SGR bill

Repeal of the SGR Bill

What does the repeal of the SGR bill mean?

There was so much energy spent on the repeal of the Medicare Sustainable Growth Rate formula.What does it mean for the average physician? How are we to interpret the results?

The Medicare Sustainable Growth (SGR) formula was enacted by Congress as part of the Balanced Budget Act of 1997 (BBA). The formula limits growth in spending for physicians’ services by linking updates to target rates of spending growth. A critical factor in the determination of the target rate is projected growth in the real gross domestic product (GDP) per capita.

1. We know it is complicated and can lead to cuts in the reimbursements for physicians.

The repeal includes replacing the SGR with an increase of 0.5% in Medicare physician reimbursement starting in July 2015 through December 2015, and then annual 0.5% increases lasting through 2019. There isn’t a potential 20+% cut facing physicians at the end of the year.

The short-term impact is basically that you get rid of the SGR and end the threat of the cuts, and that’s critical to create stability for physician practices.

2. What does it mean for future payment models for physicians?

The intermediate and longer-term impact is that over the next 3 years, we’re going to be transitioning to a system in this bill that would move physicians into alternative payment models [APMs], as well as consolidate three existing quality-improvement plan programs that already exist in Medicare.

The new bill consolidates the Meaningful Use program for electronic health records and several quality reporting programs, into a new, merit-based incentive payment system and would incentivize physicians to participate in alternative payment models such as accountable care organizations (ACOs).

Overall Assessment

In my opinion we should be glad to see the complicated SGR formula put to rest and the threat of 20%+ cuts in reimbursement disappear.
On the other side transitioning from fee-for-service to being paid for value or taking on risk requires tremendous change management including clinical, operation, financial and culture.

Physicians and medical groups are going to be taking on more risk in a complicated system that has yet to be worked out. The timelines in the legislation are ambitious and physicians will need tools from CMS that allow them the opportunity to be successful in risk-based payment arrangements.

We may be jumping from the frying pan into the fire.

Jonathan Friedman, MBA, CPC

computer security

Gangs of Hackers are After Healthcare

According to Symantec’s 2014 Internet Threat Report, Healthcare is the winner (not in a good way) of security breaches.

The Hackers major focus on breaches increased 23% from 2013.  Healthcare breaches were up 37%, compared to 11% in retail and 10% in education.

Healthcare Providers, Hospitals and Medical Groups need to be proactive today.  Patient data that can include financial data are the most valuable of data on the black market today.

I find it interesting how many times I walk around a hospital going in places I shouldn’t, or look at computer screens, touch computers and no one says a word.  This has to be stopped.  People stealing data are both on the outside and on the inside too.

Being a Healthcare IT Security consultant day in and day out the most common and wrong question asked of me is “I think I have been hacked, what do I do?” Where the right question is ‘How do I prevent being hacked?’

Feel free to email me with your questions on this topic at apatane@prnadvisors.com.

Internet security

Your Healthcare Records Have Been Stolen … Now What?

The hottest item for sale on the black market is healthcare information…your healthcare information!!

‘Threat Organizations’ aka Hackers, Cybercriminals, etc. are preying on the healthcare industry to steal patient information for many reasons and patient beware!!

Most recently a large healthcare organization was hacked and over 80 million patient names were taken from this companies database.  The worst part of this was that the threat organization was embedded in the IT systems of this company for over 1 month.

What does this mean?  Besides increasing the cost of healthcare due to this tragedy, we will also need to ensure our credit and healthcare records are now guarded.  This rule should follow for groups that had information accessed and those that did not.

Providers and Healthcare organizations need to act now.

PRN Advisors has an ecosystem to prevent this type of costly disruption as well as putting proactive safeguards in this up and coming threat.

Contact us at info@prnadvisors.com.