IRS Releases New Withholding Tables

Due to tax law changes made in the American Recovery and Reinvestment Act of 2009, the Internal Revenue Service (IRS) has issued new wage withholding and advance earned income credit payment tables. The IRS asks that employers start using the new tables as soon as possible, but no later than April 1.

http://www.irs.gov/pub/irs-pdf/n1036.pdf

Partners must bring value to a medical practice

Unfortunately, doctors rarely appreciate why their group members serve as partners or what responsibilities they should assume. Compared to commercial business, professional service groups traditionally have one serious problem: The owners or executives are also the hands-on income producers.

In commercial companies, the owners and executives run the business while machines and/or employees produce the goods. Medical practices must begin to recognize the need for owner or executive ability versus producer capabilities. Hence a partner must bring value to the practice as an executive or possessor of some other skill(s) of special value to the enterprise.

A young doctor may or may not be partnership material even if he or she possesses superb clinical skills and produces revenue. A group definitely needs such workers and should pay them generously, but that effort alone does not necessarily make them good candidates for partnership. Law, accounting, and architectural firms function that way; medical groups should, as well.

Getting a copy of a DEA Certificate

Ever need a copy of your DEA Certificate? Here is where you can get one:

https://www.deadiversion.usdoj.gov/webforms/dupeCertLogin.jsp

Medicare Physician Fee Schedule - Carrier Specific Pricing Files New for Calendar Year (CY) 2009

CMS has condensed all 56 Physician Fee Schedule (PFS) carrier-specific pricing files into one zip file. This file is found in the list on the CMS Web page at http://www.cms.hhs.gov/PhysicianFeeSched/PFSCSF/list.asp. It is labeled as “All States” in the State field, and “2009” in the Calendar Year field. Because the list is ordered by state name, “All States” appears after the Alaska files. If you sort by most recent CY, the file will appear at the top of the list.

Tap into employee complaints in your physician office

Building an effective complaint process requires more than scheduling periodic venting sessions or hanging a suggestion box. Instead, encourage staff to register their complaints in a way you can constructively use them with the following five principles:

1. Make complaining part of the job. Explain to staff that you can't be everywhere at once, so you rely on them to point out problem areas.
2. Designate complaint times. Whether as part of a regular staff meeting or in a separate gathering, keep the conversation focused on finding solutions, not placing blame.
3. Prohibit griping during other meetings. Direct staff to use the designated complaint times; otherwise, you may find other meetings falling apart.
4. Encourage constructive criticism during one-to-one sessions. Since some staffers may find it too uncomfortable to criticize in front of the group, make time to draw out their comments in private.
5. Train staffers to focus on behaviors, not individuals. When team members conflict, guide the group to discuss undesirable behaviors rather than personalities.

Six Rules Doctors Need to Know

Why are patients mad at doctors? Maybe, suggests medical blogger Dr. Robert Lamberts, it’s because doctors aren’t following the rules. Dr. Lamberts, an Augusta, Ga., physician and writer of Musings of a Distractible Mind, notes that he has a few simple rules that help him get along better with his patients.

Rule 1: They don’t want to be at your office.

It may seem odd to patients, but most doctors forget that going to the doctor is generally unnerving. We work there, and being in a doctor’s office is normal to us. Not so with most patients. The spotlight is on them and their health. They stand on the scale, undress, tell intimate things about their lives, confess errors, are poked, prodded, shot with needles, lectured at, and then billed for the whole thing….There is always an underlying fear and self-consciousness that pervades when a person is sitting on the exam table. The best thing to do in response to that is to show compassion.

Rule 2: They have a reason to be at your office.

They don’t come to the office to waste the doctor’s time. Yet early in my training I was incredulous at the reasons some of my patients were coming to see the doctor. Why come in for a headache? Why come in for a cold?…It took me being in my own practice (and trying to keep my business going) to realize that there is (almost) always an underlying reason for a patient to come in. Sometimes that reason is simple: they have terrible pain that needs to be treated. Other times, however, the reason is more subtle. When a person comes to my office with enlarged lymph nodes, for example, the real reason they are coming in is that they are afraid it is cancer. If a person has chest pains, they are afraid it is their heart. On every visit I try to identify the real reason (or the real fear) that brings them to see me. I don’t end the visit until I have addressed that reason.

Rule 3: They feel what they feel.

Patients will often tell me their symptoms in a very apologetic tone. They seem to think that they have to come to me with the “right” set of symptoms, and not having those symptoms is their fault. Sometimes those symptoms make no sense to me at all, and I am tempted to dismiss or ignore them. But as a physician, you have to trust your patient….Yes, some may exaggerate what they feel out of anxiety or out of fear that you won’t hear them for lesser symptoms, but then your job is to uncover the anxiety, not ignore the complaint. I have heard from many patients that their doctor “did not believe” their complaints because they did not make sense. If you don’t trust them, why should they trust you?

Rule 4: They don’t want to look stupid.

People are often worried that they are over-reacting. They wonder what I must think for a person to come to the office with that symptom. This is especially true of parents bringing their children in. Nobody wants to be “that mother that over-reacts to everything.” In response to this, I try to specifically say, “I am glad you came to the office for this because…” or “Yeah, I can see how that worried you because it could be….”

