The price you may pay for being in violation of the anti-kickback statute is nothing to take lightly. There are fines of up to $25,000, imprisonment of up to five years, or both. A violation of the anti-kickback statute could also result in exclusion from the Medicare program.
The bottom line is that physicians must learn how to stay in compliance with this statute to ensure no unwanted penalties or troubles with the law, says Joseph J. Russo, Esq., founder and senior partner of Russo & Russo, LLP, in Bethlehem, PA. He offers the following five tips to physicians who may be in danger of these circumstances:
1. Be aware of several safe harbors to the federal anti-kickback statute. The government is most concerned about any incentive providers may have to overutilize governmental services. The following is a list of safe harbors to consider in your practice:
Investments in large publicly traded entities
Investments in smaller ventures
Lease of space and equipment rental
Personal services and management contracts
The sale of a practitioner practice
Referral services
Warranties
Discounts
Employee groups purchasing an organization
Waiver of beneficiary coinsurance
Deductible amounts
2. Implement and follow a compliance program for your practice. For example, Compliance Program Guidance, issued by the U.S. Department of Health and Human Services Office of Inspector General (OIG), provides nonbinding compliance guidance to providers who conduct business with Medicare, Medicaid, and other federally funded healthcare programs.
3. Educate yourself about the risks. The OIG set forth various risk factors applicable to physician practices, including improper inducements, kickbacks, and self-referrals. They include:
Financial arrangements with outside entities to whom the practice may refer federal healthcare program business
Joint ventures with entities supplying goods or services to the physician practice or its patients
Consulting contracts or medical directorships
Office and equipment leases with entities to which the physician refers
Soliciting, accepting, or offering any gift or gratuity of more than nominal value to or from those who may benefit from a physician practice's referral of federal healthcare program business
In order to keep current with this area of the law, a physician practice may obtain copies of the risk areas available on the OIG Web site. "It will include all relevant OIG Special Fraud Alerts and Advisory Opinions that address the application of the anti-kickback and physician self-referral laws," Russo says. "This is to ensure that the standards and procedures reflect current positions and opinions."
4. Ask yourself whether certain gifts are legitimate. According to the Compliance Program Guidance, the OIG goes on to state that any arrangements involving pharmaceutical or other gifts should be scrutinized, taking into account the following factors:
Is the gift or other benefit made to a person in a position to generate or influence business for the paying party?
Does the gift or other benefit take into account, directly or indirectly, the volume or value of business generated (e.g., is the payment or gift only given to persons who have prescribed or agreed to prescribe the product?)
Is the gift or the benefit more than nominal in value and/or does it exceed the fair market value of any legitimate service rendered to a payer?
Is the gift or benefit unrelated to any services at all other than the referral of federal healthcare business?
5. Develop standards and procedures to address arrangements with other healthcare providers and suppliers. Physician practices should also consider implementing measures to avoid offering inappropriate inducements to patients. The following are examples of such inducements:
Routinely waiving coinsurance or deductible amounts without a good faith determination that the patient is in financial need
Failing to make reasonable efforts to collect the cost-sharing amount from the patient
Shannon Sousa is the editor of The Doctor's Office. She may be reached at ssousa@hcpro.com. This story was adapted from one that first appeared in the February edition of The Doctor's Office, a monthly newsletter by HealthLeaders Media.
In his 2001 book, Good To Great, author Jim Collins talked about research he and his associates had conducted on why some companies thrived during economic downturns and others in the same field floundered. Although the companies that Collins and his team studied didn't include medical group practices, there are a number of principles that are relevant to physicians trying to run a successful business.
So what makes a group practice great?
In many cases, marketing makes the difference between a mediocre group practice and an exceptional one. CEOs will tell you that the "moments of truth" for a business occur in daily operations. All the publicity, promotion, and advertising in the world won't matter one bit if the word on the street is that it is difficult to make an appointment or get in to see your physician. But those who would separate marketing from operations fail to see that the two are integrally wound together. Timely appointment-setting, friendly reception, respect for the patient's opinion, and protecting patients' rights are all things that happen through customer interaction--which is operations and marketing.
