What is a Medical OBL?

Office Based Laboratories

By Health Capital Consultants, LLC

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DEFINITION: OBLs, also known as office-based endovascular centers, access centers, or office interventional suites, are physician offices wherein a number of services are offered.

CITE: https://www.r2library.com/Resource/Title/0826102549

Similar to ASCs, OBLs can be single specialty or multi-specialty and can have a number of ownership structures. However, unlike ASCs, OBL procedures (because they are located in a physician office) are reimbursed under the Medicare Physician Fee Schedule.

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OBLs are typically operated and utilized by vascular surgeons, interventional radiologists, cardiologists, or other specialists, and services provided include: cardiovascular, endovascular, venous, and non-vascular services; cardiac procedures, such as diagnostic coronary angiograms, coronary stenting, electro physiology services; device implants, including pacemakers, defibrillators, loop recorders, and biventricular pacers; lower extremity endovascular revascularizations, such as chronic total occlusion and complex limb salvage procedures; renal and mesenteric revascularizations; and, subclavian stenting.23 Of these procedures, peripheral vascular intervention, cardiac services, and interventional radiology made up the majority of the OBL market share in 2019.

While slower to materialize than ASCs, OBLs have increased rapidly over the past few years, for reasons similar to ASCs, e.g., opportunities for physician ownership, the “expedient patient experience” and “favorable outpatient procedural reimbursement.”

In 2020, the global OBL market was valued at $9 billion. Similar to ASCs, an increasing focus on outpatient procedures (due to their cost-saving potential)

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PODCAST: Doctor Hospital Co-Owned Ambulatory Surgery Centers (ASC)

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By Eric Bricker MD

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MORE: https://www.youtube.com/watch?v=EuzjQcsim20

CITE: https://www.r2library.com/Resource/Title/082610254

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CMS Includes Changes in CY 2022 OPPS Proposed Rule

BY HEALTH CAPITAL CONSULTANTS, LLC

CMS Includes Several Changes in CY 2022 OPPS Proposed Rule


On July 19, 2021, CMS released the proposed rule for the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Centers (ASCs) for calendar year (CY) 2022. The proposed rule builds on President Joe Biden’s July 9, 2021 executive order on “Promoting Competition in the American Economy,” as it relates to increasing access and price transparency in the healthcare industry.

Outpatient Prospective Payment System (OPPS) Project. Understanding  Ambulatory Payment Classification (APC) - PDF Free Download

CITE: https://www.r2library.com/Resource/Title/0826102549

In a press release regarding the proposed rule, CMS stated their commitment to addressing the persistent health inequities in the U.S. and finding opportunities to improve data collection that will lead to policy changes to help meet the health needs of patients. (Read more…)

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On Single Unit Surgical Centers

Proposed Registration and Licensure Requirements

By Garfunkel Wild, PC

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Legislation enacted on March 23, 2009 required single suite surgical facilities that are conducted by surgical practices (the “Surgical Practices”) to register with the New Jersey Department of Health and Senior Services (“NJDHSS”) by September 17, 2009, and prohibited registration of new Surgical Practices. However, registration requirements were not implemented or enforced.  Previously, Surgical Practices were regulated by the Board of Medical Examiners.  The proposed regulations intend to set forth both registration and regulatory requirements for existing Surgical Practices, but preserve the statutory moratorium on new Surgical Practices.

New Jersey Department of Health and Senior Services

Surgical Practices that are in operation on the effective date of the proposed regulation must register with the NJDHSS or cease operations no later than ninety (90) days from the effective date.  A Surgical Practice that has not commenced operation by the effective date but has filed specifications and/or other required building or zoning documents with the municipality in which the Surgical Practice will be located must register with the NJDHSS prior to commencing operations.  All Surgical Practices to be registered in the future must register within two (2) years of receiving approval from the municipality in which it will be located. Registration will be valid for one year and will be subject to annual renewal.  Along with the renewal application, the registrant would be required to submit a copy of its certification from the Centers for Medicare and Medicaid Services (“CMS”) or other documentation of accreditation. In the event that a Surgical Practice fails to maintain such certification or accreditation, the registration would lapse.

