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Helping Physicians Maximize Their Shared Savings

Through Voluntary Alignment

As Accountable Care Organizations his or her cardiologist as the doctor often benefit from a 20% to 30%
(ACOs) continue to evolve, the who delivered the most care, then the increase in Medicare fee-for-service
Centers for Medicare & Medicaid cardiologist would be considered the patients attributed to their care.
Services (CMS) continue to encour- patient’s “primary physician.” That can mean tens of thousands of
age physicians to assume financial Now, with voluntary alignment, dollars in incremental revenue – not
risk for the patients attributed to their patients can identify their primary only from shared savings, but also
ACO. In fact, the most recent changes physician on their own, independent from performance bonuses that
by CMS incentivize ACOs to assume of claims data. This ensures patients’ Genuine Health ACO pays to its par-
greater upside risk by minimizing primary care doctors – those who ticipating physicians when they meet
downside risk. likely have the most thorough and certain criteria. In addition, our par-
These models are based on compar- holistic understanding of the patient’s ticipating physicians earn higher
ing the actual cost of care for a health – serve as the “captain” of reimbursement for their patients
defined population of Medicare fee- patient’s care team. attributed to our ACO.
for-service beneficiaries with the BY GAMIL KHARFAN ACOs offer a win-win for Medicare
anticipated cost for delivering care to fee-for-service beneficiaries and their
that same population. If the actual organizations, the greater the oppor- How Does A Patient Align primary care providers. However, it’s
costs are less than the anticipated tunity to demonstrate savings. With A PCP? vital these patients are attributed to
costs, then the ACO – and its physi- Likewise, for the physicians who This concept of voluntary align- the correct doctor. And Genuine
cian members – share in the savings. comprise these ACOs, patient attribu- ment makes good sense for patients Health ACO has created a voluntary
Those ACOs with well-conceived tion can mean significantly greater as well as their physicians. However, alignment program to make certain
and well-deployed care management income. as is the case with many Medicare- our participating physicians get the
programs can often achieve signifi- related enterprises, bureaucracy can credit and the income for every
cant savings and earn handsome make processes challenging. patient possible.
bonuses. From robust preventive Voluntary Alignment Trumps Voluntary alignment is no exception
care, to post-discharge follow up, to Claims Data to the rule. Learn more how Genuine Health ACO
ensuring medication adherence, suc- Historically, a Medicare fee-for-ser- For this reason, at Genuine Health can help streamline the voluntary align-
cessful ACOs produce better health vice beneficiary who elects to partici- ACO, we’ve created a program specif- ment process for your practice by
outcomes, prevent hospitalizations, pate in an ACO would be aligned ically focused on voluntary align- contacting Gamil Kharfan, Chief
and reduce overall healthcare spend- with the doctor who provided the ment. We do the heavy lifting so our Growth Officer for Genuine Health, at
ing. most care to that patient over the pre- physicians and their office staff don’t (786) 878-5500, or
For these forward-looking ACOs, vious twelve months. Therefore, if a have to. As a result, physicians who gkharfan@genuinehealthgroup.com.
the more patients attributed to their patient’s Medicare claim data shows participate in Genuine Health ACO

Telehealth in Florida; Has Its Day Finally Come?

The 2019 session of the Florida Legislature addressed an issue that has consistent with his or her scope of practice … for a health care pro-
become increasingly problematic for physicians trying to deliver cost fessional who provides in-person health care services to patients in
effective, quality, and responsive medical services – the growing demand this state.” Thus, the standard of care is no different whether treating
for telehealth. In addition to potential cost and timeliness benefits, the a patient using telehealth or in-person.
public’s acceptance of and expectation for telehealth services reflects the - Place of Service. The place of service where a professional tele-
increasing trend towards consumerism in this industry. Specifically, the health service is rendered is the location where the patient is located
tendency to provide health care services in locations that are responsive at the time services are performed or in their county of residence in
to consumers’ preferences, while protecting their safety. Florida. This is likely to prove to be problematic. For example, imag-
The 2019 Florida Legislature tried to address many of the questions ine while driving through Palm Beach County a resident of Miami-
surrounding the delivery of professional medical services using tele- Dade County engages in a telehealth consultation with a telehealth
health by adopting HB 23, which created § 456.47, Florida Statutes- Use provider located in Hillsborough County, who allegedly
of telehealth to provide services (“Telehealth Act”). misreads/misinterprets/fails to adequately explain a test result; would
The Florida Legislature elected to use the term “telehealth”, rather the place of service for any resulting malpractice suit be Palm Beach
than “telemedicine”, to mean “… the use of synchronous or asynchro- BY STEPHEN H. SIEGEL, or Miami-Dade County?
nous telecommunications technology by a telehealth provider to provide ESQ. The Telehealth Act represents the first step in clarifying the use of
health care services, including, but not limited to, assessment, diagnosis, this health care delivery method in Florida. However, it is not as com-
consultation, treatment and monitoring of a patient; transfer of medical data; patient prehensive as some may have hoped. For one thing, there still are limitations on the
and professional health-related education; public health services; and health admin- services physicians may deliver via telehealth. For example, a qualified ordering
istration. The term does not include audio-only telephone calls, e-mail messages, or physician still may not authorize a qualified patient to obtain or reauthorize that
facsimile transmissions.” Thus, the Florida Legislature recognized that telehealth may patient’s continued use of medical cannabis.
be employed in a wide variety of situations. Probably more disappointing, the Telehealth Act did not clearly address a major
The definition of who qualifies as a “telehealth provider”, is surprisingly broad and hurdle to the development of this delivery modality in Florida – reimbursement. The
includes any individual who – Act only requires a telehealth provider and payer to develop “mutually acceptable
1. provides health care and related services using telehealth and who is licensed or payment rates or payment methodologies for” telehealth services. This, essentially, is
certified under one of variety of Florida statutory schemes; what Florida’s physicians have been doing historically. The Act does not require pay-
2. is licensed under a multi-state health care licensure compact of which Florida is ers to reimburse physicians for providing telehealth services; thus, a payer may elect
a member state; or not to cover these services. The Act also does not require parity or any relationship
3. is licensed in another state, providing services to a patient in Florida, registered between what a payer reimburses a physician for an in-person visit and reimburse-
under and complies with the requirements of the applicable Florida board or depart- ment for a telehealth visit. Thus, the Legislature failed to address an issue many view
ment, and meets Florida’s financial responsibility requirements. as critical to the development of a robust telehealth delivery system.
Historically, the Florida’s boards, particularly the Board of Medicine, have taken the The good news is the Florida Legislature will be back in 2020, and members will
position that in order to provide telehealth services to a patient located in Florida, the have another opportunity to address the state of telehealth in Florida.
rendering physician must be licensed in this state. Clearly, that is no longer the case.
The Telehealth Act also addresses several issues that have arisen as this method of Stephen Siegel, Partner in the Coral Gables office of Lubell/Rosen, can be reached at
delivering health care services has evolved: (305) 298-8640 or shs@lubellrosen.com.
- Standard of Practice. A telehealth provider is expected to practice “in a manner

8 June 2019 southfloridahospitalnews.com South Florida Hospital News