Appeals court overturns ruling requiring HHS to clear Medicare appeals backlog by 2021

http://www.beckershospitalreview.com/finance/appeals-court-overturns-ruling-requiring-hhs-to-clear-medicare-appeals-backlog-by-2021.html

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The U.S. Appeals Court for the District of Columbia on Friday overturned an order requiring HHS to clear its backlog of Medicare reimbursement appeals by the end of 2020.

On Dec. 5, 2016, U.S. District Judge James Boasberg granted a motion for summary judgment filed by the American Hospital Association in AHA v. Burwell — a lawsuit that centers on the Recovery Audit Contractor Program.

He ordered HHS to incrementally reduce the backlog of 657,955 appeals pending before the agency’s Office of Medicare Hearings and Appeals over the next four years, reducing the backlog by 30 percent by the end of 2017; 60 percent by the end of 2018; 90 percent by the end of 2019; and to completely eliminate the backlog by Dec. 31, 2020.

HHS filed a motion Dec. 15, 2016, asking the judge to reconsider his decision. HHS argued it would be impossible to reduce the appeals backlog on the schedule provided by the court without improperly paying claims, regardless of merit. In January, Judge Boasberg denied HHS’ motion for reconsideration.

In late January, HHS filed an appeal in the case, seeking to avoid the district court’s order enforcing the plan to clear the appeals backlog by the end of 2020.

On Friday, the appellate court sided with HHS.

Since HHS said it was impossible to lawfully comply with the district court’s order, the appellate court ruled it was “an error of law” and “an abuse of discretion” for the district court judge to order HHS to abide by the schedule to clear the Medicare appeals backlog.

“In sum, it was an abuse of discretion to tailor the mandamus relief without tackling the Secretary’s claims that lawful compliance would be impossible,” states the appellate court’s opinion.

The appellate court held that on remand the lower court should determine if compliance with the timetable to reduce the Medicare appeals backlog is impossible.

Physician who claimed to have 11k patients sentenced to 35 years in prison

http://www.beckershospitalreview.com/legal-regulatory-issues/physician-who-claimed-to-have-11k-patients-sentenced-to-35-years-in-prison.html

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A 60-year-old Texas physician was sentenced Aug. 9 to 35 years in prison for orchestrating a $375 million healthcare fraud scheme, according to the Department of Justice.

Federal prosecutors said Jacques Roy, MD, and his cohorts used promises of cash, groceries and food stamps to recruit patients, including some of Dallas’ homeless, as part of the fraud scheme.

From January 2006 to November 2011, Dr. Roy’s office, Medistat Group Associates in DeSoto, Texas, handled more home healthcare visits than any physician’s office in the country. Dr. Roy allegedly certified or directed the certification of more than 11,000 individual patients from more than 500 home healthcare agencies for home health services during that time, according to the DOJ.

“A doctor cannot care for 11,000 patients at once,” Assistant U.S. Attorney P.J. Meitl said during the trial, according to The Dallas Morning News

In April 2016, Dr. Roy, who has lost his medical license, was found guilty on eight counts of healthcare fraud, two counts of making a false statement relating to healthcare matters, one count of obstruction of justice and one count of conspiracy to commit healthcare fraud. Three owners of home healthcare agencies were also convicted on various felony offenses.

In addition to his 35-year prison term, Dr. Roy was ordered to pay $268.15 million in restitution.

BCBS of Michigan faces more than 30 lawsuits alleging hidden health plan fees

http://www.beckershospitalreview.com/legal-regulatory-issues/bcbs-of-michigan-faces-more-than-30-lawsuits-alleging-hidden-health-plan-fees.html

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More than 30 lawsuits filed against Detroit-based Blue Cross Blue Shield of Michigan in the past week claim the insurer charged employers unauthorized and hidden fees for their health plans, Bloomberg BNA reports.

Filed between Aug. 9 and Aug. 11 in Michigan’s federal court, the lawsuits allege BCBSM issued hidden markups to employers’ health plan assets to shore up its finances, the report states. The allegations stem from a 2014 appeals court decision finding the payer responsible for the unauthorized fees under the Employee Retirement Income Security Act. The decision also upheld a $6 million judgment against BCBSM.

More than 200 ERISA lawsuits alleging hidden health plan fees were filed against the payer since the 2014 decision, the report states. A college, an auto parts maker, a plastics manufacturer and a car dealer are among the employers suing BCBSM.

BCBSM did not respond to Bloomberg BNA‘s request for comment.

Operators of nearly 300 cancer treatment centers accused of illegally dividing up Florida market

http://www.beckershospitalreview.com/legal-regulatory-issues/operators-of-nearly-300-cancer-treatment-centers-accused-of-illegally-dividing-up-florida-market.html

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A 50-page federal whistle-blower complaint accuses Florida Cancer Specialists & Research Institute and 21st Century Oncology of illegally dividing services in southwest Florida to maintain their individual oncology care monopolies, according to the News-Press.

