Preventive care; more malpractice premium hikes; e-billing; OIG's new target
It's not feasible for physicians to deliver all of the services recommended by the US Preventive Services Task Force. That's according to a study published in the American Journal of Public Health. The study found that doctors would have to spend an "unreasonable" amount of time37 hours a week to deliver enough preventive services to fully comply with the Task Force's recommendations. That would leave little time for ongoing and immediate medical care.
What can be done to resolve that dilemma? Researchers suggest that physicians concentrate on providing illness care and leave wellness services to NPs and PAs.
Doctor-owned ISMIE Mutual Insurance, Illinois' largest malpractice carrier, has announced a 35 percent increase to policyholders' annual base rate. Over the past two years, the company's average payout per claim has climbed 59 percent to $612,000, while the number of reported cases has jumped 36 percent over the past nine months alone. The same market conditions are forcing ISMIE to significantly reduce existing discounts, leaving some policyholders with premium hikes well in excess of 35 percent. The company has already imposed a moratorium on new business.
Ninety-five percent of physician group practices surveyed last year submitted claims electronically. More than half (51 percent) reported that since instituting electronic claims submission, they are reimbursed within 30 days, and none has to wait more than 90 days. When submitting paper claims, on the other hand, only 1 percent were paid in 30 days or less, and 12 percent had to wait 91 days or more. The survey, conducted by MediNetwork, a consulting firm, surveyed practices with three physicians or more.
Medicare HMOs limit Medicare beneficiaries' exposure to large out-of-pocket expenses, according to a recently released report published in Health Affairs. A study of seniors' medical spending by RAND Health researchers found that people who enroll in HMOs to supplement their basic Medicare coverage had lower average annual out-of-pocket costs ($1,738) than those relying on other types of Medigap insurance plans ($2,585). Seniors covered by former employersthe most frequent insurance optionspent an average of $1,676, while those with both Medicare and Medicaid coverage had average outlays of just $963.
The HHS Office of Inspector General has issued a Special Advisory Bulletin that cautions Mediplan providers against entering into joint venture arrangements that violate the federal antikickback statute. Suspect arrangements involve health care providers who contract with an existing supplier (a would-be competitor) to serve the provider's existing patient population. While the supplier essentially operates the business, the provider's name is used to bill insurers and patients. In the OIG's view, notes Robert G. Homchick, an attorney with Davis Wright Tremaine, the group's share of profits would constitute a kickback for the referral of the doctors' Medicare and Medicaid patients.
Here are some red flags likely to draw OIG scrutiny: if the arrangements include would-be competitors, provide a captive referral base, or offer little or no "bona fide" business risk; if the supplier provides all or many of the key services; if the owners benefit from the volume of business they generate; and if the contract includes a noncompete clause.
Joan Rose. UPDATE: Focus on practice.
Jun. 20, 2003;80:12.