InPractice Vindicator
April 2011
In This Issue
InPractice GPO –
―The BluePay Challenge‖
Employing Physicians: Insurance
Due Diligence
HHS Releases Proposed Rules on
ACOs; Requests Public Comments
Doctors Report Higher Productivity
With Fully Implemented EHR
Fitness Tips for a Busy Lifestyle
InPractice Management
About us
Our Services
Resources
Other Stories
HHS Releases Proposed
Rules on ACOs; Requests
Public Comments
From: United Benefit Advisors
The U.S. Department of Health and
Human Services (HHS) has released 479
pages of proposed new rules to help
doctors, hospitals, and other health care
providers better coordinate care for
Medicare patients through Accountable
Care Organizations (ACOs). ACOs
create incentives for health care providers
to work together to treat an individual
patient across care settings -- including
doctor's offices, hospitals, and long-term
care facilities.
A Monthly Newsletter from InPractice Management
InPractice Group Purchasing -
“The BluePay Challenge”
www.bluepay.com
The InPractice Group Purchasing merchant services vendor (BluePay) has
come up with another great promotion for the month of April!
―The BluePay Challenge‖ means that BluePay guarantees that they will lower
your practices rates and fees for merchant services or they will pay your practice
$500!!
All they need to conduct an analysis for your practice is a copy of a statement
from your current merchant services vendor.
Your practice will either receive $500 or a monthly cost savings!
For information on joining InPractice Group Purchasing or to have a cost
savings analysis conducted for your practice by BluePay, contact:
Matt Williams – (540) 504-0286, mattw@inpracticemanagement.com.
Employing Physicians: Insurance Due Diligence
By: Pamela Haughawout, CPCU, ARM, RPLU
Senior Vice President, Willis Health Care Practice
One of the most dramatic shifts in the health care delivery system in the
last several years is occurring in the relationship that physicians
have with other physicians and with hospitals. Three factors
increasingly prevalent throughout the health care industry are
influencing this shift.
Physicians are electing employment rather than solo practice
Hospitals are electing to align with their physicians in strategic
practice areas through employment
Physician practice groups are merging or acquiring to form
The Medicare Shared Savings Program
will reward ACOs that lower health care
costs while meeting performance
standards on quality of care and putting
patients first. Patient and provider
participation in an ACO is purely
voluntary. The proposed new rules are
now available for a 60-day public
comment period.
Additional resources on ACOs include:
Fact Sheet
Proposed Antitrust Policy
Statement
IRS Guidance and Solicitation
of Comments
News Release
Fitness Tips for a Busy
Lifestyle
From: United Benefit Advisors
Want faster fitness? Not only do you
burn calories while exercising, but you
also raise your metabolism – your ―burn
rate,‖ the process by which your body
converts food to energy.
Boosting your metabolism helps you burn
more calories more efficiently. Plus you
may find you have more energy overall.
To rev up your engine:
1. Get into Aerobics. Your metabolic
rate rises after a vigorous aerobic
workout, which puts your heart and
lungs through their paces.
2. Try strength or weight training. It’s
not just for jocks. The more muscle
you build, the faster your metabolic
rate, even when you’re sitting still.
3. Resist crash diets. When you
drastically reduce your daily caloric
intake, your body actually slows down
its metabolism to guard against
starvation.
Read More>
―super practices‖ in order to form accountable care
organizations (ACOs)
The emphasis on ACOs contained in The Patient Protection and
Affordable Care Act (PPACA) and The Health Care & Education
Reconciliation Act (HCERA) of 2010 has accelerated the trend toward
integration of physicians into larger and more powerful practices able to
handle the needs of a diverse population and more fully integrated hospital-
led delivery systems.
One key risk area arises in all of these scenarios – the extended reporting
provision (ERP), related to the physician’s practice of medicine prior to
becoming employed, otherwise known as the tail. The discussion of how to
finance a physician’s prior liability typically arises at the end of the
negotiations. The physician requests that the employing entity – either a
hospital or larger practice – pay for the tail for the physician’s previous
coverage. Tail coverage or ERP may be expensive, and physicians often
have not accrued sufficient funds or do not have available cash to handle
the expense.
However, a broader issue should be addressed – not at the end of the
process but at the beginning. The continuing liability of the
physician for his/her activities prior to the merger, acquisition or employment
needs to be assessed as well as how these liabilities are
to be financed and by whom. Whatever the expense calculation, it must be
added to the overall cost/benefit analysis of hiring a particular physician.
ADDRESS THE ISSUE EARLY IN THE NEGOTIATIONS
The physician’s continuing liability for his/her prior activity is a risk that the
employing or acquiring hospital or practice must face, because it may well
affect the hospital or practice’s insurance or risk financing program going
forward. In many cases the potential cost of financing the liability for prior
acts is not considered until the end of otherwise successful negotiations
and frequently arises only when a physician insists that the acquiring or hiring
practice or hospital ―pay for the tail.‖
The purchase of an ERP, or tail, from the physician’s current insurer and
which party pays are not the only considerations or the only risk financing
options. Additional information must be obtained and evaluated to determine
if purchasing a tail is necessary and the most cost-effective risk financing
solution. A well qualified insurance broker is the most appropriate
professional to assist in the evaluation. They will have information on the
current and past insurance marketplace and typical physician loss
experience that most law firms do not have readily available.
Read More>
Doctors Using Fully Implemented EHRs Report
Lower Costs, Higher Productivity, MGMA Finds
By: Joseph Conn

