The Power of Collaboration: Exploring the Partnership Model in Healthcare

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In the ever-evolving landscape of healthcare, collaboration has become a cornerstone for driving innovation, improving patient outcomes, and addressing complex challenges. One powerful framework that embodies this spirit of collaboration is the partnership model in healthcare. This blog aims to shed light on the diverse facets of healthcare partnerships, ranging from public-private collaborations to patient engagement initiatives, with a focus on fostering a holistic approach to healthcare delivery.

Healthcare Partnership Defined

A healthcare partnership involves the collaboration between various entities, including healthcare providers, government agencies, private organizations, and patients, to achieve common goals that enhance the quality and efficiency of healthcare services. This model acknowledges the interconnectedness of stakeholders and emphasizes the collective responsibility in promoting health and well-being.

Public-Private Partnership in Healthcare

One prominent manifestation of the partnership model in healthcare is the concept of public-private partnerships (PPPs). These collaborations bring together government entities and private organizations to combine their resources, expertise, and innovation for the betterment of healthcare services. PPPs can range from joint research initiatives to the development of healthcare infrastructure, ultimately creating a synergistic approach to addressing complex healthcare challenges.

Healthcare Fraud Prevention Partnership

One specific form of partnership within the healthcare realm is the Healthcare Fraud Prevention Partnership (HFPP). This initiative, led by the federal government, fosters collaboration between public and private sectors to combat healthcare fraud. By sharing data, insights, and best practices, the HFPP aims to detect and prevent fraudulent activities, ultimately safeguarding healthcare resources and ensuring that funds are directed towards legitimate patient care.

Patient Partnership in Healthcare

The partnership model in healthcare extends beyond institutional collaborations to include patients as active and informed participants in their own care. Patient partnership emphasizes the importance of involving individuals in decision-making processes, treatment plans, and healthcare policies. Engaging patients in their care not only enhances satisfaction but also contributes to better health outcomes and the overall effectiveness of healthcare delivery.

Benefits of Healthcare Partnerships

1. Improved Access to Resources: Partnerships allow organizations to pool resources, whether it be financial, technological, or intellectual, leading to more efficient and effective healthcare services.

2. Enhanced Expertise: Collaboration brings together diverse perspectives and expertise from different sectors, fostering innovation and problem-solving in the face of complex healthcare challenges.

3. Cost Savings: By sharing the financial burden and leveraging economies of scale, partnerships can contribute to cost savings, making healthcare services more sustainable and accessible.

4. Holistic Patient Care: Patient partnerships ensure that healthcare decisions consider the individual’s unique needs, preferences, and values, promoting a more personalized and patient-centered approach to care.

Challenges and Considerations

While healthcare partnerships offer numerous benefits, they also come with challenges, including data privacy concerns, varying organizational cultures, and the need for effective communication channels. It is essential for stakeholders to navigate these challenges transparently and proactively to build and sustain successful partnerships.

The partnership model in healthcare represents a paradigm shift toward collaborative, patient-centered, and innovative care delivery. Whether through public-private collaborations, fraud prevention initiatives, or patient engagement strategies, partnerships are integral to addressing the complexities of the modern healthcare landscape. As the healthcare industry continues to evolve, embracing and fostering collaboration will be key to achieving a holistic, sustainable, and patient-centric healthcare system.

Navigating Healthcare Business Operations: Hiring, Firing, and Best Practices

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Healthcare is a dynamic and ever-evolving industry, and healthcare business operations are at the heart of delivering quality care. Effective management of healthcare facilities involves various aspects, including hiring and firing healthcare professionals. In this blog, we will explore the intricacies of healthcare business operations, focusing on the hiring process, the challenging decision to terminate healthcare professionals, and best practices to ensure the smooth functioning of healthcare facilities, with a particular emphasis on addiction treatment facilities.

Understanding Healthcare Business Operations

Healthcare business operations encompass the administrative and managerial activities that keep healthcare facilities running efficiently. These operations are critical to providing high-quality patient care and ensuring compliance with industry standards and regulations.

Hiring in Healthcare

Hiring the right professionals is paramount in healthcare. The process involves several steps:

1. **Recruitment**: Attracting qualified candidates through job postings, recruitment agencies, or networking is the first step. In addiction treatment facilities, it’s essential to look for professionals with expertise in addiction counseling, therapy, and related fields.

