Month: July 2015

Health Care Alphabet Soup: EMR vs. EHR

EMR and EHR are often used interchangeably. And since electronic medical records and electronic health records sound like basically the same thing, the overlapping usage of their acronyms seems justified. But to people who spend their careers on these things, EMRs and EHRs are not the same. Indeed, the difference is subtle, but important. An electronic medical record is, quite literally, an electronic version of the medical record generated by your doctor when you go in for a visit. Instead of the old manila folders that used to line the walls behind the receptionist’s desk (how quaint that seems now), there is a file with your name on it in the doctor’s computer system. EMRs are considered superior to paper records for a number of reasons, among them that doctors can better track their patients’ conditions over time and monitor the practice’s overall quality of care. However, EMRs generally don’t leave the doctor’s office. If you switch doctors, your EMR is unlikely to go with you. An electronic health record, on the other hand, contains a great deal more than one doctor’s record of your most recent checkup. EHRs contain everything the EMRs do, plus more. The Office of the National Coordinator for Health Information Technology (ONC), which uses the term EHR almost exclusively, emphasizes that “health” has a much broader meaning than “medical,” and an EHR accordingly contains...

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News Briefs: Medicare Coverage of End-of-Life Care Planning

Earlier this month, the Centers for Medicare and Medicaid (CMS) issued its annual Medicare physician payment rule. Contained within the rule’s numerous pages was this interesting bit: CMS plans to reimburse doctors for having end-of-life discussions with patients. If this sounds vaguely familiar, it’s because it is. A similar rule was proposed as part of the Affordable Care Act, but it was effectively killed by Sarah Palin (you remember those “death panels”) and removed from the ACA before passage. But wait, it wasn’t dead after all. Patients and physicians have continued to advocate for Medicare coverage of end-of-life care planning. A report issued last fall by the independent Institute of Medicine called for an overhaul of the country’s end-of-life care, including reimbursement for advance care planning conversations. Advance care planning covers, among other things, such topics as living wills, which express a patient’s treatment preferences, and health care proxies, which give another person the power to make health care decisions for an incapacitated patient. Under the proposed rule, the discussions are voluntary; but if patients want to have them, their doctors (and nurse practitioners and physician assistants) can now bill for that time. The final rule is expected November 1, 2015, with payments commencing January 1,...

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Non-Profits Behaving Like For-Profits: The Morristown Case

At the risk of stating the obvious: Receiving the imprimatur of the IRS does not protect your tax-exempt status from the scrutiny of other government agencies. In 2008, a tax assessor in Morristown, New Jersey denied the property tax exemption for portions of the non-profit Morristown Memorial Hospital. The hospital’s parent company, Atlantic Health System Hospital Corp., sued the city. At the end of last month, a New Jersey tax court judge ruled against Atlantic Health System, finding that the hospital operated in a for-profit manner and therefore could not be exempt from local property tax. The ruling doesn’t affect the hospital’s federal tax-exempt status, but it does open it up to liability for property taxes estimated at $2.5 million per year. Judge Vito Bianco considered several factors in reaching his decision, among them the hospital’s complicated corporate structure, which included numerous for-profit entities. The opinion also cited the hospital’s relationships with for-profit physician practices, including the payment of recruitment incentives and loans to physicians. Compensation was another key factor: the judge found that the hospital’s executive compensation was unreasonably high, and its compensation to employed physicians was designed to incentivize them to generate profits for the hospital. Similarly, some third party service contracts contained compensation that, in the judge’s view, was profit sharing disguised as cost savings. Judge Bianco was apparently not pleased with what he saw in...

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News Briefs: A Kinder, Gentler Two-Midnight Rule

The Centers for Medicare and Medicaid Services (CMS) has just issued a proposed rule that would soften, but not eliminate, the Two-Midnight Rule for short hospital inpatient stays. The current version of the Two-Midnight Rule, which was first issued in 2003, provides that inpatient admissions will generally be payable under Medicare Part A if the admitting physician expected the patient to require a hospital stay that crossed two midnights and the medical record supports that reasonable expectation. Patients who are not expected to remain in the hospital across two midnights should be treated as outpatients, except for services that can only be performed on an inpatient basis. CMS proposes two key changes to the current rule. First, when a physician expects a patient to need less than two midnights of inpatient care, an inpatient admission would be payable under Medicare Part A on a case-by-case basis based on the judgment of the admitting physician. Documentation in the medical record must support that an inpatient admission is necessary.  The CMS policy regarding hospital stays that are expected to be two midnights or longer will be unchanged. Second, CMS is removing oversight of inpatient admission claims from its recovery audit contractors (RACs). Instead, quality improvement organizations (QIOs) will enforce the Two-Midnight Rule, conducting the first line medical reviews of providers who submit claims for inpatient admissions. RACs will be directed to...

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News Briefs: Tuomey FCA Verdict Upheld

After two jury trials, two trips to the appellate court, and ten years of legal wrangling, Tuomey Healthcare System is still stuck with a stunning verdict against it for violations of the Stark law and the False Claims Act – a verdict that exceeds its annual revenues and is believed to be the largest ever against a community hospital. Tuomey Healthcare System, Inc. is a nonprofit hospital system in Sumter, South Carolina. The case originated with a whistleblower claim over part-time employment contracts that Tuomey entered into with local physicians. The trial (the second one) turned on evidence that a lawyer, one of several retained by Tuomey to opine on the physician contracts, had warned Tuomey that the arrangements might be a Stark violation. Tuomey subsequently dismissed that lawyer and proceeded with the contracts anyway. The jury concluded that the contracts were a violation of the Stark law, because they rewarded the physicians for referring patients to Tuomey’s hospital. Specifically, the jury found that Tuomey knowingly submitted 21,730 false claims to Medicare, which resulted in a final judgment of more than $237 million. On July 2, the 4th Circuit Court of Appeals upheld the judgment. Despite the outcome, one concurring judge noted the “troubling” nature of the case, which “will result in a likely death sentence for a community hospital in an already medically underserved area.” Tuomey has said...

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