the Grace Report Provides Important Private Intelligence, Gathered Exclusively
for OBs & GYNs, Their Practice CEOs, and Key Administrators.

Headlines- April 3, 2006
THE GRACE REPORT

Headlines- April 3, 2006

Commentary and Opinion by Robert L. Michel:
Medicare Prepares to Publish Its Fees on the Web

IN A FEW WEEKS, the Centers for Medicare and Medicaid Services (CMS) will publish its reimbursement prices for common procedures on its Web site at www.medicare.gov. The objective is to allow consumers to see the fees Medicare currently pays to hospitals and physicians. This will allow uninsured patients to negotiate comparable discounts for services they receive.

This step is the first of several that federal healthcare officials will take to
make the prices they pay for healthcare services accessible to the public.Within a few months, federal Web sites will publish the negotiated prices for healthcare services provided to the Department of Defense, the Federal Employees Health Benefits Program, and private health plans in six communities.

These actions have a common goal: to create transparency in the
discounted prices federal agencies pay for healthcare and to allow
consumers to use this information to make informed decisions about their care. Health and Human Services (HHS) Secretary Mark Leavitt has dubbed this initiative “payer power.” During the next couple of years, his agency plans to require hospitals to publicly report data on mortality and outcomes on a variety of diseases, ranging from heart attacks to infection. It is expected that consumers, including senior citizens, will use price and outcomes data to shop hospitals and physicians in advance of elective surgeries and other procedures.

I hope most of you grasp the implications of this development. Federal
healthcare officials are irrevocably moving the American healthcare system toward a “consumer first” environment. The immediate goal is to give patients the same full range of information available to them as when they buy a car or a refrigerator, said Leavitt.

Consumer-directed health plans give patients a powerful economic
motive to know all the costs of their care—and negotiate discounts in
advance of elective services. As the federal government puts healthcare
prices from Medicare, the Department of Defense and the Federal
Employees Health Benefits Program into the public domain, it won’t be
long before ob-gyn groups get phone calls from patients inquiring about
prices. For this reason, it is timely and smart to develop policies and
procedures to meet the needs of price-shopping consumers.

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Coding for Ob-Gyn Services: Accuracy Boosts Cash Flow

Ob-gyns who lack a basic understanding of proper coding are likely being underpaid

CEO Summary: Coding specialists say physicians need to understand how to code properly and how to document correctly. They should also be willing to update their coding skills by attending coding seminars and meeting with coding and billing staff regularly. Increased communication between ob-gyns and their billing and coding staff will boost revenue. The consensus among obgyn coding professionals is that ob-gyn groups should make good use of certified coding and billing experts and use electronic medical record (EMR) systems to improve coding accuracy and documentation.

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Coding Expertise Required For Best Financial Outcomes

Billing and coding specialists recommend electronic systems to boost ccuracy & revenue

CEO Summary: Billing and coding has become a highly-complex activity. Many ob-gyn practices regularly bill dozens of payers, each of which has its own rules—and these rules change continually. As a result, it is increasingly tougher for ob-gyns to stay current in their knowledge of coding. Yet, failure to know current coding guidelines and use them appropriately creates high risk in two ways: first, it can expose the ob-gyn group to compliance failures; and, second, it often means the ob-gyn fails to bill and collect for all the legitimate medical services he or she provides.

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Patient Safety Trends:
New Guidelines to Require Single-Patient Hospital Rooms

Goal is to reduce nosocomial infections, cut down medication and other errors, increase privacy

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Payer Update:
Payers Want Patients to Shop Prices at Doctors’ Offices

Health insurers plan to use cell phone feeds to provide prescription drug prices to patients

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Building Physician Referrals To Gain More New Patients

Barlow’s four rules of referrals help ob-gyns develop a steady flow of profitable patients

CEO Summary: One of the best ways to build an ob-gyn practice is to
develop steady sources of patient referrals from other physicians. In this
exclusive interview, physician-strategist Kriss Barlow shares her four rules of referrals. Based on her experience with physicians practicing in different regions throughout the United States, Barlow’s four imperatives will help obgyns develop productive referral relationships with physicians also practicing in the community. Ob-gyns seeking to build a new practice or offer new clinical procedures will find these four rules of referral to be highly effective.

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Medical Ethics Update: Placenta Registry in Oregon Stirs Unwarranted Controversy

Ob-gyns and pathologists nationally are working together to more effectively examine placentas

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INTELLIGENCE: Late and Latent

OB-GYN NAMED TO POST AT PHS

CHICAGO HOSPITAL FACES COMPLAINTS OVER CLOSINGS

Look for the next briefing on Monday, April 24, 2006.

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