Rule 5: They pay for a plan.

What do people pay for when they come to the medical office? They pay for opinion, yes. They pay for knowledge as well. But what they really pay for is a plan of action….They want to know what is going to be done to help. I try and give a plan, either verbal or written, to each patient that walks out of the exam room. What medications are given and why? What medications are to be stopped? What tests are ordered and what will the results mean? When is the next appointment? What should they call for if they have problems? The better I can answer these questions, the more confidently the patient will walk out of the exam room. The days of paternalistic medicine are over - no handing a prescription and just saying “take it.” Patients should know why they are putting things in their body.

Rule 6: The visit is about them.

With all of the stresses in a doctor’s office, I get tempted to complain about things. Who better to complain to than someone who feels much the same way? But patients are paying for you to take care of their problems, not the reverse. I keep my personal gripes or frustrations to myself as much as possible.

Revised Form 941 with New Tax Act Change

The IRS issued the 2009 Form 941 (Employer's Quarterly Tax Return) accessible at www.irs.gov/pub/irs-pdf/f941.pdf , reflecting the change for employer COBRA subsidies enacted by the American Recovery and Reinvestment Act of 2009. Employers may be reimbursed for 65% of their total COBRA premiums through a refundable credit on Form 941. Also, employers may apply directly to the IRS for refund of premiums paid. Lines 12a and 12b have been added to the 2009 form for this change.

Medical group practice costs outpace revenues

Medical group practices’ revenues failed to keep pace with swelling operating costs in 2007, according to the Medical Group Management Association (MGMA) 2008 Cost Survey Reports.  

For example, multispecialty practices reported a 5.53 percent increase in median total medical revenue, while median operating cost increased by 6.45 percent. Some single-specialty practices experienced a similar trend.

The good news is that the rate of increase in operating costs appears to have slowed. In 2006, multispecialty practices’ operating costs rose by 4.64 percent more than revenue in 2006. In 2007, that gap shrank to 3.72 percent. However, one of the hardest hit sectors, multispecialty primary care practices, saw this gap expand to 6.29 percent.  

A number of single-specialty practices reported increases in medical revenue that lagged behind increases in operating costs, according to the survey data. For example, median total medical revenue for cardiology practices decreased 0.61 percent while median operating costs rose 6.3 percent. Family practice, OB/GYN, pediatrics and orthopedic surgery groups reported similar trends.

Gastroenterology and general surgery practices defied this trend, though, experiencing similar rates of increase between their medical revenues and operating costs.

Several specialty practices watched their total operating cost per full-time-equivalent (FTE) physician decline or flatten. Cardiology, family practice and pediatrics groups, for example, posted increases in total operating cost per FTE physician, while orthopedic surgery, OB/GYN and urology groups reported decreases.

Costs for medical malpractice insurance differed among specialties. After decreasing in 2006, rates increased in 2007 for cardiology groups. OB/GYN practices reported declining insurance costs for the second consecutive year, and orthopedic surgery and general surgery groups reported decreases for the first time in four years.

This year’s Cost Survey Reports represent data submitted by practices that provided information on nearly 30,000 providers – the largest provider population of any cost survey report in the United States. The single-specialty report includes new data for radiology practices. The multispecialty and single-specialty reports include new data on total medical revenue by type of payer.

Four year study of E/M Utilization

Frank Cohen has just completed his own four-year study on changes in E/M utilization between 2003 and 2007.  In this study, Frank created a set of values that measure the velocity (magnitude and direction) of shifts to E/M code utilization within each of seven categories, including office visits, hospital visits, consults and emergency department services.  In this study, instead of looking at changes in volume, which can be affected by many variables well beyond physician behavior, the study looked at the shifting in utilization of the code levels within each category, agnostic to the actual changes in volume during that time.  To do this, Frank created a value, called a differential that gives a picture of the distribution for each category using a single value.  According to Frank, this is a great asset when it comes to graphing the results for a presentation.

 

The results of the study have been compiled in a worksheet that shows the changes between 2003 and 2007 by specialty by category.  So, for example, you would be able to see that, for general surgery for new office visits, there was a 12% shift towards the use of higher E/M codes.

 

If you would like to get a copy of the results, including a document that outlines the methodology and interpretation of the results, Frank has graciously posted it on his website. Go to www.mitsi.org and click on the Download button.  If you have questions or would like to discuss, Frank can be contacted at his email address, frank@mitsi.org.

Third Circuit Rules Outdated Agreements May Lead to Stark Law Violations

A decision by the U.S. Circuit Court of Appeals for the Third Circuit finding that a long-standing agreement between a physician group and a hospital was insufficient to protect them from Stark Law violations underscores the need for providers to review and, where necessary, update the written contracts and fair market value determinations used to document compliance with the personal services exception to the federal Ethics in Patient Referrals Act of 1989 (the Stark Law) and the safe harbor to the Medicare and Medicaid Anti-Kickback Statute (the Anti-Kickback Statute).

Read Drinker Biddle's full alert here:

http://www.drinkerbiddle.com/files/Publication/99d11afb-62f6-4b7e-818b-0794f5fc220a/Presentation/PublicationAttachment/c889f8a3-3742-4e96-b482-09ab02f1741b/StarkLaw.pdf