Six Things to Watch Out for in Physician Employment Agreements

Healthcare reform and the shift from fee-for-service to value-based reimbursement has brought a host of new complexities to the day-to-day practice of medicine. As a result, more and more physicians are choosing to be employed by a hospital or health system, rather than owning and running their own practice.

While physician employment is not a new concept, the relationship between employed physicians and their employers is shifting as the model for healthcare reimbursement shifts. Employers not only expect their physician employees to meet or exceed RVU (“Relative Value Unit”) production goals, but also to move the needle on certain quality metrics that reflect the overall health of the patient population. This new paradigm creates unique challenges and risks for employed physicians, and is all the more reason for physicians considering employment to pay close attention to what their employment contracts actually require of them.

Physician's Guide to the New DOL Overtime Pay Law

On May 23, 2016, the Department of Labor passed long-awaited overtime pay rules, modifying the Fair Labor Standards Act (FLSA) for the first time in 12 years. The overtime rules apply to all industries across the country, but will like have a major impact on the healthcare industry, especially independent physician and other clinician employers. The rule significantly increases the amount of money an employee must be paid for that employee to qualify as exempt from the overtime pay rules. This means a much larger pool of employees that now qualify for overtime pay (an additional 4.2 million Americans), and likely significant cost increases for employers. Some healthcare employers will be hit harder than others.

NLG in the News: How to be Efficient with Vendor Relations

In the latest article in Diagnostic Imaging, NLG Partner Rebecca E. Gwilt offers advice on how medical practices can manage vendor relations. Read the full article here: http://www.diagnosticimaging.com/partnerships/how-be-efficient-vendor-relations

Firm NewsGuest UserMay 25, 2016medical practice, physician, healthcare vendor, vendor, vendor contracts

ALERT: MACRA and the Quality Payment Program (QPP) Proposed Rule

The biggest takeaway from this proposed Rule? Physicians should start planning for this change IMMEDIATELY to best position their practice for financial sustainability. This rule establishes the new Quality Payment Program (QPP) framework, which consists of two new pathways for provider evaluation and payment—the Merit-based Incentive Payment System (MIPS) and participation in Advanced Alternative Payment Models (APMs). The QPP stems from the changes passed as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), passed in April of last year. Participation in one of the QPP pathways will form the new basis for the level of payment for services Medicare Part B providers will receive. CMS will begin collecting data beginning in 2017. They will analyze the data for one year, and then use the data to adjust Medicare payments for eligible providers starting January 1, 2019.

Corporate Healthcare LawGuest UserMay 12, 2016Physicians, Medicare, MACRA

Hot Topic: CMS' Comprehensive Primary Care Plus (CPC+) Initiative

The CMS Center for Medicare and Medicaid Innovation (CMMI) has spent the last 6 years testing out a variety of models for value-based care and payment--the Medicare Shared Savings Program (MSSP) and other ACO models, the Bundled Payments for Care Improvement (BPCI) Initiative, the Comprehensive Care for Joint Replacement Model, and various Medicaid and CHIP initiatives. As the Administration doubles down on its commitment to shift payments away from fee-for-service (FFS), it continues to innovate, building programs to align incentives to person-centered, comprehensive, high quality health care. In that vein, in July of this year, CMS will begin taking applications from practices for participation in a new CMMI program: the CPC+ program.

Rebecca E. Gwilt, Esq. on Part B News' "Patient Encounters"

In the April 4, 2016 edition of Part B News, Rebecca Gwilt talks about integration of behavioral health care into acute and primary care settings.

"For individual physicians, simply instituting a process to administer basic depression screening is an easy first step,” says Gwilt. That might be the kind of depression screening attached to annual wellness visits, which may be quite simple (PBN 3/14/16). Or you can kick it up a notch with something like the PHQ-9 (Patient Health Questionnaire depression eval), the 15-item Geriatric Depression Scale (GDS) or the 20-item Center for Epidemiologic Studies Depression Scale (CES-D)."

HIPAA "Straight Talk" with Nixon Law Group

Healthcare providers in today's environment are dependent upon health information technology like electronic health records, cloud-based billing and practice management solutions, and mobile devices like laptops and iPads to run their practices. The reliability and security of this technology is key to both operations and compliance. However, physicians aren't IT professionals, and practice managers are security specialists. So how do they manage compliance risks without cutting into resources needed to provide patient care? On Tuesday, April 26, 2016, Rebecca E. Gwilt, Esq. and Joan Kassell, MLIS, CPIA will meet with Virginia practitioners to discuss what the data shows are the most common sources of health data breaches and OCR settlements. The data reveals that there are a few simple steps any physician can take to protect their practice and patients and to begin to build a robust compliance program. Topics will include (1) realistic threats to healthcare practices, (2) breaches in the real world and what they tell us, and (3) reducing the likelihood a breach will bury your practice.

PrivacyGuest UserApril 15, 2016HIPAA, physician, security, privacy and security

Nixon Law Group Speaking @ the MATRC Annual Summit

On April 10-12, Nixon Law Group's Carrie Nixon and Rebecca Gwilt will be traveling to the Hyatt Regency Chesapeake Bay in Cambridge, MD for the second year in a row to speak at the Mid-Atlantic Telehealth Resource Center's (MATRC) Annual Telehealth Summit. Telehealth Resource Centers (TRCs) are funded by the U.S. Department of Health and Human Service's Health Resources and Services Administration (HRSA) Office for the Advancement of Telehealth, which is part of the Office of Rural Health Policy. The 2016 MATRC Telehealth Summit explores how and why telehealth must intersect with both health system transformation and meaningful use if we are to successfully impact all three dimensions of the Institute for Healthcare Improvement's (IHI) "Triple Aim"

HIPAA Phase 2 Audit Program Commences

There is still time to protect your company or practice. In preparation for potential OCR audits, health care providers and health technology companies should conduct an internal audit of their compliance with State and Federal privacy and security rules, including HIPAA, and begin to address any shortfalls. OCR's increased budget and strategic plans related to HIPAA enforcement should remind the healthcare community of the growing commitment of the Federal Government to strictly enforce its privacy and security protections. Contact your healthcare attorney for advice on how to address your compliance posture.

