Health Literacy Needs a Place in Physicians' Practices

I was invited to sit in on a presentation by Mark Dumoff, an expert on patient communication and health literacy, to the chief medical officers of a large private insurer a few weeks ago.

It struck all of us, as we struggle to adapt to legislation that attempts to set our healthcare system on the right track with new taxes, mandates, and regulation, that fundamentals are falling to the wayside. Failing to master basics like doctor-patient communications is hugely expensive in terms of quality of life, time and money.

The statistics Dumoff outlined are a wakeup call:
• 90 million adults have low health literacy levels
• Cost to the U.S. economy : $106 billion to $238 billion/year
• $1.6 trillion to $3.6 trillion burden to future generations in today’s dollars
• White, native-born Americans are the majority group

This happens because one out of three patients can’t understand instructions for self-care, after-care, and transitions in care from one setting to another. Another one out of three struggles with them. As a result, patient transitions and coordinated care are adversely affected, which researchers say caused $25 billion to $45 billion in wasteful spending in 2011, mostly due to avoidable complications and hospital readmissions.

The cycle is as familiar as the solution seems to be elusive:
1. Patient seeks medical help
2. Patient is asked to complete complex, confusing forms
3. Doctor explains patient’s condition and treatment plan using medical jargon
4. Doctor writes multiple prescriptions and referrals for tests
5. Doctor does not confirm patient’s understanding
6. Patient goes home with complicated, generic instructions
7. No one follows up with patient
8. Patient takes medications incorrectly and does not follow up
9. The cycle begins again - patient seeks medical help

Those with chronic conditions such as diabetes, hypertension, and asthma are at the highest risk of disease progression and co-morbidity while patients in transition from acute to sub-acute care for conditions such as CHF, COPD, pneumonia, and AMI are at the highest risk of unnecessary hospital readmission.

As of Monday, Medicare will start fining hospitals for having too many patients readmitted within 30 days of discharge due to complications. About two-thirds of the hospitals serving Medicare patients, or about 2,200 facilities, will be hit with penalties averaging $125,000 each this coming year according to government estimates. The likely response will be to focus on discharge instructions and to initiate quality and patient experience measurements for their admitting physicians as a barometer of risk.

In an emerging era of shared risk and performance-based remuneration, getting fundamentals such as effective patient communication right is especially important to survival and success in medical practice.

It takes some work to change embedded habits and practice culture, but, once done, the rewards keep paying dividends far into the future.

These simple changes to the treatment cycle can make meaningful improvements in outcome:
1. Patient seeks medical help
2. Scheduler sends simple forms and offers help in filling them out
3. Staff collects forms and asks patient if they need help in completing them
4. Doctor explains patient’s condition and treatment plan using simple terms
5. Doctor writes multiple prescriptions and referrals for tests and doctor or staff explain what they are for, what to do, and what to expect
6. Doctor or staff or both confirm patient’s understanding
7. Patient goes home with clear, simple instructions
8. Staff follows up with patient to ensure compliance, answer questions, and ensure patient returns for follow-up visits
9. Patient’s condition is being well managed
In the end, everyone gains:

Practice/Physician Impact:
• Enhances patient engagement in self-care
• Promotes positive behavioral change
• Improves adherence and outcomes
• Upgrades quality, compliance, measurement, and reporting
• Increases patient, physician, and staff satisfaction
• Reduces risk and may lower malpractice rates
• Maximizes payment incentives
• Enhances quality of care/reduces length of stay, readmissions, and medical expenses
• Proactively manages risk
• Increases new patient referrals

Patient Impact:
• Better healthcare decisions/more effective self-care
• Healthier outcomes
• Fewer visits
• Less out-of-pocket expense
• More meaningful doctor-patient relationship

Mastering fundamentals may not be as sexy or stimulating as mastering a new technique or technology, but they win the day. Ask any athletic trainer or coach. Their success is built on executing fundamentals flawlessly.

Find out more about James Doulgeris and our other Practice Notes bloggers.

View the original article here

Medical Necessity: Physicians Need to Prove It to Payers

As frustrating as this sounds, the insurance companies really are running the healthcare industry. Yes, I said it, out loud for all to hear.

Each insurance company has a definition of “medically necessary” (or medical necessity) and one may have a different set of standards than another. You don't really know what those are until you receive the denial for payment. The other area where they really tie your hands, whether in the treatment room or hospital, is what treatment codes they will authorize and which ones they won't — restricting you from providing the very best service to the patient.

