Healthcare and 2013

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Potpourri of topics affecting healthcare professionals in 2013.

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Healthcare and 2013

  1. 1. Healthcare and 2013 1st Quarter Highlights Dr. Jose I. Delgado Taino Consultants Inc. www.tainoconsultants.com
  2. 2. Omnibus RuleEffective Date Mar 26, 2013Expands HIPAA Privacy and Security RuleLiability for Covered Entities and Business AssociatesexpandedEnforcement date Sep 23, 2013
  3. 3. Meaningful Use AuditsPre-payment audits started10% of new Covered Entities selectedfor auditAudit Agencies Medicare - Figliozzi and Company Medicaid - States and designated contractorsFailure to produce proof may beprosecuted as fraud
  4. 4. Hospital Owned PracticesLoses of $100k per year per doctorThe longer the hospital owned the higher theprobability of lossesDirect correlation with number of practices ownedand operating losses
  5. 5. Recovery Audit Contractor (RAC) 90% of Hospitals participating experience some RAC activity Medical Records Requests up by 10% Cumulative claim denials reached 1.3 billion for 2012 63% of participating hospitals spent at least $10k per quarter to manage RAC activity Note: Participating refers to participation with the American Hospital’s Association RACTRAC survey
  6. 6. SequestrationSequestration is $1.2 trillion in automatic spendingcuts due to go into effect over the next 10 years, withroughly $85 billion slated for this year.Mar 1st was the first day of sequestrationMar 22, new legislation funded government for 6more months
  7. 7. Accountable Care Organizations Networks of providers that assume risk for the quality and total cost of the care they deliver. Pioneer ACOs threatening to drop out of program More than 400 ACOs up and running ACOs success in question
  8. 8. ConciergeHybrids and graying line betweenconcierge and direct primary caremuddy the waterNearly 10 percent of doctor practiceowners will embrace direct pay or"concierge" practices in the next threeyearsIncreases in health insurancepremiums pushing patients tocatastrophic coverage and pay forservice/hybrid concierge models
  9. 9. Other topics to followHealthcare ReformMedicaid IncentivesICD-10HIPAA Audits

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