2. **Screening and Interviews**: Thoroughly screening applicants and conducting comprehensive interviews help identify candidates who align with the facility’s mission and values.

3. **Credential Verification**: Verifying credentials, licenses, and certifications is crucial to ensure that healthcare professionals are qualified to provide the necessary care. This is particularly vital in addiction treatment facilities, where specialized knowledge is essential.

4. **Background Checks**: Conducting background checks can reveal any red flags that may affect a candidate’s suitability for a healthcare position.

Firing Healthcare Professionals

Terminating healthcare professionals is a challenging decision that must be handled with care. Reasons for termination may include subpar performance, ethical violations, or organizational restructuring. Regardless of the cause, following best practices is crucial:

1. **Documentation**: Maintain detailed records of performance issues, including written warnings and improvement plans, to ensure a transparent and well-documented process.

2. **Legal Compliance**: Adhere to employment laws and regulations, such as providing adequate notice or severance pay, to avoid legal complications.

3. **Maintaining Patient Care**: Ensure that patient care remains uninterrupted during the transition, with minimal disruption to the facility’s operations.

Business Practices in Healthcare

Effective healthcare business operations require adherence to best practices:

1. **Compliance**: Healthcare facilities must stay current with industry regulations, such as HIPAA (Health Insurance Portability and Accountability Act), to protect patient privacy and data.

2. **Financial Management**: Managing finances efficiently is vital to sustaining operations. This includes budgeting, revenue cycle management, and cost containment efforts.

3. **Quality Improvement**: Continuously monitor and improve patient care quality by implementing evidence-based practices and feedback mechanisms.

4. **Patient-Centered Care**: Prioritize patient satisfaction and safety, fostering a culture that values empathy and patient-focused care.

Best Practices in Addiction Treatment Facilities

Addiction treatment facilities have unique considerations in healthcare business operations:

1. **Multidisciplinary Teams**: Employ a diverse team of healthcare professionals, including addiction counselors, therapists, and medical staff, to address the complex needs of patients.

2. **Evidence-Based Approaches**: Use evidence-based treatment methods to provide the most effective care for addiction recovery.

3. **Comprehensive Assessments**: Conduct thorough assessments to create tailored treatment plans that address each patient’s specific needs.

4. **Continuous Training**: Keep staff updated on the latest developments in addiction treatment to ensure the highest level of care.

Healthcare business operations are the backbone of healthcare facilities, ensuring they provide top-notch care and maintain ethical standards. From hiring the right professionals to making difficult decisions regarding terminations, healthcare organizations must uphold best practices to offer quality care and remain compliant with regulations. In addiction treatment facilities, these considerations take on added significance, as the specialized nature of care demands a heightened focus on patient recovery and well-being.

Florida Healthcare Business Operations

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Healthcare clinics provide a service to the community, but at their core, they are also businesses.

Businesses that are poorly run will soon find themselves in trouble: losing money, facing sanctions due to non-compliance with state and local regulations, and ultimately filing for bankruptcy.

At Florida Healthcare Law Firm, we help healthcare businesses improve their operations, creating standards of practice that support their day-to-day operations at all levels and help ensure ongoing harmony with federal and state statutes regarding healthcare practice.

What Are Healthcare Business Operations?

Healthcare business operations include all the functions that happen throughout the day and on a weekly, monthly, or annual basis that contribute to the financial and legal health of the institution.

This is a broad definition, but the truth is that business operations in healthcare clinics encompass a range of practices from the medical care itself to management of the backend of the business to management of human resources.

The categories included in healthcare business operations generally are as follows:

  • Administrative operations
  • Financial operations
  • Legal management
  • Quality improvement

For most healthcare businesses, this is just a starting point, however, as more categories will be added based on the offerings and services provided by the business. For example, if patients are treated in person on site, categories will be added that support best practices for medical and patient care.

Do We Need a Business Operations Manual for Healthcare Clinics?

There are documents designed to support healthcare clinics and other healthcare businesses in creating standards of practice that help them, but it is generally necessary for healthcare businesses to create their own business operations manual.

While some statutes, regulations, and industry standards apply across the board, most healthcare businesses, especially clinics who work directly with patients, will require very specific actions in order to protect patient data and provide the best possible medical care.