I read an article the other day about how physicians and a patient are actually suing HealthNet for not paying a claim after they authorized it, stating "not medically necessary."

I, personally, have had experience with this type of situation back in 1998. I had obtained the proper authorization from Blue Cross to have a procedure done. Two days in the hospital followed and I ended up with a $35,000 bill from the hospital, physician, anethesioligst, labs, etc.

Blue Cross denied all of the claims because “it was not medically necessary” despite the due diligence of prior appointments stating that it was indeed necessary. Luckily, I was taught the difference between right and wrong, persistence, and how to respond when I feel like I'm being pushed around. I fought back. For two years.

I wrote letters to Blue Cross asking them to pay these bills. I “cc'd” all of my physicians, and they luckily stood behind me. After two years of receiving denial EOBs in the mail, I'd had enough. I sent a very thick notebook of all correspondence between myself and Blue Cross to the California Department of Insurance. Within two weeks, I received a letter from the department stating my claims had been closed and paid by Blue Cross. It took them two weeks. It took me two years and much persistence. Can you imagine how many people do not get the treatment they need and deserve because of an insurance company stating it is not medically necessary or worse, have to pay all of those claims themselves?

Insurance companies are also known for restricting what types of services you may provide a patient. It's filled in right there on the authorization. You can do “this,” but not “that.” You want to be paid, so you go along with it. How frustrating this must be for you and the patient!

So what can you do to make sure your patient is treated the way they need to be, and that you are still being paid for your service? Work with the insurance companies. Yes, I said that out loud, too.

Be diligent and when verifying benefits and asking for authorization, be sure to ask the rep if code XYZ is covered under the patient's plan, and if not, which one is equivalent is covered. If you need to write a letter of medical necessity, do it. Show them that by providing a specific treatment, it will help the patient in the long run, and cost the insurance company much less in cost.

Will allowing a patient physical therapy avoid surgery? Explain that in your letter. Can a series of treatments provide pain relief so that the patient no longer needs expensive medication? Explain that, too.

It's all about communication. Do your very best upfront to be as open and honest with the "why"s of the treatment the patient needs, and you are more likely to take back the control of who is really treating a patient. You.

Find out more about P.J. Cloud-Moulds and our other Practice Notes bloggers.

View the original article here

Understanding Fair Market Value: A Guide for Physicians

Last week, I detailed recent case law regarding medical practice leases and avoiding big trouble from the federal government. Now let's look at what you can do to stay safe:

Step One: Is Medicare/Medicaid involved? Are you accepting Medicare and Medicaid patients which you may refer to your landlord for treatment? If the answer is “no,” federal law is not implicated.

Step Two: Understand, the law. You are required to know it. In fact the OIG takes the position that below-market office space rental is offered for the purpose of inducing referrals.

Step Three: Do not assume every business lawyer, medical malpractice defense lawyer, or real estate professional does know the law. I have personally spoken with many malpractice lawyers who ask, “What’s a Stark Law?”

Step Four: Do your “due diligence.” During negotiations, you must find out what fair market value is for office space in your location. This may require the retention of a Health Lawyer or a fair-market-value expert who specializes in hospital lease negotiations. While this is a pain, if you haven’t already, you must think of “compliance” as simply a cost of doing business.

Step Five: Haggle (and document the haggling). The hallmark of a “sweetheart deal” would be that an offer is made to you, and you replied, “Wow, that is too good a deal to pass up.” This isn’t always a bad thing – is simply could be. The offer of office space should start with a proposal per square foot, with provisions for finish out. The rate per square foot should be in line with other rates for comparable space. Naturally, finish out allowance will depend upon whether or not the landlord must pay to make the space suitable. If the space was vacated by a prior tenant and nearly perfect “as is,” then you should get a lower rate per square foot.

Step Six: Document the Safe Harbors in the lease. Recall that a violation of the False Claims Act or the Civil Monetary Penalties Statute law usually requires some showing of a “Knowing” violation. It is therefore important to show in the lease that “compliance” was top of mind. This will not be a problem if your landlord is a hospital. The hospital will certainly include this language in the contract. But if your lease is with a smaller practice, either a single doctor or a small group, you may be handed a standard real estate lease form. Put an addendum on it which complies with Stark and Anti-Kickback Statute Safe Harbors.

