NEWS YOU SHOULD KNOW
What's unclear is where the physicians will come from to fill those positions, and how practices, given current payment trends, will be able to hire the number of staff the bureau projects will be required. Experts are concerned that these projections will mean that current shortages of doctors and nurses will get worse. "We have coming work force issues that are very real and that we are going to have to grapple with," said Dr. Doescher. The situation for physician offices might be further complicated by the fact that registered nurses in this setting tend to be older than those who work in hospitals, so they may be retiring at a faster rate, experts said. "I don't know how physicians are going to do it," said Peter Buerhaus, PhD, RN, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University in Nashville, Tenn. The American Medical Association recognizes the existing shortage of physicians in many specialties and regions. The Association also supports basic nursing education opportunities, work force incentives and other efforts to increase the supply of registered nurses. The Bureau of Labor Statistics, a division of the U.S. Dept. of Labor, projected on Dec. 10, 2009, that from 2008 to 2018 the civilian labor force will grow by 12.6 million and total employment will increase by approximately 15.3 million jobs. Health care and social assistance will add approximately 4 million positions, with 772,200 of these in physician offices. About 109,300 of these new jobs will be for physicians, and 106,500 for registered nurses. In addition, 107,600 additional medical assistants will be needed, along with 248,700 office and administrative support positions. The Bureau of Labor Statistics does not break down these numbers by type of physicians or practices. But experts suspect that much of the growth of physician jobs will be in primary care specialties, which are already seeing work force shortages. "There's not a financial incentive to go into primary care. Unless primary care doctors are compensated, there won't be the physicians to coordinate the level of care," said Brian McCartie, vice president of business development for Cejka Search, a health care executive and physician search firm based in St. Louis. "A lot of our clients are very worried about primary care." High demand is also expected in geriatrics and other specialties, such as orthopedic surgery, that provide treatment for age-related conditions. Many of the administrative positions are expected to be added to larger practices or health systems. The only position in a physician's office not expected to increase is file clerk, primarily because electronic medical records are becoming more common. "This is the story of increasing complexity in health care, and why solo practices and small practices are having such difficulties with the business of medicine," said David N. Gans, vice president of innovation and research for the Medical Group Management Assn. "Existing practices are getting larger and adding sophistication. They are reducing their transcription staff and the number of medical records clerks. They are adding IT staff and technicians." Hospital job growth is expected to continue, but on a more modest scale. Hospitals will add 571,000 staff over the next decade, including 274,200 registered nurses, but only 9,600 physicians and surgeons, the Bureau of Labor Statistics projects. Some experts say the bureau's numbers run counter to their own experiences. For instance, physician search firms report an increase in the proportion of requests from hospitals, and a decrease from medical practices. "The trend we're seeing is a shift back to hospital employment of physicians, and I don't see that changing any time soon," said Jim Stone, managing partner of a physician search company, the Medicus Firm. Physicians can also expect employment opportunities in the offices of other health care professionals, such as optometrists, audiologists, mental health professionals, and physical, occupational and speech therapists. According to bureau projections, approximately 2,200 physician jobs will be added in those settings. Another 9,800 physician jobs will be added at outpatient care centers. The federal government is expected to hire an additional 2,100 physicians. State and local governments will hire another 1,200. Although projections indicate more jobs will be created than people added to the labor pool, the Bureau of Labor Statistics says this does not necessarily mean a worker shortage, since individuals might hold more than one job. But other surveys have found that health care institutions are already having work force concerns. One survey, released Nov. 16, 2009, by AMN Healthcare Services Inc., in partnership with the National Council on Physician and Nurse Supply, found that nearly all hospital CEOs believed there was a shortage of physicians, nurses and allied health professionals. In addition, the vacancy rate for physician jobs was 11%. About 6% of nursing jobs went unfilled, as did 5% of jobs for allied health professionals. Physician offices projected to see a decade of significant job growth
Concern is high that work force shortages will persist and that paying for additional staff will be challenging.
By Victoria Stagg Elliott, amednews staff.Posted Jan. 11, 2010.
The number of physicians, administrators and allied health professionals employed by medical practices is expected to increase substantially from 2008 to 2018. Hospital employment will grow more slowly, according to Bureau of Labor Statistics projections.
At the request of Members of Congress, the Federal Trade Commission is delaying enforcement of the “Red Flags” Rule until June 1, 2010, for financial institutions and creditors subject to enforcement by the FTC.
