Senate Fails to Postpone Medicare Physician Fee 10% Cut

 

Senate fails to postpone Medicare payment cut.

In continuing coverage from previous editions of Health and Life Sciences Law Daily, the New York Times (6/27, Pear) reports that physicians now "face a 10 percent cut in Medicare payments next week, following the Senate's failure on Thursday to take up legislation that would have averted the cuts." By a vote of 58 to 40 on Thursday, "Republican senators blocked" the bill, which "would cancel the 10 percent cut scheduled to occur on Tuesday and would increase Medicare payments to doctors by 1.1 percent in January." Dr. Nancy H. Nielsen, president of the American Medical Association, warned that "the cuts would force many doctors to 'limit the number of new Medicare patients they treat.'"

House Approves Medicare Physician Fee Freeze for 2008

The Medicare rules for the physician fee schedule (RB-RVS) would have mandated a 10% reduction for 2008 pursuant to the sustainable growth rate (SGR) formula. Congress postponed that for the first 6 months of 2008, but he 2nd 6 months is looming. Without actionmt he postmenement ends and the automatic 10.1% reduction kicks in automatically. The House has approved another reprieve. Quick Senate action is expected. Excerpts form the WSJ report follow.

Expect the current elected officials to enact the reprieve for the next 6 months and pass this problem on to the new administration.

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Plan Rights to Members of the Military and Their Survivors

EMPLOYEE BENEFITS LAW ALERT

June 25, 2008

EFFECTIVE IMMEDIATELY - NEW LAW PROVIDES NEW EMPLOYEE BENEFIT
PLAN RIGHTS
TO MEMBERS OF THE MILITARY AND THEIR SURVIVORS

Effective immediately, a new federal law, called the Heroes Earnings Assistance and Relief Tax Act of 2008 (HEART Act), requires action to be taken by sponsors of qualified retirement plans and permits action to be taken by sponsors of Cafeteria Plans (or Section 125 Plans) with a health flexible spending arrangement.  Two of the changes made by the HEART Act are summarized below. 

  • Qualified Retirement Plans - The HEART Act requires sponsors to amend their qualified retirement plans to provide additional benefits to survivors of participants who die while performing qualified military service.   For example, if a retirement plan provides that a participant will become fully vested upon his or her death while actively employed by the sponsor, then the retirement plan must now provide that the participant's benefit will become fully vested if he or she dies while performing qualified military service.  The effect is that the participant's survivors will receive a bigger benefit than they would have before the HEART Act was passed.  How the change affects a retirement plan will differ for each retirement plan.  Amendments to the formal retirement plan document and corresponding summary plan description will be required.
  • Cafeteria Plans / Flexible Spending Arrangements - The HEART Act permits (but does not require) sponsors of Cafeteria Plans with a health flexible spending arrangement to allow participants who are called to active duty to take distributions of the unused balance in their health flexible spending arrangements.  Ordinarily, the use-it or lose-it rule requires participants to forfeit the unused balances of their health flexible spending arrangements if they do not incur eligible medical expenses during the year.  Now, participants called to active duty may take a distribution of their unused balance to avoid forever losing the contributions.     

Since the HEART Act is effective immediately, it is important that you consult with the professional responsible for your qualified retirement plans and flexible spending arrangements. You also may contact us for more information on how the HEART Act impacts your employee benefit plans and for assistance in revising the qualified retirement plans and flexible spending arrangements sponsored by your company. 

******

Employee Benefits Law Group: The  Employee Benefits Law Group at Tucker Arensberg, P.C. has a diverse client base of private and public employers.  We are dedicated to working with our clients to resolve complicated legal issues in a practical, common-sense and cost-efficient manner.  In doing so, we routinely work with our clients to design, establish, implement, administer, and terminate many different types of employee benefit plans. Refer to http://www.tuckerlaw.com/practice/employee.html for more information on the Employee Benefits Law Group.

TAX ADVICE DISCLAIMER: Any federal tax advice contained in this communication (including attachments) was not intended or written to be used, and it cannot be used, by you for the purpose of (1) avoiding any penalty that may be imposed by the Internal Revenue Service or (2) promoting, marketing or recommending to another party any transaction or matter addressed herein. If you would like such advice, please contact us

Improving Contributions to Physician Retirement Plans

Introduction

A properly designed retirement program can increase a physician's retirement plan benefit by more than $80,000 while decreasing the practice's contribution to the non-physician and even non-owner physician employees by $20,000. If this $100,000 plus difference catches your attention, read the rest of the article! Our examples illustrate how similarly situated physicians can have dramatically different retirement plan benefits.

