The Costs of Not Planning
In a football game I was watching on TV this season a coach decided to forgo an easy field goal which would have given his team the lead and go for a first down on a fourth and two yards to go. The announcer declared: “This is a bad decision even if they make the first down. If they fail they lose the game, if they make it they still have to find a way to score.” The team made the first down, fumbled the ball on the next play and lost the game.
Georgia’s apparent decision to suspend any planning to implement the Affordable Care Act resembles that coach’s decision. State leaders are betting that the Supreme Court will declare the entire Act unconstitutional this summer. If they are wrong the consequences may be more than a lack of control over the state’s health system. It may be both a reduction in access to care and increase in costs. If they are right then the issues confronting Georgia’s health care remain: a declining employment-based health insurance particularly …
Growth in an ACO World
Later this month, fellow AJC blogger Mark Reiboldt and I will be presenting to financial executives and other healthcare leadership at the Dixie Institute for the Healthcare Financial Management Association (HFMA) on February 23. Our topic examines how healthcare reform is taking shape today, particularly around accountable care and the coordination of care. Specifically, we examine growth and what caregivers must consider in order to remain competitive in an evolving marketplace. For today’s post, I thought I would highlight some of those points and why leaders in the industry cannot just sit idly on the sidelines today. Inaction will likely have a much larger detrimental effect than any misstep made along the way to an integrated system.
Accountable Care Organizations (ACOs) are the latest rage in healthcare. You cannot attend a conference, seminar, or even inter-company meeting without hearing the muttering of those words when talking reform. And for …
The Cost of Trauma Care
When you work daily with Hospitals and reimbursement, there are certain misconstrued topics that infuriate you. When Healthcare Reform was being debated, I remember the strange look people would get when they would ask me the simple small talk question of “what do you think about healthcare reform,” and I would launch into a thirty minute lecture about the realities vs. what was being sold by the politicians and media. I felt the same feelings being aroused in me when I read Kari Huus’s piece on MSNBC.com titled “ Iconic skier’s death points out the U.S. Health gap.” (http://usnews.msnbc.msn.com/_news/2012/01/30/10274212-iconic-skiers-death-points-out-us-health-gap)
The article deals with the issue of deceased Skier Sarah Burke’s extreme medical bills for the nine days that Doctor’s in Utah fought against all odds to save her from a torn vertebral artery. The article highlights that Sarah, a Canadian citizen, would not owe anything if the accident had occurred in Canada, …
An Awareness of Mental Health
Mental health disability is on the rise. The American Journal of Public Health recently reported a study which shows a 2.7% increase in self reported mental health disability among the non-elderly. The researchers attributed this increase to the impact of factors including socioeconomics and mental health literacy. It is also well known that people with chronic diseases are more prone to mental illness. This speaks to a growing need for mental health evaluation and treatment but most of all prevention. Well that’s a easy one. Every body just stop what you are doing; take a deep breath; and just relax! Well anyone who has ever suffered from clinical Depression or Anxiety will tell you ’ it is not quite that easy’.
You may have heard of the Social Economic Determinants of Health. This concept speaks to the many factors in our environment outside of our physical bodies that attribute to our health. When it comes to Mental health the stressors of our day to day environment …
STRENGTH IN NUMBERS
There’s been a great deal of debate regarding mergers in healthcare. For regional or smaller community hospitals, their viability in many cases may depend heavily on larger economies of scale. What about doctors, physician practices and outpatient centers? From a lender’s perspective, there is definitely strength in numbers!
As shrinking reimbursement becomes the 800 pound gorilla for all healthcare providers, we have to look towards improving efficiencies to survive. From throughput and case management to materials management and contract negotiations, providers have to find ways to improve across the board and cut waste within their existing processes. On top of improved efficiencies, they have to continually drive volume growth. Procedure rooms with the lights off during operating hours at an ASC are critical dollars missed. On one side of town there’s a patient waiting 3 days or more for a scan and on the other side of town there’s a CT sitting idle.
