medical group

CMS says doctors earned $16.7M on P4P demo

Anne Zieger — Fri, 15 Aug 2008 10:43:11 -0400

You've gotta love it when CMS gives out money above and beyond the usual reimbursement rates--and it's even better when the bonuses involved work out for pretty much everyone involved. That's the cheery outcome for the second year of CMS's pay-for-performance demonstration project, under which 10 physician groups earned a total of $16.7 million in incentive payments. Under the terms of the demonstration project, which addresses the quality of care for heart patients and diabetics, physician groups were asked not only to improve outcomes for Medicare patients, but also to coordinate their care.

The groups involved were strikingly successful at meeting CMS's goals. All of the groups involved in the Physician Group Practice Demonstration met performance goals on at least 25 of 27 quality markers for patients with diabetes, coronary artery disease and congestive heart failure. Five of the groups, including Forsyth Medical Group, Geisinger Clinic, Marshfield Clinic, St. John's Health System and the University of Michigan Faculty Group Practice--achieved all 27 performance goals.

To learn more about the P4P payouts:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
CMS awards $7M to top performers in P4P program
CMS extends pay-for-performance program
Medicare plans home health P4P program
CMS P4P program shows improvements

GA doctors sue state for access to contract terms

Anne Zieger — Tue, 05 Aug 2008 12:29:02 -0400

For the last few years, a group of physicians has been working to force the health insurer administering Georgia's state employee health benefits plan to disclose what it pays physicians around the state, as well as language found in its physician and hospital contacts. While the doctors assert that such details should be public--given state open records laws--United continues to insist that such details are proprietary. Now, it appears that the state Supreme Court will get to decide whether the group will get its wish.

In 2005, United Healthcare got a five-year, $55 million contract to service the state's self-funded plan. The medical group, the South Georgia Physicians Assn. LLC, later became aware that United Healthcare was paying different fee schedules to physicians in different parts of the state. South Georgia Physicians, an IPA, has about 280 physician members that practice in about 30 counties that are largely rural.

Southern Georgia Physicians, in cooperation with the Medical Association of Georgia, filed an open records request in early 2006 asking for documents related to the state contract in an effort to see whether it was being paid fairly. The request relied on state law requiring that private entities working on a government agency's behalf be subject to public disclosure. However, United contended that the contracts and schedules South Georgia wanted were trade secrets.

The two battled back and forth until they reached the Georgia Court of Appeals, which said that doctors should get at least the records United had already turned over to the state. Now, both have filed an appeal with the state Supreme Court.

To learn more about the case:
- read this AMNews article

Related Articles:
Health plans drop out of CT Medicaid over disclosure rules
CT court makes Medicaid plans disclose MD pay
CT panel rules HMOs must disclose rates

CoxHealth to pay $60M to settle with feds

Anne Zieger — Tue, 22 Jul 2008 23:23:27 -0400

Springfield, MO-based health system CoxHealth has agreed to pay $60 million to resolve a myriad of charges related to its financial relationships with referring physicians and its Medicare billing practices. According to an announcement by the U.S. Department of Justice, which conducted an investigation, CoxHealth violated the False Claims Act, anti-kickback statute and Stark rules on self-referral between 1996 and 2005.

CoxHealth executives, who do not admit to wrongdoing, have attributed the DoJ's allegations to a disagreement over how to interpret federal regulations regarding billing and medical-director agreements for its Ozarks Dialysis Services. It also concedes that the DoJ didn't like the revenue source used to compensate the medical group staffing its Ferrell-Duncan Clinic. The issues were all identified initially by Cox itself and reported to the government, according to CEO Robert Bezanson.

Under the terms of the settlement, Cox will pay $35 million initially, then make five payments of $5 million per year. It will also enter into a five-year corporate integrity agreement with the HHS Office of the Inspector General.

To learn more about the settlement:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
Federal False Claims act uses narrowed, but legislators still want expansion
NJ hospitals face false-claims charges
St. Barnabas to pay $265 million for Medicare fraud
GA health system settles false claims suit for $5.1M

Case study: Kaiser physicians go on sales calls

Fri, 09 May 2008 06:59:55 -0400

It's not often that prospective health plan members get pitched directly by a physician. But at Kaiser Permanente Colorado, that's exactly what's happening. The HMO has launched a program under which doctors are going out into the field with sales personnel and meeting with both prospective and existing members. Not only does the program put a face on the plan's medical practice, it also allows patients to ask medical questions they might have otherwise postponed. The program had its origins in late 2006, when Dr. Jandel Allen-Davis, associate medical director for the plan's Colorado medical group, decided to accompany the sales team on calls during open-enrollment season. Since that time, Kaiser has recruited 23 doctors for its "sales ambassador team."

To learn more about the program:
- read this Denver Business Journal item

ALSO NOTED: Tool calculates ROI on quality programs; Doctors resist e-mailing patients; and much more...

