Mike Bittman, co-chair of Broad and Cassel’s Healthcare Practice Group, weighs in on the Amazon, JPMorgan, Berkshire healthcare partnership for Becker’s Hospital Review

The following article, written by Laura Dyrda, was published by Becker’s Hospital CFO Report.

When Amazon, JPMorgan Chase & Co. and Berkshire Hathaway launched their partnership in the healthcare space, they left more questions than answers about their new venture. The announcement shared few details on how the companies would partner, but ultimately shared the goal of providing high-quality, lower-cost healthcare to employees and their families.

All three companies are disruptors in their industries, but have little experience in healthcare. Here, 35 executives from across the healthcare industry share their reaction to the announcement and predictions for the future.

Note: Responses have been edited for length and clarity.

Question: What does this partnership mean for the healthcare industry?

Chuck Stokes. President and CEO of Memorial Hermann (Houston): “Today’s announcement is precisely why health systems across the country, including Memorial Hermann, have been innovating from within. Our industry has a lot to learn from these three powerhouse institutions that have transformed their consumer experiences. Through their expertise, I firmly believe that our industry will accelerate the journey to become more affordable and convenient for everyone. Here in Houston, we understand the healthcare needs of our community better than anyone else and have launched several groundbreaking solutions to make healthcare more affordable and accessible to our neighbors.”

Damian Becker. Manager of Public Relations at South Nassau Communities Hospital (Oceanside, N.Y.): “Their venture into the healthcare industry means one thing to me: disruption, with a singular focus on growth from the get-go. Accounting for the core strengths, roster of services and market share dominance of each organization and how they will innovate collaboratively, it is imperative as a healthcare organization to conceptualize and anticipate what they will bring to market as not just a national entity, but also a global entity that will either compete directly with or complement the services that your organization provides and/or specializes in. For example, health and medical care services delivered to the patients/customers wherever they are and whenever they need it, whether at the home or on the road or at work, through digital, delivery, informational and direct care services, at a lower cost and simplified payment model.”

John Driscoll. CEO of CareCentrix (Hartford, Conn.): “Anyone with a high-cost, high-margin healthcare business should be scared. But healthcare is complicated, and I believe the most effective path for this dream team of disruptors is to share their goal — to provide better care at a lower cost to patients — with industry incumbents. Bending the cost curve and improving outcomes is going to require a team effort.”

Michael Bittman. Partner at Broad and Cassel (Orlando, Fla.): “All industries are being disrupted to some extent by the new digital economy. It appears as if this will be one of the best-funded efforts to disrupt the traditional employer-sponsored health plan model. That said, it’s important to remember you can’t deliver healthcare without hospitals and physicians. The new model may involve groups of employers contracting directly with healthcare providers to decrease cost and enhance quality.

“What Amazon, JPMorgan and Berkshire Hathaway have presented could be a new national model. With their combined resources, technology and foresight, they could reduce reliance on insurers and avoid some of the related costs. It could show a new way for employers to provide good, affordable coverage, and increase wages with the savings.”

Please click here to continue reading “What the Amazon, JPMorgan, Berkshire partnership means for healthcare: 35 executives respond” from Becker’s Hospital CFO Report.

Posted in Mike Bittman

Florida Federal Judge Vacates $347 million False Claims Act Judgment against Nursing Home Operator

By: Timothy S. Wombles

On January 11, 2018, a federal judge in Tampa, Florida vacated a $347 million False Claims Act judgment against a skilled nursing facility operator and its related entities.

In United States ex. rel. Ruckh v. CMC II LLC et al., relator Angela Ruckh convinced a jury that CMC II LLC and its affiliated entities (collectively, the “Defendants”) committed certain paperwork violations, such as the failure to maintain comprehensive care plans, amounting to a material and knowing misrepresentation in the claims submitted to the government. After the jury found the Defendants liable for approximately $115 million in false claims, U.S. District Judge Steven D. Merryday trebled the damages to $347,864,285 pursuant to the False Claims Act. The Defendants moved to stay execution on the judgment, requested a new trial, and requested the court vacate the verdict.

Just under a year later, on January 11, 2018, Judge Merryday, relying on the U.S. Supreme Court’s decision in Universal Health Services v. Escobar, granted the Defendants’ renewed motion for judgment as a matter of law and conditionally granted their motion for a new trial, vacating the $347,864,285 judgment against the Defendants.

