Privatización o liderazgo profesional / Privatization or professional leadership

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Pushing the limit. Minnesota probe of Accretive's collection practices raises new questions on hospital billing policies.

The collection practices of hospitals once again grabbed the spotlight, with a report from Minnesota Attorney General Lori Swanson, left, that raises questions about aggressive techniques used by Accretive Health at Fairview Health Services in Minneapolis. While Fairview has already ended its contract with Accretive, a number of large systems still use the Chicago-based billing company.

Majority of hospitals won't bill for 'never events'.

Policy also includes apologies, reporting events to agencies such as The Joint Commission. What are considered normal customer service practices in other industries are 'radical' in health care. Risk manager says 'doing the right thing' also can help reduce your hospital's liability exposure.

Hospital associations put nix on billing for 'never events'.

Hospitals, associations agree that the policy is 'the right thing to do'. CMS announcement it would not reimburse for specified errors may have impacted timing of policies. Not paying for adverse events likely a trend to spread to other states.

Ripple effect: ethics begin with the board.

Understanding and upholding the highest ethical standards has never had higher stakes for boards, but it often means choosing between several "rights."

Ethics, morals, and integrity: focus at the top.

Five questions provide a good starting point for CFOs to verify that their organizations are operating ethically: Do we have clearly outlined policies and procedures in place? How frequently does our board's membership change? Do we consistently give our board enough information to make informed decisions? What is the nature of our internal audit function? Do we have a chief compliance officer?

The ethics of administrative credentialing.

A vascular surgeon has practiced in the same community for more than 20 years, holding privileges at the two largest local general hospitals. She is widely respected and admired by patients and fellow physicians in all specialties, and her results are consistently good. Recently, the board of directors at the hospital that has been the source of 80% of her case referrals hired a notorious slash-and-burn management firm to improve the balance sheet. The new chief executive officer (CEO) installed an information technology system that can provide management with physician-specific figures on costs and reimbursements. The management consultants identified the 10% of physicians with the worst cost/reimbursement ratios over the preceding 5 years and persuaded the board of directors to order their clinical privileges withdrawn. Our seasoned surgeon learns that she is among the targeted group. Is there an ethical issue here, and, if so, how should she respond?

Compliance. What's around the corner?

Compliance officers and financial managers should forge an alliance to ensure their organization's ethics and integrity. Many financial and compliance issues stem from clinical research. Billing for experimental devices must follow specific rules, especially when payment is from Medicare. The charge description master should receive detailed attention to improve efficiency and net revenues. Violations of protected health information can have serious financial implications.