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

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

Using the web for learning and teaching – a new understanding

Using technology for teaching and learning in higher education goes way beyond Google. Photograph: Scott Barbour/Getty Images

What are the implications for learning and teaching when we move from perceiving the web as a collection of tools to thinking of it as a series of overlapping spaces? This was the focus of a recent Higher Education Academy event on flexible learning and online residency. The term residencycomes from the Visitors and Residents continuum (V&R) which I proposed as an alternative to Marc Prensky's digital natives and immigrants idea.

V&R is a simple metaphor for online engagement: some people visit the web while others live out a portion of their lives online and are, in effect, resident in online spaces. Unlike Prensky's idea, the V&R continuum does not assume there are links between age and technical skill, but instead focuses on motivations to engage. We are currently using the V&R continuum as the underpinning principle in a longitudinal JISC-funded project which, in partnership with OCLC, is exploring what motivates learners, teaching practitioners and researchers to engage with the web. We are particularly interested in learner-owned literacies – approaches to information seeking and collaboration online which individuals evolve outside of an institutional context.

Rather than aiming to produce a framework of digital literacies, we are working with the notion of 'genres of participation', an approach first used to define aspects of digital youth culture but which, using V&R as genres, translates well into more academic contexts.

The strength of taking this approach is that the notion of genres is inherently fuzzy edged, reflecting the increasingly blurred boundaries between roles and behaviours online – between the personal and the institutional. Unlike many competency frameworks, V&R doesn't imply that there is a linear progression in developing digital literacies. In fact our data indicate that individuals evolve their forms of engagement online in a fairly ad hoc, try-it-and-see manner, based on their immediate needs. In many cases their approaches are blunt but effective, with the response to the question "How do you go about using the web for your learning?" often being "I Google and see what comes up".

At the HEA event we focused on the residency end of the continuum, not because this is necessarily a more effective genre of participation for learning, but because the implications of the web-as-a-space and the related modes of engagement are less understood than those at the visitor end of the continuum. Certainly residency is inherent in some of the new forms of practice we see emerging online such as the original form of the MOOC (massive open online course), and the notion of residency is often linked to agile, communal forms of knowledge creation and ways-of-knowing.

Many of the graduate attributes higher education institutions are espousing appear to require reasonably high levels of residency and visibility online with phrases such as "engage productively in relevant online communities" and "influence others in an increasingly digital world". So the importance of these forms of engagement is being established but what is not yet clear is how we actually support this in practice.

It's not easy facilitating a shift from a visitor to a more resident mode and some of the teaching practitioners at the HEA event shared how difficult it is to communicate to learners what the possible benefits of having a presence and sharing practice online could be. For many, education is predominantly about consuming knowledge from trusted sources and seeking the wisdom of established experts. Study is seen as a relatively private activity which finishes with a series of exams. It's not commonly perceived as an evolving practice in which personal views are openly shared and in which students' opinions become a valued part of a communal learning experience.

The resident style digital literacies that are often discussed, such as developing a professional identity online and the ability to visibly collaborate on the web, can appear daunting, risky and potentially a huge distraction from the "real" curriculum for many learners. Even so, I think this type of anxiety is a valid and good defence against a consumerist mindset. We should be pushing learners to expand their view of education beyond traditional forms of expertise. The V&R project is gaining an understanding of how, and more importantly why, we use the web for learning. It will continue to share its findings and is planning to produce a toolkit-style learning resource to support practitioners interested in resident forms of practice. We are keen to move this area forwards so that our learners, to use JISC's definition, are fitted with the capabilities for "living learning and working in a digital society", to achieve this we need to be doing much more than advising how to Google a bit better.

David White is a researcher and co-manages Technology-Assisted Lifelong Learning (TALL), a learning and technology R&D group in the University of Oxford. He tweets at @daveowhite.

This content is brought to you by Guardian Professional. To get more articles like this direct to your inbox, become a member of the Higher Education Network.

