.

Editor's Note: Percentages will not add up to 100 due to rounding errors and write-in votes.

The Use of an "Inventory" With ASC Rental Arrangements in Bodily Injury Cases Print E-mail
Written by David W. Hirshfeld   
Friday, 17 August 2012 12:10

As reimbursement from third-party payors shrunk, the uninsured accident victim emerged as a financially attractive patient. Surgeons, surgery centers, and therapists became armchair personal injury attorneys. They learned to identify and sign-up uninsured patients who had been injured as the result of negligence, and who were likely to be successful in the lawsuits arising from their accidents.

A popular model evolved in which a surgery practice leases an ambulatory surgery center for a very competitive rate, performs the surgery, charges the patient a reasonable and customary fee for the technical and professional component of the surgery, and agrees not to seek payment from the patient if his attorney and he agree, through a "Letter of Protection," that the surgery practice will be paid from the proceeds of the negligence lawsuit. These days, ASCs are leasing themselves out for very competitive rates because the surgery practice guarantees payment immediately upon completing the surgery, or even in advance of the surgery, and because many ASCs currently have excess capacity. The surgery practice often has to wait twelve to thirty-six months to be paid for its services; but when the lawsuit is resolved and they are paid, there is a healthy margin between the surgery practice's cost for the ASC and the amount the practice is paid as technical component. Remember, other than reasonable and customary, there is no fee schedule applicable in this context. The model is currently so lucrative, that it has attracted lenders who help finance the surgery practices while they await payment on the Letters of Protection. Not incidentally, this model may become less lucrative as more and more people are covered by health insurance as a result of the Patient Protection and Affordable Care Act.
The proceeds of negligence lawsuits are paid by property and casualty insurance companies, who employ professional claim adjusters, some of whom are very savvy. Surgery practices in this model may face the argument that the insurer will only pay the surgery practice what the surgery practice paid the ASC, without mark-up. In order to help avoid this sort of inquiry, we suggest that the surgery practice, as part of its arrangement with the ASC, receive a detailed inventory of every aspect of space, equipment, supplies and services provided by the ASC with respect to each procedure performed on each patient of the surgery practice. Beside each item on the inventory, the ASC should list its reasonable and customary charges for that item. This inventory can be used to support the payment secured through the Letter of Protection, and can be used by the plaintiff's attorney when (s)he is proving damages in the negligence lawsuit.

It is very important that nobody refer to the inventory as a "bill" that was or will actually be paid to the ASC; those sorts of references may lead to an accusation of fraud since the ASC has already accepted a lesser amount as payment in full. If and when asked, the surgery practice could justify its markup over what it actually paid the ASC as reimbursement for having to finance the surgery for many months, and as reimbursement for the risk of nonpayment.

This model can be lucrative, but it is fraught with potential problems. The ASC inventory described above is just one noteworthy aspect of how to work the model. Any surgery practice seeking to focus on treating negligence victims and taking Letters of Protection, should get advice from a trusted personal injury attorney and from a bona fide health care attorney.

Mr. Hirshfeld is an attorney with The Florida Healthcare Law Firm in Delray Beach.
Healthcare Reform: Now is the Time to Act Print E-mail
Written by Jodi Laurence   
Friday, 10 August 2012 10:15

Although the Affordable Care Act and the healthcare reform that has grown out of it have been in effect for more than a year, the uncertainty surrounding whether the U.S. Supreme Court would uphold key provisions left many providers wondering what they should do. As a result, many did nothing.

Now that the high court has ruled, it's time to get off the fence and prepare for full implementation which begins in 2014.

Because the premise of the legislation is to provide quality services at affordable prices, integration is critical. It will be difficult for solo practitioners to survive in this brave new world. Many already are talking of retirement. If that's not an option, then there are several corporate structures physicians can consider.

  • Those who can't afford to walk away need to consider becoming a hospital employee, forming a group practice, becoming part of an Accountable Care Organization ("ACO") or an Independent Practice Association ("IPA"). Survival as a solo practitioner will be difficult.
  • Hospital employee's need to make sure they negotiate a long-term contract with a guaranteed minimum salary, severance, and include the ability to unwind the deal if things don't work out. When signing a non-compete, make sure it doesn't apply if the hospital terminates you without cause or you terminate for cause.
  • Physicians who opt for a group practice setting should make sure a strong leader is in place. Also make sure the practice is set up with a solid electronic medical record keeping system and has more than one office to make it easier to negotiate with third-party payors. Remember, there is strength in numbers.
  • Another option is to become part of an ACO - they are groups of doctors, hospitals and other providers who work together to coordinate and provide high quality care to Medicare patients. When an ACO meets certain benchmarks for quality and efficiency it shares in the savings.
  • If you are not quite ready to become part of a group or hospital, an IPA may be the way to go. Managed care plans can contract with an IPA, which then contracts with physicians to treat patients on a negotiated per capital rate, flat retainer fee or negotiated fee-for-service basis.   
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Last Updated on Monday, 20 August 2012 08:03
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