Connect Archives

June 2015

Monday, June 22, 2015

HEALTHSPRING TERMINATION NOTICE

HealthSpring has notified Health First Network, Inc. that they are terminating their agreement with us effective midnight 12/31/2015.

HealthSpring will be contacting your office to contract directly with them. If you have any questions regarding the termination, please contact Jackie Murph, HFNI Director, Network Development/ Provider Relations/Credentialing at (850) 438-4487.

HEALTH FAIR

Blue Cross / Blue Shield will be hosting a health fair at their retail clinic on the corner of Airport Blvd. and 9th Ave. on August 1, 2015 between 8:00 am and 7:00 pm. If you would like to participate, please contact Eric Buchanan at (850) 202-4150.

COMPLIANCE UPDATE

On June 9, 2015 the OIG released a Fraud Alert regarding Physician Compensation Arrangements. In it they warn that “compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for bona fide services the physicians actually provide.” Even if the services are legitimate and the compensation rate is fair market value, if even one of the motivations for the arrangement is to influence referrals of Federal health program business, the arrangement can violate the anti-kickback statute.

The OIG recently settled claims against 12 physicians for a variety of alleged violations including:
1) Payments took into account the number of referrals made by the physician;
2) Payments were not at fair market value;
3) The physician did not actually provide the services, or;
4) The entity to which the physician made referrals paid all or part of the salary of the physician’s office staff.

SHARES FOR SALE

Recently, Health First Network, Inc. ("Health First") has received notice from several of our shareholders that they would like to sell their shares. Pursuant to Health First’s Shareholders Agreement, the selling shareholders are authorized to sell their shares to "Permitted Transferees" – which includes existing shareholders and network physicians.

If you are interested in purchasing Health First shares from a current shareholder, and you are an existing shareholder or network physician, please contact E.L. Roche, Chief Financial Officer, at 850-438-0818. Your response will be an indication of your interest in purchasing shares, but it does not obligate you to purchase, nor obligate any shareholder to sell to you, any shares. After we determine the number of shareholders and network physicians interested in purchasing shares, we will follow up with relevant information for the potential buyers and sellers. Interested shareholders and network physicians will be listed on a first-come, first-serve basis.

CHRONIC CARE MANAGEMENT (CCM) PHYSICIAN PARTICIPATION

We introduced our CCM program in last month’s newsletter. Since then we have started our outreach to a number of our PCP’s with the details of the program, and there has been a lot of interest, especially in the smaller practices. Our plans are to begin loading the eligible patients who consent to CCM (a CMS requirement for participation) into the registry by the first of July. We will be posting our progress with the Beta program on a regular basis, and hope to open this program to additional practices by early fall. If you have questions, please contact William Whibbs, M.D. at 850-438-0818.

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TERMINATION NOTICE FOR PPO PLANS EVOLUTION PRIME/TRANDITIONAL AND INTERPLAN

Evolutions Healthcare Systems Prime/Traditional and Interplan Healthcare will no longer be contracted with Health First Network, Inc. (HFNI) after August 27th, 2015.

Please contact Jackie Murph, Director, Network Development/Provider Relations/Credentialing at 850-438-4487 if you have any questions.

THE ASSOCIATION OF MEDICAL PRACTICE MANAGEMENT (AMPM)

The Association of Medical Practice Management (AMPM) is a newly formed organization in our area. This organization was created to serve as an environment for medical professionals to come together and share knowledge, provide practical management training, and facilitate networking opportunities for its members.

AMPM will hold monthly Lunch & Learn sessions on the third Thursday of each month, at 11:30 am at the Pensacola Bay Center with the exception of June 2015. In addition, they will hold an annual seminar to offer more in-depth training of the most relevant topics applicable to our field. Membership in the AMPM is not a requirement to attend any of the sessions offered, but it is certainly encouraged!

The Association of Medical Practice Management (AMPM) is proud to announce their Inaugural Seminar Event. It will be held on Wednesday, June 24, 2015 8:00 am - 4:30 pm at the Crown Plaza Grand Hotel in Pensacola, FL. This all day event features speakers: John Beard and Gary Lucas, who will provide extensive coverage of ICD-10 coding training. Open to all medical professionals, including physicians, ARNP's, PA's, Administrators, Office Managers, Billers and Coders, etc.

For more information you can visit their website at www.AMPMgroup.org
4 CEUs - Recognized by AHIMA
7 CMEs - AMA PRA Category I credits through MECOP

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2016 EHR HARDSHIP EXCEPTION APPLICATION AVAILABLE; APPLY BY JULY 1ST

Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.