The Rule was promulgated under the Fair and Accurate Credit Transactions Act, in which Congress directed the Commission and other agencies to develop regulations requiring “creditors” and “financial institutions” to address the risk of identity theft. The resulting Red Flags Rule requires all such entities that have “covered accounts” to develop and implement written identity theft prevention programs to help identify, detect, and respond to patterns, practices, or specific activities – known as “red flags” – that could indicate identity theft.
The Commission previously delayed the enforcement of the Rule for entities under its jurisdiction until November 1, 2009. The Commission staff has continued to provide guidance to entities within its jurisdiction, both through materials posted on the dedicated Red Flags Rule Web site (www.ftc.gov/redflagsrule), and in speeches and participation in seminars, conferences and other training events to numerous groups. The Commission also published a compliance guide for business, and created a template that enables low risk entities to create an identity theft program with an easy-to-use online form. FTC staff has published numerous general and industry-specific articles, released a video explaining the Rule, and continues to respond to inquiries from the public. To assist further with compliance, FTC staff has worked with a number of trade associations that have chosen to develop model policies or specialized guidance for their members.
The “Red Flags” Rule: What Health Care Providers Need to Know About Complying with New Requirements for Fighting Identity Theft
by Steven Toporoff
As many as nine million Americans have their identities stolen each year. The crime takes many forms. But when identity theft involves health care, the consequences can be particularly severe.
Medical identity theft happens when a person seeks health care using someone else’s name or insurance information. A survey conducted by the Federal Trade Commission (FTC) found that close to 5% of identity theft victims have experienced some form of medical identity theft. Victims may find their benefits exhausted or face potentially life-threatening consequences due to inaccuracies in their medical records. The cost to health care providers — left with unpaid bills racked up by scam artists — can be staggering, too.
The Red Flags Rule, a law the FTC will begin to enforce on August 1, 2009, requires certain businesses and organizations — including many doctors’ offices, hospitals, and other health care providers — to develop a written program to spot the warning signs — or “red flags” — of identity theft. Is your practice covered by the Red Flags Rule? If so, have you developed your Identity Theft Prevention Program to detect, prevent, and minimize the damage that could result from identity theft?
WHO MUST COMPLY
Every health care organization and practice must review its billing and payment procedures to determine if it’s covered by the Red Flags Rule. Whether the law applies to you isn’t based on your status as a health care provider, but rather on whether your activities fall within the law’s definition of two key terms: “creditor” and “covered account.”
Health care providers may be subject to the Rule if they are “creditors.” Although you may not think of your practice as a “creditor” in the traditional sense of a bank or mortgage company, the law defines “creditor” to include any entity that regularly defers payments for goods or services or arranges for the extension of credit. For example, you are a creditor if you regularly bill patients after the completion of services, including for the remainder of medical fees not reimbursed by insurance. Similarly, health care providers who regularly allow patients to set up payment plans after services have been rendered are creditors under the Rule. Health care providers are also considered creditors if they help patients get credit from other sources — for example, if they distribute and process applications for credit accounts tailored to the health care industry.
On the other hand, health care providers who require payment before or at the time of service are not creditors under the Red Flags Rule. In addition, if you accept only direct payment from Medicaid or similar programs where the patient has no responsibility for the fees, you are not a creditor. Simply accepting credit cards as a form of payment at the time of service does not make you a creditor under the Rule.
The second key term — “covered account” — is defined as a consumer account that allows multiple payments or transactions or any other account with a reasonably foreseeable risk of identity theft. The accounts you open and maintain for your patients are generally “covered accounts” under the law. If your organization or practice is a “creditor” with “covered accounts,” you must develop a written Identity Theft Prevention Program to identify and address the red flags that could indicate identity theft in those accounts.
SPOTTING RED FLAGS
The Red Flags Rule gives health care providers flexibility to implement a program that best suits the operation of their organization or practice, as long as it conforms to the Rule’s requirements. Your office may already have a fraud prevention or security program in place that you can use as a starting point.
If you’re covered by the Rule, your program must:
- Identify the kinds of red flags that are relevant to your practice;
- Explain your process for detecting them;
- Describe how you’ll respond to red flags to prevent and mitigate identity theft; and
- Spell out how you’ll keep your program current.
What red flags signal identity theft? There’s no standard checklist. Supplement A to the Red Flags Rule — available at ftc.gov/redflagsrule — sets out some examples, but here are a few warning signs that may be relevant to health care providers:
- Suspicious documents. Has a new patient given you identification documents that look altered or forged? Is the photograph or physical description on the ID inconsistent with what the patient looks like? Did the patient give you other documentation inconsistent with what he or she has told you — for example, an inconsistent date of birth or a chronic medical condition not mentioned elsewhere? Under the Red Flags Rule, you may need to ask for additional information from that patient.