Thu, 01 May 2008 06:59:50 -0400

> A new tool could help health plans and providers demonstrate the return on investment from quality improvement. FierceHealthFinance

> While many patients like the idea of corresponding with their doctors via email, few physicians have gotten on the email bandwagon. FierceHealthIT

> San Diego, CA-based Scripps Health has acquired Sharp Mission Park Medical Group. The deal gives Scripps access to 35 family and internal medicine and pediatric physicians. Article

> Another health plan gets on the retail clinic train. Blue Cross of Tennessee has struck a deal with Walgreens' Take Care clinics. Article

And Finally... It seems the governor of this Chilean suburb wants to make sure its seniors get their jollies. Article

Trend: Medical prices set to jump again

Tue, 22 Apr 2008 06:59:57 -0400

While medical prices fell for the fourth consecutive year in 2007, observers say that health costs likely will shoot up again, soon. According to an article in the journal Health Affairs by author Paul Ginsburg of the Center for Studying Health System Change, there are several factors contributing to the coming jump in prices, including a hospital's need to cover the cost of their tremendous recent investments in new buildings; the growth in physician ownership of ambulatory surgery centers and specialty clinics, which Ginsburg says has historically driven up prices; and a shift in the overall U.S. economic cycle. Such price increases could drastically hike health insurance premiums. Even with health cost increases having been moderate over the last few years, health insurance premiums still have risen 78 percent since 2001.

To learn more about this trend:
- read this article from The Oregonian

Related Articles:
Critics doubt benefit of posting hospital prices online
Transparency goes mainstream
California medical group among first to offer price list

Cigna pays for more retail clinic services

Thu, 13 Mar 2008 07:59:56 -0400

Cigna has expanded the number of retail clinics for which it will reimburse services, making it more likely that its peers will add such clinics to their provider list. The health plan already covers care for MinuteClinic, RediClinic, Take Care Health Systems, Little Clinic and Cigna Medical Group's CMG CareToday clinics. It's now going to cover care delivered at MedBasics Family Health Centers, which are based at Carnival Supermarkets in Dallas-Fort Worth, and USA Drug Stores in Little Rock. Cigna pays retail clinic claims at the same benefit level as a primary care office visit, and it asks that the member pay 20 percent of the cost.

To learn more about the deal:
- read this Healthcare Finance News piece

Related Articles:
IL bill could choke retail clinic growth. Report
Start-up closes 23 Wal-Mart retail clinics. Report
Resource Center: Retail Clinics
Retail clinics go from concept to reality. Report
AMA demands retail clinic regs, backs off ban. Report
MA doctors protest CVS retail clinic expansion. Report
Doctors push law regulating retail clinics. Report
Retail clinics: thousands on the way? Analysis

MD groups struggle with Medicare incentive goals

Tue, 19 Feb 2008 06:59:58 -0500

It looks like the initial stages of a new CMS demonstration project have turned out to be something of a disappointment. In April 2005, CMS began offering annual bonuses to 10 physician groups if they met cost savings and quality targets. While all 10 implemented care-coordination programs during the first performance year, only two of the groups met CMS bonus criteria, according to a new report from the Government Accountability Office. However, that's not solely the groups' fault. The GAO report said that part of the reason physician groups had trouble meeting the goals was the design of the demonstration project, including the fact that CMS gave no feedback to the groups until after the third year had begun. Along the way, the GAO report suggested that it might be difficult to broaden enrollment in the demonstration project--even without design challenges--given that all of this round's participants were larger than the average medical group size for the United States.

To learn more about the demonstration project:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
Primary care MDs should manage chronic diseases. Report
CA case management program cuts ED visits 30 percent. Report
Questions arise over "medical home" payments. Report
Health plans, MD groups plan 'medical home' project. Report
Policy experts propose new payment schemes (including payments encouraging development of medical homes). Report

Case study:Hospital creates patient-sharing network

Thu, 24 Jan 2008 06:59:55 -0500

If you're a provider in the Boston suburbs, you stand a chance of losing your patients to the high-prestige hospitals and specialists found in the city--which houses, among other institutions, Harvard-affiliated Brigham & Women's Hospital. To fight back against such competition, one Brockton, Mass.-based hospital has created a community-based network of doctors who share patient network of doctors who share patient medical records and databases. The idea is that the new network, Signature Healthcare, will offer patients everything they need, from primary care to alternative health, and allow doctors to refer within the system.

Signature Health will include not only the hospital's existing medical group affiliates, including a women's health practice, a primary care group, a specialist practice and a school of nursing, but also Bridgewater Goddard Park Medical Associates, the largest multi-site, multi-specialty group in the area, which it just acquired. All told, Signature will now have more than 550 affiliated providers around Brockton.

Signature plans to build efficiencies into the system, as well. The groups will work from a shared standard of care, and the same prescription drug formulary. Also, the different groups will merge their separate labs into one, saving an immediate $1 million. On top of that, the groups will share all patient information through an electronic medical record system.

To learn more about Signature:
- read this article from The Boston Globe

Study: CMO compensation up in 2006

Tue, 22 Jan 2008 06:59:57 -0500

Total pay for chief medical officers was up across the board in 2006, though modestly within medical groups, hospitals and integrated health systems, according to a new study. CMOs with managed care organizations did particularly well, with total compensation climbing 17 percent, to $325,355 in 2006, according to the Physician Executive Management Center. That included a 26 percent average bonus/incentive payment. However, CMOs within other organizations saw smaller raises. Medical group CMO pay climbed 7 percent, to $293,027, including a 33 percent average incentive payment, hospital CMO average total compensation rose 3 percent, to $280,851, including a 16 percent average incentive payment. Pay for CMOs within integrated health system stayed about the same, at $357,137, including 17 percent in bonuses.

To get more data from the study:
- read this Modern Physician piece (req. req.)

Related Articles:
Study: Pay jumps for key specialists. Report
Report: Primary care MD pay rose 3.9 percent in 2005. Report
Maryland studies physician pay rates. Report
Challenges in recruiting a CMO. Editorial