$2.5 million settlement shows that not understanding HIPAA requirements creates risk
— HHS, Press Release, April 24, 2017
The press release above, issued by the U.S. Department of Health and Human Services (HHS) was prompted by the theft of a laptop from a parked car in front of an employee’s home. Disastrously, for Pennsylvania-based CardioNet, it contained the protected health information (PHI) of 1,391 individuals. While headlines announcing a costly HIPAA breach are not new to community behavioral health organizations (CBHOs); their implications are increasingly important in today’s tumultuous environment. A steady stream of health care reform, enacted both before and since the Patient Protection and Affordable Care Act (ACA), has left many provider organizations unfamiliar with forms of unseen risk — until now.
The ACA’s myriad clinical, financial and regulatory benchmarks initially ignited these risks, requiring CBHOs to transform once routine business practices. Newly established government auditing programs expanded the definition of fraud and increased both the potential liability and amount of penalty violations. For example, providers that participate in Medicare need to be prepared for the Quality Payment Program changes set forth by the Medicare Access and CHIP Reauthorization Act (MACRA) that fundamentally change the way they are paid. Furthermore, the 21st Century Cures Act, passed in 2016, provides significant funding for treating opioid abuse, but also makes changes to health information technology and data management and provides guidance on compliance with parity. Now—after years of preparing for, adapting to and participating in these changes—CBHOs face new sets of regulatory challenges and opportunities. Even when providers are aware of these challenges, many lack the comprehensive information and planning that can ensure compliance.
Since January, a new federal administration has brought fresh uncertainty to the health care industry. Efforts to repeal the ACA, in whole or in part, have been followed by proposals to cease paying insurance subsidies that currently support the entire Marketplace. Major cuts to Medicaid and Medicare are included in proposed budgets. Recently, the opioid epidemic was declared a national emergency and is expected to continue to receive bipartisan political attention in the future. The impact on resource revenue is less clear. Yet amid these unknowns, there is one certain thing: knowledge and flexibility will be key to navigating the signs of the times.
While many aspects of the ACA are the focus of passionate political debate, the movement toward value-based purchasing (VBP) models is here to stay. Politicians on both sides of the aisle have supported VBP and the Centers for Medicare and Medicaid Services (CMS) have established VBP target goals and timelines. While behavioral health has been slower to adopt VBP than physical health providers, it is likely your organization will soon be paid primarily for the quality, rather than quantity of your care. Whatever comes, it is a good time to craft very careful utilization, conservation and allocation strategies to preserve scarce resources.
Behavioral Health Advisor provides organizations easy access to information that teases out the complexities of our ever-changing compliance environment. In this first issue, we offer resources and tools on up-to-the-minute compliances issues, plus access to informational webinars that complement each issue. You will have quarterly opportunities to learn from compliance experts who can answer your specific questions. These live instructional events help you customize your compliance strategies and stay abreast of the most current issues impacting behavioral health organizations.
We begin with a Value-Based Purchasing Roadmap that guides providers through five key domains requiring risk assessment. Navigating these potential roadblocks will equip providers that participate in alternative payment models avoid hazards. We provide solid directions on utilization of treatment methodologies that support VBP arrangements. Specifically, we offer guidance around medication-assisted treatment (MAT) and cybersecurity; tools that encourage more efficient and effective care. These articles provide rich discussion for C-suite and compliance executives, as well as clinicians who are so critical to successful implementation. Finally, Behavioral Health Advisor will highlight the impact to a few organizations that have collided head-on with specific risks while on this journey.
We hope you enjoy this fresh approach and take full advantage of Behavioral Health Advisors’ new, value-added features. As always, we welcome your questions and feedback. Feel free to email us at Compliance@TheNationalCouncil.org with your reactions and suggestions. We’d love to hear from you!