Examples

Dr. John is a 55 year old physician who makes approximately $350,000 and is the sole owner of his practice. Dr. John has one 36 year old physician working for him and has 4 staff employees.   In 2007, Dr. John had a commonly-used profit sharing plan with a 401(k) feature for his practice. He wanted to put as much money away as allowed by law on a pre-tax basis for his retirement. (For 2007, the defined contribution limit was $45,000.) For Dr. John to receive the maximum personal benefit under the profit sharing plan in 2007, Dr. John’s practice had to make a total employer contribution of $55,883. The portion of the employer contribution Dr. John received was $29,500, which was equal to roughly 53% of the total employer contribution. (Dr. John could have contributed another $20,500 as a 401(k) contribution, consisting of a $5,000 catch-up contribution that is permitted because he was over 50 in 2007.) [1]

Dr. Jane is also a 55 year old physician who makes approximately $350,000 and is the sole owner of her practice. Dr. Jane also has one 36 year old physician working for her and 4 staff employees. Like Dr. John, Dr. Jane wanted to put as much money away as allowed by law on a pre-tax basis for her retirement in 2007. However, unlike Dr. John, Dr. Jane’s share of her physician group’s total contribution to the retirement plan was 87.8%! Dr. Jane was able to accomplish this by adopting a special kind of profit sharing plan with a 401(k) feature and by adopting a second kind of retirement plan called a “cash balance plan”.   Contributions to the two plans for all employees totaled $141,168, of which $124,000 was allocated to Dr. Jane’s accounts under the two plans. (Dr. Jane also could have contributed another $20,500 as a 401(k) contribution, consisting of a $5,000 catch-up contribution that is permitted because she was over 50 in 2007). 

Summary of Examples

  • In 2007, Dr. John’s practice contributed $55,883 to its retirement plan where Dr. John received a personal benefit of only $29,500, i.e., 53% of the practice’s total contribution.
  • In 2007, Dr. Jane’s practice contributed $141,168 to its two retirement plans where Dr. Jane received $124,000, e.g., (87.8% of the practice’s total contribution.
  • Dr. Jane’s practice contributed a total of $85,285 more to its two retirement plans, and Dr. Jane received $94,500 more contributions to her retirement plan accounts.
 

[1]  All examples were based on actuarial runs performed by Mark K. Dunbar and Molly Balkey of db&z, Inc.

HOW IS THIS POSSIBLE

Many small employers, specifically medical practices, often times have basic retirement plans without understanding the flexibility that can be achieved within their retirement programs. Many employers (similar to Dr. John) provide a straight level of benefit to all employees. However, it is not necessary for Dr. John’s practice to provide the same percentage of contributions for every participant.

Effective retirement program planning takes into account several factors in determining the appropriate retirement vehicle for a practice. Two of these factors are: (1) the amount the owners want to contribute on behalf certain groups of individuals and (2) the amount the owners wish to contribute for themselves.

In very general terms, many physician groups may take advantage of a two qualified retirement plan system: (1) a profit sharing plan with a 401(k) feature and a "new comparability" or "cross-tested" component to their defined contribution plan and (2) a “cash balance” defined benefit plan. Under the first type of plan, employers can group certain employees and provide different levels of contributions to different groups of employees.   

Under the second type of plan, i.e., the cash balance plan, physicians may receive the benefit of contributions in excess of $100,000 each. In this situation, certain employees will participate in the defined benefit plan while others will participate only in the defined contribution plan. The amount of contribution that can be made will depend upon the number, salaries, and ages of the employees and physicians. Using the two qualified retirement plan program can help the owners seriously increase contributions made on their behalf while still passing nondiscrimination tests.

In addition to increased flexibility, the use of both of these types of retirement plans may ensure that a higher percentage of employer contributions are made for owner physicians and, thus, make the program more efficient. 

The following chart illustrates how Dr. Jane’s retirement plans would work with a new comparability defined contribution plan (“DC Plan”) and a cash balance defined benefit plan (“CB Plan”):

Name

Age

Compensation

DC Plan

CB PLan

Total Employer Contribution

% of Total Employer Contribution

Dr. Jane

55

$225,000[1]

$29,500

$94,500

$124,000

87.84%

Other Doctor

36

$150,000

$10,725

$0

$10,725

7.60%

Staff 1

52

$25,274

$1,372

$505

$1,887

1.33%

Staff 2

30

$20,271

$1,101

$405

$1,506

1.07%

Staff 3

30

$21,980

$1,194

$440

$1,634

1.16%

Staff 4

32

$19,193

$1,042

$384

$1,426

1.01%

As mentioned above, the demographics of the physician group can impact the numbers, but many, if not most physician groups, can improve their retirement plan benefits through effective planning and design. A qualified actuary must review the employer's census and an attorney should be retained to draft, review and update the retirement plans themselves. There are numerous federal tax and ERISA requirements that must be satisfied to effectively plan your retirement program, and only experienced employee benefit attorneys can ensure that an employer is meeting all of the requirements.