Understand, none of these steps will absolutely guarantee you won’t be sued. You cannot control whistleblowers. You can only control your actions. Adopting and implementing good compliance practices simply offers your best chance that a whistleblower law firm will decline to accept the case, or that an OIG agent will elect to quietly pass you by.

Find out more about Martin Merritt and our other Practice Notes bloggers.

View the original article here

Physicians Survey Sheds Light on EHR Implementation Anxieties

In addition to being overworked and financially overextended, physicians are concerned about the effect EHRs will have on the care they provide patients, a recently released survey of 13,575 U.S. physicians reveals. 

The mammoth-size, 100-plus-page survey — commissioned by The Physicians Foundation, a nonprofit organization with members drawn from 20 signatory medical societies and associations — covered a number of areas, from feelings about finances to attitudes about patients. But it was, arguably, the comments and answers to technology questions by physicians that reflected a lingering sense of EHR anxiety among the medical community.

More than 69 percent of physicians surveyed indicated they have implemented EHRs. But not all of them believe their EHRs have improved (or will improve) quality of care.

Fewer than half (46 percent) of physicians who have implemented an EHR indicated their system has already improved quality of care or that they anticipate it will. Another four percent noted their EHR has, so far, decreased quality, but they expect things to turn around.

But one-third of those with EHRs — 31 percent — said their EHR has either had no effect on quality or has not improved quality, nor do they expect it to do so. And more than ten percent of EHR-holding physicians indicated the technology has actually decreased quality of care.

Physicians didn’t hold back their emotions about EHRs in the survey’s comments section. Aside from quality-of-care issues, one big complaint was the lack of compatibility and interoperability among EHRs.

“Until all doctors are on the SAME electronic network it’s a complete waste of time and money,” noted one physician. “There are so many different EMRs that are NOT compatible with one another.”

Another big issue is the cost of EHRs, especially for small practices.

“It would be a significant financial hardship (actually, financial impossibility) for me to begin using electronic prescriptions and /or EMR,” wrote one physician, who described himself as a solo practitioner with one full-time nurse and one part-time employee. “Not only the equipment and software costs, I simply do not have the revenue to hire someone nor the time to enter patient data, demographics, etc into a system of that kind nor the revenues to hire an IT person to manage and maintain it."

Walker Ray, vice president of The Physicians Foundation and chair of its Research Committee (and former practicing pediatrician), said he’s not surprised. Many physicians are already so overwhelmed with primary concerns — such as potential Medicare and private payer reimbursement drops, and the erosion of autonomy (not being able to give the care they want in a highly-regulated environment) — that implementing EHRs and adjusting to them can be highly stressful. 

“EHRs are seen as a necessity as much as a disruption,” Walker told Physicians Practice. “It takes significant distraction to implement EHRs. They will increase quality, [however], there’s no evidence they’re going to save physicians money.”

What does surprise Walker is the sheer number of physicians who have adopted EHRs, though it should be noted that the survey showed attitudes and adoption varied by age and other demographic factors.

“Younger physicians are a little more optimistic that electronic medical records can improve care,” said Walker.

Indeed, 63 percent of physicians age 39 and younger expressed optimism over the ability of EHRs to improve quality of care, compared with 47.5 percent of physicians age 40 or older. And primary-care physicians expressed more optimism than specialists, as did female physicians.

“As far as the EHRs go,” says Walker, “there is quite a diversity in physicians’ opinions on whether they’re going to help or not.”

View the original article here

Understanding Fair Market Value: A Guide for Physicians

Last week, I detailed recent case law regarding medical practice leases and avoiding big trouble from the federal government. Now let's look at what you can do to stay safe:

Step One: Is Medicare/Medicaid involved? Are you accepting Medicare and Medicaid patients which you may refer to your landlord for treatment? If the answer is “no,” federal law is not implicated.

Step Two: Understand, the law. You are required to know it. In fact the OIG takes the position that below-market office space rental is offered for the purpose of inducing referrals.

Step Three: Do not assume every business lawyer, medical malpractice defense lawyer, or real estate professional does know the law. I have personally spoken with many malpractice lawyers who ask, “What’s a Stark Law?”

Step Four: Do your “due diligence.” During negotiations, you must find out what fair market value is for office space in your location. This may require the retention of a Health Lawyer or a fair-market-value expert who specializes in hospital lease negotiations. While this is a pain, if you haven’t already, you must think of “compliance” as simply a cost of doing business.

