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Practice Group Update
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Please save the date for our Third Annual Broad and Cassel Health Forum
October 4, 2013
12:00 - 5:30 pm
Hard Rock Hotel & Casino
Hollywood, FL
Registration information will be provided in the coming months.
Upcoming Speaking Engagements
Gabriel Imperato: 6/5-6/7, False Claims Act Institute, Washington, D.C. 8/5-8/8, HCCA Basic Compliance Academy, New York, NY 9/16-9/19, HCCA Basic Academy, Las Vegas, NV
10/6-10/9, SCCE 12th Annual Compliance & Ethics, Washington, D.C.
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To our clients and friends:
As of recent, providers are working on creating ACOs to be effect in 2014. The notice of intent deadline for an effective date of 2014 expires this month, and the application deadline is July 14, 2013. From what we can gather, there will be a significant number of filings in Florida. ACOs are becoming a true reality. In fact, last week a trade organization for ACOs, the Florida Association of ACOs ("FLAACO"), was officially started.
In addition, hospitals are finally reading the tea leaves and are beginning to look for ways to participate in ACOs. They are also working hard to create clinically integrated networks, sometimes actually partnering with physician organizations to do so. We are really seeing a seismic boom in ACO and clinical integration in Florida. Consolidation continues as health care dollars keep shrinking. I think more significant changes have occurred with health care in the last year than in the entire decade preceding!
Merritt Hawkins, a national physician search firm, recently announced that for the first time in five years PCPs generated more hospital revenues than specialists in 2013. This is a big deal. Historically PCPs have, for hospitals, essentially been an afterthought to the specialists who drove the hospital referrals, surgeries and testings. This is changing -- rapidly.
The big question is still whether physicians and hospitals can successfully align their interests AND work with health plans in a productive manner, to reduce costs and increase the quality of care. I'm an optimist, but this certainly represents a difficult challenge!
Chair, Health Law Practice Group
Broad and Cassel
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Are You Overlooking the Ability to Use an ACO Waiver?
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By: Mike Segal
I believe that many ACOs may be overlooking the ability to enter, pursuant to an ACO waiver (a "Waiver"), into certain transactions that might be beneficial for the ACO but could implicate the Stark or anti-kickback laws, or the Gainsharing CMP (collectively the "Penalties").
Below is a summary of some of the key elements of the ACO Waiver provisions that the ACO Board and you may want to know about. On November 2, 2011, CMS issued an Interim Final Rule setting forth the Waiver Provisions and a preamble (the "Interim Waiver Rule"). It is not necessary, or even anticipated, that a request be made to CMS before moving forward where a waiver is believed to apply. The waiver is self-implementing.There are five different types of waivers (each a "Waiver"). The waiver that will most commonly apply is the "Participation Waiver." It covers "arrangements" that occur after the ACO has entered into the Medicare Shared Savings Program ("SSP") with CMS.
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Top HIPAA-HITECH Trends
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By: Stephen Siegel
On January 25, 2013, the Department of Health and Human Services published the final rule implementing and incorporating the provisions of the Health Information Technology for Economic and Clinical Health Act ("HITECH") into HIPAA. The purpose of this article is to attempt to provide a BRIEF summary of some of the most likely trends, both intended and unintended, that will be consequences of the Rule.
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CMS Proposes to Enhance its Revocation Authority
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By: Anne Novick Branan
On April 29, 2013, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) that will dramatically expand its authority to deny Medicare enrollment and revoke Medicare provider numbers and billing privileges for healthcare providers. With the Proposed Rule, CMS demonstrates that it is serious about preventing individuals and organizations from participating in the Medicare program if they propose risk to the Medicare Trust Fund.
Click here to learn about the proposed changes.
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EHR Safe Harbor and Exceptions Extended
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By: Fred Segal
On April 10, 2013, the Officer of the Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) proposed three year extensions to the Anti-Kickback Safe Harbor and Stark Law exception regarding donations of electronic health records (EHR) software and equipment to hospitals. The nearly identical proposed amendments would extend the Anti-Kickback Statute and Stark Law protections for donations of EHR equipment to physicians until December 31, 2016. The protections were originally to sunset on December 31, 2013.
The EHR exception and safe harbor were originally released in 2006. The regulations protect certain types of donations of EHR technology and training services to physicians and hospitals.
Please click here to continue reading.
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