South Florida Hospital News
Sunday September 22, 2019
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November 2006 - Volume 3 - Issue 5

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Business Muse - Reflections on the Business of Healthcare Delivery

For those of you who are unaware or just need a friendly reminder, January is NPI month.

NPI (National Provider Identification) is a new number that all providers of healthcare must apply for and have in place to add on all claims filed. To be sure it is needed for Medicare but as we all know as goes Medicare so goes all carriers. We are hearing that enforcement wonít begin in earnest until the end of May, a grace period for straglers. Like all rumors about these things they are probably true.

The NPI as an idea makes one think of big brother and that the government is watching you. Take heart the government is already watching you. This number is no different than a license number or your DEA number. It is more like your DEA in that it is federal rather than state. Of course this begs the question as to whether or not it is a first step toward a national license. After all Medicare is national, most health care carriers are national, many hospital chains are multi state, and the fed gives states dollars toward state Medicaid programs. It seems the time is coming for a national license.

When you drive from state to state your driverís license is valid as is your insurance. States even have laws and regulations dealing with which no-fault coverage is in force in their state for example. Why is this portability not so for healthcare providers? I believe it may, as with many things, have to do with money. States make a good deal of revenue with healthcare licensing fees (another word for taxes, but without the public connotation). Most states have reciprocity with each other, but it requires a long and tiresome process to navigate. Why not have a federal license where all information resides? One repository of all the information about your training, practice demographics and any information that allows them the ability to track bad apple providers to avoid them from state jumping. Arenít they gathering that information currently, and even expanding it to a greater degree with the advent of the NPI?

The federal government could certainly bestow a license that is valid in all fifty states. It could then be set up such that when you practice in a state you pay a license fee to that state. Thereby the state does not suffer an economic loss. The same goes for any fines given by the stateís office of professional conduct. The result of any state investigation would be reported to the fed as well. This way the state exerts controls, the fed does not have to reinvent the mechanisms already in place and the state still captures the revenue.

However at the same time a practitioner could see patients anywhere, but would have to declare a primary state of residence and practice. His license and malpractice coverage would then be in force if he did any work in another local. For example radiologists reading films from other states by teleradiography, or providers doing part time locum tenens work would not need multiple licenses and insurances. As things currently exist there is much medical and legal confusion as business models change. Where do you practice when giving advice over the net for which you a remunerated? What about the same over a 900 number? Are providers who do chart reviews for insurance carriers or attorneys practicing in their state or as an expert in a state where they may not even have a license but the patient resides? Courts accept professionals licensed by other jurisdictions as experts, why donít we as a nation allow them to provide services and be licensed in all jurisdictions? These are but a few of current services being provided and questions being asked.

Isnít time we developed one national license? Change and growth begin with ideas and dialogue. I have given my ideas to overcome some of the obstacles I envision for developing a national license. Iíd like to hear yours.

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