The proposed regulations would also provide for standardized requirements for the transfer of ownership and relocation of all Surgical Practices. Importantly, a Surgical Practice would be permitted to apply for approval of a transfer of ownership by submitting a completed registration application at least ninety (90) days prior to the planned transfer of ownership.  Additionally, a registered Surgical Practice would be permitted to relocate within twenty (20) miles after submitting certain documentation set forth in the regulations. A relocated Surgical Practice would not be permitted to expand the scope of services at a new location.

New Legislation

In addition, legislation has been introduced which would go further than the proposed regulations and require all Surgical Practices in operation as of the date of enactment to become licensed by the NJDHSS as ambulatory care facilities licensed to provide surgical services within one year of the effective date.  Such Surgical Practices would be exempt from the ambulatory care facility assessment.  In addition, the moratorium on new ambulatory care facilities would remain in effect. 

Assessment

If this legislation is enacted, the NJDHSS would not issue new registrations for Surgical Practices after the effective date.  However, a registered Surgical Practice may transfer ownership or relocate after the effective date if it becomes licensed as an ambulatory care facility prior to applying for a new license. Surgical Practices would be required to obtain ambulatory care accreditation from an accrediting body recognized by CMS as a condition of licensure.

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Understanding HMO Negotiation Tactics

Tricks Often Used Against Doctors

By Dr. David Edward Marcinko; MBA, CPHQ, CMP™

By Hope Rachel Hetico; RN, MHA, CPHQ, CMP™

[Publisher-in-Chief and Managing Editor]dave-and-hope6

It is well known that stakeholders of the healthcare industrial complex often have different, and divergent, interests. Intra-as well as inter-stakeholder competition occurs; as well.

The Friends-Enemies [“Frenemies”]

For example, several decades ago, the authors were often at odds at the payer negotiation table.

He was managing partner of a large private medical practice, ASC and later PPMC. First, she was the representative of a national DME vendor, healthcare system and later, private insurance payer.

The Tactics

The following trick negotiating tactics can be used to gain an advantage over your opponent, or they can be used against you to your disadvantage. The key is to recognize them immediately:

1. Deliberate deception with phony facts about contracts, providers, patients, venues, demographics, prices, utilization rates or services.  Some MCO’s may even offer a fee-for-service fee schedule as enticement into the plan. Then, fees are dramatically reduced once the initial enrollment period has elapsed.

2. Ambiguous authority regarding negotiating intentions or power. One the deal is done and a firm agreement has been made, the other side announces that they must take the agenda to a higher authority for final approval and another shot at your resistance. 

3. Avoid stressful personal situations before beginning the negotiating process. Don’t negotiate when sick, your personal life in shambles, your children or spouse is sick or when you feel too mentally exhausted or “psyched out”.

4. Personal attacks can be in the form of verbal abuse or simply loud talking, avoidance of eye contact or asking you to repeat yourself, endlessly. Extremely offensive to most physicians, and increasingly used today, is the phrase “remember doctor, you are an over supplied commodity”.  Now ask yourself, do you really want to be on a plan that doesn’t respect your profession?  

5. The “good guy-bad guy” routine is a psychological tactic where one partner appears to be hard nosed and the other appears more yielding. Small concessions result which, upon repetition, become larger in aggregate.

6. The “take it or leave it” tactic can be easily avoided by knowing your BANTA [Best Alternative to a Negotiated Agreement]. More formally, this is known as a unilateral contract of adhesion.

7. Escalating or increasing demands occur when the opponent increases his demands or reopens old demands. Call their bluff on this one by pointing it out to them and replying that you are aware of its use.

Assessment

Always remember, today’s enemy – may be tomorrow’s ally.

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Conclusion

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More about Healthcare Organizations [Financial Management Strategies]

Our Print-Journal Preface

By Hope Rachel Hetico; RN, MHA, CMP™hetico1

As Managing Editor of a two volume – 1,200 pages – premium quarterly print journal, I am often asked about our Preface.

