BMN Blog

For years, medical professionals have discussed the need to transform the healthcare system, while also keeping it available to all people. There are many different ways of doing this including government programs, fee-for-service, Medicare programs, waivers, etc.

For many physicians, the practice retirement plan can result in providing one of their most significant assets to be used after retirement. These plans are called qualified retirement plans because they fall under requirements of IRS Internal Revenue Code and are eligible to receive certain tax benefits, unlike non-qualified plans. These plans are governed by the Employee Retirement Income Security Act (ERISA).

A pediatric oncologist colleague of ours from Cornell Medical Center in New York posted a question to Facebook on March 23, 2020: How would the new COVID-19 pandemic impact the pediatric cancer population? We were asking ourselves the same question here at Children’s of Alabama. As social distancing and virtual meetings became the norm, we put our heads together – nearly 1,000 miles apart – to figure out how best to provide ongoing care for our oncology patients.

The result is the Pediatric COVID-19 Cancer Case (POCC) Report, a national registry of pediatric cancer patients diagnosed with COVID-19. It’s designed to better help our fellow clinicians provide vital care during an evolving pandemic.

In my June blog, we looked at what is occurring rate-wise in the Medical Professional Liability market in the United States overall, none of it positive. In this article I want to focus on factors that are just as important as price and which almost always affect premium. (In the third and last installment of this blog I will look more closely at rates in our region, and specifically in Alabama, for both physicians and hospitals).

Why do physicians leave their employment with a practice group? 

There’s no single reason for such a separation. A physician's leaving might be planned well in advance, or might be an unplanned, precipitous event. 

[This is the first of a three-part series. By the end of the series, I hope to have covered national, regional, local, and personal realities of the medical malpractice market so that the reader (especially physicians, practice administrators, office managers, and hospital executives) has a sense of the current disturbing developments they may be experiencing.]

When the Birmingham Medical News asked me to write a blog, they told me I could write about anything. Anything? Anything. 

In the past year, most physicians have been so busy with all the complications and changes in approach to care that resulted from the pandemic that they haven’t had time to examine aspects of their practice that aren’t part of the daily work. If you haven’t performed a recent review of the potential threats to your practices’ financial health, I recommend doing that, starting with your commercial insurance plan.

Partnering with an experienced agent who specializes in the healthcare arena can provide you with multiple carrier options to compare while helping you negotiate more favorable terms than some companies will offer to clients who work directly with the carrier only. Let’s take a look at a few of the items my team is focused on for our healthcare clients and the emerging threats that are continuing to impact more medical businesses. 

It’s great to see the continued momentum in the state’s quest to get all Alabamian’s vaccinated. As COVID-19 vaccine availability expands to include more age groups, providers are naturally going to get more questions about the vaccine, potential side effects, interactions, etc. The Risk Consultants at Inspirien Insurance Company have compiled a list of 10 frequently asked questions regarding the vaccine to expedite clinical visits and support clinicians in their quest to combat COVID-19. These FAQ’s were obtained from evidenced based sites such as the CDC, The American Medical Association, and The New England Journal of Medicine.

1. Is a patient who is immune-compromised, has an immune disease or has cancer eligible to take the COVID-19 vaccine?

According to Dr. Carlos del Rio, a Global Health Expert at Emory University “there is no contraindication in my mind to take the COVID-19 vaccine.” Dr. Rio goes on to note that clinical trials did not include those individuals in an immune-compromised state, so the efficacy of the vaccine is still unknown and may not be the same as an individual who is not in an immuno-compromised state. Patients are advised to not take the vaccination if they have had an allergic reaction to the vaccine or any component of the vaccine.

2. What are the most common side effects after getting the COVID-19 vaccine, and how long do they last?

The journey toward mental health parity began in 1961, when President Kennedy directed the Civil Service Commission (now known as the Office of Personnel Management) to implement mental health parity. The Strengthening Behavioral Health Parity Act (“SBHPA”), which was signed into law on December 27, 2020 as part of the Consolidated Appropriations Act of 2021, represents a major milestone in that journey by adding ERISA plans to the plans that are covered by the Mental Health Parity Act of 1996 and by working to achieve parity in physical and mental health care management processes.

By now you have probably heard this and read it a thousand times. But one last time, we will cover it with some background on the whys and how’s.

As 2020 approaches and people begin to contemplate their New Year’s resolutions, weight loss is often at the top of the list. There are two excellent options available for dramatic weight loss: the gastric bypass procedure and gastric sleeve procedure.

According to the Medical Group Management Association (MGMA), the fourth most challenging issue in practice management is collecting from self-pay and high deductible patients. With patient payments representing a growing portion of practice revenue, re-engineering how patient collections are approached is crucial to practice success.

Real estate is the second highest expense behind payroll for most healthcare practices. The benefits of capitalizing during lease negotiations can include a healthy raise through increased profitability, reduced debt, a nicer office and more. On the contrary, if negotiations are not handled properly, the results can be decreased profitability, resulting in the need to produce tens to hundreds of thousands of additional dollars just to pay the same bills that should have cost less.