Step Five: Haggle (and document the haggling). The hallmark of a “sweetheart deal” would be that an offer is made to you, and you replied, “Wow, that is too good a deal to pass up.” This isn’t always a bad thing – is simply could be. The offer of office space should start with a proposal per square foot, with provisions for finish out. The rate per square foot should be in line with other rates for comparable space. Naturally, finish out allowance will depend upon whether or not the landlord must pay to make the space suitable. If the space was vacated by a prior tenant and nearly perfect “as is,” then you should get a lower rate per square foot.

Step Six: Document the Safe Harbors in the lease. Recall that a violation of the False Claims Act or the Civil Monetary Penalties Statute law usually requires some showing of a “Knowing” violation. It is therefore important to show in the lease that “compliance” was top of mind. This will not be a problem if your landlord is a hospital. The hospital will certainly include this language in the contract. But if your lease is with a smaller practice, either a single doctor or a small group, you may be handed a standard real estate lease form. Put an addendum on it which complies with Stark and Anti-Kickback Statute Safe Harbors.

Understand, none of these steps will absolutely guarantee you won’t be sued. You cannot control whistleblowers. You can only control your actions. Adopting and implementing good compliance practices simply offers your best chance that a whistleblower law firm will decline to accept the case, or that an OIG agent will elect to quietly pass you by.

Find out more about Martin Merritt and our other Practice Notes bloggers.

View the original article here

Physicians Survey Sheds Light on EHR Implementation Anxieties

In addition to being overworked and financially overextended, physicians are concerned about the effect EHRs will have on the care they provide patients, a recently released survey of 13,575 U.S. physicians reveals. 

The mammoth-size, 100-plus-page survey — commissioned by The Physicians Foundation, a nonprofit organization with members drawn from 20 signatory medical societies and associations — covered a number of areas, from feelings about finances to attitudes about patients. But it was, arguably, the comments and answers to technology questions by physicians that reflected a lingering sense of EHR anxiety among the medical community.

More than 69 percent of physicians surveyed indicated they have implemented EHRs. But not all of them believe their EHRs have improved (or will improve) quality of care.

Fewer than half (46 percent) of physicians who have implemented an EHR indicated their system has already improved quality of care or that they anticipate it will. Another four percent noted their EHR has, so far, decreased quality, but they expect things to turn around.

But one-third of those with EHRs — 31 percent — said their EHR has either had no effect on quality or has not improved quality, nor do they expect it to do so. And more than ten percent of EHR-holding physicians indicated the technology has actually decreased quality of care.

Physicians didn’t hold back their emotions about EHRs in the survey’s comments section. Aside from quality-of-care issues, one big complaint was the lack of compatibility and interoperability among EHRs.

“Until all doctors are on the SAME electronic network it’s a complete waste of time and money,” noted one physician. “There are so many different EMRs that are NOT compatible with one another.”

Another big issue is the cost of EHRs, especially for small practices.

“It would be a significant financial hardship (actually, financial impossibility) for me to begin using electronic prescriptions and /or EMR,” wrote one physician, who described himself as a solo practitioner with one full-time nurse and one part-time employee. “Not only the equipment and software costs, I simply do not have the revenue to hire someone nor the time to enter patient data, demographics, etc into a system of that kind nor the revenues to hire an IT person to manage and maintain it."

Walker Ray, vice president of The Physicians Foundation and chair of its Research Committee (and former practicing pediatrician), said he’s not surprised. Many physicians are already so overwhelmed with primary concerns — such as potential Medicare and private payer reimbursement drops, and the erosion of autonomy (not being able to give the care they want in a highly-regulated environment) — that implementing EHRs and adjusting to them can be highly stressful. 

“EHRs are seen as a necessity as much as a disruption,” Walker told Physicians Practice. “It takes significant distraction to implement EHRs. They will increase quality, [however], there’s no evidence they’re going to save physicians money.”

What does surprise Walker is the sheer number of physicians who have adopted EHRs, though it should be noted that the survey showed attitudes and adoption varied by age and other demographic factors.

“Younger physicians are a little more optimistic that electronic medical records can improve care,” said Walker.

Indeed, 63 percent of physicians age 39 and younger expressed optimism over the ability of EHRs to improve quality of care, compared with 47.5 percent of physicians age 40 or older. And primary-care physicians expressed more optimism than specialists, as did female physicians.

“As far as the EHRs go,” says Walker, “there is quite a diversity in physicians’ opinions on whether they’re going to help or not.”

