Donna Fraiche, JD, managing partner for the law firm of Locke, Liddell & Sapp, LLP, reviewed the history and evolution of Fraud and Abuse laws as they relate to the healthcare industry (Anti-Kickback, False Claims, and Stark Laws). She related many exceptions to these laws, including the permitting of certain referrals by physicians to entities in which they hold a financial interest. Ms. Fraiche also addressed the importance of having a compliance plan which covers both under- and over-coding, as well as unbundling and and dealing timely with overpayments. She also reviewed sample cases and advised the membership that the enforcement arms of the government were focusing primarily on conduct and intent, rather than the incidental or occasional violation of the regulations.
A copy of Ms. Fraiche's presentation may be downloaded by clicking here
The December meeting
was sponsored by Silver Affiliate:
To download the ACMPE credit hour form, click here
Kimberly Hlavinka,
Vice President of Marsh &
McLennan Companies, spoke on the �Medical Malpractice Crisis.� She
reviewed the reasons for the �hard� market and loss of market competitors,
which included: 1) catastrophic losses in the insurance industry, e.g.
terrorist attacks, natural disasters and Enron; 2) high claim frequency and
severity; and 3) large stock market losses. Many insurers over-leveraged
their investments and have had to pull out of the market after being unable to
meet regulatory requirements.
She warned of continued sharp premium increases until economic strength is regained and recommended looking for ways for physicians and practices to be attractive to the remaining carriers by showing the insured�s loss history and disclosing any and all steps taken to manage future risks.
Gulf Coast MGMA annual meeting: President John Watson presented the Nominating Committee's recommendations for officers and directors for the 2003 calendar year. The nominees were: President - Jim Keil, MBA; Past President - John Watson, CMPE; President-Elect - Pam Potter, MBA, CMPE; Secretary - C. Jane Hill; Treasurer - Rick Canady; At-Large Directors (2) - Andrea Anderson, MBA/MHA and Tomorrow Orsak, MBA/MHA; and Student Director - Terronica Wilson. The membership approved the slate by acclamation. The officers and directors will take their positions at the January meeting.
To download a copy of the presentation in PowerPoint format, click here
The November meeting was sponsored by Bronze Affiliate
To download the ACMPE credit hour form, click here
James
A. Reeder, Jr., partner in the
healthcare law section and co-chair of the litigation practice group of Houston-based Vinson
& Elkins, spoke on anti-trust and collective bargaining as it relates to
physician contracting with insurance companies.
He explained that
physicians can jointly negotiate prices only if they are 1) financially and
clinically integrated, or 2) accept risk contracts (capitation) which include an
incentive for cost containment.
Additionally, any discussion of prices with one�s competitors is considered price fixing by the FTC. Many �messenger model� PHOs have recently faced charges by the FTC for negotiating contracts and not following the messenger model which is primarily for the purpose of �communicating� on behalf of the individual participants.
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The October meeting was sponsored by Bronze Affiliate, the
To download the ACMPE credit hour form, click here
Susan Olis (formerly of University Care Plus), Vonda Hall (of Memorial Hermann Hospital) and Jim Hyland (of the UT Health Science Center - Houston) recounted their stories of recovery after the disaster of Tropical Storm Allison in June, 2001.
Their lessons learned were to a) have a disaster plan, b) have a good communication plan in order to stay in touch with staff, c) identify key vendors who provide essential services in an emergency and get them in immediately, and d) be prepared to hire consultants who are experienced in disaster recovery to minimize operational down time.
To download the presentation in PowerPoint, click here
To evaluate this meeting, click here
For a copy of the ACMPE credit hour form, click here
Diane Peterson, FACHE, President of D. Peterson & Associates, discussed the impact that appearance and presentation have on patients� perceptions of customer service. Her �secret shopper� experiences on behalf of healthcare organizations have revealed the many ways that gaps occur between what the entity intends to accomplish and the message that it actually sends to the patient.
The August meeting was
sponsored by Silver Affiliate:
To download the ACMPE credit hour form, click here
To download the presentation in PowerPoint, click here
To evaluate this meeting, click here
Mark Briggs, Compliance
Assistant Specialist for the Occupational
Safety and Health Administration (OSHA) spoke about the mandatory needle
stick safety and prevention law that was effective April 18, 2001. He also
spoke about the importance for employers to maintain an OSHA 300 log, which is
the employer�s record of injuries and illness of employees.
He emphasized the need for
employers to review/re-evaluate the processes and procedures in place that
reduce exposure to blood and other potential infectious material exposures.
