Medicare Physician Fee Schedule 2016 Updates
In November 2015, many healthcare providers were surprised to learn that Medicare payments for all physician services would receive a small cut for calendar year 2016. Only a few months before, physicians had celebrated the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA removed the threat of a massive cut and promised a small increase to Medicare's physician payments in 2016. However, provisions from other, lesser-known laws included reductions sufficient to override the raise included in MACRA. This Health Capital Topics article will explore Medicare physician reimbursement for 2016 - including these additional provisions and their ultimate impact on physician practices. (Read more...)

Telemedicine Series Part 1: Utilization and Trends
With healthcare reimbursement shifting from volume to value-based care, partially as a result of the Patient Protection and Affordable Care Act, healthcare practitioners are increasingly utilizing telemedicine to improve the value of care provided to patients. Although utilization of this technology has been low in the past, in recent years, practitioners' use of telemedicine services has grown considerably as the technology becomes more readily available and affordable to providers. Regulatory bodies, such as the Centers for Medicare and Medicaid Services, are progressively recognizing the utility of telemedicine services due to the cost savings it realizes from facilities that use these services. The cost savings achieved by telemedicine may provide motivation for other facilities to begin using the services, especially when provider cost savings can be achieved, while simultaneously promoting the goal of patient-centered, quality-based care. Part one of this four-part series will detail recent telemedicine utilization trends as well as provide the technological background behind these services. (Read more...)

SCOTUS to Weigh in on Definition of "False" Under FCA
The breadth of the False Claims Act (FCA) has become an increasingly divisive issue among federal courts in recent years, with many implications for the healthcare industry. At the heart of this issue is a key definition within the FCA - the definition of "falsity." Many federal courts of appeals have reached contradictory opinions on this definition by applying different theories of "falsity." These contrary decisions are a source of confusion as to what is, or is not, fraud or abuse under the FCA. In a potential effort to resolve this issue, the Supreme Court of the United States (SCOTUS) accepted the writ of certiorari in Universal Health Servs., Inc. v. United States ex rel. Escobar, which examines the definition of "falsity" under the FCA. This Health Capital Topics article will describe the varying definitions of "falsity" between different U.S. courts, as well as examine the potential consequences of the SCOTUS decision that may impact healthcare providers. (Read more...)

The Re-Emergence of Provider-Sponsored Plans
In recent years, healthcare providers are increasingly operating health insurance plans for consumers, acting as both provider and payor. Some of the primary factors contributing to this trend are the value-based reimbursement reforms included in the Patient Protection and Affordable Care Act and the Medicare Access and CHIP Reauthorization Act, through which reimbursement is becoming more dependent upon cost-effectiveness and quality of services provided rather than simply the amount of services provided. Health systems may be able to benefit from this era of reform by ensuring cost and quality efficiency due to the ability of controlling premium dollars and patient care through the entire healthcare process. This Health Capital Topics article will discuss the current environment for provider-sponsored health insurance, present some of the advantages and disadvantages associated with provider-sponsored health insurance, and discuss potential future developments on this topic. (Read more...)