The lawsuit, which was filed under seal last year and recently made public, alleges the two Fort Myers, Fla.-based cancer care companies had an illegal “gentleman’s agreement” under which they provided exclusive patient referrals to each other.

The lawsuit further alleges Florida Cancer Specialists allowed unqualified medical assistants to service patients’ surgically implanted catheters.

The federal government declined to intervene in the case; therefore, the whistle-blowers will continue in the litigation.

The lawsuit was filed by Sharon Dill, who served as Florida Cancer Specialists’ vice president for human resources and chief human resources officer between 2012 and 2015, and Christina Sievert, Florida Cancer Specialists’ vice president of clinical financial services between 2013 and 2015.

Ms. Dill alleges she was fired after disclosing an unspecified disability. Ms. Sievert alleges Florida Cancer Specialists retaliated against her for waging a gender discrimination claim, according to the report.

Florida Cancer Specialists said it takes the allegations in the complaint seriously and is looking into the matter. 21st Century Oncology, which filed for Chapter 11 bankruptcy in May, told the News-Press it does not comment on pending litigation.

21st Century Oncology operates 179 cancer treatment centers across the U.S. and Latin America, and Florida Cancer Specialists has nearly 100 treatment locations.

Medicaid Expansion Out of Pocket Spending Low Income

http://www.commonwealthfund.org/publications/newsletters/ealerts/2017/aug/low-income-families-in-medicaid-expansion-states-have-much-lower-oop-spending?view=newsletter_email&email_web=true&omnicid=EALERT1260685&mid=henrykotula@yahoo.com

New Commonwealth Fund research out today demonstrates how states that expanded Medicaid eligibility have not only improved low-income residents’ access to health care but have also reduced what families must spend out of pocket on premiums, cost-sharing, and other related expenses.

Prior studies had shown that low-income residents of states that expanded Medicaid under the Affordable Care Act (ACA) are less likely to experience financial barriers to health care access. But the impact on people’s out-of-pocket spending had not been measured until now.

The new analysis, conducted by a team headed by Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service, found that the average low-income family in a Medicaid expansion state saves about $382 annually relative to a comparable family in a nonexpansion state. Moreover, low-income families in states that expanded Medicaid are less likely than their counterparts to have any out-of-pocket health care costs at all.

The authors say there was no statistically significant difference in outcomes for states that expanded through conventional Medicaid or through a waiver program.

http://www.commonwealthfund.org/publications/issue-briefs/2017/aug/medicaid-expansion-out-of-pocket-spending-low-income?omnicid=EALERT1260685&mid=henrykotula@yahoo.com

 

89% OF EMPLOYEES ARE DEMOTIVATED BY INEFFECTIVE MANAGERS AND LEADERS

89% of Employees are Demotivated by Ineffective Managers and Leaders

It might hurt, but look in the mirror if people around you are low energy slugs.

The greatest ability is the ability to develop abilities.

98% of employees who have good leaders are motivated to do their best. Only 11% of employees with ineffective managers felt motivated to give their best.*

The magic question:

Improvement stops when people believe they’ve reached the level of “acceptable” performance.

Challenge people to reach for the next level by asking a simple question.

“How do we take this to the next level?”

I’ve been asking teams this question. It works.

7 keys to reaching the next level:

  1. Paint a picture of the next level. “What might the next level look like?”
  2. Ask, “What might you do to take your performance to the next level?” Identify three or four possible behaviors.
  3. Create focus before performance.
    • “What do you plan to do?”
    • “What’s important?”
  4. Give pep talks before performance.
    • “You got this.”
    • “I know you can do this.”
    • “I know you’re going to do even better than last time.”
  5. Provide immediate feedback after performance.
    • “You looked down when you were thinking. You lost me.”
    • “You wandered at the end of the meeting. How might you end better next time?”
    • “You seemed resistant when you kept asking the same question. How might you practice greater openness?”
  6. Appreciate improvement. “You paused and lowered your voice before the main point of your presentation.That really worked.” The Boston Consulting Group reports that the number one factor in employee happiness is appreciation for their work.
  7. Clarify reasons for success.
    • “What did you do differently?”
    • “What did you do this time that you need to keep doing?”

Tip: You never get to the next level by repeating the past.

How might leaders bring out the best in others? In teams?

Stop Hiring for Cultural Fit and Start Hiring For Cultural Fitness

https://www.tlnt.com/stop-hiring-for-cultural-fit-and-start-hiring-for-cultural-fitness/?mkt_tok=eyJpIjoiWmpsbE5HVmpNRFl6WXpabCIsInQiOiI0V1Fvbmcrbk1LMVBWcHpDZ3hCYmc1MVJMTlwvT2g1RUdzMHNBeFY3Vit3b2tiU2dDaDdFWStzYzFnaG9YZ1dzVDgrTUZvR2p1T212MTBKTnFVa0RzNUVyWXdNUXhCUlUrV04wVFBqeGhxWWt0aVBBVzQzbENKUjdkTTlMN00zT2YifQ%3D%3D

Culture is the glue that brings a team or organization together. But if the glue is too sticky it can make them stuck instead of making them stay together. Cultural fit can become a limitation rather than a strength.

