Getting your employees to complete their compliance training can be a challenge!
Compliance training is not something that your employees want to take time away from their busy schedule to complete. It is not high on their priority list and they feel like it is a waste of their time. This attitude is very common throughout many healthcare organizations. This type of employee attitude is a dangerous attitude to have within a healthcare organization. I have received many calls from clients asking for help with correcting this attitude within their organization.
Here are two of my suggestions for correcting a poor attitude towards training within a healthcare organization:
Create a Culture of Compliance - When employees see that protecting the health information of the patient is not a high priority for their leaders (doctors, administrators, etc.), then protecting the patients privacy and health information will not be a priority for them either. This type of behavior and attitude will then become part of the organization's culture.
Performance Review - Incorporate the completion of the employee's compliance training into their performance review. If an employee has not completed all of their compliance training, then that will be a negative factor in their performance review.
It is important that all employees (including doctors) complete their required compliance training every year!
SoPE
Today’s show features an interview with Dr. Arlen Meyers, the president and co-founder of the Society of Physician Entrepreneurs, or SoPE. Lance King, of Healthcare Compliance Solutions Inc. conducted the interview.
Dr. Arlen Meyers, An Introduction
Dr. Arlen Meyers was raised in Philadelphia. He moved to Colorado in 1976 to attend the University of Colorado and has lived there since. Dr. Meyers practiced Ear, Nose, and Throat medicine for 40 years. He started SoPE because he was frustrated with the process of commercializing a
device/process that could optically detect cancer cells. He realized that other people were probably having similar struggles and so he, along with some colleagues, started SoPE as a way for entrepreneurial-minded physicians and healthcare providers to connect and collaborate. Dr. Meyers credits a lot of his entrepreneurial spirit to watching and working with his pharmacist father. He learned of and found a love for commercial healthcare at his father’s drugstore, where he worked from the time he was eight or ten years old.
Challenges Faced
Dr. Meyers says that although physicians have always been entrepreneurs, having an entrepreneurial mindset and formally packaging oneself as a physician entrepreneur is a fairly new idea in healthcare. He defines a Physician Entrepreneurship as the pursuit of opportunities with scarce resources, the goal of which is to create user defined value with the deployment of innovation. When he first began SoPE, Dr. Meyers’ message fell on deaf ears, essentially because doctors didn’t need to focus on being innovation-minded. They could graduate in the middle of their class, set up a practice, and make more money than most people in the country. Recently, healthcare providers have realized they need to step-up their game if they’re going to compete in today’s market.
Dr. Meyers says that although it’s more important now to have an entrepreneurial mindset, his greatest challenge still is finding people who have that trait. He said doctors and healthcare providers need to create opportunities out of challenges and they need to be creative. One of the reasons those people are hard to find is that doctors need to be very good at taking tests and memorizing facts to be at the top of their class. Unfortunately, that doesn’t always translate into creativity; in fact, innovation gets punished in some ways. Dr. Meyers asserts that the industry conveys the message, “We want you to be innovative, but we don’t want to hear about it.” The Society of Physician Entrepreneurs is a group of people who want to hear about innovations.
Society of Physician Entrepreneurs, or SoPE
The Society of Physician Entrepreneurs is a good fit for healthcare providers who are fed up with certain processes, devices, situations, et cetera and who are able to see innovative ways to fix or improve those things. It is also a good fit for people who are looking for a different role in the healthcare industry. Dr. Meyers asserts that creating a process or gadget that delivers value to thousands of patients is just as valuable, if not more valuable, as a physician who sees 40 patients a day for 40 years.
The goal of SoPE is to bring together like-minded people who have ideas on how to deliver value to patients. The SoPE will help members get ideas to commercialization by providing members with education, resources, networks, mentors, and experiential learning through chapter networks. Dr. Meyers says that the SoPE is “preaching the gospel of innovation” and the society would welcome anyone who is entrepreneurial-minded to become a ‘disciple.’