A Two-Volume Guide

As so, our hope is that Healthcare Organizations: [Financial Management Strategies] will shape the hospital management landscape by following three important principles.

What it is – How it works

1. First, we have assembled a world-class editorial advisory board and independent team of contributors and asked them to draw on their experience in economic thought leadership and managerial decision making in the healthcare industrial complex. Like many readers, each struggles mightily with the decreasing revenues, increasing costs, and high consumer expectations in today’s competitive healthcare marketplace. Yet, their practical experience and applied operating vision is a source of objective information, informed opinion, and crucial information for this manual and its quarterly updates.

2. Second, our writing style allows us to condense a great deal of information into each quarterly issue.  We integrate prose, applications and regulatory perspectives with real-world case models, as well as charts, tables, diagrams, sample contracts, and checklists.  The result is a comprehensive oeuvre of financial management and operation strategies, vital to all healthcare facility administrators, comptrollers, physician-executives, and consulting business advisors.

3. Third, as editors, we prefer engaged readers who demand compelling content. According to conventional wisdom, printed manuals like this one should be a relic of the past, from an era before instant messaging and high-speed connectivity. Our experience shows just the opposite.  Applied healthcare economics and management literature has grown exponentially in the past decade and the plethora of Internet information makes updates that sort through the clutter and provide strategic analysis all the more valuable. Oh, it should provide some personality and wit, too! Don’t forget, beneath the spreadsheets, profit and loss statements, and financial models are patients, colleagues and investors who depend on you.ho-journal9

www.HealthcareFinancials.com

Assessment

Rest assured, Healthcare Organizations: [Financial Management Strategies] will become an important peer-reviewed vehicle for the advancement of working knowledge and the dissemination of research information and best practices in our field. In the years ahead, we trust these principles will enhance utility and add value to your subscription. Most importantly, we hope to increase your return on investment [ROI] in some small increment.

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Understanding MD/DO HMO Contracts

Pitfalls Physicians Must Avoid

By Dr. David Edward Marcinko; MBA, CPHQ, CMP™

By Hope Rachel Hetico; RN, MHA, CPHQ, CMP™

[Publisher-in-Chief and Managing Editor]dave-and-hope5

It is well known that stakeholders of the healthcare industrial complex often have different, and divergent, interests. Intra-as well as inter-stakeholder competition occurs; as well.

The Friends-Enemies [“Frenemies”]

For example, several decades ago, the authors were often at odds at the payer negotiation table.

He was managing partner of a large private medical practice, ASC and later PPMC. First, she was the representative of a national DME vendor, healthcare system and later, private insurance payer.

Key Pit Falls to Avoid

There are seven key pitfalls to watch out for when evaluating an MCO contract.

1.  Profitability: Less than 52% of all senior physician executives know whether their managed care contracts are profitable. “Many simply sign up and hope for the best”.

2. Financial Data:  90% of all executives said the ability to obtain financial information was valuable, “yet only 50% could obtain the needed data”.

3.  Information Technology: IT hardware and sophisticated software is needed to gather, evaluate and interpret clinical and financial data; yet it is typically “unavailable to the solo or small group practice”.

4. Underpayments: This rate is typically between 3-10% and is usually “left on the table”.

5. Cash Flow Forecasting: MCO contracting will soon begin yearly (or longer) compensation disbursements, “causing significant cash flow problems to many physicians and physicians”.

6. Stop Loss Minimums: SLMs are one-time upfront premium charges for stop loss insurance. However, if the contract is prematurely terminated; you may not receive a pro-rata refund unless you ask for it!

7. Automatic Contract Renewals: ACRs or “evergreen” contracts automatically renew unless one party objects. This is convenient for both the payer and payee, but may result in overlapping renewal and re-negotiation deadlines. Hence, a contract may be continued on a sub-optimal basis, to the detriment of the provider. 

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Assessment

Always remember, in the game of negotiations, today’s enemy – may be tomorrow’s ally.

Conclusion

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