Which takes me to the topic of hiring the right talent for your organization:

Do you hire people that are a cultural fit?

Or do you hire to improve your culture fitness?

Culture is something dynamic

The notion that people can or can’t fit into a specific culture is, to at least some extent, at odds with the fluid teams organizational structure. Cultural fit as an operating requirement not only forces new employees to adapt but, also hinders your culture’s ability to be influenced by outsiders. It limits its ability to grow.

When interviewing people, I do care about cultural fit,  but I also look for culture disruption. As I like to tell candidates: “I want you to be influenced by our culture but, most importantly, I want you to challenge and influence our culture too.”

Cultural dynamics involve an ongoing struggle between old and new elements. If you only stick to what fits your existing culture, your organization will get stuck. Yet, if you only care about the new shining object, you might be throwing away core elements of your culture just for the sake of change.

Before practicing any competitive sports, we need to prepare our body. We stretch our muscles and warm up, not just to avoid injuries, but also to make sure we can play to our highest potential.

The same is true when confronting change. Just like with sports, you need to stretch your organizational culture. It needs to prepare, to warm up, to be ready to adapt to an ever-changing world.

Hire for cultural fitness

When evaluating candidates, choose those that will make your team grow. Stretch your culture by hiring people who will make it more adaptive, experimental and resilient.

Here are some considerations when hiring for cultural fitness:

  • Amplify your team’s perspective:Hire people with diverse backgrounds, skills and personalities to avoid biases and so you are drinking something more inspiring and refreshing than your own corporate Kool-Aid.
  • Encourage teams to dissent:Promote differences and tensions, not just affection. Dissent is not comfortable for everyone, but is the only way to avoid group thinking and stretch your team beyond its comfort zone.
  • Continuously challenge your culture: Hire opinionated people, hire outsiders or hire from outside your industry. Bring someone with the right talent, but goes against your culture. Shaking things up from time to time will keep your culture in good shape. As I wrote here, misfits are the best option for energizing a team.
  • Promote diversity of thinking not just demographic diversity: Train your team to embrace difference of opinions. The more heterogeneous the members, the more interesting and productive the team. Being more open to people from different walks of life will provide fresh eyes and make the team smarter. It will help solve for the “demographic” diversity needed too but with a purpose.

Diversity takes training

The real problem behind diversity is that teams are not trained to deal with differences of opinions. Managers and team members alike have been trained to think and behave the same: the corporate way. People are expected to accommodate rather than to challenge the status quo.

One of the key issues of bringing “diverse” people to a team is that they see things differently. They challenge things through their fresh eyes. And not every organization and manager can swallow that.

Here are some points to help embrace diversity to improve cultural fitness.

  • Diverse means different not inferior: Conversations around diversity need to shift from quota to curiosity. Instead of thinking how we can provide a certain demographic with opportunity — a hierarchical approach — we need to ask what we can we learn from people that are different from us. Diversity is about becoming better at interacting with those who can provide fresh eyes and challenge the way we operate.
  • Quotas limit rather than provide opportunities: Establishing percentages to have representation from different sectors might come from a place of good intention. But, in most cases, it misses the point — the need to create a balanced team. I’ve seen many companies that use quotas, simply to check the box and appear to be a good corporate citizen. But they have little commitment to embracing diversity of thinking.
  • People are more than a demographic: Being part of a minority (age, gender, sex preference, etc.) is just one aspect of any person. Our identity is more complex than our religious or sexual preferences. Those do play an important role. But who we are is a composite of multiple factors: our origin, experience and dreams. Organizations need to encourage their teams to see people beyond their demographics.
  • Encourage transparent conversations:Trust is the basis in which all emotional transactions are done. And is one of the most powerful elements to keep culture alive. Conversations around diversity are still too controlled. Organizations need to discuss these things more openly. Help people realize we are all different, not just those who don’t belong to our tribe. Creating experiences where people can share their journey or their personal hobbies and passions can definitely spark curiosity and show how that everyone can learn from each other. Creating a culture of transparency can help reposition diversity as learning.

Why cultural fitness matters to me

Everyone can learn (almost) anything. And anyone can adapt to any corporate culture. It can be hard or tough but smart people always adapt.

What I care the most, is how a new hire can help make our organization smarter. This is my checklist of what I look for:

  • They are smart and talented
  • They possess the ability to adapt to change
  • They are genuine and have a voice of their own
  • They are open to learn
  • They are generous rather than selfish

If they score well in the above, then they will definitely help our culture stretch, regardless if they are – today — the right cultural fit.

One last thing. I always like to ask candidates: “What are you bringing to the table that is unique?” Basically, I want to know not just what that person is good at but how they will help make our organization smarter. I want people who will build and strengthen our cultural fitness.

A Looming Leadership Talent Crisis: Can you solve the Leadership gap?

https://cdn2.hubspot.net/hubfs/498900/WP_Healthcare_Looming%20Talent%20Crisis.pdf?t=1503343642250

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