View the original article here

Using the web for learning and teaching – a new understanding

Using technology for teaching and learning in higher education goes way beyond Google. Photograph: Scott Barbour/Getty Images

What are the implications for learning and teaching when we move from perceiving the web as a collection of tools to thinking of it as a series of overlapping spaces? This was the focus of a recent Higher Education Academy event on flexible learning and online residency. The term residencycomes from the Visitors and Residents continuum (V&R) which I proposed as an alternative to Marc Prensky's digital natives and immigrants idea.

V&R is a simple metaphor for online engagement: some people visit the web while others live out a portion of their lives online and are, in effect, resident in online spaces. Unlike Prensky's idea, the V&R continuum does not assume there are links between age and technical skill, but instead focuses on motivations to engage. We are currently using the V&R continuum as the underpinning principle in a longitudinal JISC-funded project which, in partnership with OCLC, is exploring what motivates learners, teaching practitioners and researchers to engage with the web. We are particularly interested in learner-owned literacies – approaches to information seeking and collaboration online which individuals evolve outside of an institutional context.

Rather than aiming to produce a framework of digital literacies, we are working with the notion of 'genres of participation', an approach first used to define aspects of digital youth culture but which, using V&R as genres, translates well into more academic contexts.

The strength of taking this approach is that the notion of genres is inherently fuzzy edged, reflecting the increasingly blurred boundaries between roles and behaviours online – between the personal and the institutional. Unlike many competency frameworks, V&R doesn't imply that there is a linear progression in developing digital literacies. In fact our data indicate that individuals evolve their forms of engagement online in a fairly ad hoc, try-it-and-see manner, based on their immediate needs. In many cases their approaches are blunt but effective, with the response to the question "How do you go about using the web for your learning?" often being "I Google and see what comes up".

At the HEA event we focused on the residency end of the continuum, not because this is necessarily a more effective genre of participation for learning, but because the implications of the web-as-a-space and the related modes of engagement are less understood than those at the visitor end of the continuum. Certainly residency is inherent in some of the new forms of practice we see emerging online such as the original form of the MOOC (massive open online course), and the notion of residency is often linked to agile, communal forms of knowledge creation and ways-of-knowing.

Many of the graduate attributes higher education institutions are espousing appear to require reasonably high levels of residency and visibility online with phrases such as "engage productively in relevant online communities" and "influence others in an increasingly digital world". So the importance of these forms of engagement is being established but what is not yet clear is how we actually support this in practice.

It's not easy facilitating a shift from a visitor to a more resident mode and some of the teaching practitioners at the HEA event shared how difficult it is to communicate to learners what the possible benefits of having a presence and sharing practice online could be. For many, education is predominantly about consuming knowledge from trusted sources and seeking the wisdom of established experts. Study is seen as a relatively private activity which finishes with a series of exams. It's not commonly perceived as an evolving practice in which personal views are openly shared and in which students' opinions become a valued part of a communal learning experience.

The resident style digital literacies that are often discussed, such as developing a professional identity online and the ability to visibly collaborate on the web, can appear daunting, risky and potentially a huge distraction from the "real" curriculum for many learners. Even so, I think this type of anxiety is a valid and good defence against a consumerist mindset. We should be pushing learners to expand their view of education beyond traditional forms of expertise. The V&R project is gaining an understanding of how, and more importantly why, we use the web for learning. It will continue to share its findings and is planning to produce a toolkit-style learning resource to support practitioners interested in resident forms of practice. We are keen to move this area forwards so that our learners, to use JISC's definition, are fitted with the capabilities for "living learning and working in a digital society", to achieve this we need to be doing much more than advising how to Google a bit better.

David White is a researcher and co-manages Technology-Assisted Lifelong Learning (TALL), a learning and technology R&D group in the University of Oxford. He tweets at @daveowhite.

This content is brought to you by Guardian Professional. To get more articles like this direct to your inbox, become a member of the Higher Education Network.

View the original article here