It costs $75 per year to be a member of SoPE. The SoPE provides a chance for physicians, researchers, marketers, patients, attorneys, and anyone else who wishes to provide value to patients through innovation to connect in monthly meetings. Additionally, the SoPE provides other connection opportunities multiple times a year through virtual meetings with organizations that have similar or compatible missions. The SoPE is a virtual organization; it has a Board of Directors, Chapter Leaders, and Members. It is completely voluntary and not-for-profit. Local chapters are led by physicians, but anyone may be a member. The only thing that matters to the SoPE is the answer to the following question, “How can you deliver value to patients through innovation?” Anyone who has a good answer to that question is invited to join.
More Information; How to Join
To learn more about SoPE, or to join, please visit www.sopenet.org and look for local chapters. If there is not a chapter nearby, any innovation-minded physician is welcome to start one in his/her area. Dr. Meyers has found that the chapters in smaller cities have had great success because of less competition for the same resources. He says that when chapters hold meetings and connect, things happen.
Final Advice
Dr. Meyers has two final pieces of advice. First, don’t take advice! Second, don’t point the finger; jerk the thumb—meaning, cultivate the inner-entrepreneur. Decide for yourself what you want to accomplish. Ask yourself if you have a risk-tolerant personality. Look at your blind spots. If you’re an employee, find a culture that will allow your entrepreneurial spirit thrive. If you’re a business owner, create the kind of culture that builds on innovation.
Show sponsored by Healthcare Compliance Solutions. Please visit our website at www.hcsiinc.com
With recent and upcoming state modifications regarding minimum wage laws, be certain to check with your state's Labor and Industry division/commission to ensure you have their latest minimum wage notice poster(s) required for your office or practice.
Generally these posters can be downloaded, free of charge, in PDF format from your state's labor division website or optionally can be purchased through various re-sellers and online sources. See this DOL listing of State Labor Offices for more information on resources.
The following states have announced increases to the minimum wage and have issued new posters:
State
New Minimum Wage
Effective Date
Alaska
$9.80
Jan. 1, 2017
Arkansas
$8.50
Jan. 1, 2017
California
$10.50 (for employers with 26 or more employees
Jan. 1, 2017
Colorado
$9.30
Jan. 1, 2017
Connecticut
$10.10
Jan. 1, 2017
District of Columbia
$12.50
Jan. 1, 2017
Florida
$8.10
Jan. 1, 2017
Hawaii
$9.25
Jan. 1, 2017
Maryland
$9.25
Jan. 1, 2017
Massachusetts
$11.00
Jan. 1, 2017
Michigan
$8.90
Jan. 1, 2017
Missouri
$7.70
Jan. 1, 2017
Montana
$8.15
Jan. 1, 2017
New Jersey
$8.44
Jan. 1, 2017
Ohio
$8.15
Jan. 1, 2017
Vermont
$10.00
Jan. 1, 2017
Washington
$11.00
Dec. 31, 2016
The following states have announced minimum wage increases and new posters are pending:
State
New Minimum Wage
Effective Date
Arizona
$10.00
Jan. 1, 2017
Maine
$9.00
Jan. 1, 2017
New York
Variable rates based on location
Dec. 31, 2016
Oregon
$10.25
Jan. 1, 2017
Overview of state minimum wage changes:
Effective December 31, 2016
New York:
$9.70 per hour for Greater New York
$10.00 per hour for Nassau, Suffolk, and Westchester counties
$10.50 for New York City (small employers)
$11.00 for New York City (large employers)
Effective January 1, 2017
Alaska: $9.80 per hour.
Arizona: $10.00 per hour. The minimum wage is also scheduled to increase to $10.50 per hour on January 1, 2018.
Arkansas: $8.50 per hour.
California: $10.00 for employers with 25 or fewer employees; $10.50 for employers with 26 or more employees. The minimum wage is also scheduled to increase to $11.00 per hour on January 1, 2018.
Colorado: $9.30 per hour. The minimum wage is also scheduled to increase to $10.20 per hour on January 1, 2018.
Connecticut: $10.10 per hour.
Florida: $8.10 per hour.
Hawaii: $9.25 per hour. The minimum wage is also scheduled to increase to $10.10 per hour on January 1, 2018.
Maine: $9.00 per hour. The minimum wage is also scheduled to increase to $10.00 per hour on January 1, 2018.
Massachusetts: $11.00 per hour.