In most cases, it is recommended to begin the process of building a unique business operations practice by looking at available manuals. Know that the process will not be complete until it has been thoroughly vetted by a professional who knows and understands the expectations for that particular business.

Florida Healthcare Law Firm Supports Healthcare Leaders in Business Operations

At Florida Healthcare Law Firm, we make it our business to keep up with ever-changing standards and regulations in the state of Florida and at a federal level that impact healthcare clinics and businesses.

We can help you to create and implement business operations and standards of practice that support a thriving healthcare business or clinic and the professional growth of all involved.

If, for some reason, there is already litigation underway due to a breach of statutes or regulations, we can assist with correcting this situation and helping to prevent a recurrence.

Contact Florida Healthcare Law Firm today for a consultation.

Understanding the Termination Upon Death or Disability Clause in Your Lease

So what exactly does a death and disability clause do? It protects you, your family and/or your estate from liability under your lease in the event of your death or disability. It allows you or the entity through which you lease space (the “tenant”) to be relieved of all obligations under the lease. Without including such language, the tenant will remain obligated to perform all the terms under the lease, including, for example, paying monthly rent and common area maintenance expenses.

Remaining obligated under the lease can cause undue hardship. For example, if you are your medical practice’s sole provider and you become disabled or your practice loses a critical employee due to death, your practice won’t make money, as the practice can’t see and treat patients.

Of course, landlords aren’t the biggest fans of death and disability clauses because such clauses don’t benefit them. Even in the case where a landlord allows for a death and disability clause, it likely will come with conditions. For example, a landlord may require you or your estate to pay for costs associated with reletting the leased space and pay rent until a new tenant leases the space. Or, if the landlord funds your tenant improvements and they are of a significant amount, the landlord may require a hefty termination fee upon your death or disability to recoup those improvements costs.

If your landlord refuses to allow for a death and disability clause, it’s important to have a plan that comes into play upon your death or disability. That may be by having an arrangement in place where you or your estate sells your practice and the lease transfers to the buyer. In such a case, it’s important to have language in the lease that expressly allows for such a transfer.

Article by: Amanda Howard

Dental Lease “Use” Clauses Can Grow or Cripple a Practice

A “use” clause is a term in a dental lease agreement that defines how a provider can use the leased space. In other words, a use clause defines the activities one can undertake and what services one can provide in a leased space. A use clause will typically also define the landlord’s control over the use of the leased space and the consequences for failing to abide by the use clause. A use clause typically works together with an “exclusivity” clause.

Despite its importance, use language is often overlooked by tenants because tenants don’t think it has as great an impact as it does, or tenants don’t seek legal advice and come to understand its significance. As a tenant, it is critical to review use language. A broadly defined use clause can facilitate the growth of a dental practice. Whereas a narrowly defined use clause can cripple it.

Consider: You are a general dentist who has offered general dentistry services for many years. You see an opportunity to grow and expand your business by adding and providing new services. You’ve decided that you want to bring an orthodontist and cosmetic dentist into your practice so that your business can be a one-stop shop.

Which use clause will allow you to grow your business? Which use clause will stop you from expanding?

  •  “for oral health and any and all other related activities”

OR

  •  “for general dentistry only”

If your lease contains the second clause, your opportunity for expansion is severely limited. And, if you choose to expand your services anyway, your landlord could terminate your lease and seek damages for breach of contract, depending on the lease terms.

The moral of the story is: Don’t underestimate the importance of the use clause in your dental lease!

Compounded Bioidentical Hormone Replacement Therapy (cBHRT) in Jeopardy of Being Added to the FDA’s “Difficult to Compound List”

Currently, cBHRT is not on FDA’s list of difficult to compound products, falling under certain exemptions of the FD&C Act, particularly, Sections 503A and 503B. Under Section 503A, a human drug compounded for an identified individual patient based on a prescription qualifies for exemption from three sections of the FD&C Act: 1) current good manufacturing practice for drugs; 2) labeling of drugs with adequate directions for use; and 3) approval of human drug products under new drug applications or abbreviated new drug applications. One of the criteria for these exemptions is that the Secretary has not identified the drug, by regulation, as a drug product that presents demonstrable difficulties for compounding that reasonably demonstrate an adverse effect on the safety or effectiveness of that drug product. However, before the Secretary may promulgate regulations to add a drug to the difficult to compound list, it must convene and consult an advisory committee on compounding of such drug(s), unless the Secretary finds that issuance of such regulations before consultation is necessary to protect the public.Continue reading

Genetic Testing: Be Hopeful but Wary

Genetic tests are valuable because they can provide important information to patients and their medical providers regarding diagnoses, treatment, and disease prevention. However, the rapid growth in the number of tests ordered, especially in light of the telemedicine expansion during the pandemic, has invited well-earned scrutiny to the industry.