View the original article here

Medical Necessity: Physicians Need to Prove It to Payers

As frustrating as this sounds, the insurance companies really are running the healthcare industry. Yes, I said it, out loud for all to hear.

Each insurance company has a definition of “medically necessary” (or medical necessity) and one may have a different set of standards than another. You don't really know what those are until you receive the denial for payment. The other area where they really tie your hands, whether in the treatment room or hospital, is what treatment codes they will authorize and which ones they won't — restricting you from providing the very best service to the patient.

I read an article the other day about how physicians and a patient are actually suing HealthNet for not paying a claim after they authorized it, stating "not medically necessary."

I, personally, have had experience with this type of situation back in 1998. I had obtained the proper authorization from Blue Cross to have a procedure done. Two days in the hospital followed and I ended up with a $35,000 bill from the hospital, physician, anethesioligst, labs, etc.

Blue Cross denied all of the claims because “it was not medically necessary” despite the due diligence of prior appointments stating that it was indeed necessary. Luckily, I was taught the difference between right and wrong, persistence, and how to respond when I feel like I'm being pushed around. I fought back. For two years.

I wrote letters to Blue Cross asking them to pay these bills. I “cc'd” all of my physicians, and they luckily stood behind me. After two years of receiving denial EOBs in the mail, I'd had enough. I sent a very thick notebook of all correspondence between myself and Blue Cross to the California Department of Insurance. Within two weeks, I received a letter from the department stating my claims had been closed and paid by Blue Cross. It took them two weeks. It took me two years and much persistence. Can you imagine how many people do not get the treatment they need and deserve because of an insurance company stating it is not medically necessary or worse, have to pay all of those claims themselves?

Insurance companies are also known for restricting what types of services you may provide a patient. It's filled in right there on the authorization. You can do “this,” but not “that.” You want to be paid, so you go along with it. How frustrating this must be for you and the patient!

So what can you do to make sure your patient is treated the way they need to be, and that you are still being paid for your service? Work with the insurance companies. Yes, I said that out loud, too.

Be diligent and when verifying benefits and asking for authorization, be sure to ask the rep if code XYZ is covered under the patient's plan, and if not, which one is equivalent is covered. If you need to write a letter of medical necessity, do it. Show them that by providing a specific treatment, it will help the patient in the long run, and cost the insurance company much less in cost.

Will allowing a patient physical therapy avoid surgery? Explain that in your letter. Can a series of treatments provide pain relief so that the patient no longer needs expensive medication? Explain that, too.

It's all about communication. Do your very best upfront to be as open and honest with the "why"s of the treatment the patient needs, and you are more likely to take back the control of who is really treating a patient. You.

Find out more about P.J. Cloud-Moulds and our other Practice Notes bloggers.

View the original article here

Health Literacy Needs a Place in Physicians' Practices

I was invited to sit in on a presentation by Mark Dumoff, an expert on patient communication and health literacy, to the chief medical officers of a large private insurer a few weeks ago.

It struck all of us, as we struggle to adapt to legislation that attempts to set our healthcare system on the right track with new taxes, mandates, and regulation, that fundamentals are falling to the wayside. Failing to master basics like doctor-patient communications is hugely expensive in terms of quality of life, time and money.

The statistics Dumoff outlined are a wakeup call:
• 90 million adults have low health literacy levels
• Cost to the U.S. economy : $106 billion to $238 billion/year
• $1.6 trillion to $3.6 trillion burden to future generations in today’s dollars
• White, native-born Americans are the majority group

This happens because one out of three patients can’t understand instructions for self-care, after-care, and transitions in care from one setting to another. Another one out of three struggles with them. As a result, patient transitions and coordinated care are adversely affected, which researchers say caused $25 billion to $45 billion in wasteful spending in 2011, mostly due to avoidable complications and hospital readmissions.

The cycle is as familiar as the solution seems to be elusive:
1. Patient seeks medical help
2. Patient is asked to complete complex, confusing forms
3. Doctor explains patient’s condition and treatment plan using medical jargon
4. Doctor writes multiple prescriptions and referrals for tests
5. Doctor does not confirm patient’s understanding
6. Patient goes home with complicated, generic instructions
7. No one follows up with patient
8. Patient takes medications incorrectly and does not follow up
9. The cycle begins again - patient seeks medical help

Those with chronic conditions such as diabetes, hypertension, and asthma are at the highest risk of disease progression and co-morbidity while patients in transition from acute to sub-acute care for conditions such as CHF, COPD, pneumonia, and AMI are at the highest risk of unnecessary hospital readmission.

