Friday, April 19, 2013

Business as Usual in the Fee-for-Service, Government Payer World

A New Jersey Cardiologist recently admitted to a long-running health care fraud that cost insurers millions. 

This is a cautionary tale for Florida clinicians running high volume practices, insurers, taxpayers and healthcare reformers. It's also a sobering reminder of the massive flaws inherent in the Fee-for-Service, Government/Managed Care Payer business model.  

According to an article posted April 10 at NJ.com, Dr. Jose Katz maintained a sprawling cardiology practice that included two companies and five medical offices in northern New Jersey and New York. Authorities say he ran his illicit business from 2005-2012. Posing as a successful multi-site physician practice, Dr. Katz was in fact running a Medicare mill. He appeared in Federal Court, in Newark, the same day the NJ.com article was posted.

The author of the article, Jason Grant, reports further that:

By ordering essentially the same battery of diagnostic tests for nearly all his patients, regardless of their symptoms, and by dishing out a slew of false diagnoses, authorities say, Katz rung up large - and fraudulent - bills with the Medicare Part B program as well as Medicaid, Empire Blue Cross Blue Shield, Aetna and other insurers.

Appearing in federal court in Newark today, Katz, 68, of Closter, admitted to bilking the government health programs and private insurers out of more than $19 million over seven years. He also pleaded guilty to conspiracy to commit health care fraud and making false claims to the Social Security Administration in connection with a no-show office position given to his wife.

Under his plea agreement, Katz, the founder, CEO, and sole equity-holder of Cardio-Med Services LLC in New Jersey and Comprehensive Healthcare & Medical Services LLC in New York, faces 57 to 87 months in prison.

Officials called the health care fraud the largest ever by a single practitioner in the tri-state area.

Click
here to see the full story from NJ.com.

Friday, April 5, 2013

Docs Weigh In on Future of Medicine

Deloitte just released their 2013 Survey of U.S. Physicians and the results reveal important attitudes and beliefs among practicing physicians.

For example, 38% of physicians believe the ACA is "A Step in the Wrong Direction." This is down from last year (44%) but continues to be ominously high as we head into the final stages of implementation of the new law.  Without physician buy-in, it's hard to imagine the ACA truly reforming healthcare.  On a positive note, physicians uniformly agree that "Patient relationships" and "Protecting and promoting the health of individuals" are the most satisfying aspects of practicing medicine.

The study also illustrates the differences in the opinions and convictions among various categories of doctors.

For example, among physicians dissatisfied with the practice of medicine, PCPs and Non-Surgical Specialists agree that "less time with each patient" is the chief grievance.  Meanwhile Surgical Specialists list their primary complaint as "long hours/work weeks".  Non-Surgical Specialists (67%) and Surgical Specialists (63%) are more likely to be satisfied with the practice of medicine than PCPs (59%).

Despite all the talk about payment reform, fee-for-service is still firmly entrenched in our healthcare system. The majority (73 percent) of physicians do not work in a setting that provides gain-sharing or an incentives program; only three in 10 do so.  Pay-for-performance is more prevalent in the primary care setting.  PCPs (37 percent) are significantly more likely to participate in such a program than Non-Surgical (25 percent) or Surgical Specialists (23 percent).

There were 613 completed surveys and the margin of error is +/- 3.89 percent at the .95 confidence level according to Deloitte.