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Newsletter September 18, 2015

Friday, October 9, 2015   (0 Comments)
Posted by: Diane Berg
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Newsletter September 18, 2015

 

Florida Orthopedic Community Bulletin

 

September 18, 2015

 

 

 

Treatment Authorizations for Workers Compensation -

Your Assistance is Needed

 

One of the more troubling items discussed at the Workers Compensation Conference last month in Orlando is that the Workers Compensation Carriers are taking advantage of a loophole in the statutory language regarding treatment authorizations to get around the intent of the statute to expedite authorization and treatment.

 

The statutes, (linked here), establish that the carrier must "RESPOND" to a request for authorization from a treating provider within 3 days. (10 days if the treatment requested is likely to be over $1,000).

 

The carriers have interpreted this literally to mean they just have to "RESPOND" and acknowledge receipt that they have your request for authorization. They believe they are not required to approve or deny the authorization within those statutory timeframes. And have no specific timeline to provide authorization. Evidently they have case law that backs up their interpretation as well.

 

We believe the Division of Workers Compensation would be concerned about this situation and the potential for this interpretation to significantly delay treatment and compromise the intent of the statutes. The ball is in our court to collect data on how long it is taking carriers to provide your practice with authorization to treat. Once we have the data we can provide this evidence to the Division so they can decide if this can be handled via a ruling or guidance from the Division or if this will need to be fixed in the statutes.

 

We need your help!

 

We have created a simple Excel Spreadsheet (linked here) that is a data collection tool that your staff can use to either retrospectively collect data ....or initiate moving forward for the next couple months to track performance of the carriers as you request treatment authorization.

 

Please review the spreadsheet and let me know if your have any questions. Once you have collected some data on authorization performance, please send your spreadsheet back to the FOS office, fcobbe@cobbemanagement.com.

 

We greatly appreciate your assistance on this project.

 

 

FOS Announces Capitol Hill Days Tallahassee - November 16-17, 2015

The FOS is putting together our advocacy team that will travel to Tallahassee on November 16th and 17th for the 2016 Orthopaedic Capitol Hill Days. Committee Meetings are already underway in Tallahassee for the 2016 Legislative Session. Physicians and Administrators are welcome to join us as we charge the hill and advocate on behalf of orthopaedics in Florida.

 

The event will include a debriefing and dinner on Monday evening, November 16th. Followed by Hill Visits on Tuesday, November 17th. The FOS staff will make all of the appointments and will provide talking points and leave behind materials. All you need to bring is your wealth of knowledge and enthusiasm and some business cards.

 

This is a great opportunity to visit with legislators, develop meaningful relationships, and lobby for important issues such as raising physician fees in workers compensation, expansion of Ambulatory Surgery Centers, and reducing administrative burdens on physician practices.

 

Attendees will be required to pay for their own hotel and transportation. We do have a small block of hotel rooms set aside. Once you confirm you are interested, we will assign a room to you and send you confirmation.

 

Attached is a very preliminary draft of our agenda for the trip.

 

Please email the FOS directly if you are interested in participating, fcobbe@cobbemanagement.com

 

 

Readmissions reduction program may unfairly penalize hospitals that serve more poor patients, study suggests

The Washington Post (9/15, Sun) reports in its "Federal Eye" blog that a Medicare program meant to reduce hospital readmissions may be penalizing hospitals "to a large extent based on the patients they serve," according to a study published in JAMA Internal Medicine. Researchers at Harvard Medical School "found that nearly two dozen variables, such as patients' education, income and ability to bathe, dress and feed themselves, explain nearly half of the difference in readmission rates between the best- and worst-performing hospitals."

Vox (9/15) reports that the study suggests the Hospital Readmissions Reduction Program could set off "a vicious cycle: Hospitals that see sick patients end up with higher penalties, lose money, and end up with less money to manage their already complex patients."

 

Modern Healthcare (9/15, Subscription Publication) notes that in March, Sen. Joe Manchin (R-WV) "re-introduced legislation that would reform the calculation of the readmissions penalty to factor in socio-economic characteristics of patients." Additionally, the National Quality Forum is working with Medicare officials "to develop a two-year trial with measures that are risk-adjusted for factors such as socio-economic and demographic characteristics."



 

 

New study: Orthopedics Closed Claims Study

 

The Doctors Company analyzed 1,895 claims against orthopedists that closed from 2007-2014. The study found that the top patient allegation-accounting for 46 percent of claims-was improper performance of surgery, but in almost a third of the cases, patients were not in compliance with their treatment plan. The study also showed that the top factor contributing to patient injury, as determined by a panel of experts, was technical performance. However, reviewers found in most of these cases, the claims were related to known risks disclosed to the patient prior to the procedure.

 

Study link: www.thedoctors.com/orthopedicsstudy

Study video link: www.youtube.com/watch?v=SZkW-W6RmLg

 

 

Upcoming Events

 

2015 BSOF Annual Conference

September 25 - 27, 2015

J W Marriott OrlandoGrande Lakes, Orlando

Conference Details

 

Click here to view the updated Preliminary Program

Get the latest information on speakers, agenda, schedule,

social events, and exhibitors.

 

The program has been approved for16.5 CEU'sfrom AAPC.

Online RegistrationRegistration Form

 

 

The BONES Society of Florida would like to recognize and thank the companies who are exhibiting at the2015 BSOF Annual Conference

 

Conference Sponsors

 

Join us for the "TRI-LAMBS"

WelcomeReception in Exhibit Hall

Friday, September 25th

4:15 PM - 6:30 PM

 

 

2015 ICD-10 Coding Course for Physicians

Saturday September 26, 2015

J W Marriott Orlando Grande Lakes Orlando



The Florida Orthopaedic Society and Bones Society of Florida will host an

ICD-10 Coding Course for Physicians takingplace during the2015 BSOF Annual Meeting at theJ W Marriott Orlando Grande Lakes, (4040 Central Florida Pkwy,Orlando, Florida 32837).

 

The course is specifically designed for physicians to discuss documentation tips and best practices to ensure you give your staff the information they need to make sure you get paid.

 

Saturday September 26, 2015

10:00 AM - 1:30 PM

$75 for FOS & BSOF Members

$300 for Non Members

Click here for more information and to register.

 

 

 

 

 

 

 

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more Calendar

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