Judge Merryday recognized that “the False Claims Act requires the relator to prove both that the non-compliance was material to the government’s payment decision and that the defendant [knew] at the moment the defendant sought payment that the non-compliance was material to the government’s payment decision.” Further, Judge Merryday stated that “[a]t an irreducible and necessary minimum, the ‘essentially punitive’ False Claims Act requires proof that a vendor committed some non-compliance that resulted in a material deviation in the value received and requires proof that the deviation would materially and adversely affect the buyer’s willingness to pay.”

Judge Merryday acknowledged that Ms. Ruckh’s burden was to show that the government did not know about the recordkeeping violations and would have refused to pay the defendants’ claims if it was aware of the violations. Judge Merryday found that the government continued to pay the Defendants’ claims, despite its knowledge of their recordkeeping deficiencies. Judge Merryday relied on Escobar for the proposition that a government’s reimbursement of a facility’s claims after fraud allegations emerge is “very strong evidence” that the allegations were not material to the government. Since the record failed to include evidence that the recordkeeping deficiencies were material to the government, Judge Merryday found that the judgment could not stand and vacated the judgment.

Posted in Timothy Wombles, Uncategorized | Tagged , , ,

Do Not Forget to Review These Items in the New Year

By: Stephen H. Siegel

With the holidays behind us, the world should become a more orderly place. In fact, that frequently is not the case. In addition to remembering to use 2018 as the correct year for checks, etc., every new year seems to be the point in time to start new diets, new exercise plans, and other well-intentioned resolutions. The start of the year is also an excellent time for medical practices and other healthcare businesses to either review or make plans to review a number of important matters. Here are a few of the issues that merit review, either early in the year or at a later pre-determined time.

Licensure and Certification
Even if the time for renewing professional or business licenses, permits, or certifications is not early in the year, now is the time to add these items to your calendar to be done at a later date. DO NOT rely on receiving and timely acting once the notice for renewal is received from the Board of Medicine, Secretary of State, or another licensing or accrediting organization, like the Medicare program. If those licenses and permits are not timely renewed, the business will be harmed with little opportunity or relief, especially inexpensive relief.

Business Organization
Typically, a healthcare business is organized as a professional corporation, limited liability company, or partnership in order to take advantage of certain federal tax benefits available to these entities. In any case, it is prudent to review the businesses’ articles of incorporation/organization, operating agreement/bylaws, etc., at least annually in order to ensure that they accurately reflect both what the owners want and what the business is doing.

Please visit South Florida Hospital News and Healthcare Report to continue reading. 

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Former Federal Prosecutor Benton Curtis Named Partner at Broad and Cassel

MIAMI (Jan. 2, 2018) — Statewide law firm Broad and Cassel LLP today announced Benton Curtis has been named a partner in the firm’s Miami office, effective Jan. 1.

A former federal prosecutor for 10 years, Curtis focuses his practice on white collar criminal and civil matters and complex civil litigation, government investigations and compliance counseling, with an emphasis in the health care industry. He is a member of the firm’s Health Law and White Collar Defense and Compliance practice groups.

“Since joining the firm just over two years ago, Ben has proven himself as a rising star in the profession and firm,” said Gabriel Imperato, a managing partner and co-chair of the firm’s White Collar Defense and Compliance department. “He has become an integral part of the firm’s white collar practice, and we look forward to his continued success in this new role.”

To continue reading, please click here.


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December 2017 NLRB Changes Direction

Please click here to learn more about the December 2017 NLRB Memorandum and recent changes.

Posted in Regulatory | Tagged , , ,

Uncertainty is Creating Fear, and Private Equity Claims to be the Savior

The following article, written by Heather S. Miller, was published by the Palm Beach County Medical Society.

The Affordable Care Act (ACA) and passage of the Medicare Access and CHIP Reauthorization Act (MACRA) and its primary vehicle, the Merit-Based Incentive System (MIPS), have been transformative influences in the health care sector. Despite attempts to repeal and replace the ACA, the sentiment underlying MACRA – the transition from volume to value-based payments – is here to stay. Many small practices seem reluctant to take MACRA seriously, despite the fact that it puts yet another significant percentage of a provider’s Medicare reimbursements at risk. Large practices, understanding the uncertainties of complex payment reforms requiring advanced technology and business savviness to remain competitive, are responding by merging with other groups, joining hospital systems, or selling their practices to private equity investors. This niche is well-suited for private equity firms, as they feed on uncertainty.

Please click here to continue reading on Page 20 of the Palm Beach County Medical Society’s “On Call” Newsletter.

