On November 1, 2018, CMS issued a 2,379 page final rule titled “Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2019.”  While there are some interesting changes related to remote patient monitoring for chronic kidney disease patients and loosening of originating site requirements for certain behavioral health services, most notable is the new “virtual check-in” code (HCPCS code G2012). Traditionally, CMS viewed brief telephone calls as non-billable, deeming the services rendered by providers to patients on such calls to be merely ancillary and included in an office visit. Conversely, the only way to bill for the exchange was to conduct the office visit.

The stated purpose of the “virtual check-in” code is for the billing provider herself (not her clinical staff) “to assess whether the patient’s condition necessitates an office visit.” To the extent the in-person visits are rendered unnecessary by the “virtual check-in,” both CMS and the patient save money. Continue reading…

House Bill 37 (“HB 37”), a bill intended to codify and regulate direct primary care in the State of Florida, which had sailed through the Florida House with virtually unanimous support, died in the Senate as the legislative clock ran out on it last week. When the Senate failed to take it up for vote before the session expired on March 11^th, it had the effect of killing the bill. The 60-day 2017 legislative session begins on March 14, 2017.

For more information, please contact Marc I. Goldsand of Cozen O’Connor at mgoldsand@cozen.com or (786) 871-3935, or a member of Cozen O’Connor’s Health Law team.

House Bill 37 (“HB 37”) passed the Florida House 116-0 today. In a hostile political environment, the unanimous vote in Florida’s more conservative chamber confirms what many in the direct primary care medical (“DPC”) space already believe: that DPC is not a political issue.

HB 37’s virtually identical Senate counterpart, Senate Bill 132 (“SB 132”), is on that chamber’s “Second Reading” calendar, and also appears to be moving forward. If SB 132 is indeed approved in the coming weeks it will be sent to Governor Scott for his signature. The 2016 legislative session ends on March 11^th. This one is going down to the wire.

For more information, please contact Marc I. Goldsand of Cozen O’Connor at mgoldsand@cozen.com or (786) 871-3935, or a member of Cozen O’Connor’s Health Law team.

A five-year study released by the Minnesota Department of Health this week, which recorded reams of data in comparing traditional primary care practice patient and cost results with those of health care home practices (“HCH”), gives a fascinating, data-driven glimpse of patient center medical home plans established within the existing Medicare/Medicaid/third party payor system over a five-year period. The findings are especially notable in that these HCHs remained within the traditional reimbursement system as opposed to a direct primary care medical home practice model, which generally requires the practice to forego traditional insurance and seek payment only from the patient.

Some notable results:

• HCHs had significant and substantial savings on their Medicare, Medicaid, and Medicare/Medicaid dual-eligible patients compared to non-HCHs between 2010 and 2014.
• HCHs had lower costs.
• In the subject population, there was a major decrease in the use of hospital services, which was the primary driver of cost savings.
• In the subject population, there was a modest decrease in prescription drug use.
• HCHs generated over $1 billion in savings.

The full study is available here.

For more information about this blog, please contact Marc I. Goldsand, Esq., or another member of Cozen O’Connor’s Health Care team.

Consistent with what we have been seeing in our own practice, and consumers’ growing demand for better access to telemedicine services, a bi-partisan movement is growing in both houses of Congress to expand telehealth services, improve health outcomes, and reduce healthcare costs. On Wednesday February 5, 2016, U.S. Senators Brian Schatz (D-Hawaii), Roger Wicker (R-Miss.), Thad Cochran (R-Miss.), Ben Cardin (D-Md.), John Thune (R-S.D.), and Mark Warner (D-Va.) introduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (s. 2484), which seeks to overhaul Medicare’s treatment of the practice of telemedicine and its related technologies. Companion legislation was introduced in the House of Representatives by U.S. Reps. Diane Black (R-TN), Peter Welch (D-VT), and Gregg Harper (R-MS). According to the Senate bill’s sponsors, the CONNECT for Health Act would:

1. Create a bridge program to help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and RPM without most of the 1834(m) restrictions contained in the aforementioned Senate bill;
2. Allow telehealth and Remote Patient Monitoring to be used by qualifying participants in alternative payment models, without most of the aforementioned 1834(m) restrictions;
3. Permit the use of remote patient monitoring for certain patients with chronic conditions;
4. Allow, as originating sites, telestroke evaluation and management sites; Native American health service facilities; and dialysis facilities for home dialysis patients in certain cases;
5. Permit further telehealth and RPM in community health centers and rural health clinics;
6. Allow telehealth and RPM to be basic benefits in Medicare Advantage, without most of the aforementioned 1834(m) restrictions; and
7. Clarify that the provision of telehealth or RPM technologies made under Medicare by a health care provider for the purpose of furnishing these services shall not be considered “remuneration.”

