As the discussion continues with regard to the role of physician extenders hospitals and medical practices will need to determine the best way to go forward. In some circumstances it will be appropriate for primary care as well as specialty practices to continue to include physician extenders within the four walls of the practice. The same will be true in hospital settings with physician extenders providing certain care on behalf of the institution. In other cases it will be clear that, based on state law and local economic conditions, physician extenders will begin and continue practicing more and more on their own. Being able to make the financial decisions and calculations in advance, as well as the strategic decisions in understanding and implementing new and continually changing relationships will enhance the financial success going forward.

The United States has a shortage of primary care doctors, and some policymakers want to fill the gap by expanding the role of nurse practitioners. But the two professions are engaged in a turf war over who can do the job better, a new survey finds. The results of the survey were reported in the May 16 issue of the New England Journal of Medicine. Experts expected some controversy, but said they were surprised at how far apart doctors and nurse practitioners were in their opinions. The nearly 1,000 doctors and nurse practitioners surveyed were most divided on the question of who gives the higher quality of care: Two-thirds of physicians said if a doctor and nurse practitioner provided the same service, the doctor would do it better.  

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On May 13th, 2013CMS announced, as part of the Obama administration’s work to make our healthcare system more affordable and accountable, Health and Human Services (HHS) Secretary Kathleen Sebelius announced a three-part initiative that for the first time gives consumers information on what hospitals charge. New data released today show significant variation across the country and within communities in what hospitals charge for common inpatient services. Also today, HHS made approximately $87 million available to states to enhance their rate review programs and further health care pricing transparency. In an example of how these data might be used, the Robert Wood Johnson Foundation (RWJF) is planning a data visualization challenge which will further the dissemination of these data to larger audiences.

“Currently, consumers don’t know what a hospital is charging them or their insurance company for a given procedure, like a knee replacement, or how much of a price difference there is at different hospitals, even within the same city,” Secretary Sebelius said. “This data and new data centers will help fill that gap.” 

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On June 5, 2013, the General Assembly passed House Bill 6705 containing the statutory changes necessary to implement the budget plans for SFY 2014 and SFY 2015.

Section 74 of the 238 page bill outlines the Medicaid nursing facility rate-setting method to be used by the Department of Social Services for the July 1, 2013 through June 30, 2014 (SFY 2014) and July 1, 2014 through June 30, 2015 (SFY 2015) rate periods. The biennial budget includes savings of $11.0 million in SFY 2014 and $14.8 million in SFY 2015 related to Medicaid rate revisions for nursing facilities as part of a state restructuring of the Medicaid rate increase and provided tax adjustment adopted in 2011 to take advantage of federal matching funds which added approximately 4% ($59 million) to Medicaid rates and increased Nursing Home User Fees paid to the state by $39.4 million. 

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With physicians being employed more often by hospitals and health care systems, the issue of employee satisfaction is an increasing troubling issue. Many physicians who transfer from private practice to an employment situation find that the patient and practice satisfaction levels decrease. The institution may see what is perceived as a decrease in physician productivity. Working through these issues in advance of the transaction, and especially the expectation levels, can go a significant distance in making the transaction better financially as well as professionally. [we can assist in the planning process to help smooth out the inevitable bumps]

The transition of physicians from private practice to hospital employment can be quite rocky. The biggest challenge, say consultants and physician leaders, is the loss of autonomy that many physicians experience when they become employed. This loss of autonomy shows up in several different aspects of practice. 

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A receiver is an impartial person appointed by a court to preserve a business and its assets pending ongoing legal proceedings. A crisis likely exists where the business and its assets are at risk of being lost, removed or injured. Not simply risk, but a risk so great that it would compel a Court to order removal of control over the business and its assets from its owner(s).

A Court may insert a receiver on its own volition; but typically a party who believes that their interest in the business and its assets are at risk of being lost, removed or injured will petition the court to appoint a receiver to prevent that from happening. A petitioner will present its case for the appointment of a receiver, likely under significant opposition. A petition to appoint a receiver will likely fail unless evidence is presented, so compelling, that the court agrees that the business and its assets are at grave risk of rapid deterioration which will result in irreparable harm to those with an interest in that business and its assets. Use of legal counsel skilled and knowledgeable of the process to properly present such a petition to the court is critical toward achieving the desired appointment. 

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As physicians and their advisers finish up tax season, the information on who earned how much from drug company related programs is fresh in our minds. Many physicians may need to file reports with the hospitals on which they have staff privileges. If so, Marcum can assist in complying.

For the first time, the government will make information about financial relationships between doctors, teaching hospitals and drug manufacturers publicly available.

To comply with a provision in the Affordable Care Act, drug and device manufacturers, along with group purchasing organizations, will have to disclose all of their payments and other compensation to physicians and teaching hospitals. Those who don't comply could be fined. 

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By William Weir, Courant Staff Writer The Hartford Courant

Based upon proposed Legislation the Hartford Current recently identified details of changes to Malpractice Insurance that may impact the Physician practice. Please consider the following:

Two bills that would change medical malpractice laws are making their way through the legislature: one to make it easier to sue a physician, and one to make it more difficult.

A public hearing of the judiciary committee will be held Monday on a bill that would lessen the requirement for filing such a suit. Current law requires that a plaintiff receive the signature of a "similar health care provider" stating that the case is a valid one. The proposal would change "similar" to "qualified." 

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The State of Connecticut budget plan presented by the Governor on February 6, 2013, included a $14.8 million annualized cut to current Medicaid nursing facility rate levels equating to approximately 1.2% reduction. Budget implementation legislation (House Bill 6367) released later in the month indicated state fiscal year (SFY) 2013 rates would remain in effect through SFY 2015 unless the Department deemed a rate reduction was warranted based on facility costs or available funding levels.

It was recently learned that July 1, 2013 Medicaid nursing facility rates may be rebased using the September 30, 2011 or 2012 Annual Report of Long Term Care Facility cost report and the statutory cost-based rate setting method. That means that the rates for some facilities may increase while others may decrease.  

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With the retirement looming for many physicians, the financial and operational planning for the future of the practice, and the implications for hospital practice, as well, will require several years of planning. Understanding the timing and number of physicians finishing residency programs 3, 4 or 5 years from now, and predicting the retirement of the practice’s physicians, and those on staff and acting as hospital lists, is an important part of the planning practices and hospital administrators need to study.

Most physicians have a pessimistic outlook on the future of medicine, citing eroding autonomy and falling income, a survey of more than 600 doctors found. Six in 10 physicians (62%) said it is likely many of their colleagues will retire earlier than planned in the next 1 to 3 years, a survey from Deloitte Center for Health Solutions found. 

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Most recently there is an act concerning the expenses relating to the sale of nonprofit hospitals. The Senate and House of Representatives in the General Assembly may contract with experts or consultants to assist in the reviewing the proposed agreement.

Be it enacted by the Senate and House of Representatives in General Assembly convened: Section 1. Subsection (c) of section 19a-486c of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage): (c) The Attorney General may contract with experts or consultants to assist in reviewing the proposed agreement, including, but not limited to, assistance in independently determining the fair market value of the nonprofit hospital's assets. The Attorney General may appoint, or contract with, another person to conduct the review required by this section and make recommendations to the Attorney General. The Attorney General shall submit any bills for such contracts to the purchaser. The purchaser shall pay such bills [within thirty days of] not later than thirty days after receipt. Such bills shall not exceed [three] five hundred thousand dollars. This act shall take effect as follows and shall amend the following sections: Section 1 from passage 19a-486c(c)  

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