Posted in Heather Miller | Tagged , , , , ,

Taking Florida into the Future with Telemedicine

The following article, written by Kristina G. Maranges, was published by the Florida Bar Health Law Section Winter 2017 Newsletter.

On October 31, 2017, the Telehealth Advisory Council issued its recommendations to Florida Governor, Rick Scott, and the Florida Legislature on how to increase the use and accessibility of services provided via telehealth. The report comes on the heels of a state and national shortage of healthcare practitioners to serve our country’s growing and aging population. Echoing HHS’s designation of telehealth as a means or method  of delivering healthcare, not a type of healthcare service, and noting Florida regulations include multiple definitions of “telemedicine” but no definition of “telehealth” and these terms are commonly used interchangeably, the Council recommended a definition of “telehealth” to replace all existing definitions. “Telehealth is defined as the mode of providing health care and public health services through synchronous and asynchronous information and communication technology by a Florida licensed health care practitioner, within the scope of his or her practice, who is located at a site other than the site where a recipient (patient or licensed health care practitioner) is located.”

Recognizing the lack of adequate insurance coverage and reimbursement for healthcare services as barriers to the delivery and growth of telehealth services, the Council next recommended the Florida legislature require both coverage and reimbursement parity, excluding Medicare plans. Specifically, insurance policies must provide coverage for health care services delivered via telehealth if coverage is available for the same service provided in-person without the imposition of any additional conditions for coverage of services by the insurer,, and payment rates must be the equivalent to rates for comparable in-person services. Regarding Medicaid, the Council recommended the Agency (1) modify its telehealth fee-for-service rule to include coverage of store-and-forward (transmission of recorded health history like X-rays and photos through a secure electronic communications system to a practitioner who uses the information to evaluate the case or render a service outside of a real-time or live interaction) and remote patient monitoring (personal health and medical data collection from an individual in one location via electronic communications technologies, which is transmitted to a provider in a different location for use in care and related support) modalities; and (2) develop a model that would allow Medicaid Managed Care plans to utilize telehealth in order to meet network adequacy.

Posted in Kristina Maranges, Technology | Tagged , , , , ,

Have you seen CMS’ 32 measures under consideration for value based programs in 2018?

Visit this link for information directly from the Centers for Medicare & Medicaid Services.

Posted in Regulatory | Tagged , , , , ,

Firm Client Tops Nation in Medicare Savings

Broad and Cassel client, Palm Beach Accountable Care Organization, tops the nation in Medicare savings, as detailed in the article below from the Palm Beach Post: 

A doctor group based in Palm Beach County leads the country in saving taxpayers money while meeting goals for keeping Medicare patients happy and healthy.

Palm Beach Accountable Care Organization based in Palm Springs saved taxpayers $62 million and was allowed to keep $30 million of that for 2016 because it earned high scores for patient health and satisfaction, according to federal officials. The group ranked No. 2 nationally in shared savings a year ago.

“We’re keeping our patients healthier and out of the hospital,” said board chairman Richard Weisberg. “The savings are good and we’re proud of those. Keeping patients healthy is most important.”

The group of 275 primary-care doctors and 175 specialists serves 69,000 Medicare patients from St. Lucie County to Miami-Dade County.

Please visit this page to continue reading. 


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Predictive Analytics: New Frontiers in Hospital Pharmaceutical Inventory Management

The following article, written by Paul R. DeMuro, Ph.D. and Richard M. Klass, was published by South Florida Hospital News and Healthcare Report.

It’s 3:00 a.m. The administrator on duty gets a frantic call from the pharmacy. “We ran out of cytarabine! This means no treatment for our existing leukemia patients and turning away ten newly diagnosed with appointments tomorrow! My doctors are screaming at me!

Panic sets in. The administrator thinks: “What if we can’t get other hospitals to lend us a supply? Do I dare access the ‘gray market’? Can we compound the drug ourselves?”

A good inventory control model can reduce such frenzied situations and:

• Minimize total inventory costs, including holding (interest rate) and order placement expenses.
• Support just in time inventory levels – having supplies when you need them and stocking nothing else saves cash outlays, and optimizes storage space. Remember, over-stocking is just as bad as under-stocking.
• Ameliorate out-of-stock situations of the most critical drugs, particularly those with no substitute alternative.
• Minimize expired pharmaceutical waste. “U.S. hospitals and long-term care facilities annually flush approximately 250 million pounds of unused pharmaceuticals down the drain.” Mismanaged expiration dates is a big cost driver.

To continue reading, please click here.

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