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By James J. Eischen, Jr., Esq.
Whether you consider “Obamacare” a swear word, the arrival of end days, or the beginning of long overdue reform, national health care reform affects private fee physicians. As the scope of Medicare coverage expands to include more preventative care (including more frequent or more extensive physical exams), how can private fee physicians be certain that when they privately charge patients covered by Medicare, they are compliant with federal laws requiring Medicare fee schedule compliance?
The easy (really, the uneasy) answer is that they cannot necessarily know with absolute certainty that their private charges to Medicare-covered patients for preventive care or physical examinations are absolutely neither charging for services covered by Medicare nor charging for services that may be considered “bundled” with covered services. Of course, there is little anyone knows with absolute certainty (death and taxes come to mind), but how can private fee physicians most effectively address this risk?
- Ensure that your physician-patient private fee contract confirms your intent not to charge privately for what a Medicare-covered patient is entitled to receive under the Medicare covered services fee schedules. Your contract should reflect your intent not to violate Medicare billing laws.
- When creating or evaluating your physician-patient contract private fee schedule, or your allocation of medical services to an annual (or quarterly or monthly) “retainer” or fee that you may charge for superior access, evaluate whether you are allocating any medical services potentially covered by Medicare to a private fee or retainer. By attempting to carve out medical services currently or potentially covered by Medicare from your private fee schedule or retainer services menu, you better protect yourself from a possible claim that your private fee or retainer improperly exceeds the Medicare fee schedules. This is not as simple as it sounds (it certainly is not simple), but it is a worthwhile exercise.
- Ponder whether your private fees or retainers should be allocated to services or benefits that are unlikely to represent Medicare covered medical benefits. For example, if your private fee medical practice offers telecommunications/electronic records access or other unique administrative benefits that are not truly a “medical” service, consider whether you can or should allocate certain fees or your retainers toward non-medical services benefits.
- Traditional concierge medical practices often allocate annual retainers to a superior and in-depth annual physical coupled with other preventive care benefits. With Medicare evolving toward more preventive care and more frequent physicals, reconsider if the annual physical is truly what your patient pays for with their retainer payments.
Determining how best to structure a private fee physician-patient contract is by no means a cookie-cutter project. Private fee physicians are implementing diverse and creative methods of creating superior patient experiences in exchange for private fee payments. Some private fee medical practices focus on house calls and personal face-to-face interaction and access. Other private fee medical practices emphasize immediate technological communications access with health records platform access/interactions. Private fee physician practices have access to a growing array of EMR and communications platform, and cutting-edge diagnostic tools. So there is no one method of allocating private fees or retainers to medical or non-medical services. Review what your private fee medical practice offers, and question why you would allocate any medical services potentially covered by Medicare to private fees or retainer payments. Your practice may offer benefits unlikely to deemed covered by Medicare.
Medicare is evolving, and necessarily so. Private fee physicians should consider reforming their fee/retainer schedules. “Obamacare” represents an opportunity for private fee physicians to evolve, and to consider reframing what they sell to patients to better ensure ongoing Medicare compliance. And one more recommendation: while it might go against your grain, consult an attorney to enhance your Medicare compliance and your peace of mind.
James J. Eischen, Jr. is an attorney with over 23 years experience handling a wide range of business matters, including medical business planning. His practice, Eischen Law Group, APLC, is located in Cardiff By The Sea, California. His email address is jim@eischenlaw.com, and his office telephone number is 760-943-7997. Mr. Eischen has lectured for AAPP conferences regarding medical billing issues, and currently represents concierge physicians and private medicine vendors regarding billing compliance issues.
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 By Tom BlueWith so many of our members and their patients now carrying iPhones, it seems only appropriate that we begin to highlight the Apps that you are using to enhance your practice, productivity, and/or patient communications.
Many of our AAPP iPhone users are in love with the new FaceTime video calling capability but wish it could be done on the 3GS and without WIFI. Well now it can (with only slight limitations).