PrivacyGuest UserMarch 25, 2016covered entity, business associate, HIPAA, privacy and security, privacy, OCR

Payer Contract Negotiation Nuts and Bolts

Contracts are long and complicated, often missing or obscuring key information a provider needs to make an informed decision about whether to agree to the contract’s terms. In addition, insurance companies are incredibly resistant to modifying their contracts. Contract negotiation employees often say “no” to even minor changes, expecting that the provider will back down. It takes a significant amount of pushing back to gain access to the staff with the power to make changes. Many providers, we know, simply negotiate the fee schedule, and sign the payer contract without a full understanding of its content. We think that is a mistake—these contracts can have legal and financial impacts unrelated to the fee schedule rates, which outlive the contract itself. But, it's not always clear what parts of these gargantuan documents medical practices should be looking for to reduce their risk. In this post, we describe specific types of provisions to read carefully and consider, how easy it will be to change them, and why you may be agreeing to more than the language inside the contract:

6 Key Things Medical Practices Should Consider When Negotiating Payer Contracts

Learn what kinds of questions you and your medical practice team should be asking when negotiating insurance contracts

Rebecca E. Gwilt speaking at the NASW-VA Annual Meeting

Nixon Law Group is proud to join with the Virginia Chapter of the National Association of Social Workers on March 3-5, 2016, at the Hilton Richmond, to discuss the impact of health reform on social workers and their emerging role in value-based, patient-centered health care.

Busting Barriers to Exchange of Health Care Records

On February 5, the Secretary of Health and Human Services, Sylvia Burwell, announced a proposed rule that would update privacy rules regarding substance abuse records--for the first time since 1987. This proposed rule has the potential to ease barriers to streamlined and efficient exchange of patient information across the care spectrum.

Rebecca E. Gwilt speaking at CMS' DATA PRIVACY DAY Forum

NLG Partner Rebecca E. Gwilt speaking at Centers for Medicare & Medicaid Services DATA PRIVACY DAY forum, alongside Maya Bernstein, HHS ASPE Senior Advisor for Privacy Policy and Rogelyn McLean, HHS Office of General Counsel. Rebecca will be sharing her perspective on the role of the government in creating a workable framework for HIPAA compliance and the role of the private sector in respecting privacy, safeguarding data and enabling trust.

Firm News, Privacy, Care Management ServicesGuest UserJanuary 28, 2016CMS, data privacy, Rebecca Gwilt

Alphabet Soup! Physician Quality Reporting and Reimbursement

PQRS… VPM... MU… MIPS. These letters represent a complex world of quality reporting requirements that physicians must adhere to if they want to maximize their reimbursement and ensure the sustainability of their practice.

Corporate Healthcare LawCarrie NixonJanuary 25, 2016PQRS, MACRA, MIPS, quality reporting, Meaningful Use

The Price of Overpromising

Health IT vendors are under incredible pressure to represent to customers that their hardware and software solutions are impervious to cyber threats. Pick any major trade show and the first line you'll hear from exhibitors is that their solution is HIPAA-compatible, and, even more misleading, HIPAA-compliant. It's important that vendors understand overstating security protocols and capabilities can have major legal and financial implications.

HIPAA and Gun Control

On January 6, 2016, in a dramatic national press conference, President Obama announced several actions by his administration to address gun violence in the US. One of these actions is a long-planned modification to the Health Insurance Portability and Accountability Act (HIPAA). The same day, the Department of Health and Human Services (HHS) published a Final Rule adding a permitted disclosure to the HIPAA Privacy Rule, which expressly permits a limited number of Covered Entities to disclose protected health information (PHI) of certain individuals to the National Instant Criminal Background Check System (NICS). The modification is aimed at removing one barrier to expanding the quality of the information in NICS, which is used by firearms vendors to disqualify potential purchasers who are federally barred from owning firearms.

Nixon Law Group Announces New Partner, Establishes Richmond Office

VIRGINIA, January 4, 2016/Nixon Law Group, LLC/- Nixon Law Group, a Virginia law firm focusing on healthcare law and the Affordable Care Act reforms, kicks off 2016 by welcoming Rebecca Gwilt, Esq. as Partner. Ms. Gwilt brings a wealth of knowledge and experience in health law, serving previously as counsel at the Center for Medicare and Medicaid Services ("CMS"). In her new role, she will also lead the Richmond office of Nixon Law Group.

Buying Professional Liability (Malpractice) Insurance

One of the key elements of any healthcare provider’s risk management plan is securing professional liability (also known as “medical malpractice”) insurance coverage. But, all professional liability policies are not created equal. When considering which policy to purchase, physicians and other healthcare providers should thoroughly examine and understand who the policy covers, how coverage is triggered, and the types of patient claims that are eligible for coverage. . . .

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216 Apple Blossom Court, Suite 200
Vienna, VA 22181

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Nixon Law Group216 Apple Blossom Court, Suite 200Vienna, VA 22181

Nixon Law Group
216 Apple Blossom Court, Suite 200
Vienna, VA 22181