Michigan: $8.90 per hour. The minimum wage is also scheduled to increase to $9.25 on January 1, 2018.
Missouri: $7.70 per hour.
Montana: $8.15 per hour.
New Jersey: $8.44 per hour.
Ohio: $8.15 per hour (gross receipts of $297,000 or more); $7.25 per hour (gross receipts under $297,000)
South Dakota: $8.65 per hour.
Vermont: $10.00 per hour. The minimum wage is also scheduled to increase to $10.50 per hour on January 1, 2018.
Washington: $11.00 per hour. The minimum wage is also scheduled to increase to $11.50 per hour on January 1, 2018.
Effective July 1, 2017
Washington D.C: $12.50 per hour on July 1, 2017. The minimum wage is also scheduled to increase to $13.25 per hour on July 1, 2018.
Maryland: $9.25 per hour on July 1, 2017. The minimum wage is also scheduled to increase to $10.10 per hour on July 1, 2018.
Oregon: $10.25 per hour standard rate on July 1, 2017; the Portland metro rate will increase to $11.25 per hour; and the nonurban counties rate will increase to $10.00. The minimum wage is also scheduled to increase to $10.75 per hour standard rate on July 1, 2018; the Portland metro rate will increase to $12.00 per hour; and the nonurban counties rate will increase to $10.50.
In this week's episode, Lance King from Healthcare Compliance Solutions (www.hcsiinc.com), interviews Josh Johnson, the Executive Vice President of Advanced MD. Advanced MD is a cloud-based service-provider for EMR (electronic medical record), billing, and telemedicine software.
Get to Know Josh Johnson
Josh Johnson has a passion for sports. He grew up playing four high school sports and now enjoys coaching his children's teams. His father was a great example of not quitting and instilled that value in him. Josh's favorite quote is from Henry Ford, “Whether you think you can or think you can't, you're right!”
Josh Johnson as a Manager
Josh has relied on that philosophy of positive thinking and giving it his all throughout his career. He especially had to rely on it during times of transitions. Josh worked as the VP of sales for ADP. When ADP acquired Advanced MD, Josh made a lateral move to work for them and has since been promoted to Executive Vice President of Sales. Josh Johnson recommends the book Culture Eats Strategy for Breakfast and tries to stick to it's principles when managing his sales team. When acquiring new companies and instilling the new culture of commitment, Josh looks for people who are willing to not give up and want to have a long-term career with the company. He prides himself on developing a positive culture where his salespeople can succeed if they're willing to put in the effort. A key part of that culture development is the practice of giving nicknames to co-workers. Giving everyone nicknames is just part of building a culture of success, motivation, and retention at Advanced MD.
Advanced MD
Advanced MD is a nation-wide, cloud-hosted tech company that specializes in technology and software for medical offices as large as 25 or more practitioners or as small as a single doctor-owned practice that is just starting out. Within the software, they provide electronic medical record (EMR), patient portals so patients can access their information and fill out forms online, telemedicine platforms where patients can receive healthcare remotely, as well as scheduling software and more. Josh says that Advanced MD's biggest competitive advantage is their billing software. Because of billing inefficiencies, physicians end up treating their first two patients of every day for free. Advanced MD's billing products will help eliminate that inefficiency. Besides offering billing software directly to clients, Advanced MD also offers software for billing companies, or can take over billing entirely.
Another competitive advantage of Advanced MD is their specialized sales and implementation teams. These teams are familiar with the needs and nuances of specific specialties. The implementation teams will walk everyone, established practice or brand-new start-up, through all aspects of the software. This includes set-up, credentialing, billing, scheduling, reporting, and submitting claims. Once the client understands the product, they are turned over to service specialists who continue to support the practice with any questions or continuing needs. Advanced MD also offers additional products, such as analytic tools which can help a practice compare and contrast their performance with others in the same specialty or locality.