So far, the following organizations have publically endorsed the bill:

• AARP
• ACT | The App Association
• Airstrip
• Alliance for Aging Research
• Alliance for Connected Care
• Alliance of Community Health Plans (ACHP)
• Alzheimer’s Foundation of America
• America’s Essential Hospitals (AEH)
• America’s Health Insurance Plans (AHIP)
• American Academy of Neurology (AAN)
• American Academy of Physician Assistants (AAPA)
• American Association of Diabetes Educators (AADE)
• American Heart Association/American Stroke Association (AHA)
• American Medical Association (AMA)
• American Medical Group Association (AMGA)
• American Nurses Association (ANA)
• American Occupational Therapy Association (AOTA)
• American Osteopathic Association (AOA)
• American Psychological Association (APA)
• American Society of Nephrology (ASN)
• American Telemedicine Association (ATA)
• American Well
• Anthem
• Association for Ambulatory Behavioral Healthcare
• Association for Behavioral Health and Wellness (ABHW)
• CAPG
• Cerner
• DaVita
• Federation of State Medical Boards (FSMB)
• Hawaii Medical Service Association (HMSA)
• Health Care Chaplaincy Network
• Healthcare Leadership Council (HLC)
• Healthcare Information and Management Systems Society (HIMSS)
• Intel
• Kaiser Permanente
• LifeWIRE
• NAADAC
• National Association for Home Care & Hospice
• National Association for the Support of Long Term Care (NASL)
• National Association of ACOs (NAACOS)
• National Association of Community Health Centers (NACHC)
• National Council for Behavioral Health
• National Council of State Boards of Nursing (NCSBN)
• National Health IT Collaborative for the Underserved
• Personal Connected Health Alliance (PCHA)
• Population Health Alliance
• Qualcomm Incorporated (and Qualcomm Life)
• Telecommunications Industry Association (TIA)
• The ERISA Industry Committee (ERIC)
• The Evangelical Lutheran Good Samaritan Society
• The Jewish Federations of North America
• Third Way
• University of Mississippi Medical Center (UMMC) Center for Telehealth
• University of Pittsburgh Medical Center (UPMC)
• University of Virginia (UVA) Center for Telehealth

The full text of the bill can be found here.

Florida House Bill 37 and Florida Senate Bill 132, similar bills aiming to expressly authorize and regulate direct primary care medical home plans in the State of Florida (“DPCs”) and both stating that DPCs are not “insurance” under State law, have been smoothly sailing through committees in their respective chambers. The House Bill has already passed through the Select Committee on Affordable Healthcare Access, the Finance and Tax Committee, and the Health and Human Resources Committee. Its next step is a vote in front of the entire House. The Senate Bill cleared the Health and Policy Committee, but no word yet from the Banking and Insurance and Fiscal Policy Committees. At some point before the session ends on March 11, 2016, if they continue to move forward, the bills will be consolidated and approved by both chambers, after which the final bill will be subject to approval or veto of Governor Rick Scott. Passage is by no means certain, but there appears to be an appetite for this law with – so far – no real opposition this year.

 DPCs are private payment agreements between primary care physicians and their patients, whereby patients typically pay low dollar (perhaps $75 to $100) monthly payments directly to the provider for primary care services, in lieu of typical insurance covering primary care services.  In return for the monthly payments (which are easily collected by credit card or cash, without the need for insurance/managed care code-based reimbursement billing), primary care providers offer at little or no additional charge an array of primary care services to the member patients. When paired with a high-deductible “wrap-around” insurance policy, the DPCs comport with the requirements of the Affordable Care Act.     

After a significant number of settlement agreements between the U.S. Department of Health and Human Services Office of Inspector General (OIG), OIG decided to release a Fraud Alert reminding physicians, practices and hospitals about the significant compliance risks with medical director agreements. The June 9, 2015 Fraud Alert highlights four issues of concern in medical director agreements and relationships:

1. Agreements providing for medical director compensation based upon a calculation taking into account the volume of a medical director’s referrals to the entity he or she is serving as medical director.
2. Agreements providing for medical director compensation above fair market value for the services to be rendered by the medical director.
3. Medical directors failing to actually render the services set forth in medical director agreements, yet still being compensated for such services.
4. Agreements providing that affiliated health care entities pay for a medical director’s front office staff, thereby relieving the medical director of a financial burden such medical director would otherwise have incurred.

This Fraud Alert offers nothing new in terms of Anti-Kickback regulation and enforcement, reiterating to providers that the Anti-kickback statute generally prohibits a provider from being paid any form of remuneration for referring a patient for federal healthcare business.  It appears to be a not-so-friendly reminder that “remuneration” can come in many shapes and sizes and physicians must continue to be vigilant in their negotiating and entering into medical director agreements, as well as their adherence to same. A physician considering entering into any business venture in the health care sector should proceed with caution, and always confer with a health care attorney before signing on the dotted line.  The complete June 9, 2015 Fraud Alert can be found here: http://oig.hhs.gov/compliance/alerts/guidance/Fraud_Alert_Physician_Compensation_06092015.pdf.

For further information contact a member of Cozen O’Connor’s health care team.

Authored by Ryan Blaney (Washington, DC) and Marc Goldsand (Miami, FL).