Little Health Law Blog

Things to Consider When Moving Your Medical/Dental Practice

January 31, 2013 | Little Health Law

Physicians and dentists often decide to choose a new place to practice. Sometimes it might be in the same area but a different part of town or it can be in another city or state. Whether you are considering opening a new office or simply relocating, it is extremely important to do your homework before making this decision.

Here are a few tips from an experienced Georgia health care lawyer to consider.

One of the primary factors in making this decision is physician density. In areas where there are not as many doctors, it will be far easier to cultivate a new patient base. This is especially true if there are no physicians in the area with your expertise. In areas saturated with doctors, you are provided with the opportunity to expand your area of expertise and set yourself apart from the others.

Another thing to consider is an area with high unemployment. This would mean the people in that area would be less likely to have insurance coverage. This would make them less likely to make routine visits. This may all change under the Patient Protection and Affordable Care Act (PPACA).

Nobody really wants to talk about the costs involved for medical malpractice but it is a decision that has to be faced if considering a move. If you are moving in the same city or same area, this is not of significant concern. However, if you are considering moving to another state or a smaller town, the costs of malpractice insurance could vary greatly.

Lastly, consider what your earnings will be in the area you are considering. Physician compensation in the Midwest is higher than the Southwest. In reality a reputable physician can make a good living in any area he or she chooses to go to. One way to get inside information is to visit with other doctors in the area considering that they might not be entirely honest with their answers.

Unfortunately there is no cookie cutter format for determining the best place for a physician to be; there are issues specific to each practice that will need to be answered. The bottom line is that an experienced physician or dentist will flourish and succeed in any area that they choose.
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Final HIPAA Rule Becomes Effective March 26, 2013

January 31, 2013 | Little Health Law

The final Health Insurance Portability and Accountability Act (HIPAA) rule was announced on January 17, 2013, modifying the original 1996 version. The rule becomes effective on March 26, 2013, with full compliance mandated by September 23, 2013. After that, enforcement will commence.

Under the new rule, patients have new rights to their health information, greater privacy protection and the government has increased ability to enforce the law.

It is time to begin implementing a reporting plan for covered entities and business associates. Such a plan should consider four factors. Those factors to be considered in determining whether a breach must be reported include: (1) the type of protected health information (PHI) involved; (2) who used the PHI or to whom the PHI was disclosed; (3) whether the PHI was viewed or acquired; and (4) whether the risk to the PHI was mitigated, such as through assurances by trusted third parties that the PHI was destroyed.

Some other changes to be aware of are:

• Business associates are liable for HIPAA privacy and security rule requirements.

• A business associate includes subcontractors that create, receive, maintain or transmit PHI on the behalf of a business associate.

• Subcontractors for business associates are bound by the same compliance obligations no matter how far away the services are from the covered entity.

• A breach is any wrongful use or disclosure of PHI unless the covered entity or business associate assures that there was no compromise of the PHI or a small chance that it was.

• Covered entities have to protect the PHI of a decedent for 50 years following the date of death.

• Patients can request a copy of their electronic medical record (EMR) in an electronic form.

• For all practical purposes the sale of a patient’s PHI is prohibited without their authorization.

• Penalties are enhanced for noncompliance depending upon the level of culpability up to the civil monetary cap of $1.5 million per violation.

Navigating the expanded HIPAA rule and making certain that you are in compliance by September 23, 2013 can be a daunting task for small and large healthcare businesses, physicians, dentists and hospitals.
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The Electronic Medical Records (EMR) Mandate

January 31, 2013 | Little Health Law

While only slightly more than two-thirds of primary care physicians in the United States used electronic medical records (EMR) in 2012, this is an increase of 50% over the 46% that reported using them in 2009. This data is documented in a Commonwealth Fund International Health Policy Survey, which was published in Health Affairs.

The use of electronic medical records can make physicians’ offices more efficient and improve the quality of patient care by making their medical history available to any physician treating them. Unfortunately, many physicians still prefer to maintain voluminous files containing patient information and illegible handwritten comments and progress notes.

Make no mistake about it, electronic medical records are the way of the future for medical practices of all sizes. With the passage of the Patient Protection and Affordable Care Act (PPACA), and its constitutionality ruling by the United States Supreme Court last June 28, 2012, healthcare reform is on its way. A mandate requiring electronic medical records for all practitioners is a part of PPACA and is set to take effect in 2014. Some mandates included in the Health Insurance Portability and Accountability Act (HIPAA) have been included in and strengthened under the PPACA.

