Guest guest Posted December 2, 2011 Report Share Posted December 2, 2011 [image: Posterous Spaces] [image: Your Daily Update] December 2nd, 2011 Why Conrad Murray, a Convicted Felon, Remains on the Medicare Payroll - Forbes<http://ptmanagerblog.com/why-conrad-murray-a-convicted-felon-remains-o> Posted about 17 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=83277792> Why Conrad Murray, a Convicted Felon, Remains on the Medicare Payroll murphyslawThings are not always clear cut. There is a bit of true in everything. In the bizarre world of we may never know what’s true and what’s fal [...]<http://www.forbes.com/sites/aroy/2011/11/30/why-michael-jacksons-doctor-a-\ convicted-felon-remains-on-the-medicare-payroll#> 1 comments, 1 called-out<http://www.forbes.com/sites/aroy/2011/11/30/why-michael-jacksons-doct\ or-a-convicted-felon-remains-on-the-medicare-payroll#comments_header> + Comment now<http://www.forbes.com/sites/aroy/2011/11/30/why-michael-jacksons-doctor-a-co\ nvicted-felon-remains-on-the-medicare-payroll#comment_reply> + Comment now<http://www.forbes.com/sites/aroy/2011/11/30/why-michael-jacksons-doctor-a-co\ nvicted-felon-remains-on-the-medicare-payroll#comment_reply> [image: LOS ANGELES, CA - NOVEMBER 01: Dr. Conrad Mur...]<http://www.daylife.com/image/0fIq2AH0AAeY8?utm_source=zemanta & utm_medium\ =p & utm_content=0fIq2AH0AAeY8 & utm_campaign=z1> Image by Getty Images via @daylife Yesterday in Los Angeles, Dr. Conrad Murray was sentenced to four years in prison<http://news.yahoo.com/michael-jacksons-doctor-sentenced-4-years-175525206\ ..html>for helping to kill by prescribing him propofol, an industrial-strength anesthetic, for ’s insomnia. California Superior Court Judge Pastor called Murray a “disgrace to the medical profession” who had committed a “horrific violation of trust.” Dr. Murray was convicted on November 7, and the State of California suspended his medical license back in January. But not to worry: Murray can continue to get paid by Medicare. This factoid is one of many contained in a letter<http://blogs-images.forbes.com/aroy/files/2011/11/11-29-11-Sebelius-Sept-\ 27-follow-up-no-attachment.pdf>that Senators Orrin Hatch (R., Utah) and Tom Coburn (R., Okla.) sent yesterday to Health and Human Services Secretary Kathleen Sebelius<http://www.forbes.com/profile/kathleen-sebelius/>. In September, Hatch and Coburn sent Medicare chief Berwick a list of 34 doctors and non-physician practitioners who have either been convicted of a felony, or pled guilty to a felony “generally considered detrimental to the Medicare program,” but retained their ability to bill Medicare for patient services, and/or to write orders and referrals. Move up Move down <http://www.forbes.com/sites/aroy/2011/07/21/why-washington-lets-medicare-and-me\ dicaid-fraudsters-bilk-taxpayers-of-trillions/> Why Washington Lets Medicare and Medicaid Fraudsters Bilk Taxpayers of Trillions <http://www.forbes.com/sites/aroy/2011/07/21/why-washington-lets-medicare-and-me\ dicaid-fraudsters-bilk-taxpayers-of-trillions/> [image: Avik Roy] *Avik Roy* Contributor <http://blogs.forbes.com/aroy/> <http://blogs.forbes.com/aroy/> <http://www.forbes.com/sites/aroy/2011/06/30/the-myth-of-medicares-low-administr\ ative-costs/> The Myth of Medicare's " Low Administrative Costs " <http://www.forbes.com/sites/aroy/2011/06/30/the-myth-of-medicares-low-administr\ ative-costs/> [image: Avik Roy] *Avik Roy* Contributor <http://blogs.forbes.com/aroy/> <http://blogs.forbes.com/aroy/> <http://www.forbes.com/sites/aroy/2011/04/12/how-corrupt-hospitals-bilk-medicare\ -of-billions-of-dollars-the-tenet-community-health-bombshell/> Healthcare Bombshell: Tenet Lawsuit Alleges Community Healthcare Cheats Medicare <http://www.forbes.com/sites/aroy/2011/04/12/how-corrupt-hospitals-bilk-medicare\ -of-billions-of-dollars-the-tenet-community-health-bombshell/> [image: Avik Roy] *Avik Roy* Contributor <http://blogs.forbes.com/aroy/> <http://blogs.forbes.com/aroy/> <http://www.forbes.com/sites/aroy/2011/06/28/tom-coburn-and-joe-liebermans-impre\ ssive-new-medicare-reform-proposal/> Tom Coburn and Joe Lieberman's Impressive New Medicare Reform Proposal <http://www.forbes.com/sites/aroy/2011/06/28/tom-coburn-and-joe-liebermans-impre\ ssive-new-medicare-reform-proposal/> [image: Avik Roy] *Avik Roy* Contributor <http://blogs.forbes.com/aroy/> <http://blogs.forbes.com/aroy/> “In response to our findings,” write Hatch and Coburn, “CMS confirmed that 37 individuals who were participating in the Medicare program were convicted of a felony. However, CMS did not confirm that they would revoke any single physician or non-physician practitioner identified for such crime.” Berwick languidly responded that Medicare is “implementing an automated screening contract to help address the challenge of continuously monitoring provider licensure status,” but conceded