OSHA advises employers to include employees in the exposure review and in the
selection of equipment used to reduce risks and exposure.
Mark�s phone number is: (281) 286-0583 and email address is: mark.briggs@osha.gov.
To download the presentation, click here
To download the ACMPE credit hour form, click here
To evaluate this meeting, click here
Audrey Selden, Provider Ombudsman and Senior Associate Commissioner of the Texas Department of Insurance, provided an overview of the Texas Department of Insurance's role in monitoring the reimbursement process between managed care plans and physician practices. She explained about common filing errors, clean claims, restitution and fines. She discussed upcoming amendments on clean claims and provider contracts providing for physician protection, which are now open for public comment.
Links to the information provided by Ms. Selden can be found:
https://www.tdi.state.tx.us/commish/doctors.htmlhttps://www.tdi.state.tx.us/consumer/drnews.html
To download the ACMPE credit hour form, click here
To evaluate this meeting, click here
Daniel
Stech, MBA, Survey
Operations Director for the Medical
Group Management Association in
The May meeting was sponsored by Silver Affiliate:
For a copy of the presentation, click here
To download the ACMPE credit hour form, click here
Mark T. Phelps, attorney-at-law and affiliate member of Gulf Coast MGMA, spoke to one of the largest groups of attendees regarding the impact of HIPAA on physician practices. According to Mr. Phelps:
Healthcare
providers have until April 14, 2003 to be fully compliant with HIPAA privacy
standards. The plan�s �Covered Entities� are: health plans,
healthcare providers (direct and indirect) and clearing houses.
The
information to be covered is �Protected Health Information� which is
individually identifiable health information in any form (written, verbal or
electronic). Confidentiality contracts will be required of �Business
Associates� who perform a function on behalf of the �covered entity�
and who are not a part of a practice�s workforce.
Notice must be given to patients on �uses and disclosures� of protected health information. The patient�s consent will be needed for 1) treatment, 2) payment, and 3) healthcare operations, i.e. accreditation. This would include a consent needed in order to verify benefits.
Mr. Phelps concluded by saying that he was available to meet with practice administrators to discuss their HIPAA concerns, and that he was offering a discounted professional rate to members of Gulf Coast MGMA. He can be contacted at his office number: (281) 540-6662.
To download the ACMPE credit hour form, click here
The April meeting was
sponsored by Bronze Affiliate
Joe B. Herrera, Director of Healthcare
Services for Dickey, Rush,
Duncan, Ansell & Co. spoke to those in attendance on �Strategic
Management.� Mr. Herrera discussed the importance of physician practices
having a strategic plan in place that includes near term goals to as far as five
years in the future. Strategic planning should be followed by strategic
management and should involve the entire staff in the �buy-in.� The
mission statement should also support the strategic plan or may need to be
updated.
He also recommended that when developing
a strategic plan to consider where the leaders of the practice want the
organization to be in the future; what�s occurring in health care, with
competitors, patients; and will the plan meet the financial goals of the owners?
Several �strategy traps� were discussed, a key one being that a practice
should not assume that bigger is better unless a competitive advantage or
increased profits can be gained.
For a copy of his PowerPoint presentation, click here
To download the ACMPE credit hour form, click here
Greg Barnes, CHE, Managing Director in Houston for Korn/Ferry International, the world's leading executive search and leadership capital consulting firm, addressed the GCMGMA membership on career management strategies. Mr. Barnes presented a fresh approach to consider in our strategy for achieving career success.
Barnes recommended that we would benefit by developing ideas about how we can apply our experience and accomplishments to broader areas than previously considered. He gave many examples of healthcare-related services not reimbursable by Medicare, but which have a strong consumer demand. Using the marketplace as a guide could reveal new possibilities and challenges over traditional practice management positions.To download the ACMPE credit hour form, click here
For a copy of the presentation, click here
Pat Harris of
the Harris County Medical Society
spoke to our group on the latest state and federal legislative developments,
i.e. Medicare reimbursement fee decreases and an upcoming Prompt Pay Hearing to
be held on January 24, 2002 at Rice University. She also discussed the
need to address skyrocketing mal-practice premiums through lawsuit reform and
advised our members of the need to voice our concerns over slow payors to our
legislators.
Members had a round-table discussion of current topics affecting physician practices, mainly the frustration over the large reduction in Medicare rates, which trickles down to all plans � resulting in lower revenue for all specialties, especially surgery.
To download the ACMPE credit hour form, click here