Funding for the EMR legislation will cover a span of 10 years. By the end of that time, it is hoped that all practices will have implemented electronic medical records. Incentive programs are available through the federal government. Some professionals meeting federal requirements for EMRs can get up to $44,000 through the Medicare Electronic Health Records Incentive Program. Others who are providing service to patients in a Health Professional Shortage Area might qualify for incentives in excess of $44,000. Incentives for institutions are significantly higher, starting at $2 million, but the requirements are stiffer than for individual professionals.

Naturally there are requirements established by the federal government to make certain the incentive funding is being used properly. For example, there are specific formats for use in the areas of medical billing, patient medical history and employee communication.

Ultimately, the use of modern technology to comply with the electronic records mandate of PPACA will make our healthcare system better, provide better care to the patients and make it more affordable to all.
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Seven Arrested, Charged with $22 Million Detroit-area Home Health Care Fraud Scheme

January 25, 2013 | Little Health Law

Federal law enforcement agents arrested one Chicago-area resident and six Detroit-area residents based on allegations of home health care fraud. In an 18-count indictment unsealed on January 17, 2013, the federal government contends that the seven parties effectuated a scheme to defraud Medicare based on claims for in-home health services at Royal Home Health Care Inc., Prestige Home Health Care Services Inc., Platinum Home Health Services Inc. and Empirical Home Health Care Services Inc. According to the indictment, Medicare was defrauded of over $22 million based on false claims for services since August 2008.

The Medicare Program is a federal health care program that provides benefits to the disabled and persons over age 65. It is administered by the Centers for Medicare and Medicaid Services (“CMS”), a division of the United States Department of Health and Human Services Office of Inspector General (“HHS-OIG”). In order for a health care provider to participate in Medicare, the provider must agree to abide by Medicare polices and procedures, rules, and regulations published by the federal government. When a provider is certified as a participant in the program, the provider receives a provider identification number for billing purposes, known as a “PIN.” A provider uses the PIN to submit claims for reimbursement to the government for services rendered to a patient, or “beneficiary.” A Medicare beneficiary has a Medicare beneficiary number that is used for billing purposes.

Combating Medicare fraud has been a major priority and focus of the federal government for many years. Since March 2007, the federal government’s Medicare Fraud Strike Force, which involves HHS-OIG, the FBI and other federal law enforcement, have charged more than 1,480 defendants who have falsely billed Medicare for over $4.8 billion. This indictment is part of the effort of the government’s Medicare Fraud Strike Force to effectively combat Medicare Fraud in an effort to curb the spiraling costs of the Medicare Program and otherwise for the benefit of the federal taxpayer.

According to the indictment, the home health care companies purported to provide in-home physical therapy, occupational therapy, speech pathology and/or skilled nursing services to patients. Royal, Prestige, Platinum and Empirical were Medicare providers that submitted claims directly to Medicare using PINs and beneficiary numbers. The individuals named in the indictment were either owners and/or officers of the home health care companies, or were employed as therapists or patient recruiters. The indictment charges that the defendants offered and paid kickbacks and bribes in the forms of cash payments and/or prescription narcotics to Medicare beneficiaries for the purpose of such beneficiaries arranging for the use of their Medicare beneficiary numbers by the conspirators as the bases of claims for physical therapy and other services. The indictment further alleges that Medicare claims were submitted to the government for physical therapy services and other services that were not provided and/or were not medically necessary. The indictment states that the defendants used false medical documents to support the fraudulent claims.
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How The PPACA Can Affect Your Medical/Dental Practice

January 19, 2013 | Little Health Law

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According to an economist with Moody’s Analytics, the new health care law is set to negatively impact hiring in 2013; this is based on what human resource firms are saying, anyways. They are predicting that some businesses are going to be taking on more part-time employees rather than hiring full-time employees, in addition to reducing the hours for permanent employees.

The reason is the Patient Protection and Affordable Care Act (PPACA). Under PPACA, businesses that have 50 or more full time employees must provide health insurance to employees who work at least 30 hours a week. If employers fail to offer health insurance, they will face a penalty of $2,000 for every worker in excess of the first 30.

This mandate for employers does not take effect until January 1, 2014. However, in order to determine whether employees average enough hours to qualify for benefits, employers have to track their work schedules for at least three months and up to 12 months before 2014. As a result, employers are already starting to restructure their payrolls and will continue to do so into 2014.

Approximately 25 percent of businesses do not provide health insurance to employees who work at least 30 hours per week, according to a consulting firm study. The survey further revealed that 50 percent of those businesses intend to make necessary changes so that fewer employees will meet the 30 hour threshold provided by PPACA.