that, in the meantime, “there are significant challenges with obtaining licensure information in real-time for all Medicare providers and suppliers.” But Conrad Murray lost his license in January. Today is the last day of November. Only in Washington does ten-plus months get called “real-time.” Hatch and Coburn pointed out that CMS doesn’t appear to have built the basic infrastructure needed to root out felons. “CMS confirmed our understanding,” they write, “that it does not have basic data sharing agreements or performance metrics to share felony indictment or conviction data with the Department of Justice, the Internal Revenue Service, Office of the Inspector General within the U.S. Department of Health and Human Services (HHS OIG), or State Officials.” In other words, Medicare doesn’t know whether or not the people they send taxpayers’ checks to are criminals. And we wonder why Medicare and Medicaid lose trillions of dollars<http://www.forbes.com/sites/aroy/2011/07/21/why-washington-lets-medicare\ -and-medicaid-fraudsters-bilk-taxpayers-of-trillions/>to fraud? via forbes.com<http://www.forbes.com/sites/aroy/2011/11/30/why-michael-jacksons-doct\ or-a-convicted-felon-remains-on-the-medicare-payroll/> Health Care Billing: Can We Tame the Monster? - Forbes<http://ptmanagerblog.com/health-care-billing-can-we-tame-the-monster-f> Posted about 17 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=83277959> Advisor Network <http://www.forbes.com/advisor-network> | 12/01/2011 @ 11:37AM |274 views Health Care Billing: Can We Tame the Monster? 2 comments, 0 called-out<http://www.forbes.com/sites/carolynmcclanahan/2011/12/01/health-care-\ billing-can-we-tame-the-monster#comments_header> + Comment now<http://www.forbes.com/sites/carolynmcclanahan/2011/12/01/health-care-billing\ -can-we-tame-the-monster#comment_reply> + Comment now<http://www.forbes.com/sites/carolynmcclanahan/2011/12/01/health-care-billing\ -can-we-tame-the-monster#comment_reply> Instead of delving into the Affordable Care Act title by title, which could be extremely boring, I am going to discuss it in relation to the pain we are feeling and what we can most easily fix. In medicine, it is easiest to talk with a patient after I’ve helped their pain and everyone is at ease. For our health care system, an obvious source of considerable “pain” is the health care billing system. Estimates regarding the overall cost of health care billing and administration vary. The Healthcare Administrative Simplification Coalition estimates administrative costs at 25% of total expenditures, and the Physicians for a National Health Program<http://www.pnhp.org/single_payer_resources/administrative_waste_consumes\ _31_percent_of_health_spending.php>determined that “overhead” (with everything thrown in) is about 31%. I don’t pretend to know the real number. What I do know is that the billing system in this country is a mess, and messes are usually expensive. Humor me, and ignore the rest of the health care system until we take care of this one problem. Let me share a vision just regarding billing… Imagine that you are diagnosed with cancer, and thankfully you live in the U.S., where we are outstanding at treating cancer. You have first-rate health insurance, providing access to the expert care you need – oncologist, surgeon, anesthesiologist, nurses, and a quality hospital. You have an excellent chance of being just fine. You have a $2,000 deductible, and thankfully you have the money set aside to cover it in your health savings account. (So far, this part of the scenario is reasonable. Now we get to the dream portion.) The initial doctors’ visits in getting diagnosed helped you reach $1,500 of your deductible. When you register at the hospital for your surgery, you pay the remaining $500, so you owe nothing more and receive no more bills in your mail or email. The doctors are paid by the insurance company within 15 days no matter what, so they don’t have to employ an army to follow up continually to make certain they are getting paid. If a claim is disputed, the insurance company takes it up with the doctor after the claim is paid and you are in no way involved. You are busy getting chemotherapy and working very hard to get well, so you are grateful you don’t have to worry about this. Claim denial is rare, because everyone is clear on what is covered, and if a claim is denied, it is the doctor’s responsibility, not the patient’s. Paperwork is minimal, so entire forests don’t need to be sacrificed in the name of billing for your treatment. Isn’t that beautiful? It is attainable, but it certainly isn’t the current reality. Let me share real stories from just the past few months… You are diagnosed with cancer, and register at the hospital for your upcoming surgery. They say you still owe your $2,000 deductible, even though you know you paid $2,000 