- Suspicious personally identifying information. If a patient gives you information that doesn’t match what you’ve learned from other sources, it may be a red flag of identity theft. For example, if the patient gives you a home address, birth date, or Social Security number that doesn’t match information on file or from the insurer, fraud could be afoot.
- Suspicious activities. Is mail returned repeatedly as undeliverable, even though the patient still shows up for appointments? Does a patient complain about receiving a bill for a service that he or she didn’t get? Is there an inconsistency between a physical examination or medical history reported by the patient and the treatment records? These questionable activities may be red flags of identity theft.
- Notices from victims of identity theft, law enforcement authorities, insurers, or others suggesting possible identity theft. Have you received word about identity theft from another source? Cooperation is key. Heed warnings from others that identity theft may be ongoing.
SETTING UP YOUR IDENTITY THEFT PREVENTION PROGRAM
Once you’ve identified the red flags that are relevant to your practice, your program should include the procedures you’ve put in place to detect them in your day-to-day operations. Your program also should describe how you plan to prevent and mitigate identity theft. How will you respond when you spot the red flags of identity theft? For example, if the patient provides a photo ID that appears forged or altered, will you request additional documentation? If you’re notified that an identity thief has run up medical bills using another person’s information, how will you ensure that the medical records are not commingled and that the debt is not charged to the victim? Of course, your response will vary depending on the circumstances and the need to accommodate other legal and ethical obligations — for example, laws and professional responsibilities regarding the provision of routine medical and emergency care services. Finally, your program must consider how you’ll keep it current to address new risks and trends.
No matter how good your program looks on paper, the true test is how it works. According to the Red Flags Rule, your program must be approved by your Board of Directors, or if your organization or practice doesn’t have a Board, by a senior employee. The Board or senior employee may oversee the administration of the program, including approving any important changes, or designate a senior employee to take on these duties. Your program should include information about training your staff and provide a way for you to monitor the work of your service providers — for example, those who manage your patient billing or debt collection operations. The key is to make sure that all members of your staff are familiar with the Rule and your new compliance procedures.
WHAT’S AT STAKE
Although there are no criminal penalties for failing to comply with the Rule, violators may be subject to financial penalties. But even more important, compliance with the Red Flags Rule assures your patients that you’re doing your part to fight identity theft.
Looking for more information about the Red Flags Rule? The FTC has published Fighting Fraud with the Red Flags Rule: A How-To Guide for Business, a plain-language handbook on developing an Identity Theft Prevention Program. For a free copy of the Guide and for more information about compliance, visit ftc.gov/redflagsrule.
In addition, the FTC has released a fill-in-the-blank form for businesses and organizations at low risk for identity theft. The online form offers step-by-step instructions for creating your own written Identity Theft Prevention Program. You can fill it out online and print it. The do-it-yourself form is available at ftc.gov/redflagsrule.
Questions about the Rule? Email RedFlags@ftc.gov.
Steven Toporoff is an attorney with the FTC’s Division of Privacy & Identity Protection.
Health Care: Obama Adopts A Good Idea From The GOP
President Obama picked up a good idea from the Republicans at last week's health care summit, one that will add a badly needed dose of fiscal reality to the health care bill. What's more, this Republican idea will improve the lives of tens of millions of poor people.
It has to do with the dramatic expansion of Medicaid that is envisioned under the health care bill. Obama mentioned it among four GOP proposals that he embraced in his letter to congressional leaders on Tuesday:
3. At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states, and that if Medicaid is expanded to cover more people, we should consider increasing doctor reimbursement. I'm open to exploring ways to address this issue in a fiscally responsible manner.
Nearly half of the people who would gain coverage under this bill--15 million of the estimated 31 million newly insured people--would get it through an expansion of Medicaid and the Children's Health Insurance Program. Why did Congress do it this way? In part because it is cheaper, as we have written here before. The Medicaid program varies by state, but it generally pays health care providers significantly less than either private insurance or the Medicare program.
To keep the official price tag of the bill down, lawmakers have written it with an assumption that Medicaid would continue to reimburse health care providers at its current rock-bottom rates. But in the real world, that can't happen. As many governors have pointed out, that is a totally unrealistic assumption that would only compound what is already a grave problem. In many parts of the country, it is difficult to find providers willing to accept Medicaid patients already enrolled in the program. Is it reasonable to expect that the government could add 15 million more, without raising what it pays providers to treat them?