Make no mistake: genetic testing is heavily regulated (and enforced). The Federal Anti-Kickback Statute, Eliminating Kickbacks in Recovery Act, and Commercial Insurance Fraud Law have all been used to prosecute unscrupulous marketers, call centers, and telemedicine providers in the last few months. Kickbacks in exchange for genetic specimens are just as illegal as kickbacks for patients. Three months ago, a Florida man was sentenced to 10 years in prison for conspiracy to commit health care fraud. His actions resulted in the submission of approximately $3.3 million in fraudulent claims to Medicare for genetic testing.Continue reading

The Five Levels of The Medicare Appeal Process

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medicare appeals pricessBy: Zach Simpson

There might be times when Medicare denies coverage for an item, service, or test that you or your company provided. In the event this occurs you have the right to formally disagree wit the decision and encourage Medicare to change it. Therefore, understanding the appeals process for Medicare claims is vital for all providers. The aim of this article is to give providers a better understanding of the five (5) levels of the Medicare Appeal process, and what must occur at each level.

The Medicare Fee-For-Service (FFS) has five levels in the claims appeal process:

Level 1 – Redetermination by a Medicare Administrative Contractor (MAC)

Level 2 – Reconsideration by a Qualified Independent Contractor (QIC)

Level 3 – Disposition by Office of Medicare Hearings and Appeals (OMHA)

Level 4 – Review by the Medicare Appeals Council (Council)

Level 5 – Judicial review in U.S. District CourtContinue reading

6 Essential Questions For Audit Preparedness

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medical practice auditBy: Zach Simpson

As you train your staff on the changes that were recently made regarding evaluation and management coding it is very important to ensure that your staff understands the auditor’s perspective as well. There are four distinct portions of an auditor’s tool when evaluating the documentation guidelines for office/outpatient evaluation and management (E/M) services (99202-99215). The four distinct portions are diagnoses, data, risk, and calculation of medical decision making (MDM).  In order to ensure that a provider’s progress note is complete in the auditor’s eyes the provider should ask themselves the following six questions to create the best chances of successfully meeting the auditors expectations:

  1. Does my progress note contain a medically appropriate history and examination?
  2. Were my diagnoses addressed appropriately?
  3. Did I document all orders and data reviewed?
  4. Were other professionals included in my documentation that I worked with?
  5. Was an independent historian used?
  6. Does the documentation support the level of risk I chose?

For the remainder of the article, I am going to dive deeper into each question above so that you, as providers are able to recognize insufficient areas in a provider’s E/M documentation when you perform a self audit to better your practice.Continue reading

How Often Should Chiropractors Have Their Patients Sign A New Advance Beneficiary Notice (ABN)?

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chiropractor abnBy: Zach Simpson

Over the years I have come to grasp that ABNs although very useful are quite difficult to implement appropriately for chiropractic practices. My goal for this article is to help practices understand how often ABNs should actually be signed by their Medicare beneficiary patients. A question I am typically asked about ABNs is when should a patient sign a new one? Many offices have the misconception that a new ABN should be signed by Medicare beneficiaries at the beginning of each year which is not the case.

Medicare only requires that the ABN form be completed before the first spinal chiropractic manipulative treatment is rendered for maintenance, wellness, palliative, and/or supportive care. Until one of the following takes place the ABN remains active:

  • In the event a new condition or active treatment is initiated the current ABN would be rendered invalid because the active treatment would likely meet Medicare’s medical necessity guidelines and be considered eligible for payment again; or
  • The current ABN on file is more than twelve (12) months old. In the event the ABN is more than twelve (12) months old an updated ABN must be signed in order to continue maintenance care. Once the new ABN is signed it shall be valid for twelve (12) more months or until another active treatment is initiated.

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