As of Monday, Medicare will start fining hospitals for having too many patients readmitted within 30 days of discharge due to complications. About two-thirds of the hospitals serving Medicare patients, or about 2,200 facilities, will be hit with penalties averaging $125,000 each this coming year according to government estimates. The likely response will be to focus on discharge instructions and to initiate quality and patient experience measurements for their admitting physicians as a barometer of risk.

In an emerging era of shared risk and performance-based remuneration, getting fundamentals such as effective patient communication right is especially important to survival and success in medical practice.

It takes some work to change embedded habits and practice culture, but, once done, the rewards keep paying dividends far into the future.

These simple changes to the treatment cycle can make meaningful improvements in outcome:
1. Patient seeks medical help
2. Scheduler sends simple forms and offers help in filling them out
3. Staff collects forms and asks patient if they need help in completing them
4. Doctor explains patient’s condition and treatment plan using simple terms
5. Doctor writes multiple prescriptions and referrals for tests and doctor or staff explain what they are for, what to do, and what to expect
6. Doctor or staff or both confirm patient’s understanding
7. Patient goes home with clear, simple instructions
8. Staff follows up with patient to ensure compliance, answer questions, and ensure patient returns for follow-up visits
9. Patient’s condition is being well managed
In the end, everyone gains:

Practice/Physician Impact:
• Enhances patient engagement in self-care
• Promotes positive behavioral change
• Improves adherence and outcomes
• Upgrades quality, compliance, measurement, and reporting
• Increases patient, physician, and staff satisfaction
• Reduces risk and may lower malpractice rates
• Maximizes payment incentives
• Enhances quality of care/reduces length of stay, readmissions, and medical expenses
• Proactively manages risk
• Increases new patient referrals

Patient Impact:
• Better healthcare decisions/more effective self-care
• Healthier outcomes
• Fewer visits
• Less out-of-pocket expense
• More meaningful doctor-patient relationship

Mastering fundamentals may not be as sexy or stimulating as mastering a new technique or technology, but they win the day. Ask any athletic trainer or coach. Their success is built on executing fundamentals flawlessly.

Find out more about James Doulgeris and our other Practice Notes bloggers.

View the original article here

'Red Flags Rule' Applicability to Physicians Challenged

By Sheri Porter

The Council of Medical Specialty Societies, or CMSS, recently filed a motion to intervene on behalf of all physicians in an existing case filed by the AMA, the American Osteopathic Association and the Medical Society of the District of Columbia. The case involves the applicability to physicians of an antifraud identity theft federal regulation known as the "Red Flags Rule."

The rule, which was originally drafted in 2008 in connection with the implementation of the Fair and Accurate Credit Transactions Act of 2003, requires financial institutions and creditors -- including physician practices -- to address the risk of identity theft by implementing identity theft prevention programs.

The AAFP is one of 26 medical organizations seeking to be specifically added as plaintiffs pursuant to the CMSS motion to intervene in the existing case, which seeks to prevent the Federal Trade Commission, the government agency charged with upholding the rule, from applying it to physicians.

According to an Aug. 17 notice posted on the CMSS website, the Red Flags Rule "imposes significant burdens on physicians, particularly solo practitioners and those practicing in small groups."

Norman Kahn, M.D., EVP and CEO of CMSS, said in the press release that his organization took the lead on this issue "to protect all physician members of the CMSS societies from the unintended consequences of the Red Flags Rule."

"Adhering to the policies of the Red Flags Rule would substantially drain the financial resources of physicians, particularly those whose support systems are limited," said Kahn.

The Academy's General Counsel Tom Robinett, J.D., said in an interview that the AAFP would like to see a ruling on CMSS' motion to intervene and the AMA lawsuit by the end of the year.

"A positive ruling on the case would provide a definitive decision that will apply to all physicians and will exclude physicians from the application of the Red Flags Rule and the hassles that go along with being a creditor," said Robinett.

"This rule shouldn't apply to physicians who take a credit card or bill a patient for services and thus extend credit to that patient," said Robinett. The Red Flags Rule was an outgrowth of identity theft problems associated with financial institutions and credit card companies and was never intended to include America's physicians, he added.

The U.S. District Court for the District of Columbia recently ruled in favor of an American Bar Association request to exempt lawyers from the Red Flags Rule.