Manage My Practice

The Group Practice Definition (courtesy of HealthNoob.com)

Under Stark, a group practice is a physician practice that meets the following conditions:

Single Legal Entity.

The group practice must consist of a single legal entity operating primarily for the purpose of being a physician group practice in any organizational form recognized by the State in which the group practice achieves its legal status.

Physicians.

The group practice must have at least two physicians who are members of the group (whether employees, or direct or indirect owners). Stark defines a member of the group as a direct or indirect owner of a group practice (including a physician whose interest is held by his or her individual professional corporation or by another entity), a physician employee of the group practice, a locum tenens physician, or an on-call physician while the physician is providing on call services for members of the practice. An independent contractor is not a member of the group.

Range of Care.

Each physician who is a member of the group, must furnish substantially the full range of patient care services that the physician routinely furnishes, including medical care, consultation, diagnosis, and treatment, through the joint use of shared office space, facilities, equipment, and personnel.

Services Furnished by Group Practice Members.

Substantially all of the patient care services of the physicians who are members of the group (that is, at least 75% of the total patient care services of the group practice members) must be furnished through the group and billed under a billing number assigned to the group, and the amounts received must be treated as receipts of the group. Patient care services must be measured by one of the following:

• The total time each member spends on patient care services documented by any reasonable means (for example, time cards and appointment schedules.)
• Any alternative measure that is reasonable, fixed in advance of the performance of the services being measured, uniformly applied over time, verifiable, and documented.

Distribution of Expenses and Income.

The overhead expenses of, and income from, the practice must be distributed according to methods that are determined before the receipt of payment for the services giving rise to the overhead expense or producing the income.

Unified Business.

The group practice must be a unified business having at least the following features:

Centralized decision making by a body representative of the group practice that maintains effective control over the groups assets and liabilities; and

Consolidated billing, accounting, and financial reporting.

Volume or Value of Referrals.

No physician who is member of the group practice directly or indirectly receives compensation based on the volume or value of referrals except as provided under the specialty rules for productivity and profit shares.

Physician-Patient Encounters.

Members of the group must personally conduct no less than 75 percent of the physician-patient encounters of the group practice.

Special Rules for Productivity Bonuses and Profit Shares

The special rules for productivity bonuses and profit shares allow a physician who is in the group practice to be paid a share of overall profits of the group or a productivity bonus based on services that he/she has personally performed (including services incident to those personally performed services), provided that the share or bonus is not determined in any manner that is directly related to the volume or value of referrals of DHS by the physician. CMS now takes the position that diagnostic-testing services cannot be billed as incident to but practices that provide physical therapy can, however, bill physical therapy services as incident to services (provided that all of the incident to requirements are met).

The Stark regulations specifically set forth examples of formulas that will be deemed not to relate directly to the volume or value of referrals. For example, a groups profits will be deemed not to relate directly to the volume or value of referrals if revenues derived from DHS are distributed based on the distribution of the group practices revenue attributed to services that are not DHS payable by any Federal health care program or private payer.

Second Life is a virtual world accessible via the Internet. A free program called the Second Life Viewer enables its users called Residents, to interact with each other through avatars (two-dimensional representations of people.) Residents can explore, meet other residents, socialize, participate in individual and group activities, and create and trade virtual property and services with one another, or travel throughout the world, which residents refer to as the grid. Second Life is for people aged 18 and over, while Teen Second Life is for people aged 13 to 17. (definition adapted from Wikipedia)

Among many other applications, SL is used to simulate situations in healthcare and teach clinical students in an almost real-world setting. In 2009, Medical Group Management Association (MGMA) used Second Life as part of its virtual conference.

Electronic faxing (also called efaxing, online faxing or internet faxing) is the process of sending a document between two people/accounts via the Internet, much in the way email sends messages over the Internet between two people. eFaxing is a preferred method of sending information as opposed to traditional faxing as it is more compliant with HIPAA security regulations as it can be encrypted and password protected.

eFaxing is also preferable because:

1. No dedicated telephone line is required for the efax
2. No fax machines are needed (purchase, maintenance, toner)
3. No paper is used – it’s green!
4. Multiple faxes can be sent and received simultaneously
5. Long-distance and monthly phone costs are eliminated
6. Any location that has Internet access can send or receive faxes

I would also add that efaxing can also automatically index a document to a repository or to an electronic medical record.

Medicaid is a medical assistance program that pays medical bills for people who meet certain eligibility requirements (such as income, age, or disability) which are based on Federal regulations and State law.Medical benefitsmay beauthorized for services such as hospitalizations, physician services, medications and different levels of care in nursing and residential facilities.

Medicaid may help pay for certain medical expenses such as:

• Doctor Bills
• Hospital Bills
• Prescriptions (Excluding prescriptions for Medicare beneficiaries)
• Vision Care
• Dental Care
• Medicare Premiums
• Nursing Home Care
• Personal Care Services (PCS), Medical Equipment, and Other Home Health Services
• In-home care under the Community Alternatives Program (CAP)
• Mental Health Care
• Most medically necessary services for children under age 21

Interventional cardiologists – do stents and PTCAs

Non-interventional Cardiologists – do caths, but no stents or PTCAs

Invasive Cardiologists - do caths, and may do stents or PTCAs

Non-invasive Cardiologists – does not do caths, stents or PTCAs

PCTA – Percutanueous transluminal coronary angioplasty is one of the most common procedures for opening damaged or obstructed coronary arteries (sometime referred to as the “balloon” procedure.)

A stent isa wire metal mesh tube usedto prop open an artery during angioplasty. The stent is collapsed to a small diameter and put over a balloon catheter. It’s then moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a scaffold. This holds the artery open. The stent stays in the artery permanently, holds it open, improves blood flow to the heart muscle and relieves symptoms (usually chest pain).

Cardiac catheterization (cath) is a medical procedure used to diagnose and treat certain heart conditions. A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. Through the catheter, doctors can do diagnostic tests and treatments on your heart. Blockages in the coronary arteries also can be seen using ultrasound during cardiac catheterization. Ultrasound uses sound waves to create detailed pictures of the heart’s blood vessels.

A Do Not Resuscitate order ia a kind of Advance Directive. A DNR is a request not to have cardiopulminary resuscitation (CPR) if your heart stops or if you stop breathing. You can use an Advance Directive to tell your doctor that you do not want to be resuscitated.

A Durable Power of Attorney for healthcare is a kind of Advance Directive. A DPA states whom you have chosen to make health care decisions for you. It becomes active any time you are unconcious or unable to make medical decisions for yourself. A DPA is generally more useful than a Living Will, but only if you have another person who you trust to make medical decisions for you.

A Living Will is a type of Advance Directive which comes into play when you are terminally ill (expected to live less than 6 months.) A living will allows you to describe the kind of care you want based on certain life-states.

An advance directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions for yourself. Your requests may come into play if your illness is one you won’t recover from or if you are premanently unconcious.