The companies intending to grow that have 40 to 45 employees are most affected, since they are apprehensive about crossing over the 50 employee threshold. For example, a Melville advertising group with 45 employees had intended to hire another 10 but will no longer do so to stay under the limit. Others simply intend to have more part-time employees that they do not need to offer health coverage to.

Employers who have a large number of part-time or low-wage employees will especially be burdened. Under the PPACA, employees are supposed to pay no more than 9.5 percent of their wages for health insurance premiums, causing employers to be forced to contribute more for low-wage employees than those who are higher paid.

According to the International Franchise Association, 31 percent of all franchisees surveyed intend to reduce their number of employees to get below the magic 50 employee threshold. Additionally, employers have indicated that they plan to reduce the work schedule of employees to get below the 30 hour per week requirement.

The constitutionality of the Patient Protection and Affordable Care Act (PPACA) was upheld by the United States Supreme Court on June 28, 2012. This complex act is focused on reducing the number of people who do not have health care. Contained in it are numerous mandates, subsidies and tax credits which employers need to be educated about.
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Dental Therapists – A New Trend In Dentistry

December 28, 2012 | Little Health Law

In 2011, the first nine dental therapists (DT) of the University of Minnesota, School of Dentistry’s Dental Therapy program graduated. A second group graduated in early December 2012. Dental therapists go through a two and one-half year program, versus a four year degree for dentists, and are destined to make approximately half of what a dentist makes. They also are restricted from working in any dental practices other than those where a majority of the patients are on medical assistance or are low income families.

States following Minnesota’s move to license dental therapists are California, Kansas, Maine and New Hampshire. The need for more dental-care practitioners is particularly evident at community clinics and other under served populations. Dental therapists can fill cavities, extract teeth, put crowns on and provide other preventative and restorative care normally performed only by dentists.

The action of the University of Minnesota and the State of Minnesota revolved around reports indicating that untreated oral diseases often lead to other more serious diseases, such as diabetes and heart disease.

According to a 2012 Senate report approximately 130 million people in America have no dental insurance; 47 million live where dental care is difficult to access; and 17 million poor children have no annual dental care. Furthermore, there were 830,000 hospital ER visits in 2009 because of preventable dental issues. This is a 16% increase from 2006. Part of the problem, according to the report, is that the number of new dental graduates is not keeping pace with the number of dentists retiring each year.

A study by the W.K. Kellogg Foundation arrived at the conclusion that dental therapists have been serving patients in 54 countries for almost 100 years, providing patients with preventative and restorative care. Dental therapists have also treated patients located in remote tribal areas of Alaska.

After licensed dental therapists have accumulated more than 2,000 hours of on the job experience, they can attend the University of Minnesota, Metropolitan State University in St. Paul to attain a degree and be certified as an advanced dental therapist (ADT), allowing them to perform additional procedures. As an advanced dental therapist, they are able to provide dental care to more locations, such as shelters, nursing homes, schools and emergency rooms, at a significant saving as compared to visiting a dentist.

Some dentists have been skeptical of the dental therapy concept. Emily Eggebrecht, with Children’s Dental, was one of those initially but now believes in the program because it provides care to so many more patients, who would otherwise go untreated.
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Tips For Improving Your Medical/Dental Practice

December 27, 2012 | Little Health Law

Despite all of your training in medical or dental school, many patients may feel that you have a long way to go with administrative efficiency or bedside manner.

As medical professionals, your job is more than examining, diagnosing and treating patients. It is imperative that your patients feel truly cared for by you and your staff. Since there are many doctors and dentists to choose from, losing your patients to another professional is just a phone call away. The internet is filled with sites such as Angie’s List, HealthGrades, RateMDs and Vitals; all of which provide information related to patient satisfaction.

Patients require more than simply taking care of their illness, injury or toothache. These patients, like it or not, are “customers.” They deserve to be treated with kindness, dignity, respect and courtesy. If a patient is having a particularly hard time with a physical condition, a mental problem or a painful dental ailment, taking the time to call and ask how they are doing can be particularly comforting. By going the extra mile, you are setting yourself apart from other professionals in your field.

One of the items on patients’ complaint list is having to sit and wait for one or two hours to see their doctor or dentist, when they have had an appointment for weeks. If for some reason you are running behind, make sure your staff calls them or sends a text message advising them of the delay. This will send a message to your patients that you respect their schedules and they will in turn respect yours.

Always have your staff call your patients if you are going to be out of town or have some other conflict for the date of their appointment. Never allow a patient to show up for an appointment only to be told that you are on vacation or attending a conference.