Knocking Live Video enables an iPhone user to broadcast live video to another iPhone user over the 3G network. The service is one-way (only one party is broadcasting video during a call). But the app is cheap, and it works. Tell us about your favorite apps for private physicians. With 250,000 apps in the App Store, we need to work together to find the best of the best for private medicine. _____________________
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| | You may have noticed our recent promotion of the 
Bale/Doneen Method
of heart attack and stroke prevention. We view this method as an incredible, life-saving approach to preventing cardiovascular events and also a powerful engine or practice growth for private physicians.
A number of AAPP members have been certified in the Method, and we encourage everyone to give it serious consideration. AAPP Members receive a $500 discount. Learn more at AAPP.org or by contacting us directly.
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AAPP PARTNERS WITH NEXT HEALTHCARE TO BRING MEMBERS AN EXCLUSIVE OPPORTUNITY TO OFFER REGENERATIVE MEDICINE
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A significant new era of medicine is emerging as the fields of cell therapy, regenerative medicine and tissue engineering converge. The days of treating diseases and injuries with drugs and devices will slowly make way for approaches using a patient’s own cells. What was once thought of as science fiction is becoming reality. Our bodies have the ability to self-renew and repair, but now technologies are maturing whereby these processes can be controlled and applied when needed using cells from the body, with stem cells having the most promise.
The AAPP is partnering with a pioneering company in regenerative medicine, Next Healthcare, Inc. The company was founded around the promise of induced pluripotent stem cell technology (iPS) that is a method of converting ordinary adult skin cells into stem cells. iPSC’scan be differentiated into liver cells, heart cells, or many of the cell types in the body.
Next Healthcare provides a personal biobanking service for skin and blood cells. Through their proprietary process, these cells become the ideal biological starting material for cell and tissue therapy and genetic testing.
AAPP members will have an exclusive opportunity to present this service to their patients. Next Healthcare will enroll an initial group of 50 AAPP members to be the first in the country to offer this service on preferred terms. Please contact us if you would like more information on how you could incorporate this service into your patient offering. ____________________
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The AAPP co-hosted an extremely successful event at the Cleveland Clinic in partnership with the Cleveland Heart Lab in August. More than 100 physicians attended this event and walked away with a wealth of knowledge on building and implementing a state-of-the-art heart attack and stroke prevention program.
The central theme of the meeting derived from the Bale/Doneen Method that the AAPP has been highlighting in recent months. As this method gains a growing following among private physicians, we are encouraging all of our members to become acquainted with powerful approach to cardiovascular disease prevention.
In addition to co-hosting this meeting again in September 2011, the AAPP will be co-hosting four Bale/Doneen preceptorship programs in 2011. Watch for details at AAPP.org.
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AAPP HOSTS THE FINAL SUMMIT OF 2010 IN CONCIERGE MEDICINE IN AUSTIN, TX ON NOVEMBER 6
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2010 has brought a record number of incredibly successful regional meetings on private medicine. On November 6 in Austin, TX, we will host our grand finale for the year. We hope you will be in attendance. We expect this to be our best meeting of the year, and when you see the agenda, we think you will agree.
Among a cast of outstanding speakers, the Austin Summit will feature:
• Holly Buchanan, renown marketing guru and Author of The Soccer Mom Myth speaking on how to market private medicine to women
• e-Patient Dave deBronkart, speaking on orienting your service to appeal to the patient of the future.
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AAPP FORGES RELATIONSHIP WITH CASTLIGHT HEALTH TO FEATURE PRIVATE PHYSICIANS IN NATIONAL PROVIDER DIRECTORY
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Pricing transparency in health care has been a recurring topic of discussion among our members. With more than $80 million in investor financing, a company called Castlight Health is leading the field in creating the most comprehensive database of medical service pricing in the country. Initially the users of this pricing directory are the employees of large, self-insured companies. Their first client is Safeway (200,000 employees), and they are quickly growing.
Until now, there has been no opportunity for private physicians to feature their unique services and transparent prices in this directory. AAPP has reached an agreement with Castlight Health that if a sufficiently significant number of private physicians would be willing to complete a practice/pricing survey to enable them to create a private physician category in their system, they will implement the necessary programming to present our private physicians to their employer subscribers.
In addition to being a novel new way to attract patients, this is an opportunity to participate in an important movement toward pricing transparency in health care.
If you would like to be featured in the Castlight system, please contact Shelly Banyay at the AAPP within the next two weeks.____________________
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