Benefits
Doctors/business owners like to have control over data. Advanced MD offers that control through access to information and charts electronically. The efficiencies gained through Advanced MD allows doctors to use their time on patient care, instead of keeping track of papers. Doctors can enter information on a tablet or phone and it will be uploaded to the cloud. Electronic charting systems are also more effective in safeguarding patient information. Advanced MD prides itself on billing efficiency so offices have higher bill-pay, thus becoming more profitable. Advanced MD also offers continued support for their clients after purchase through product enhancements, question support, access to newsletters, and monthly webinars Finally, if clients refer other practitioners resulting in a sale, the referring office earns discounts and other incentives. Josh Johnson says Advanced MD's mission is to save the private practice by focusing on billing efficiency, continuous advancement, and putting the customer first.
Contact
Potential clients may visit Advanced MD's website at www.advancedmd.com; it's easy to navigate and offers access to webinars, information by specialty, and newsletter subscription.
Or call 800-825-0224 and anyone in the company would be happy to answer questions.
What is the difference between an incidental/accidental disclosure and a breach?
With the approaching breach notification deadline (Before March 1st, all breaches must be reported 60 days after the end of the previous calendar year that the breach occurred), I have receive many calls and emails asking, "is this a breach and do I need to report it?". This is an important topic that needs some clarification.
Incidental Disclosure
These disclosures are non-intentional and occur as a by-product of allowed uses and disclosures. They are allowed as long as the minimum necessary standard and reasonable safeguards are applied in the course of your everyday operations. An example would be if a passerby overhears PHI being discussed at a nursing station. These disclosures do not have to be accounted for.
Accidental Disclosure
These types of disclosures are distinctly different from incidental disclosures. Accidental disclosures
happen when a mistake is made in disclosing a patient’s PHI. Examples include faxing or mailing PHI to the wrong destination or disclosing PHI to an unauthorized person. If you are aware of an accidental disclosure, you need to log the disclosure on the disclosure log. If the disclosure is potentially harmful or damaging to the patient, you need to notify the patient of the accidental disclosure.
Identifying a Breach of Unsecured PHI
A breach is defined in the HIPAA HITECH Act as:
The unauthorized acquisition, access, use, or disclosure of unsecured protected
health information which compromises the security or privacy of such
information, except where an unauthorized person to whom such information is
disclosed would not reasonably have been able to retain such information. (Note
that de-identified health information, as defined in HIPAA’s Privacy Rule, is not
PHI; therefore no breach notification is required.)
Exceptions include:
• Any unintentional acquisition, access, or use of protected health information by an
employee or individual acting under the authority of a covered entity if:
• Such acquisition, access, or use was made in good faith and within the course and
scope of the employment or other professional relationship of such employee or
individual, respectively, with the covered entity; and
• Such information is not further acquired, accessed, used, or disclosed by any
person; or
• Any inadvertent disclosure from an individual who is otherwise authorized to
access protected health information at a facility operated by a covered entity to
another similarly situated individual at the same facility; and
• Any such information received as a result of such disclosure is not further
acquired, accessed, used, or disclosed without authorization by any person.
I hope the information listed above helps you have a better understanding of the difference between an incidental/accidental disclosure and a breach. Here is another article that could offer some additional information.
If you would like additional information, please feel free to email support@hcsiinc.com
A January 10, 2017 Issuance from
Heath and Human Services' (HHS) Office if Civil Rights (OCR) updating new
privacy guidance is aimed at clarifying that the HIPAA Privacy Rule does permit disclosures of health information to a patient's loved ones regardless of
whether they are recognized as relatives under applicable law. This guidance
for healthcare professionals is to help clear up confusion about allowable
disclosures of protected health information to spouses, relatives, and
patients’ loved ones.
The majority of healthcare
professionals are aware that the HIPAA Privacy Rule permits them, within the exercise of their own professional judgement, to share the protected health information of a patient
with a relative or loved one or if it is in the patient's best interest.
However, the 2016 Orlando nightclub shooting incident revealed that many
healthcare professionals are unsure about how the HIPAA Privacy Rule – 45 CFR164.510(b) – applies to same sex couples.
OCR has confirmed that the Privacy
Rule permits a covered entity to “share PHI with an individual’s family
member, other relative, close personal friend, or any other person identified
by the individual, the information directly relevant to the involvement of that
person in the patient’s care or payment for health care.” OCR has also
confirmed that covered entities are allowed to disclose relevant information
“to notify, or assist in the notification of (including by helping to identify
or locate), such a person of the patient’s location, general condition, or death.”
