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Peter Waegemann, founder of the Boston Medical Records Institute states that his his opinion, there is not one successful EHR system in the whole world. He states that user friendliness, usability and interoperability are not there. He believe there is too much emphasis on documentation for reimbursement. He continues with the lack of true integration. Top
The AMA has put out a warning for all physicians to be careful not to get snared in a trap that will only allow you to participate in one ACO. Unless you are employed by a hospital and need to do your master's bidding, if you are a specialist group or solo practice, want to service several ACOs and bill using a EM code, you and your group are screwed. It is imperative that if you use the EM codes the patient is immediately referred and seen by a PCP. It is not good enough only to refer the patient, they must be seen. If not you are the PCP and a PCP can only belong to one ACO. The reason for this is that the feds as usual screwed up. They say that a PCP is anyone who uses the EM codes. If one person in a group bills using an EM code the whole group is bound by it. Another way to get out of the bind is to set up a secondary billing system with a second TIN, not the one associated with the group practice. If you are a solo specialist you may be better off billing under SSN. Be careful here since you do not want to no longer be considered a group under Stark. It is also imperative that someone read the contract to make sure it is not an exclusive contract. It may even be to your advantage not to contract with any ACO as the ACO only applies to physicians and not patients who can see anyone they wish. Top
The Charlotte, North Carolina, newspaper has caught on. They ran a story of the rising costs of medical care when physicians are purchased by hospitals. The Charlotte Observer investigation found much higher bills for the same services when the physicians are owned by the hospital than when the same services were billed by the private physicians. They found the services may double in price. The reason for the higher prices is that insurers including Medicare pay more for the service if a hospital performs it than if a physicians does it. The hospitals attempt to defend their position by stating they take on all comers and have more expenses than physicians. However, they had them prior to purchasing the physicians and the purchase did not increase the costs. Hopefully, the CMS and other insurers will soon stop this huge pay differential and the use of facility fees as well. The increased billing means higher out of pocket expenses for patients and is just plain wrong.
The Washington Post also did an article on the immoral hospital charges of facility fees. They told the story of a patient in a Vermont whose out of pocket fees went from $120 t0 $1000 after the hospital bought the practice. There were no other changes. An attempt in Vermont to legislatively stop the facility fees failed. Nationally, Medicare pays over $1 Billion in facility fees alone. This would certainly be easy to save money for the feds by just refusing to pay the immoral fee. Private insurers would then follow suit. MedPAC has recommended the stopping of the payments.
All is not happiness in New Mexico. The Lovelace Clinic, long known for it's hard stance against physicians, has struck again. The system which owns their own insurance has notified ABQ Health Partners that they could no longer treat the Lovelace insured patients at Lovelace hospitals. This stems from a contract dispute about how much Lovelace was to pay the physicians to care for their patients.
St. Peter Hospital in Minnesota has asked the attorney general to investigate the Mayo Clinic for telling lies to patients about the type of services that can be obtained at St. Peter's. Mayo denied the charge but minutes of meetings between the two in 2010 tell that Mayo knew.
Two of the largest healthcare systems in the Dallas area are planning to merge. Baylor and Scott & White are planning to merge which most feel will drive up costs in the area. These consolidations and price increases to the patients are a direct consequence of Obamacare to survive against the insurers and regulators.
Prime Healthcare has stopped billing for Kwashiokor a disease of wasting due to malnutrition. They billed for this disease for years in seniors. Now that it has attracted more attention they have stopped the billing even though the seniors have not changed. It is now being billed as other forms of malnutrition. Top
DISCLAIMER: Although this
article is updated periodically, it reflects the author's point of view at the
time of publication. Nothing in this article constitutes legal advice. Readers
should consult with their own legal counsel before acting on any of the
information presented.