Just as it’s common for our families to have “Dr. Mom,” it’s also common for one spouse to serve as the family’s Chief Financial Officer (CFO). The family CFO takes the lead in paying bills, making investment decisions, selecting insurance policies and employee benefits, etc. This division of labor is common because one spouse may have more interest in financial matters, and the set-up works fine - as long as both spouses are physically and mentally healthy.

You are likely aware of the outbreak of measles that has received a lot of attention in 2019. The CDC reports that over 1,000 cases of measles have been reported this year, which is the greatest number of cases reported in the U.S. since 1992.

While it’s easy to shop around for the best price on a car or the cheapest gallon of milk, it can be nearly impossible to predict what your medical bill will be following a procedure or hospital visit, regardless of your health insurance coverage.

As financial advisors, we help our clients to consider and plan not only for their own goals, but also for some of life’s serious “what ifs.” What if you want to retire early? What if you want to buy a vacation home? What if your child is planning to attend graduate school? What if you need long-term care?  What if you are raising a young family and you get cancer?

At this point, nearly every American has heard about the opioid crisis. With increasing scrutiny from governing bodies regarding opioids, pain physicians are tested in treating patients in the challenging chronic pain population. While non-opioid medications, therapy and procedures have their place in treating chronic pain, what are physicians to do when patients fail all of these options? One treatment to consider is spinal cord and peripheral nerve stimulation.

During my 30 years in healthcare consulting, I have seen several reform initiatives come and go.

In many cases, the initiatives have enhanced the ability of consumers to access insurance coverage and ultimately healthcare. In 1993, President Clinton proposed legislation that led to growth in Health Maintenance Organizations (HMOs) and also the HIPAA privacy standards which are still in place today. In the 2000s, President George Bush proposed changes to the Medicare program that led to the implementation of Medicare Part D coverage.

Venous ulcers of the lower extremities can be a frustrating disease process for clinicians. Do I send them to wound care center (WCC), do I need to order specific studies, are they venous or arterial? 

Is your EHR application in the cloud or are you considering moving to a cloud based provider? If so ensuring that you know the providers processes for data backup, disaster recovery and overall security are extremely important.

I find it intriguing that physicians are one of the only professionals who pledge an oath before practicing their craft. Other notable “oath” moments in our country focus mainly on Nationalism and Service (Military, Law Enforcement, Public Servants and Naturalization among others). How different might some professionals behave, if included in their daily duties, was the acknowledgement that they are working under an assumed set of values and principles that help guide their tasks? For CERTIFIED FINANCIAL PLANNER™ professionals this exists, not in an oath form however; but within principles expressing ethical and professional ideals.

I recently visited a specialty practice at a major health system. As I approached the registration desk a posted sign directed me to a standing kiosk to sign in. The family member I accompanied to the visit was unable to stand at the kiosk, so I provided the needed information and signed her in.  Although it was a quick and seamless process, I was concerned because if I needed assistance, there were no employees to ask.  Many practices have implemented kiosk sign-ins and have someone to assist a patient with the process if needed.  Practice administrators have made the decision to implement kiosk to assure verification of the current insurance policy and prompt the patient to pay any out of pocket expense before they see the doctor.  Many of the kiosk solutions allow a pre-registration via email to allow the patient to populate data and upload information from their own device at their convenience.  Benefits of Kiosk Sign-ins include: reduction in the staffing at the front desk, decrease in patient wait time, and most impressively is the increase of time of service collections.

As today’s healthcare drive pushes practices even further down the path of pay for performance versus the older models of pay for volume, administrators and executives throughout healthcare are researching and implementing ideas to provide an overall better experience for patients.

Are you sleeping well? One in three Americans suffer from sleep-related issues. If you or someone you know suffers from a sleep disorder, there has never been a better time to find a solution. Lack of good sleep can be detrimental to one’s quality of life in many aspects. Untreated sleep disorders make it difficult to control other health conditions such as migraines, anxiety, depression, pain, and more. Poor sleep due to a disorder such as sleep apnea can also have negative effects on your social life, as you are too tired to participate in social activities. People who snore could also interrupt the sleep of their bed-partners!  Finally, sleep issues can lead to poor concentration, job performance, and lack of productivity.

The new tax reform law — commonly referred to as the "Tax Cuts and Jobs Act" (TCJA) — is the most significant tax legislation in decades. Although the law was passed only a few weeks ago, the impact on the economy and business outlook cannot be overlooked as the stock market rally continues and both individuals and businesses appear the most optimistic in quite some time.

At the core of the Affordable Care Act (ACA) is the three-legged stool: (1) insurance reforms; (2) the individual mandate; and (3) premium and cost-sharing subsidies. Removal of any one of these legs could destabilize the ACA. The ACA established insurance marketplaces in every state to provide access to ACA compliant private health insurance coverage (Qualified Health Plans) in the individual and small group markets. The ACA provides premium subsidies on a sliding scale for persons with incomes up to 400% FPL for the purchase of an individual policy on the marketplace exchange. It also provides cost-sharing subsidies for persons with incomes below 250% FPL. Prior to the implementation of the ACA, manual rating was typically used by insurers for rate-making in the individual and small group markets and exclusions from coverage for pre-existing conditions were common. Age-based rates were typically 5:1. The insurance reforms in the ACA are largely directed at the small group and individual markets (e.g., guaranteed issue/renewal, no preexisting condition limitations, adjusted community rating capped at a 3:1 ratio for age). Standardization of benefits is achieved by requiring coverage for ten essential health benefits (EHBs) and certain preventive services which in the latter case services must be provided without cost-sharing.

