The document summarizes key healthcare topics and events from the 1st quarter of 2013. It discusses the expansion of HIPAA rules and enforcement starting in September 2013. It notes that 10% of new covered entities were selected for pre-payment meaningful use audits by Medicare and Medicaid audit agencies. It also discusses losses incurred by hospital-owned physician practices, increased RAC activity resulting in over $1.3 billion in claim denials in 2012, and the impact of sequestration cuts on healthcare spending. Finally, it provides updates on accountable care organizations and the growing trend of direct primary care and concierge medical practices.

1. Healthcare and 2013
1st Quarter Highlights
Dr. Jose I. Delgado
Taino Consultants Inc.
www.tainoconsultants.com

2. Omnibus Rule
Effective Date Mar 26, 2013
Expands HIPAA Privacy and Security Rule
Liability for Covered Entities and Business Associates
expanded
Enforcement date Sep 23, 2013

3. Meaningful Use Audits
Pre-payment audits started
10% of new Covered Entities selected
for audit
Audit Agencies
Medicare - Figliozzi and Company
Medicaid - States and designated
contractors
Failure to produce proof may be
prosecuted as fraud

4. Hospital Owned Practices
Loses of $100k per year per doctor
The longer the hospital owned the higher the
probability of losses
Direct correlation with number of practices owned
and operating losses

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. Sequestration
Sequestration is $1.2 trillion in automatic spending
cuts due to go into effect over the next 10 years, with
roughly $85 billion slated for this year.
Mar 1st was the first day of sequestration
Mar 22, new legislation funded government for 6
more months

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. Concierge
Hybrids and graying line between
concierge and direct primary care
muddy the water
Nearly 10 percent of doctor practice
owners will embrace direct pay or
"concierge" practices in the next three
years
Increases in health insurance
premiums pushing patients to
catastrophic coverage and pay for
service/hybrid concierge models

9. Other topics to follow
Healthcare Reform
Medicaid Incentives
ICD-10
HIPAA Audits