The recipient can be a “patient’s
family member, relative, guardian, caregiver, friend, spouse, or partner,” but
also any other individual that is a nominated personal representative of the
patient. A personal representative of a patient must, as far as the Privacy
Rule is concerned, be treated as the individual for purposes such as exercising
the patient’s Privacy Rule rights, including providing access to their health
information. There are limited exceptions, which are detailed in 45 CFR164.502(g).
OCR has confirmed that covered
entities are permitted to share a patient’s PHI with same-sex partners, and
explains that the list of potential recipients of PHI is in no way affected by
an individual patient’s sex or gender identity, and neither by the sex or
gender of the potential recipient.
OCR also sought to confirm who can
be classed as a personal representative of the patient, saying “the Privacy
Rule generally looks to state laws governing which persons have authority to
act on behalf of an individual in making decisions related to health care.”
For example, if a state grants
legally married spouses health care decision making authority for each other, a
covered entity would be in violation of the Privacy Rule if access to the
patient’s information was not granted if requested by a spouse, regardless of
the sex of that individual.
While the covered entity should
seek permission from the patient concerned prior to sharing information, in
cases when the patient is incapacitated or not available, covered entities
should use their professional judgement if the sharing of information is in the
patient’s best interest. Should a patient be deceased, information can be
shared with a person who has been involved in the patient’s care or who has
made payment for medical services prior to the patient’s death.
The new OCR privacy rule guidance,
issued in a frequently asked questions format, was developed in large part to
address confusion following the 2016 Orlando nightclub shooting about whether
and when hospitals may share protected health information with patients' loved
ones, OCR says in a statement. "In particular, the FAQ makes clear that
the potential recipients of information under the relevant permissive
disclosure provisions ... are not limited by the sex or gender identity of the
person," OCR says.
On that same topic, OCR also issued
updated guidance "that makes clear that the terms 'marriage, spouse and
family member' include, respectively, all lawful marriages - whether same-sex
or opposite-sex) - lawfully married spouses and the dependents of all lawful
marriages, and clarifies certain rights of individuals under the Privacy
Rule."
Heathcare Compliance Solutions Inc. recommends consulting with your practice or organization's attorney and/or your state medical association/board to verify your state's legislation regarding the definitions and legal ramifications of terms relating to this regulation such as: "Personal Representative", "Lawful Marriage", "Family Member", etc..
Compliance training is not an end of the year check list item
It is the last week of December and Stephanie has just begun to do her compliance training for the year. She had not progressed too far into the training when she was pulled away in order to help a co-worker. Two days later, Stephanie tries to continue with her compliance training, but runs into an unforeseen technical issue. Another day passes before the technical issue is resolved and she can continue with her compliance training. Stephanie's anxiety is beginning to rise as she only has two more days before the end of the year to complete her training.
At the end of last year, I received many phone calls from healthcare professionals who needed assistance trying to complete their required compliance training before the end of the year. These people's emotions ranged from anxious and panicked to the always fall back emotion of, "oh well, I'm not the one who will be held liable if some thing happens".
There are many areas of compliance where Healthcare Professionals are required to have annually documented compliance training. These areas include, but are not limited to HIPAA, OSHA, and Medicare. In the case of an audit, it is always the recommend practice to have all of your compliance training documents reflect the current year.
Having a proactive approach to compliance is the best way to protect your office against possible liability and a proactive approach begins with early in the year compliance training. Give yourself the peace of mind knowing that your office has its compliance training done for the current year.
Managing compliance with multiple offices at different locations can be challenging, but it is possible if done right.
Rita just finished talking with the Tampa office, as they have been struggling with some compliance issues. She begins drafting her report when the phone rings again. This time it is another issue with a misinterpretation of a compliance issue, but this one is at their office in Atlanta. Rita clarifies the issue and makes notes for her next report that will be done after she has completed the one from the Tampa office. "That's two offices in the last few minutes," Rita says aloud. "As long as I don't hear from the other seven offices I should be alright." At that moment, Rita's phone rings again.