already in your workup last week. You go to the outpatient lab, and they also say that you owe your $2,000 deductible. You go to the surgeon’s office, and again they say you owe your $2,000 deductible. The “system” doesn’t recognize that you have already met your deductible, and you spend hours of your time trying to straighten it out. It would be great to use those worry minutes over your cancer instead. Your husband died after a long illness. You are stricken with grief. He had great insurance and got the best of care. You are arranging the memorial, taking care of the kids, and figuring out what is next in life. Daily, you get stacks of paperwork in your mailbox (more trees gone) outlining your explanation of benefits for each visit and telling you how much you owe (Gosh, didn’t we meet that deductible already? I better pay it because I don’t have time or energy to think about it.) At least four letters so far say certain doctors aren’t responding to a request for records and the insurance company isn’t going to pay the bills until they get those records. They request you to call the doctors and tell them to send the records. Grief heaped on grief. I have many stories – bills sent to collections when the patient never received a bill, people calling to discuss billing errors only being fed “empty words” read off scripts by insurance company employees, and people spending day after day on the phone and in voice mail hell trying to get billing situations straightened out. Are the elderly, sick, and minimally educated able to deal with this effectively? The indirect costs in terms of lost productivity and increasing despair are huge. And I bet those people working at the insurance company who have to read empty words to us aren’t happy either. We can do better. In my next post, I will cover what the Affordable Care Act does to address this pain, and together, we can decide if this will get us toward our desired outcome of billing nirvana. Please share your thoughts and stories. If we get enough of us singing the same song of simplicity, the tune will be so catchy that everyone else will start singing along. via forbes.com<http://www.forbes.com/sites/carolynmcclanahan/2011/12/01/health-care-\ billing-can-we-tame-the-monster/> Another POPTS View and Smoking as an Underused tool in Endurance Training<http://ptmanagerblog.com/another-popts-view-and-smoking-as-an-underuse> Posted 3 minutes ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=83505747> Another POPTS View and Smoking as an Underused tool in Endurance Training <http://feedproxy.google.com/~r/EvidenceInMotion/~3/eF0cldhiV3I/another-popts-vi\ ew-and-smoking-as-an-underused-tool-in-endurance-training.html> from MyPhysicalTherapySpace.com by Larry Benz While I am not a regular reader of Advance Magazine<http://physical-therapy.advanceweb.com/>for Physical Therapy & Rehab Medicine (and I doubt this blog is in their RSS reader), it was with great interest that I read " Another POPTS View<http://physical-therapy.advanceweb.com/features/articles/another-popts-view\ ..aspx?CP=3>. A healthcare attorney challenges the APTA's campaign against physician-owned PT services " . The article was strangely reminiscent of a published study <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001541/> which clearly demonstrates that cigarette smoking is an underused tool in high performance training. The study on runners does an excellent job of documenting numerous research which demonstrates that cigarette smoking has an impact on three factors related to endurance performance: serum hemoglobin, lung volume, and weight loss. There is nothing inherently incorrect about the citations. However, as Myers from the University of Calgary points out, " " if research results are selectively chosen, a review has the potential to create a convincing argument for a faulty hypothesis. Improper correlation or extrapolation of data can result in dangerously flawed conclusions. " This couldn't be any more relative towards Cary Edgar's POPTS viewpoint (he is founder of Ancillary Care Solutions which works with physician groups on in-house physical therapy). While the smoking study only made improper correlations, the Advance article provides major inaccuracies. The most obvious one is the major point of their contention-the 2005 Medpac report<http://www.medpac.gov/documents/Dec05_Medicare_Basics_OPT.pdf>which reports on physical therapy spending per patient in a variety of ways to include practice setting. The data reported in the 2005 report is for the year 2000, not 2005 as he cites but let's not let the facts get in the way of improper correlation. Even if the data weren't eleven years old (no shortage of POPTS proliferation during this time), the " spending per patient of $653 in private PT practices, and only $405 in physician groups " is like saying the increased