To show opposition to the move of South Bay Hospital, the community association for Sun City Center, FL, have kicked off a letter-writing campaign to send opinions to state officials, representatives and senators. South Bay is trying to move its hospital to Riverview and leave behind an emergency room and diagnostic services. In late 2007, the Agency for Health Care Administration approved South Bay's plans despite opposition voiced during a community meeting that drew more than 1,000 residents.
The debut of Los Angeles County-USC Medical Center is coming soon, but doctors and politicians are still sparring over scarce bed space, workers are trying to fix last-minute glitches, and contractors are struggling to incorporate new technologies. The most pressing dispute surrounds bed space. When doctors and patients move to the new campus, the number of budgeted beds will drop from 671 to 600 and it is unclear how many will be dedicated exclusively to children. Twenty-five beds are certain, but some people want a total of 44. Without the additional beds, they say, the USC pediatric residency program would be at risk of shutting down.
Japan has begun recruiting hundreds of nurses and caregivers from Indonesia to work in the nation's hospitals and nursing homes, where there's a severe labor shortage. Tokyo is also preparing for similar arrangements with nations such as the Philippines and Thailand as part of broader bilateral economic-partnership agreements. Japan is striving to figure out how to care for its growing population of elderly as the number of young workers who can support them is dwindling.
One of the best physician-to-physician strategies currently in existence is the development of ancillary services within an existing practice, whether it is a single-specialty or multispecialty group. In fact, one reason hospitals employ physicians is to keep from having to compete with physicians for ancillary dollars.
Most practices are looking to ancillary services as an opportunity to augment revenue and enhance their bottom line as a result of declining reimbursement for most basic clinical services. Practices also look to ancillary services to broaden the service offerings provided to their patient base, which eventually creates loyal and satisfied patients.
Depending on the type of ancillary services involved, the revenues associated with them can quickly become a substantial portion of overall profit and physician compensation. Many ancillary ventures are capital-intensive because they require expensive medical equipment. But if the practice generates enough volume to operate such equipment at or near capacity, the investment in such equipment is likely worthwhile.
Of course, these initiatives require a substantial amount of due diligence and financial projection to ensure that the investment is worthwhile. Some of the necessary due diligence required includes the following:
Research of the equipment alternatives and financing opportunities
Volume projections based on the number of applicable procedures referred out to other organizations in the past
Consideration of reimbursement for the procedures considered and potential changes to reimbursement in the near future
Assessment of all costs to acquire and operate the equipment, such as leasehold improvements, increases in staffing and facilities, and other, more minor costs
Determining when the ancillary venture would break even and what the return on investment would be
Assessing any regulatory requirements associated with providing the ancillary services
Just as with starting up a new medical practice, developing an ancillary service is often a stressful venture due to the risk and uncertainty involved. With careful planning, much of the risk can be removed to the extent that success is almost certain.
This article was adapted fromPhysician Entrepreneurs: Strength in Numbers, a new HealthLeaders Media book about consolidation and collaboration strategies to grow physician practices.
Will Congress stop the cut in time? What if they don't? How will it affect my practice? Should I stop seeing new Medicare patients?
Physicians have many questions on their minds as the July 1 deadline for the 10.6% reduction in Medicare payments draws near and physician groups and associations are intensifying their advocacy efforts in hopes of sparking Congressional intervention on their behalf.
But the 40-day window is deceiving—the time for Congressional action actually is a little shorter. CMS would need a couple of weeks to "amend payment instructions and send them to Medicare carriers," says CMS Deputy Administrator Herb Kuhn, and the Bush administration has asked Congress to pass a bill by mid-June. Any later and physicians would likely receive the reduced payments and then receive full reimbursement retroactively, if at all.
But to be honest, I'm not all that concerned about the payment reduction. It's not that the cut wouldn't have serious consequences. In fact, a significant portion of physicians would likely follow through on their promise to drop Medicare patients and the financial squeeze on practices, particularly small ones, would tighten. But Congress is fully aware of the repercussions and for that reason your representatives have little choice but to intervene. In fact, I'm willing to go on record with a prediction: Congress will freeze (or perhaps slightly increase) payments by mid-July.
That's not exactly a bold prediction (and it's only good news compared to the current alternative). It's the same course of action Congress took earlier this year, and again the year before that, and it has been the only course of action for so long that the hand-wringing, calls to action, warnings about reduced patient access and last-minute legislation have become an annual late-December tradition. The only difference is this time it's happening in the middle of the year.
It's as if we're aboard a leaky ship and the only tool the federal government can find is a bucket. Yes, they've been diligently scooping out the water to keep the ship afloat for longer than it would have been on its own, but at some point they have to try a different tactic. Like plugging the holes.
It's too late this time. It is unclear what the final legislation will look like, but Max Baucus, chair of the Senate Finance Committee, has been spearheading the issue, and his proposal would freeze payments for the rest of 2008 and provide a slight (most likely 1.1%) increase for 2009. There's also talk of attaching an e-prescribing mandate to the bill.
But like the fixes before it, this one is only temporary. It would rely on "balloon financing ," meaning physicians might face another 21% payment cut in 2010. The good news is the 18-month window should provide time to develop a sustainable fix to the payment system.It's a tall order, but if physicians keep up the pressure and play an active role in developing a new system, it's feasible. Who knows? This may be the last article about a pending Medicare fee cut I'll ever have to write.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.Note: You can sign up to receive HealthLeaders Media PhysicianLeaders, a free weekly e-newsletter that features the top physician business headlines of the week from leading news sources.
The private health information of 1900 local patients may have been compromised when a Francis D. Ong, MD, resigned from his position as a University of Florida and gave his computer away. UF privacy officials say Ong stored his patients' health records on a computer, which he eventually gave to some acquaintances. The computer has been returned to the school, and UF officials say the risk of anyone using the information for unlawful or mischievous purposes is extremely low.