Physicians and other medical care professionals spend years studying, training and preparing themselves to provide best possible care to their patients. In many instances, these professionals spend the bulk of their attention and energy on treating their patients and meeting the day-to-day challenges that come with providing the best care possible. Unfortunately, practicing in today’s economic climate within a medical industry undergoing a vast transformation has forced many medical professionals to place equal value on business issues that effect their practice. Often times, the business of operating a medical practice is never discussed in medical school. Instead, many healthcare professionals are forced to learn fundamental business principles on the fly in private practice. With the emergence of electronic medical records and coding, many healthcare providers and practices are spending a substantial amount of time concentrating on the business of healthcare in addition to patient care. Of all the business issues that must now be prioritized by the medical industry, medical billing and managing account receivables can bear the most burden of all.

Venous reflux in the lower extremity is when blood from the foot which should travel towards the heart reverses downwards due to gravity.

There is a lot of confusion about SSDI and SSI, the two types of disability benefits that can be received from Social Security. The definition of disability is the same under both programs, but that is where the similarity ends. The following is a very basic description of the disability programs provided under the Social Security Act, titles II and XVI.

  As of September 30, 2017, the Department of Health and Human Services Office of Civil Rights (OCR) has received notices of 237 breaches. 46% occurred as result of hacking or IT security incidents; many at the business associate level.  Ransomware is rampant and projected to increase 670%.  As a covered entity, although a breach occurs at your business associate, under HIPAA, you are responsible for your protected health information and responding to the breach.  OCR has been clear that breaches of 500 or more records will be investigated. Given the significant increase in breaches over the past few years, advance preparation is critical and can reduce the cost and burden of breach response. 

It has now been two years since the implementation of ICD-10, everyone survived! While denials have been minimal, the goal of implementing ICD 10 to acquire more specificity and a complete picture of health has not been fully achieved.  Physicians and managers have created a new set of shortcuts to assure payment of claims, relying on paper superbills or inappropriate conversions from ICD 9 to ICD 10.

Hearing loss is a common problem. 15% of American adults aged 18 and over report trouble hearing. Over the age of 65, one third of the population has significant hearing loss. Most people with Hearing Impairment suffer some social, psychological and physical problems. Social consequences of hearing loss include reduced social activity and problems communicating with family and at work.  Particularly in the elderly Hearing Loss can be isolating.

A family medicine doctor is someone you can always feel comfortable voicing your concerns to and leave an appointment feeling as though you were really listened to. They will help you to become an informed and active member of your healthcare decision-making process.
 

As we approach the beginning of summer, our minds are likely not on summer vacation. The process of assessing our electronic medical record vendor, absorbing the details of MIPS, and making the decisions on how to prepare, is overwhelming for small practices.  The transition to value based medicine has been evolving over the last 10 years in stages; adopting electronic health record, Quality Reporting, and Meaningful Use.  Many administrators and physicians did not realize the importance of each project; from choosing the right EMR, to implementing it properly, therefore achieving best practice workflows.

Social Security Disability under Title II of the Social Security Act*

Surveys have shown that most Americans know little about Social Security law and the vital benefits it provides. By far, the least understood Social Security benefit is Social Security Disability Insurance (SSDI). This lack of knowledge has been measured through objective testing in various academic studies. Anecdotally, I know this to be true based on recurring questions and comments I have received from the public and clients alike over the last several decades of my work as a social security disability attorney.

CASE STUDY

A 34-year-old male presented to a family medicine physician for chronic low back pain. The physician is comfortable prescribing opioids and has many patients on scheduled drugs. The patient has had chronic pain for many years and has undergone multiple treatments including physical therapy, steroid injections and many medications. On presentation, the patient was on Robaxin and oxycodone (four times a day). His past history is positive for hypertension and alcohol abuse, although he stated he hasn’t drank in the past year. He works as a laborer.

Early detection of coronary artery disease is a significant problem. One third of deaths after 35 are secondary to cardiovascular disease. One half of middle aged men and one third of middle aged women will develop coronary artery disease. Currently our ability to detect early disease is limited. By the time symptoms occur there is usually 70% obstruction of the coronary artery. Data from autopsies on Korean War casualties indicate initial signs of development of coronary plaque in the early 20’s of age. Theoretically it would seem appropriate to begin prevention therapy as soon as possible but who should get it? Obviously, the patients with known vascular disease and equivalents such as diabetes would need this therapy. Those without established disease need an estimate of their risk.

In the last 10-15 years, the use of mid-level providers has increased to expand the base of patients in many practices.  The Nurse Practitioner scope of practice is more flexible and there are specialty designations available to foster expertise in certain areas.  The insurance companies have expanded the number of plans covering a mid-level provider’s services.