Tucker Arensberg, P.C. has the capability to design and draft these types of programs for physician practices and any employers at reasonable costs. Please contact Jonathan Grossman at 412-594-5574 for more information regarding this planning idea.



[1] The maximum compensation that retirement plans may take into account when determining a participant’s benefit was $225,000 for 2007. The limit for 2008 is $230,000.

Monitor Your Billing Company's Collection Practices

Collection Notices Must Interpreted From The Point Of View Of The "Least Sophisticated Debtor"

The U.S. District Court for the Middle District of Pennsylvania has reinforced that collection notices must be interpreted from the point of view of the "least sophisticated debtor."

Under the Fair Debt Collection Practices Act, 15 U.S.C. § 1692 (FDPCA), the initial written notice to the consumer regarding a debt owned must contain certain information. At issue in this case was 15 U.S.C. § 1692g(a)(3), which states there must be "a statement that unless the consumer, within thirty days after receipt of the notice, disputes the validity of the debt, or any portion thereof, the debt will be assumed to be valid by the debt collector." (emphasis added).

The court in Galuska v. Collectors Training Institute of Illinois, Inc., found that the language used in the collection notice at issue ("Unless you notify this office within thirty (30) day after the receipt of this notice that you dispute the validity of the debt, or any portion thereof, this debt will be assumed to be valid.") was not in compliance with the requirements of the FDPCA.

It must be made clear to the consumer who would assume the debt to be valid. Use of the words "we" "our" "us" or "this office" were not specific enough to specify to the least sophisticated debtor who exactly would assume the debt to be valid.

The court found that the failure to include "by the debt collector" or its equivalent (i.e. the name of the company or individual, or other specifically identifying information) is sufficient to allege a claim for which relief may be granted.


Danielle Hodnicki
412-594-5605
dhodnicki@tuckerlaw.com

Kansas Heart Hospital ≠ Baptist Health

The Supreme Court of Kansas ruled on May 16, 2008 affirmed in the case of Kansas Heart Hospital, LLC and Cardiac Health of Wichita vs. Badr Idbeis, M.D. and 13 other shareholder defendants, that the Kansas Heart Hospital, LLC and Cardiac Health of Wichita were justified in forcing a mandatory redemption of the other physician's ownership interest due to investment in a competing medical facility.

 

Medical industry commentators were quick to compare this case to the Baptist Health case in which a hospital system is imposing non-competition or loyalty provisions as a condition for obtaining staff membership and clinical privileges, i.e. economic credentialing.

 

Note that the cases, although perhaps similar in impact, are quite different from a legal prospective.  The Kansas Heart Hospital case involves a determination by the Kansas Court regarding the applicability of a very technical provision of corporate law regarding the difference between redemption provisions and corporate by-laws and repurchase provisions in corporate agreements involving private shareholders.  The Court basically enforced the provisions of the corporate agreements voluntarily entered into by the physicians. 

 

Baptist Health is quite a different story.  It involves an attempt by a hospital to enforce economic credentialing by-law provisions which allow physicians to practice within its facilities only if they do not have competing investments.  That case involves the application of fraud and abuse rules and the community responsibilities of non-profit heath care facilities.  The Baptist Heart case has not yet been finally resolved.

 

A copy of the Kansas Heart Opinion appears at the link below.

www.medlawblog.com/Kansas Heart Hospital.rtf

HCQIA Does Not Establish Federal Jurisdiction

The U.S. District Court for the Eastern District of Tennessee concluded that a hospital's affirmative defenses pursuant to the Healthcare Quality Improvement Act (HCQIA) were not sufficient to independently establish federal jurisdiction, and therefore approved a physician's motion to remand the state court case that had been removed to federal court by the hospital defendant. 

 

You can view an analysis of the case by Bart Lee, Esquire (www.medlawblog.com/Breach of Contract.doc) and a copy of the opinion.  www.medlawblog.com/Opinion.pdf

Joint Commission Implementation Task Force to Continue Work on Medical Staff Standard Revision (MS1.20)

 

The Joint Commission announced the suspension of the planned July 2009 implementation date for the revised MS1.20 Medical Staff Standards.  The Implementation Task Force has recommended a full field review and anticipates both changes to the existing proposals and a delayed implementation date.  The full text of the news release is available at the link below.

 

 

http://www.jointcommission.org/NewsRoom/NewsReleases/nr_06_03_08.htm

 

Attorney Successes: Mike Cassidy Co-Authors AHL Peer Review Guide Book and is Reappointed MSCPR Chair

 

The American Health Law Association has just published its revised Peer Review Hearing Guide Book.  Mike Cassidy is one of five co-authors, the others being Patricia Hofstra, Steven Schnier, Ann O'Connell and Al Adelman, the last two of whom were co-editors.

 

Mike was also reappointed as the Chair of the American Health Lawyers Association Medical Staff Credentialing and Peer Review ("MSCPR") practice group.