lung capacity of a COPD patient provides an advantage in an ultra marathon. To be fair, it is probably difficult for an attorney to realize that there are major differences between patients seen in an orthopedic POPTS clinic vs. a freestanding private practice relative to acuity or routines including the " one visit only home program or DME only visits cause the patient lives far away " syndrome that is commonplace. Of course, there are tons of anecdotes of patients self-discharging because of the cattle call or inconvenience of the POPTS clinic resulting in a lower per episode cost but let's not even go there. Furthermore, medicare's data in private PT practices includes many POPTS who have obtained medicare numbers and re-assignment of their PT's. The bottom line is that medicare's own data doesn't unfortunately fully discern between POPTS and non-POPTS. As to the claim that APTA is misrepresenting conflict of interest. Are you kidding? The major issue of inherent conflict of interest via self-referral is not cost per episode but in excess referring of patients that don't need the service. There are a plethora of studies that show the problems of referring to entities that a physician owns including this recent one <http://www.rsna.org/Media/rsna/RSNA11_newsrelease_target.cfm?id=568>from a few days ago which show there is a different threshold for referral where there are financial incentives. By the way, if you are going to reference Medpac reports, why wouldn't you provide the one from June 2010 as highlighted in this blog<http://blog.myphysicaltherapyspace.com/2010/07/office-memo-regarding-medpac\ -report.html>which includes the following quotes: * " Moreover, there is evidence that some diagnostic imaging and physical therapy services ordered by physicians are not clinically appropriate " * * " There is evidence that physician investment in ancillary services leads to higher volumes through greater overall capacity and financial incentives for physicians to order additional services. In addition, there are concerns that physician ownership could skew clinical decisions " * APTA's white paper on POPTS <http://www.mopt.org/pdf/POPTS.pdf> was written in 2005 prior to 2010 Medpac and the significant number of published imaging studies which continue to demonstrate self-referral problems. APTA shouldn't be attacked for this paper, they should be applauded as the evidence since then <http://content.healthaffairs.org/content/29/12/2231.abstract>is more than just a little compelling. Perhaps my favorite part of the viewpoint is the contention that " APTA's promotion of autonomous private therapy practices has almost undoubtedly resulted in lower payment rates for physical therapy services " . While I completely agree that payment rates for services have been unfortunately lowered, this is mostly due to PT's who sign the contracts and their inability to have any leverage in contract negotiations-something we can't put on the shoulders of APTA. As to common ground, there is one area that I completely agree with the author: * " While the APTA and its state chapters have devoted a tremendous amount of time, energy and money in their decades' long campaign against POPTS and therapists that work for POPTS, they have apparently not conducted or sponsored any studies seeking to validate their allegations that physician-owned PT results in overutilization and unnecessary cost. Instead, as discussed above, the APTA has chosen to cite outdated and misleading studies that support its position and ignore findings that do not support its position. " * However, as this blog pointed out a few months ago, the time has come.<http://blog.myphysicaltherapyspace.com/2011/09/referral-for-profit-study-i\ n-physical-therapy-the-time-has-come.html>It would be a little disingenuous for APTA to do its own study on POPTS. This is the role of the independent Foundation for Physical Therapy <http://foundation4pt.org/>(full disclosure, I am a Trustee) and this exact study has been approved pending funding which is why APTA <http://apta.org>, Private Practice Section of APTA <http://www.ppsapta.org/> (in a major way), and others are stepping up to earmark a donation to the Foundation. I believe the results will settle this argument once and for all. How about it Ancillary Care Solutions? Put your money where your viewpoint is and send some research dollars to the Foundation (you can even do it online<http://foundation4pt.org/get-involved/donate/> ). larry@...<http://www.google.com/reader/view//mailto:larry@phys\ icaltherapist.com> via google.com<http://www.google.com/reader/view/#stream/user%2F08170950267104389123\ %2Flabel%2FHealthcare> [image: App] On the go? *Download Posterous Spaces* for your phone <http://posterous.com/mobile> Sent by Posterous. Is this spam? 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