Having a competent and friendly staff is a tremendous asset to your practice. They are an extension of you and their demeanor and attentiveness can go a long way to the success of your practice. They are the first and last people a patient sees when coming into your office. How they are perceived can result in positive or negative feelings. Occasionally, it is a good idea to visit with patients about how they feel about the staff members. Ask if they are they attentive, do they promptly return phone calls, and have they been treated well or has someone been rude or impatient with them.

Since your staff can either make or break your practice, it is important to take care of them and show your appreciation for their team effort. Make them want to come to work every day, thrilled, excited and with a smile on their face. Take time to inquire about their likes and dislikes. Perhaps there are some changes in the office that would make them happy and improve their effectiveness.
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Marketing Tips For Medical Practitioners

December 12, 2012 | Little Health Law

Physicians often feel that marketing or branding their medical practice is unnecessary. Perhaps they think that by being a doctor they have a built in identity or they have plenty of patients. This does not even take into consideration the anticipated influx of new patients being thrust into the patient pool by Congress over the next few years.

In reality, physicians who own their own practices see themselves as someone who was “called” to be a doctor. Their medical practice is their career or profession but they rarely think of it as a “business.” The fact is that basic marketing principles that apply to other businesses also apply to the healthcare practice owners.

Medical professionals who own their own practice sometimes think that marketing or advertising is inappropriate or even unethical. This is especially true for physicians who began their medical practice before advertising was as prevalent as it is today. The fact is that marketing and branding a medical practice can do more than generating more revenue and patients. It can help patients who are best suited to your practice, as well as other physicians wanting to make a referral, identify with you.

Most physicians have had no formal business education, training or experience in running a business before opening their first practice. Other than perhaps the new generation of recent graduates from medical school who are entering practice, most physicians are unfamiliar with how to make their practice more noticeable through social media and making their website more relevant to search engines.

Social media can create interest in your practice and allow you to interact with existing or potential patients. It can also connect you with other physicians seeking to make a referral. LinkedIn is a social media tool that can boost your name recognition and your practice’s online image. Facebook can be an interesting place for patients to obtain reliable information or supply input about your practice. YouTube can provide you with a great opportunity to provide a virtual tour of your office and allowing patients to see pictures of you and your staff. Twitter can provide you with information about your followers and give you a venue to provide breaking news about your practice.

Maintaining a professional and informative website can also be an important tool in marketing your practice, allowing new patients to find you on the web and providing information to current patients. many physicians also have blogs, where they provide information on current issues in the healthcare world.

Marketing your medical practice is really no different than marketing any other small business or firm. The same proven strategies that work in other industries apply and are successful in the healthcare industry.
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What Buyers Look For When Purchasing Medical Practices

December 7, 2012 | Little Health Law

Physicians often reach a point where they no longer want the headaches of owning their medical practice, which comes with administrative, financial, regulatory and legal burdens. While they might wish to continue to see patients, they no longer want the headaches of ownership and desire the financial security from selling their practice.

Buyers of medical practices generally are looking for one that is well regarded, has a similar philosophy regarding patients, is healthy financially and has a potential to generate income. Finally, they want to be able to arrive at an agreeable compensation agreement. In the process, a buyer will look for anything that could be a deal breaker.

The status of a medical practice is very important for many reasons. Name recognition can be a primary factor for new patients, referrals, hospital relationships and insurance carriers, as well as recruiting new physicians. Reputation is the key. The staff should be prepared for a visit from potential buyers to size up the organization, the office, its furnishings, professionalism and interaction with the patients.

Buyers need to feel like the practice is a group of team players who are willing to work together to grow the practice through eliminating unnecessary expenses, improving its efficiency and the quality of patient care.

Obviously, the physician wishing to sell the practice wants to obtain a generous compensation package. Some of this money will be up front. The remainder can be in the continued employment agreement providing a base salary and incentives for growth and performance. Both sides will have their own parameters and negotiations will be ongoing throughout the process, until the terms and conditions are agreed upon.

Once the reputation of the practice has been accepted and it is determined that there is a group of team players who match the buyer’s philosophy, the task of analyzing the financial health and income potential begins. Financial statements, tax returns, salary histories of staff and physicians, payer mix reports and coding practices must be reviewed. Disclosure of any outstanding liability exposure, including existing or potential malpractice claims must be made. Finally, an examination of the quality of furnishings, equipment and computers must be conducted. It is never a good sign if a practice is still using paper files for billing purposes or patient information.

Just as in the purchase of a home, a primary factor to consider is price. Red flags that prevent a deal from ever getting off the ground are unrealistic expectations of the worth of the practice or unreasonable expectations of future compensation.
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