Ambulatory-care physicians who have implemented an electronic health-

record system are largely satisfied with their purchases, and their
satisfaction increases if they have their EHR systems optimized, according
to data from a survey by the Medical Group Management Association.

The survey also indicates that financial benefits accruing to the practices
tend to follow levels of optimization.

More than seven in 10 practices (72%) that had completed an EHR

implementation were either "satisfied" or "very satisfied" with their systems,
according to the survey. Those that claimed they had fully optimized their
systems were even more pleased—86% were "satisfied" or "very satisfied."

In addition, the financial rewards of EHR adoption were greater for those
who had fully optimized their systems. According to the survey, 61% of
respondents who reported their EHR had been fully optimized indicated
their systems had 1) increased provider productivity and 2) boosted
practice revenue, compared with 37% and 42% respectively, for those
practices that had an EHR implemented but were still focusing on getting
dialed in with their systems.

Veteran numbers cruncher Dave Gans, the MGMA's vice president of

innovation and research, oversaw the survey project and said that what
jumped out of the data for him was that "organizations not only are
acquiring electronic health records, they're embracing electronic health
records." He added: "It's changing the way they're doing business. We're
re-engineering healthcare. That's what's coming through."

"(For) the majority of the organizations, they reduce their cost, and increase
their productivity," Gans said. ―The popular conception is that electronic
health records slow you down, they cost you money, and we wouldn't want
them. And now we have a very large sample of people who say we've
embraced it, it's making a difference and we're satisfied with what we're
doing.‖

The MGMA study gleans information from a cross-section of physician

group practices, including independent medical practices, 59%; hospital- or
integrated delivery system-owned practices, 17%; academic faculty
practices, 5%; federally qualified health centers or community health
centers, 3%; and more than a half dozen other practice arrangements,
representing workplaces of more than 120,000 physicians in total. Data was
collected between Oct. 1, 2010, and Nov. 9, 2010. There was a "profusion"
 of 148 EHR systems in use by survey participants, with no one system
capturing more than an 11% share of the systems reported.

More than half (52%) of those practices surveyed reported that they used
an EHR system. In comparison, 36% used paper charts and 6% used a
document scanning system. Of the practices still using paper records, 63%
plan to adopt an EHR system and seek federal incentive payments under
the American Recovery and Reinvestment Act of 2009. The survey was
open to practices of all sizes, and nearly 10% were one- and two-physician
practices; while 23% had three or fewer physicians.

EHR adoption rates in the MGMA survey comport with preliminary

estimates from the 2010 survey by the National Center for health Statistics,
which found that 51% were using at least a partial EHR system.

But among the practices in the MGMA study that claim to have an EHR
system, nearly a quarter (24%) said the system is still being implemented.
Only 16% indicated they have completed implementation and believe they
have optimized their systems.

Even among provides with fully optimized systems, a lack of EHR

interoperability functions could be a barrier to meeting federal meaningful-
use criteria and qualifying for federal EHR incentive payments under the
American Recovery and Reinvestment Act, according to the survey.

Only 44% of practices with optimized systems reported their EHRs could
meet meaningful-use criteria for clinical decision support and exchanging
clinical information with other providers. Only 38% of optimizers reported
their systems could send clinical quality measures to CMS or to states.

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