Being responsible for the compliance regulations (HIPAA, OSHA, Human Resources, and Medicare) at one office is a demanding and time consuming job. Being responsible for all of the compliance regulations at multiple offices is, in all likelihood, overwhelming and ineffective. There are three specific areas that we are going to be reviewing where having a "multi-office Compliance Administrator" is a challenge.
So Many Duties, So Little Time
In many offices, the person who is assigned to be responsible for the compliance duties within that office, is also responsible for many other duties that have been assigned. These conflicts often lead to one or more of the person's assigned duties being neglected. Far too often, the duties that are often left neglected within an office turn out to be those duties that the person wants to do the least . . . compliance. Neglecting compliance, even if unintentional, will lead to an increase of liability for the organization as a whole. An adequate amount of time needs to be accounted for in order for the assigned person to be able to protect the organization by being effective in their compliance duties.
Compliance Representation
Even in a multi-office structure, it is essential to have compliance representation for each individual office. Examples of compliance representation include:
Office specific compliance policies and procedures
Compliance forms identified for each individual office
Subject matter expert (SME) at each location as the go-to person for compliance questions or patient concerns
Compliance and Employee Awareness
Being aware of what is happening within each individual office is a big challenge for multi-office Compliance Administrators. However, this is the most important factor in determining the success for failure of a compliance program.
Needs and Circumstances - Each office has its own uniqueness in terms of compliance needs, focus, and circumstances. For example, restricted access areas within the office might be a huge issue at one office. Where as, verbal protected health information (PHI) exposure could be a concern at a different location. Each office is unique and has its own challenges. One office could have a ramp safety issue and another office could be facing IT security issues. Each office is unique and should be treated as such.
Employees - Do you know what your employees are doing and saying when it comes to compliance? This is the biggest liability challenge for any organization. Having the ability to identify and quickly correct any possible compliance issue brought on by your employees lack of understanding or poor attitude, is a big difference maker for any compliance program. This goes a long way to creating the all too important culture of compliance within any healthcare office. Lacking employee awareness will leave your organization open to compliance issues and liability. It is also the quickest way for the multi-office Compliance Administrator to have an involuntary job change.
Can one person be the multi-office Compliance Administrator? The answer is, yes. If one person wants to be responsible for the compliance of the entire organization, they can do that, but they need to ensure that they have the following at each location:
Written and customized policies and procedures
Customized compliance material (forms, Business Associate Agreements, etc.)
Compliance Representative/SME
Having an effective compliance program and developing a culture of compliance within each healthcare office can be achieved. However, having one person trying to do all of the compliance program themselves for multiple healthcare offices is not the sign of a hard worker. It is a risky course to take that is laden with pitfalls and unnecessary liability.
Take a moment to review your current compliance situation. Ask yourself, "is my current compliance program protecting the organization or putting it at risk?" Could your current compliance program be better based on the needs of your organization and its individual offices? We can all do better improving our compliance efforts and meeting the needs of the organization. Rita has begun reviewing her compliance situation, maybe its time to review yours as well.
Discussing Healthcare's Variable and Evolving Paths
From contributing author Mendel Zilberberg, attorney and founder of Mendel Zilberberg & Assoc P.C., specializing in legal and allied legal services to healthcare related entities.
The recent election has had a reeling effect on most Americans. There
is a prevailing sense of uncertainty about many important matters that
are vital to this country’s future. However, healthcare, which currently
represents approximately 17% of GDP looms large in the uncertainty
column.
Irrespective of anyone’s particular view as to the advantages or
disadvantages of Obama Care, or whether the plan initiated by President
Obama adequately, substantially, or even substantively addresses the
underlying healthcare issues, it is most certain that healthcare cannot
be steered like a sports car, but maybe and hopefully it can be
navigated like a cruise ship. Even if change can be effected, it is
reasonable to assume that even if there were quick fixes, it most
certainly would have to be phased in over time to allow the economy,
marketplace and government to efficiently implement and absorb the
changes. What I’m trying to say is that any hope or promise of somehow
pulling a rabbit out of a hat is unrealistic, irrespective of the
ultimate plan and corresponding changes, particularly, given the time
needed to adjust for and to the unintended consequences of the seismic
changes that have been promised. Simply stated, to those who believe
that healthcare can be transformed overnight – please be ready to
readjust your sights.
