Category Archives: healthcare marketing

KINLEY TO SPEAK ON “WHO OWNS PATIENT DATA”

R-HEALTH BY THE HEALTH MANAGEMENT INTEREST GROUP SEEKS TO EDUCATE ON THE DANGERS AND OPPORTUNITIES IN PATIENT DATA

University of California, Riverside. HIPAA and the Hi-Tech regulations impose burdens on healthcare providers on how private health information can be utilized.  Given the potential penalties for missteps, this is an important topic for the healthcare industry to grasp.  Tickets are still available!

As a recent Office of Civl Rights Report recently pointed out, 2016 was a record year for enforcement: “OCR has been on a tear, settling 11 cases in 2016 with resolution agreements and corrective action plans. The agency also won a decision by an administrative law judge in an enforcement action contested by a home healthcare and medical equipment supplier (see OCR Slaps Home Health Provider with Penalty.”

Private Health Information must be maintained and utilized in ways that protect the information from exposure.

Matt Kinley is a health care attorney and founder of Kinley Law Practice in California. You can contact him at matt@kinleylawpractice.com.

 

WHAT ABOUT A MANAGEMENT SERVICES ORGANIZATION?

AVOIDING THE PROHIBITION AGAINST NON-PHYSICIAN OWNERSHIP OF MEDICAL ORGANIZATIONS

A management services organization (“MSO”) is an entity which would contract with a physician or a medical corporation owned and operated by physicians. The MSO could be owned by non-physicians.  The physician or medical corporation can pay the MSO for everything. Employees would work for the MSO; the MSO would pay for the lease.  The MSO would pay for all significant expenses and receive a fee for its services.

The Corporate Practice Medicine Doctrine (CPOM) is strong in California. Under this doctrine, physicians must control clinical decisions. The concern is that if business entities owned by non-physicians are permitted to control the rendering of care, they will subordinate clinical care to commercial considerations and profits. The objective, therefore, is to prevent non-physicians and non-physician-owned business entities from influencing treatment decisions.

This presents a significant constraint to physician business ventures. Specifically, if physicians or other clinical personnel work for entities other than professional medical corporations, they may be exposed to disciplinary risks, as well as to forfeiture of revenues.. For non-physician business partners, violating the CPOM may also bring both civil and, in extreme cases, potential criminal liability for engaging in medical practice without a license.

MSO

In California, the solution for avoiding violations of the CPOM in business ventures in which physicians work with businesses owned by unlicensed persons is a contractual relationship between the physician entity and the unlicensed business entity, or a “management services organization (MSO).” This is a business vehicle that permits unlicensed persons to provide services to physicians and their professional medical corporations. In its simplest form, an MSO provides basic practice support services to physicians and professional medical corporations via a contractual relationship, commonly known as a management services agreement. These services frequently include activities such as billing and collection, administrative support in certain areas, and electronic data interchange (e.g. electronic billing). Some MSO’s provide a broader set of services: the MSO may purchase many of the assets in a medical practice, such as office space or equipment. MSO’s can employ office support staff, and assist with a wide range of non-clinical functions. MSO’s can also assist in functions such as marketing. Often, MSO’s can reduce costs by bringing economies of scale and professional management experience into physician practices, thereby improving operational efficiency and reducing overhead costs.

the MSO must be carefully considered and constructed.  Review and application of relevant laws and regulations is a must.

By Matt Kinley, Esq. of the Kinley Law Practice

Kinley Law Practice starts January, 2017

QUALITY HEALTH LAW ADVICE

The California Healthcare Law Blog was created several years ago to keep the healthcare industry abreast of new developments in health law.  It’s been an amazing journey!  It’s culminated in a new law firm, Kinley Law Practice, committed to supporting health care entities with quality advice.  Give me a call at 562.715.5557 or email me at matt@kinleylawpractice.com with comments or questions.

 

klp_newyearannouncement

COVERED CALIFORNIA TRANSITIONING TO VALUE PAYMENTS

HEALTHCARE PROVIDERS SHOULD PREPARE FOR END OF FEE FOR SERVICE PAYMENTS

Introduction

Medicare reimbursement has slowly changed from a system primarily based on fee for service to a system paying for treatment of a population.  Physicians and other providers who have relied on Medicare have seen payments reduced and general income levels decline as a result.

Covered California and Value Payments

Reinforcing the view that medical care can be less expensive if incentives are put in place for providers, Covered California has always promoted the utilization of value payments over fee for service for physicians and other healthcare providers.  They view it as a method to reward quality care and patient satisfaction, even though it is having the effect of reducing payments to providers, making medicine more corporate medicine and driving smaller practices out of business.  This has happened with similar Medicare reforms.

The Model QHP Contract

The Covered California Board has been considering its contract with Qualified Health Plans (“QHP”) for the coming years.  A review of the 2017 Qualified Health Plan Contract and Attachments shows that the Covered California Board is continuing its advance to reform payment models under the Healthcare Exchange.

The Qualified Health Plan Model Contract (“Model Contract”) is the agreement entered into between the Qualified Health Plans (“QHP”) and Covered California. The contract sets the terms for the QHP  operate under in order to participate in California’s healthcare exchange.  These contracts have become the major method by which Covered California promotes its major policy initiatives, such as appropriate healthcare networks and payment reform to healthcare providers.

The Model Contract specifically references federal policy on incentivizing quality by tying payments to providers by measuring performance. When providers meet specific quality indicators or enrollees make certain choices or exhibit behaviors associated with improved health, providers receive a higher level of payment.    Such policy requires quality reporting, care coordination; chronic disease management, patient-centered care, evidence based medicine and health information technology. (Quality Improvement Strategy: Technical Guidance and User Guide for the 2017 Coverage Year.)

Attachment 7 to the QHP Model Contract

Attachment 7 to Covered California 2017 Model Contract provides the meat of the policy.  According to Attachment 7, QHPs are to work with Covered California to create healthcare networks that are based on value.   By working with Covered California, all QHPs will share data which they have received from providers across the state.  The plan also contemplates meetings where best practices are discussed.

QHPs Must Select Healthcare Providers Who Are Utilizing Quality Measurements

Under Attachment 7, all plans must include “quality” measurements in the selection and utilization of providers, including “clinical quality, patient safety and patient experience and cost.” Covered California will carefully monitor the plans to assure that that  QHPs only contract with providers and hospitals that demonstrate quality care.

QHPs are to ensure that providers which are serving enrollees with conditions that require highly specialized management have “documented special experience and proficiency based on volume and outcome data.”   Attachment 7 further specifically requires the submission of the Consumer Assessment of Healthcare Providers and Systems, developed by the Agency for Healthcare Research and Quality.  The CAHPS requests information from the consumer experience, including:

  Asking about aspects of care for which a patient or enrollee is the best or only source of information.

  Asking about the aspects of care that patients say are most important.

  Asking patients to report on the health care they receive.

  Reflecting input from a broad spectrum of stakeholders, including patients, clinicians, administrators, accrediting bodies and policymakers.

Finally, Attachment 7 promotes the use of Patient-Centered Medical Homes as well as integrated care models, with quality and patient satisfaction as key data points; population-based care, including integrated care; utilization of electronic health record technology, including utilization of data for results management and clinical decision support and patient support.

2017 continues the trend toward value added care.  Physicians and other providers should start preparing practices for this new payment models if they intend to continue in medicine.

By Matt Kinley,Esq., LLM, CHC

562.715.5557

 

 

GO GREEN TO ATTRACT MARKET SHARE

Physicians Need to Stand Out

Physicians who are completing new construction should consider designating their development as green construction. While there is not legislative guidance in for green development in the healthcare arena, there is the Green Guide for Healthcare.

image.axd

According to the guide, it is “healthcare sector’s first quantifiable, sustainable design toolkit integrating enhanced environmental and health principles and practices into the planning, design, construction and maintenance of facilities….[it] provides the healthcare sector with a voluntary, self-certifying metric toolkit of best practices that designers, owners, and operators can use to guide and evaluate their progress towards high performance healing environments.performance healing environments.

The guide is a project of the non-profit organizations Health Care Without Harm  and Center for Maximum Potential Building Systems.

Posted by Matt Kinley, Esq.