The Republicans deserve credit here for forcing some realism into this aspect of the health care debate.
More of this, please.
Read more: http://swampland.blogs.time.com/2010/03/03/health-care-obama-adopts-a-good-idea-from-the-gop/#ixzz0h7VrqGsZ
HIT Realist: Does the Promise of HITECH Money Have You Thinking about Installing an EHR? Think Again.
By Alberto Borges, MD
Published Online: January 21, 2010 - 10:32:26 AM (CST)
Almost from the moment the HITECH Act was passed, various pundits and
industry experts have been trying to convince physicians that they should
submit to the Act's mandates and provisions so they can earn the promised
$44,000 grants. I disagree with these incentives, because despite what some
vendors and politicians may think, for physicians it's not all about the
money; even if it were, $44,000 is not nearly enough to cover the costs
associated with implementing a full-featured EHR. Large practices with large
Medicare panels may realize significant bonus payments, but smaller
practices may find it impossible to make a profit. What is at stake is the
autonomy and viability of the small physician office.
I think that there are many good reasons why physicians should think twice
about complying with the new mandates, and possibly reconsider their
association with Medicare. Medicare often rejects or delays payment on a
significant portion of claims due to computer glitches, changes in payment
methods, and outright incompetence. Years ago, a whistleblower even admitted
to the use of a machine referred to as "Jaws," which shredded thousands of
letters (www.jpands.org/vol8no4/burr.pdf).
The HITECH bonus payments may be difficult to attain. In past PQRI projects,
the majority of physicians and offices have failed to receive payments, and
those who did received low payments for all of their efforts
(http://tinyurl.com/58r7sv; http://tinyurl.com/pssjbx). The bonuses will not
be given up front, but rather as rebates based on meeting exact performance
parameters. An important hurdle is the required minimum patient panel size
(see the HITECH Act for particulars). I question whether CMS/Medicare will
provide sufficient and timely feedback, leaving providers unable to correct
a submission of data in time. There is also little physicians can do to
appeal a CMS ruling that a practice incorrectly submitted sufficient data to
be eligible for a full bonus payment (http://tinyurl.com/onncys).
In my practice, Medicare patients can make up 20% of a typical schedule, but
since these patients are older and typically more complicated than
non-Medicare patients, seeing them can require 30% of my time, expended for
about 10% less pay. The workfl ow changes associated with capturing and
coding quality data will be significant, and the new administrative burdens
will be costly (http://tinyurl.com/qlue6e).
The HITECH Act mandate lacks important details. CMS has not set a specific
date or method for issuing bonus payments, and is still modifying the
definition of "significant use" of an EHR system. On July 16, 2009 HHS
announced that it would not use the Certification Commission for Health
Information Technology (CCHIT) as the agency that will determine what
qualifies as a "certified EHR"(http://tinyurl.com/m9jle8). Unfortunately,
the "ONC certification" scheme is not set up, and it is unknown whether
"CCHIT-certified" EHR systems will be grandfathered.
The central core of "significant use" is interoperability, which has yet to
be codified by EHR vendors (http://tinyurl.com/o6boht). Many states are
trying to set up health information exchanges (HIEs), but most of these
centralized exchanges have suffered from major financial difficulties
(http://tinyurl.com/pnfppu).
Many current EHR systems have poor user interfaces, which has resulted in a
50% installation failure rate (http://tinyurl.com/cds6uh) and a reported 8%
de-installation rate. In some early adoption spots, the de-installation rate
has been higher, as is now being seen in Arizona, where physicians pressured
to purchase expensive c-EHR systems have found themselves unable to
economically survive ownership of their systems (http://tinyurl.com/ndebgp).
The government wants to electronically collect "granular" data on patients,
despite growing concerns about patient privacy, as required by HIPAA
(http://tinyurl.com/pnujom). The concept of PQRI quality reporting can be
used as another weapon to control costs by limiting physician payments
(http://tinyurl.com/osohvj). This is on top of the fact that Medicare
already reimburses $0.35-$0.50 per $1.00 of charges submitted for patient
care, barely covering overhead costs.
It is time for physicians, who still overwhelmingly accept Medicare, to take
a close look at the HITECH Act and the potential consequences of continued
participation in Medicare. Failure to evaluate your options objectively
could be a big mistake.
_____
Alberto Borges, MD, is in private practice and is an associate clinical
professor of medicine at the George Washington University in Washington, DC.
Check out his website at http://msofficeemrproject.com.