Skilled Nursing Facilities in the News

Staff Writers

The Carlyle Group is taking steps to head off critics of its $6.3 billion acquisition of long-term care player Manor Care.

Responding to pressure from unions representing Manor Care’s workers, Carlyle sent letters to state regulators pledging that it would hire enough staff, train them well and make proper infrastructure investments in its homes. This gesture, however, apparently wasn’t enough to impress some Congressmen, who have begun an inquiry into not only Carlyle, but business practices at investor-owned nursing homes generally. They’re investigating widespread allegations that private equity firms cut staff to the bone while remaking corporate structures to avoid getting sued when patients are harmed.

Reps. John Dingell (D-MI) and Barney Frank (D-MA) are planning hearings on the topic, and most likely legislation as well. This follows action by Sens. Max Baucus (D-MT) and Charles Grassley (R-IA), who have sent letters to five private investment firms asking for information on their ownership structure and management practices. Baucus and Grassley also asked CMS for information on its oversight of nursing homes.

The concern on the The Hill isn’t unique. Earlier this month, officials in Florida, Illinois, Pennsylvania, Michigan and Washington asked regulators to investigate the Carlyle acquisition–and to withhold approval of the deal until they did so.

New York Times – October 24, 2007

NOTE: Any insider thoughts on this breaking development?

It seems to co-incide nicely with release of our November print edition which features financial benchmarks for this industry. 

-The Moderators

HIT and Virtual Medical Visits?

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Compensation for e-mail – A New Payment Model for Doctors?

By Staff Writers

It’s been a long wait, but we have recently learned that – ever so slowly – some health plans are beginning to pay doctors for ‘virtual visits’ with patients.

Vendors like McKesson-owned RelayHealth, Epic Systems and Web portal vendor Medfusion have offered the technology for some time, but payer acceptance has been slow. However, a consensus is building that such visits may be a good idea, despite lingering questions over billing and the ability of physicians to legally offer e-care from out of their home state. These visits might save substantial amounts of money while keeping patients healthy–including a Kaiser study concluding that it saves $70 to $120 on each virtual visit.

  1. And so, are hospitals to follow this physician trend?
  2. How about CMS and the various state Medicaid systems?
  3. What about private insurance companies, HMOs and MCOs, etc?

Please opine!

The Moderators 

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What is a Certified Medical Planner™?

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The CMP™ Defined

[By Staff Writers]


Here is the answer taken directly from the website.

The CERTIFIED MEDICAL PLANNER™ charter designation program is a live, instructor-led, online asynchronous educational exercise designed to increase your health industry knowledge, affinity for physician-clients and financial advisory practice revenues in an honest and ethical fashion; regardless of compensation model. Fiduciary capacity is implicit.

We provide 500 hours of health economics and medical practice management education, during a 12 month period, that comprises four quarter-mesters. Adult learners should plan on spending 5-10 hours per week on study activities. The program may be crashed under special situations and/or delivered traditionally and onground upon request.

Check it out for yourself!
Prof. Hope Hetico; RN, MHA, CMP

Enter the CMPs

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NPI Numbers

The Impending NPI Deadline 

By Staff Reporters

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Most of us know that until now, hospitals and other healthcare organizations had until May 23, 2008 to implement the National Provider Identifier (NPI) scheme for Medicare claims; but we were apparantly wrong! 

CMS said today that hospitals must get their NPI in place for submitting Medicare fee-for-service claims by January 1, 2008. If not, CMS will begin rejecting such claims. (CMS is will still accept non-NPI claims from professional services providers like doctors, labs and clinics).

CMS officials say they’re moving up the deadline because most providers are already on board with the NPI.

Really! Are they sure? Not from my view of the universe!

To be sure, providers who aren’t using the NPI are already technically in trouble already, as the original deadline is long past. However, as part of the transition to full NPI rollout, CMS has been letting them slide if (in essence) they promised to work on it by filing a contingency plan.

Anyone caught off guard with this announcement?

– A Healthcare CTO

Pay-4-Performance Healthcare

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Pay for Performance Initiatives

[By Staff Writers]

Of couse, consumer directed healthcare trends and fee transparency increasingly mandate physician economic accountability, such as in the P4P initiatives, but CMS may also begin profiling physicians and targeting those it deems inefficient sometime next year, as well.

In May 2007, Herbert Kuhn, acting deputy administrator of CMS, told a House subcommittee that the agency will have the data and computer capacity available to do tracking as soon as mid-2008.

To monitor efficiency, CMS would compare levels of tests physicians order for certain types of patients to tests ordered by other doctors who achieve similar outcomes. The agency would then contact the physicians whose testing patterns seem to be out of line. No doubt, the effects on private pay-for-perfrmance [P4P] initiatives is obvious.  Kuhn told the subcommittee that his largest concern was figuring out how to use the data to help physicians grow more efficient.


To date, the agency hasn’t established plans to link efficiency measures with reimbursement changes. If it wants to do so, Congress would probably have to enact new legislation, according to several policymakers.


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High Deductible Health Care Plans

Providing Health Care in a High-Deductible World

By Steven Podnos MD, CFP®

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With the increasingly common use of  High Deductible Health Care Plans (HDHCP) (often combined with a Health Savings Account), health care providers are seeing a growing population of health care consumers that are paying “out of pocket” in some fashion for the first several thousand dollars of health care expenses each year.

Q: What is the impact of this for health care providers and hospitals? 

Consider that historical pricing for health care services are much higher than providers expect to receive. Many “fee schedules” hark back to a day in which reimbursement bore some relationship to charged fees-almost unheard of now. 

Let’s illustrate

Enter the consumer with a high deductible plan.  Last year, with his old more traditional health insurance, he sees a physician for an initial visit.  With ancillaries, the office bill might be $300, but the patient pays his $20 co-pay and leaves.  The physician is contracted with the insurer to provide that level of service for a total of $110, and collect the remaining $90 from the carrier.  Everybody is happy. 

This year however, no one is happy.  The consumer with the HDHCP gets a $300 bill for the same service that cost him $20 last year.  He doesn’t know or doesn’t remember that his health care insurance premiums are lower than last year (as he may not pay them). 

The result is one very unhappy patient. Clearly, health care providers need to adapt to the new world of HDHC plans. Hospitals and physician offices should have a list of charges for patients paying cash or having these plans.  The charges would fairly approximate what they expect to receive from patients with Medicare and/or managed care plans for the same services. 

Conversely, patients with these HDHC plans must learn to ask up front for a “cash” price on health care services.  

Dr. Podnos is a fee-only financial planner in Brevard County, Florida.

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By Dr. David E. Marcinko; FACFAS, MBA, CPHQ, CMP™


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