Archive for August, 2011

Identifying Charity Care – A Shared Responsibility

As a result of the enactment of the Patient Protection and Affordable Care Act, every charitable hospital must adopt a written financial assistance policy that identifies the specific eligibility criteria used by that hospital for providing free or discounted medical services to qualifying patients. In addition, a charitable hospital is prohibited from engaging in extraordinary collection actions before reasonable efforts have been made to determine whether a patient is eligible for assistance under the organization’s financial assistance policy. The Joint Committee on Taxation Technical Explanation indicates that “extraordinary” collection actions include “lawsuits, liens on residences, arrests, body attachments, or other similar collection practices.” The Technical Explanation indicates that “reasonable efforts” will include “notification by the hospital of its financial assistance policy upon admission and in written and oral communications with regard to …

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Bundled Payments Have Arrived

Providers should take notice the Single Payment for multiple providers has arrived! The Centers for Medicare and Medicaid Innovation (”CMI”) created by the Patient Protection and Affordable Care Act (”Healthcare Reform Act”) tests innovative healthcare payment models with a focus to reduce healthcare cost of while enhancing the quality of care delivered. As part of its charge, CMI engages in demonstration projects and creates models throughout the United States that changes how providers are paid for care. CMI is driving care coordination between different providers, in different types of service settings through innovative payment changes that cause the provider to change their behavior.

On Tuesday, August 23, 2011, CMI announced its new Bundled Payment for Care Improvement Program (”Program”). This Program is intended to improve patient care by driving innovative and coordinated efforts between providers by changing the payment delivery. There are four potential …

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Healthcare Reform is missing the mark to reduce a key driver of healthcare costs

Healthcare Reform is missing the mark to reduce a key driver of healthcare cost, chronic diseases. It does not contain a strategy or approach to control or reduce the costs associated with chronic diseases. A chronic disease is a medical condition that cannot be cured and usually lasts a lifetime. An example of a chronic disease is Diabetes. The CDC estimates that seventy five percent of U.S. healthcare costs can be attributed to chronic diseases and is responsible for seven out of ten deaths. There is also the associated cost of disability with chronic diseases that takes productive people out of the workforce. When this occurs, a financial burden is placed on their family and subsequently the U.S. healthcare system.

Healthcare reform under the stewardship of the current administration and Centers for Medicaid and Medicare Administration (CMS), are testing various healthcare delivery models and forms of payment such as an Accountable Care Organization (ACO) and Bundled …

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Does the 11th Circuit Court of Appeals’ Ruling Help Anybody?

A divided 11th Circuit Court recently ruled that the individual mandate in the Patient Protection and Affordable Care Act (PPACA) exceeded “Congress’s enumerated commerce power and is unconstitutional.” Opponents of PPACA declared the ruling a victory. Texas Attorney General Greg Abbott was quoted as saying: “Obamacare is closer to an end.” News reports declared the ruling a serious blow to the act.

If the 11th Circuits ruling is indicative of how the Supreme Court will rule on the matter the ruling actually has the opposite effect. The ruling overturned a key element of District Judge Vinson’s ruling that the individual mandate could not be separated from the rest of the act. The court found: “The Act’s other provisions remain legally operative after the mandate’s excision, and the high burden needed under Supreme Court precedent to rebut the presumption of severability has not been met.” While other courts have differed on the constitutionality of the …

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Limiting the Cost of Medical Malpractice

A September 2010 study by researchers at Harvard University found that the cost of Medical Malpractice in the US was $55.6 Billion Dollars, or 2.4% of Healthcare Spending. They looked at a variety of factors such as money paid to Plaintiffs, legal expenses, administrative expenses, and the cost of defensive medicine. While there may be disagreement regarding how Harvard reached this number, there is little disagreement that this cost exists.

Georgia’s own US Representative Phil Gingrey has set out to address this problem in Bill H.R. 5. The HEALTH (Help Efficient, Accessible, Low Cost, Timely Healthcare) Act of 2011 aims to reduce the burden that the current liability system places on the healthcare delivery system. This bill was considered in committee and has been recommended for consideration by the entire House. Many of the provisions of this bill aim to reduce the cost of Medical Malpractice.

For instance, the bill limits non-economic damages to $250,000.00. This is …

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The Economy of Health

The economic impact of recent financial woes of our ailing economy is unmeasurable. The policy changes which will follow are unpredictable. The changes that will occur with the Health reform initiatives are unknown. However, one thing is for certain, there will be changes.

I am not the financial specialist but I do realize that when the economy is not so healthy, the budgets of state and federal organizations can  become sick.  This can result in decreased funding for programs that support Health initiatives which focus on population health improvement. Therefore, potentially reducing innovative research aimed at technology, practice improvement, and chronic disease management. Without new solutions to improve population health the cost of healthcare could continue to rise.  

The cost of treating preventable chronic diseases and  related illnesses account for a disproportionate share of the health care cost in this country. The people who bear  most of this …

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Making the Case for Medicaid

By the stroke of President Obama’s pen on August 2, America averted its first-ever default and a major economic crisis by raising the debt limit.  And even if the country in the words of the Obama administration lifted “a cloud of uncertainty hanging over the economy,” plenty of economic uncertainty continues today.  Congress and the administration still need to agree on $1.5 trillion more in budget savings by year’s end.  The prime targets:  Medicare and Medicaid.  The “supercommittee” of 12 members of Congress can’t ignore such a huge part of the budget and will have to deal with healthcare costs.  More details can be read here.

If we look into a crystal ball, it would be a safe bet to argue that Medicaid will likely get the brunt of those cuts.  While nearly every major industry or interest group has some form of representation to lobby federal and state representatives (including Medicare), select organizations that may include some of …

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Spending to IMPROVE your bottom line

Counterintuitive? Not at all! Keeping up with your clinical life-cycle and leveraging the latest technology is paramount to your ongoing success. Most, if not all hospitals are coming off a long spending freeze in reaction to the continuing recession. Getting your purchasing back on track, upgrading equipment and taking advantage of the latest technology to improve efficiencies and profitable revenue, will positively impact your bottom line.

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The Importance of Patient Adherence to Medication Therapy

As former Surgeon General Dr. C. Everett Koop said, “Drugs don’t work in patients who don’t take them.” Prescription medications are only effective when they are taken. 

In many pharmacy circles, the term medication “adherence” and medication “compliance” are used virtually interchangeably.  However, in more recent years, the pharmacy profession and pharmaceutical industry have gravitated more toward medication adherence as the term of choice.  Adherence to a medication regimen is usually defined as the extent to which patients take medications as prescribed by their healthcare providers.

Non-adherence is a serious problem in the United States, causing thousands of premature deaths and demanding care that would otherwise have been unnecessary. According to the Journal of Managed Care Pharmacy, every day, 342 people die because of poor medication adherence.  That’s 125,000 Americans who die unnecessarily each year because of not taking their medications as …

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Healthcare Technology is our Friend. Embrace It, Empower It.

Technology is dramatically changing our everyday lives, both personally and professionally. Think about it from your own perspective: You probably own a smart phone, participate in social media as well as shop, research and communicate online, use iPads or other tablets, and increasingly use your mobile device to access all sorts of information on-demand. Technology does make our lives easier, and it certainly gives us access to information and knowledge in real-time, right at our finger tips. That’s empowering for both consumers and business. And that certainly rings true with healthcare and wellness.

Last week, “The Future of Connected Health Devices” was released and revealed that consumers are increasingly turning to technology to manage various health issues and wellness goals. The study also showed that consumers are increasingly seeking products that will give them the ability to connect with physicians, healthcare providers and gather information. As the study …

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