Single doctor …
My Super Bowl Experience… and Healthcare?
Like most of you, I spent last evening at a party watching the Super Bowl. No real surprise there as attending a Super Bowl party is a national pastime, regardless if you are a sports fan or not. I am an avid sports fan and paid close attention to the game. But I also keep an eye on what is becoming another national pastime: Our obsession with our smartphones and technology. Almost everyone was glued to his/her smartphone at some time during the game whether following Twitter, posting on Facebook, or interacting with Coke’s polar bears online. And yet with phones in hand, and heads down in a digital connection, everyone still maintained the real-world social experience gathered around the giant flat screen TV.
And this got me thinking about consumer behavior and technology and how they collide with both our real world and digital world. I believe that we will always gather together to watch live TV events like the Super Bowl, Academy Awards, and The Grammys. Despite the …
Continue reading My Super Bowl Experience… and Healthcare? »
Let’s Get Serious About Healthcare Costs
We are all concerned about the ever escalating healthcare costs. Employers struggle whether to offer health insurance benefits because premiums continue to rise at an alarming rate.
Employees and patients who do have insurance must endure higher, premiums, higher co-pays and coinsurance. With healthcare costs are out of control, we must consider something totally transformational.
One primary driver of rising healthcare costs is due to the way physicians practice medicine these days. Physicians order unnecessary tests, procedures and prescription drugs simply to protect themselves from being sued. This practice is known as “defensive medicine.”
And, according to Oppenheim Research, defensive medicine costs Georgians more than $14 billion each year. Eighty-two percent of the Georgia doctors polled by Oppenheimer said they practice defensive medicine.
Solutions vary. Traditional tort reform measures like caps on “pain and suffering” damages help to stabilize the medical …
Red Tape -Why does an Undermanned Agency Create Unnecessary Work?
In general, the letter requests that the IRS make Part V, Section B optional for 2011 (as the IRS did for 2010) to allow additional time to work through the application of these rules to a diverse group of charitable hospitals, to eliminate redundancies that have no clear relationship to the statutory requirements of the law or that do not result in a clear benefit to the public, and to simplify reporting for increased understanding (and to eliminate unneeded paperwork).
Continue reading Red Tape -Why does an Undermanned Agency Create Unnecessary Work? »
Home Is Where the Physician Is
Patients with multiple chronic disorders often spend the majority of their time going from one doctor to another. With different providers and hospital visits, it is difficult to provide clinical care coordination and communication between providers. The lack of communication and coordination usually leads to disjointed care, duplicate tests and ultimately adds to the expense of a healthcare delivery system.
Now, chronic disease patients can merely open the door to their home to receive primary care services. Pursuant to the Patient Protection and Affordable Care Act (“Healthcare Reform Act”), the Federal Government has directed the Centers for Medicare and Medicaid Innovation (“CMI”) to engage in a demonstration project to test a model of providing care in the patient home instead of in a physician office. The concept is to engage primary care physicians and physician extenders to provide care in each patient’s home. Ultimately, the intent is to reduce the costs to the …
Medicaid Expansion under ACA
One of the issues in the lawsuit twenty-six states (including Georgia) have brought to the overturn the Affordable Care Act is the expansion of Medicaid eligibility. The argument against this expansion seems to be that the expansion will cost state money. There is a counter argument that Georgia taxpayers are likely to be better off after the expansion.
Currently eligibility is determined by family income and other characteristics. For example in Georgia the Department of Community Health website has this information:
“You may be eligible for Medicaid if your income is low and you match one of the following descriptions:
• You think you are pregnant
• You are a child or teenager
• You are age 65 or older
• You are legally blind
• You have a disability
• You need a nursing home”
The income levels necessary to qualify for Medicaid depend upon which of those groups the individual is in.
Under the ACA beginning in 2014 all individuals in families whose income lies below 133% of …
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