The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use, and how to apply.

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CMS ANNOUNCES JULY 2015 TRANSITION FROM IACS TO EIDM

The Centers for Medicare & Medicaid Services (CMS) would like to inform Physician Quality Reporting System (PQRS) participants and their staff to an important system update scheduled to be in place on July 13, 2015.

The Individuals Authorized Access to CMS Computer Services (IACS) system will be retired, but current IACS user accounts will transition to an existing CMS system called Enterprise Identity Management (EIDM).

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THE NEXT STEPS TO TAKE FOR A MEDICAL PRACTICE CLOSURE OR RETIREMENT

When a medical practice closes or a physician retires, one of the most important things to address is patient medical records. We recently covered the first steps to take when facing a medical practice closure, like the importance of safeguarding confidential information. After taking inventory of medical records and contacting a document storage company, take these next steps to carry out a medical practice closure to protect patient files and stay in line with regulations.

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ADDITIONAL SERVICES

As part of the commitment of The Sigma Group at Morgan Stanley to bring research and market information to the physicians at Health First Network, Inc., the following is from Morgan Stanley’s Global Investment Manager Analysis.

Choosing Managers with Adverse Active Alpha
In the investment business, “alpha” is the holy grail. Alpha represents the difference between a portfolio’s actual returns and the performance expected given the amount of risk the portfolio manager undertook as measured against a passive index or benchmark. Simply put: Did the manager add value? After all, why employ active management if the results are no better — or even worse —than the indexes? Why not just invest in low-cost index funds?

Of course, active money managers hope to outperform their benchmark indexes. Our analysis indicates that over time, about half of them have done so before fees. The real issue is how to spot the outperformers in advance. Morgan Stanley’s proprietary Adverse Active AlphaSM manager ranking tool attempts to do just that. This screening process, developed by the Global Investment Manager Analysis team seeks to identify active managers with strong stock-picking skills and the ability to outperform indexes and peers across cycles. It points toward managers whose investment processes incorporate factors linked with a greater likelihood of outperformance.

ACTIVE SHARE
Adverse Active Alpha builds upon academic and industry research indicating that higher “active share” managers outperform lower active share managers over time. Of course, past performance is not a guarantee of comparable future results. The “active” component of the screening methodology seeks managers with high active share relative to peers. This metric gauges how different a portfolio is from its benchmark based on its security weightings. It also often captures how much conviction a manager has in a particular investment idea.

In our view, active share alone is not enough. However, managers must effectively combine high active share with low-to-moderate tracking error to score more favorably in Adverse Active Alpha. Tracking error measures how closely a portfolio’s return follows its index return. By limiting tracking error, we attempt to find managers that are not seeking to outperform based on factor bets such as large overweight positions in particular sectors or industries, such as a 30% allocation to a sector that makes up 20% of the benchmark index. While such trades may at times be profitable, they tend to be more unpredictable. Additionally, we find that processes that emphasize factor bets are often less repeatable.

PERFORMING THROUGH HEADWINDS
Intuitively, one would imagine that managers able to outperform when most of their peers are struggling likely possess investment skill. With this in mind, the “adverse” component of the screening tool awards managers that performed well in difficult markets for active managers, such as periods when the majority of managers underperformed. We do this by breaking down track records into snapshots of time and scoring each period based on factors indicative of how difficult the environment was for active managers to outperform their index. By scoring a manager’s track record of out-performance based on the degree of difficulty, the rankings award managers who were able to rise to the top in difficult environments.

ACHIEVING ALPHA
We believe that managers able to outperform when their peers are challenged while also executing an investment process exhibiting high active share and low-to-moderate tracking error are more likely to possess genuine stock-picking skill. Additionally, our analysis thus far has shown that our methodology may produce higher realized returns than screening for managers on each factor individually.

For more information about Adverse Active Alpha and the methodology involved, ask the Sigma Group at Morgan Stanley for a copy of the publication Adverse Active AlphaSM Manager Ranking Model, dated December 3, 2013.

ADVERSE ACTIVE ALPHA is a registered service mark of Morgan Stanley and/or its affiliates. U.S. Pat. No. 8,756,098 applies to the Adverse Active Alpha system and/or methodology.

©2015 Morgan Stanley Smith Barney LLC. Member SIPC. Consulting Group is a business of Morgan Stanley. CRC988400 12/14 CS8072152 04/15