In a recent focus group I arranged, the facilitator asked participants what they felt truly equated to a great experience when seeing a physician. "I was concerned that there may have been wrong information in my medical record and asked if I could review it," one participant explained. "Not only did they let me review it, but they apologized after I pointed out mistakes in the record and promised to correct them. They also asked that I double-check with them later to make sure the corrections were made."
Another participant boasted that the nurse arranged for a pick up when she wasn't able to drive. Others lauded simple things like being able to make appointments online or in the evening, and for being informed of the doctor's progress every ten minutes when waiting for an appointment.
These are the things that Jim Collins would say are the mark of a great, not just a good, medical group practice. They are the result of truly listening to the patient, putting the customer (patient) first, and doing something as opposed to just talking about it. At first, employees and their managers are worried that implementing patient-driven enhancements will take too much time and cost too much. However, practices that operate with a focus on the patient have actually seen employee morale improve--without seeing costs skyrocket. In fact, in some cases, they have gone down because of spin-off efficiencies as a result of process improvements.
A number of progressive medical groups have learned the secret to building and sustaining patient volume. They have integrated market research into their efforts to improve operations, and they have fine-tuned their operations to incorporate marketing concepts. But even the best-run practices struggle with the ongoing throughput/efficiency vs. customer satisfaction challenge. There is an opportunity cost to an unused MRI machine or an empty exam room. Machines and buildings have sunk costs that must be covered by paying customers. To the degree that a practice can accommodate throughput without sacrificing clinical quality, it will achieve coverage of the fixed and variable costs that exist with all operations. But will it achieve customer satisfaction?
A recent study that was reported in the Denver Business Journal suggests that efforts at increasing efficiency can be compatible with customer service. The article claims that overbooking patients (similar to how airlines overbook flights) may be better for large practices where there can be a significant number of patient no-shows. Which leads one to ask: Wouldn't it make sense to find out why there are so many no-shows and devise a strategy that would cut down on them? This is where market research and strategy can be instrumental in not only improving operational efficiency but in increasing patient loyalty and satisfaction.
Together, operations and marketing help bring in patients and keep them coming back to a physician's practice (if medically necessary). There are many factors involved in attaining patient loyalty, including competent clinical management of chronic disease from specialists and pharmacologic management of cholesterol levels and blood pressure by primary care physicians. However, what makes a patient refer other potential patients to the practice (the "multiplier effect" of marketing), is primarily the skills and understanding of the physician in meeting the patient's specific health care needs. And what makes you're a great group practice is making your interaction with patients more than just a "get 'em in, get 'em out" experience.
Patrick T. Buckley, MPA, president and CEO of PB Healthcare Business Solutions, LLC, a consulting firm that assists healthcare organizations with strategy, marketing, and management. He is also the author of the new HealthLeaders Media book, Physician Entrepreneurs: Marketing Toolkit, which includes marketing techniques, sample forms, and templates geared specifically for physician practices.
Georgia is seeking to be one of 12 "demo sites" for a $150 million pilot federal program to provide money to some physicians to set up electronic health records systems. Supporters of the program, including Georgia Gov. Sonny Purdue, say electronic medical records would ensure better care for patients, but others question cost and raise security concerns.
Brentwood, TN-based Little Clinic has agreed to support the "desired attributes" set forth by the American Academy of Family Physicians to ensure safe care for patients of retail health clinics. The Little Clinic operates retail clinics inside Kroger and Publix Grocery stores.
The online video-sharing site YouTube has become a battleground in the competition among Nashville-area hospitals for heart care patients. Saint Thomas Health Services and Vanderbilt University Medical Center are trying to generate word-of-mouth marketing by posting videos on the site with testimonials from patients. Doctors and staff also talk up their own experience on the video clips as well.
The nation's cities and states have made a strong effort to prepare for emergency health crises, but big challenges remain, according to a report from the Centers for Disease Control and Prevention. The report looked at staffing, laboratory capability, and other resources of state, local, and territorial health departments for handling bioterrorism or other disasters.