One challenge that I see in the future is that it is easy to
promise lower cost and higher quality healthcare, however, in a sense
the quality and cost of healthcare pull in opposite directions unless
there is a new paradigm – a paradigm that has not yet been articulated.
If you add quality, it raises the cost, and if you lower the cost of
insurance you have less money to pay for whatever benefits you are
offering. To further complicate matters, President-elect Trump said that
he intends to leave coverage for pre-existing conditions. Aside from
the actual cost of covering those situations, the ability for adverse
selection looms large. Essentially, adverse selection means that the
people who are most likely to buy the insurance are the people who need
it the most. Let’s face it, insurance, by its very nature is a
redistribution of risk. If you cannot distribute the risk between those
who are less likely to need medical care and those who are more likely
to need medical care the general principles of insurance become
inapplicable.
Another issue is the apparent failure to distinguish between the
cost of healthcare and the cost of healthcare insurance. I think it is
best understood by way of example in which someone goes to lease a car.
The marketplace can in an effort to lower the cost of an auto lease
focus on lowering monthly lease rates by squeezing markups charged by
the dealer, negotiating lower interest rates, or have subsidized
interest rates promoted by the automaker , but ultimately one gets to
the point where if you don’t lower the actual underlying cost of the car
you can’t lower the monthly or overall cost of the lease. Similarly,
with healthcare, you can squeeze the doctors in terms of their
reimbursement, you can squeeze the hospital in terms of their margins,
but you reach a certain point (a point that we may have already reached)
in which you cannot achieve any material efficiencies unless you lower
the underlying cost of healthcare. There seems to be some mental block
between understanding that increased insurance premiums reflect
increased cost of providing medicine and the increased cost of
underlying medical care.
Of course, when we get to this point in the conversation the big
target is Pharma. The general argument is a call to arms to get those
high-priced drugs out of the stream of commerce. However, the insurance
companies seemingly have already negotiated down the cost of these
drugs, and many of these drugs actually save lives. Even if Medicare
started negotiating prices, it would be a small step in the right
direction which carries its own potential consequences. But, do we
really want to suppress innovation in healthcare? A very small
percentage of potential drugs make it to or through clinical trials, and
then a very small percentage make it through the lengthy and torturous
FDA approval process. If the few winners do not earn enough money to pay
for the other laggards (those drugs that either don’t make it to the
finish line or will only treat a few people) big Pharma may cut R&D
budgets, which ultimately will impede our progress. The bottom line is
that ultimately it will lead to debilitated health or loss of life. This
is a decision that we will have to make as a society. The issue of the
propriety or ability of the government to dictate pricing to private
industry is beyond the scope of this article.
Lower cost higher quality healthcare is a great tagline. However, I think it is easier said than done.
As a final note, it pains me to see American healthcare in a state
of suspended animation. As just one example, I recently saw a flyer for a
very large convention from the American Bar Association for its Health
Law practitioners which is scheduled for the beginning of December. I am
sure that in the months leading up to this convention there were
numerous and highly detailed discussions relating to prevailing
regulations, future trends, emerging strategies and various other very
important topics. I can only wonder what they will be discussing as they
look at their notes and PowerPoint slides for the scheduled
presentations, all the while twiddling their thumbs and trying to figure
out whether (or how) to keep on saying that we will have to see how
much of the presentation will be around in six months, whether the
stroke of a pen will make the presentation wholly irrelevant, or that
thanks to the new administration they won’t have to wait a year for
another health law convention.
What do you think?
---
DISCLAIMER - This post and the analysis
submitted are not a legal conclusion and should not be construed as such
but are presented for discussion and informational purposes only. In
addition, in some jurisdictions this post may be considered to be
attorney advertising. About Mendel Zilberberg: An attorney, visionary and entrepreneur admitted to practice
in New York, New Jersey and Florida who has represented and counseled
clients with nationwide interests in many areas of the healthcare arena. MZ blog : www.stateofthought.com
Here are two of my suggestions for correcting a poor attitude towards training within a healthcare organization:
