Medical real estate development expected to boom soon in valley - Business - ReviewJournal.com

Good article about Medical Real Estate and the state of health care in Las Vegas in general:
Medical real estate development expected to boom soon in valley - Business - ReviewJournal.com

Southern Nevada is poised to experience a major surge in medical real estate development in the next few years, an expert at Colliers International said.

The surge will be driven by 79 million baby boomers headed into retirement and millions of Americans covered under President Barack Obama's health care plan, said Stacy Scheer, who specializes in medical real estate properties at Colliers.

She expects to see a wealth of new development and expansion in Southern Nevada's medical office market as the health care industry shifts toward patient-centered accountable care organizations, or ACOs. Small practices and sole practitioners are joining larger ACOs, and the need for skilled nursing and assisted-living facilities is rising, Scheer said.

This massive influx of patients will create demand for more doctors' offices, hospitals, outpatient clinics and long-term care facilities. About 60 million square feet of medical real estate will be developed nationwide.

Colliers formed a specialty group led by Scheer and Andrew Kilduff focusing solely on real estate needs of next-generation health care providers in a rapidly changing market.

There's also a growing trend toward building off the hospital campus as physician groups look for ways to expand while curbing costs, Scheer said.

"The basic premise is you're seeing a migration to off-campus locations and the reason is just higher costs to be in a full-blown hospital," she said. "They're not restricted in construction, and beyond the cost is patient accessibility and convenience. So you're seeing medical facilities like quick-care centers popping up in Walgreens, even Wal-Mart. They're migrating more towards the retail setting."
Las Vegas hospitals are responding to the expected medical boom by expanding facilities. MountainView Hospital has a $68 million expansion project under construction that will add a new emergency room and 12-bed intensive care unit, and St. Rose Dominican Hospital is planning a new five-story, 326-bed tower at its Siena campus.

The $1.5 billion, 150-acre Union Village medical and senior-living complex in Henderson is expected to break ground in 2013.

"Medical is on everybody's radar screen," Southern Nevada Medical Industry Coalition Chief Executive Doug Geinzer said. "Not just medical, but health and wellness. It's a cottage industry and we're already killing it with spa treatments on the Strip. The MGM (Grand) built stay-well suites, totally rehabilitated for wellness fanatics. They've got vitamin C-infused showerheads."
It's all part of the "medical tourism" industry emerging in Las Vegas, he said. The Las Vegas Convention and Visitors Authority hired a full-time employee to focus on medical tourism, and the newly formed Las Vegas Regional Economic Development Council put health care at No. 2 on its priority list.

Las Vegas has some of the best cosmetic surgery facilities in the country and does a great job of protecting patients' anonymity, Geinzer said. And it's relatively cheap to fly here and stay here.
Tom Weniger, business development manager for Crovetti Orthopaedics, said patients are coming from as far as Alaska and China to have surgery performed in Las Vegas. Hip and knee replacement surgery for the 45- to 65-year-old age group is expected to increase 17 times by 2030, he said.
"People are more active now. Exercise used to be a walk, then it was aerobics with Jane Fonda, and now it's gyms and fitness centers," Weniger said. "I know we have tremendous potential for growth."
Dr. Michael Crovetti has performed nearly 350 outpatient surgeries and his patients are usually up and walking the same day, Weniger said.

Scheer said downtown Las Vegas will see new medical development to meet the needs of 1,500 Zappos employees working at their new headquarters, employees of startup technology companies and a growing population of condominium residents.

Research firm Applied Analysis reported 8.3 million square feet of medical office space in the Las Vegas Valley with a vacancy rate of 24.5 percent as of the third quarter, slightly below the 27.6 percent overall office vacancy.

The vacancy rate has been trending downward as demand has outpaced new inventory, Applied Analysis principal Brian Gordon said. He showed 171,209 square feet of positive net absorption, or more space taken than vacated, year to date. Only 44,000 square feet of medical office is under construction.

Contact reporter Hubble Smith at hsmith@reviewjournal.com or 702-383-0491.

OIG: watch for fraud in Home Health Agencies

"CMS and Contractor Oversight of Home Health Agencies (OEI-04-11-00220) http://go.usa.gov/gGU5
 
WHY WE DID THIS STUDY

In 2010, Medicare paid $19.5 billion to 11,203 home health agencies (HHA) for home health services provided to 3.4 million beneficiaries. HHAs are considered to be particularly vulnerable to fraud, waste, and abuse. CMS designated newly enrolling HHAs as high-risk providers in March 2011, citing their record of fraud, waste, and abuse. A 2012 OIG report also found that one in four HHAs had questionable billing, which was concentrated in certain geographic areas where Federal investigators and analysts have focused their efforts to combat fraud, waste, and abuse. Other OIG studies have found vulnerabilities in Medicare contractors' efforts to identify and investigate potential fraud and abuse, as well as limitations in CMS's oversight of these contractors.

HOW WE DID THIS STUDY

We collected information and supporting documentation from CMS, selected Medicare Administrative Contractors (MAC), and selected Zone Program Integrity Contractors (ZPIC) regarding activities to prevent improper payments on home health claims and to detect and deter potential HHA fraud in 2011. In addition, we identified geographic areas prone to HHA fraud, waste, and abuse and determined whether contractor activities focused on these areas. We also analyzed claims data to determine whether Medicare paid HHAs that were suspended or had their billing privileges revoked, and we examined the timeliness with which CMS and its contractors acted on revocation recommendations.

WHAT WE FOUND

In 2011, the 2 MACs we reviewed collectively prevented $275 million in improper payments and referred 14 instances of potential fraud. The four ZPICs we reviewed did not identify any HHA vulnerabilities and varied substantially in their efforts to detect and deter fraud. In 2011, Medicare also inappropriately paid five HHAs with suspended or revoked billing privileges; additionally, CMS did not act on all revocation recommendations.

WHAT WE RECOMMEND

We recommend that CMS:

(1) Establish additional contractor performance standards for high-risk providers in fraud-prone areas,

(2) Develop a system to track revocation recommendations and respond to them in a timely manner, and

(3) Follow up on and prevent inappropriate payments made to HHAs with suspended or revoked billing privileges.

CMS concurred with all three recommendations."

Mass Medicare Payment Adjustment Forthcoming

The Office of Inspector General (OIG) of the Department of Health and Human Services advised in the 2013 OIG Work Plan that they would be reviewing payments for Alien Beneficiaries Unlawfully present in the United States. The OIG will determine whether Medicare payments were made on behalf of beneficiaries who were unlawfully present in the United States on the dates of services. Medicare payment may not be made for items and services furnished to alien beneficiaries who were not lawfully present in the United States. (The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual, Medicare Claims Processing Manual (100-04), Chapter 1, § 10.1.4.8.) Medicare prohibits payment for services rendered to individuals who are not "qualified aliens." (Personal Responsibility and Work Opportunity Reconciliation Act of 1996, § 401.)

These audits that have been conducted by the OIG have resulted in overpayments to providers across the country, including the National Government Services states of business being identified. As a result of these audit findings, the OIG and the CMS have charged National Government Services to begin the process of recouping those overpayments. The first tier of this process has now begun and we have generated the first round of those overpayment adjustments. As with any overpayment situation letters have also been generated. These letters will begin to be mailed on Monday, December 10. The listing of the claims impacted by this action that you will receive with your letter will indicate that; "This claim adjustment was due to a mass adjustment." The detailed description of the adjustment can be found on Fiscal Intermediary Standard System. The letters will contain the guidelines for applying for an extended repayment plan so that you may research that option if necessary.

If you receive one of these overpayment letters it will be of major importance for your facility/office to review it and plan appropriately. All normal overpayment options apply and will be described completely in the letter. It will be important for you to be aware so that your facility/office can stay on top of the overpayment situation and work with National Government Services to control how your overpayment is repaid.

From National Government Services: http://view.email.ngsmedicare.com/?j=ff051670766607&m=fe98137075650c7976&ls=fe6a16757565037c7616&l=ff2c1579756d&s=fe8d1277776c057474&jb=ffcf14&ju=fec11776776d007b&r=0 

Feeling secure about HIPAA Security Audits?

At a recent HIPAA Security Rule conference, Linda Sanchez with the Office of Civil Rights (OCR) advised that the results of the first 20 OCR/KPMG pilot audits found security compliance was in worse shape than privacy compliance. In fact, security gaps or security breach issues constituted 74% of the findings while privacy violations accounted for 26%.

As a reminder, significant funding has been appropriated for the purpose of continuing to audit health care privacy practices. And I know that there has been Federal interest in ramping up compliance investigations in the Las Vegas area. So health care practitioners should be preparing for continued or increased oversight and investigation of their HIPAA practices by HHS. 

Re: NYT, A Hospital War Reflects a Bind for Doctors in the U.S.

The NYTimes reports on doctors' struggles to maintain independence and thrive in a world where hospitals are increasing in influence. One doctor states that "the driving reason [for selling the practice to a local hospital] was the changing landscape of health care delivery and the uncertainty around that." 

But selling to the hospital isn't guaranteed to make life any easier. It's interesting to note how many different types of lawsuits and legal issues are referenced in this article. It seems the only certain things in healthcare are that (1) you're going to be heavily regulated and scrutinized, and (2) you're going to have disputes.

Ready the full NYTimes article: http://www.nytimes.com/2012/12/01/business/a-hospital-war-reflects-a-tightening-bind-for-doctors-nationwide.html?smid=pl-share

Facilities Licensed by the Nevada Health Division

Not all medical offices are licensed by Nevada's Department of Health and Human Services (NV HHS).  This means that Nevada's Bureau of Health Care Quality and Compliance (HCQC) does not have the same jurisdiction to investigate your practice as it does in relation to facilities subject to NV HHS's licensing requirements. Although you probably know who you are (if not please find help), a list of the types of health care facilities licensed by the NV HHS can be found here: http://health.nv.gov/HCQC_HealthFacilities_WhoWeLicense.htm.

If your type of practice or facility is not on this list, make sure to take a careful look at NV HHS's or HCQC's jurisdictional powers if they request to inspect or investigate your facilities.

OIG Recovers $6.9 Billion in FY 2012

In its Semiannual Report to Congress, the Department of Health & Human Services (HHS) Office of Inspector General (OIG) today announced expected recoveries of about $6.9 billion from audits and investigations. The report highlights OIG accomplishments for the second half of FY 2012 (April 1, 2012 - September 30, 2012) and for FY 2012 in total.

The $6.9 billion in expected recoveries consists of $923.8 million in audit receivables and $6 billion in investigative receivables. Read the full release

For comparison's sake, in FY 2011 the OIG reported recoveries of about $5.2 billion consisting which consisted of $627.8 million in audit receivables and $4.6 billion in investigative receivables.

Las Vegas Brings in More Health Compliance Inspectors

From HCQC's Newletter available here

Nevada's Bureau of Health Care Quality and Compliance (HCQC) recently reported that it has hired several new inspectors/investigators, assigned to the Las Vegas office. Some are brand new to the agency, others have been promoted into different roles within the agency, some transferred from education/consulting roles back into regulatory roles within the agency and others have returned to the agency after working in the industry for a period of time. HCQC welcomes this recent influx of new staff to help accomplish our workload; but also recognizes the need to provide good training and guidance and this initially renders us a little less efficient until we bring new employees up to speed. As always, our goal is to assist our industry partners in achieving high standards, through education, regulation and enforcement.

HIPAA Audits

The Office for Civil Rights announced at a recent Health Care Compliance Association conference that it will continue through 2013 the HIPAA/HITECH audit program that started this year. Significant funding has been appropriated for this purpose. Apparently a serious lack of compliance was found in the audits that were conducted and OCR is planning to continue to audit the full spectrum of covered entities in the coming year using the Audit Protocol jointly developed by OCR and KPMG.


The next round of Audits will be focused on Business Associates and Business Associate Agreements.

Fastest Growing Job: Home Health Nurse

In my last post, I mentioned that CNN Money rated home health nurse as one of the most satisfying jobs in America. Today, CNN Money lists it as the fastest growing occupation.

But can you believe they just recycled the same picture? I can.

Home Care Nurse: Top 50 of Best Jobs

CNN Money lists Home Care Nurse as #49 out of the top 100 best jobs in America.

Somehow, though, attorneys didn't even make the list.  See more at http://money.cnn.com/pf/best-jobs/2012/snapshots/49.html

5th Annual Nevada Healthcare Forum

I attended the 5th Annual Nevada Healthcare Forum earlier this month. And I made the news!

You can totally see me in that red box.

To read the full story, go here: http://www.8newsnow.com/story/19777917/affordable-care-big-concern-for-medical-professionals