Archive for November, 2011

Healthcare and the 6-napkin Roast Beef Po’boy

Capital planning for the unexpected

I was enjoying my New Orleans’, 6-napkin roast beef po’boy, carefully avoiding the anticipated drip down my shirt and realizing how healthcare and this dripping sandwich have a lot in common. Healthcare is challenged from every angle and the constant, multi-front battle creates opportunity for waste, inefficiency and non-compliance.  Improving in one area almost certainly leaves another vulnerable.  If a provider gets caught up, legislation changes or reimbursements get slashed.  The drips in the napkin are an acceptable casualty because we know we can’t possibly keep it all in the bread.  But what about the drips down the chin? What about the drips on the shirt, embedded deeply in the fabric’s fibers and potentially causing permanent stain?   As the pendulum shifts from doing more with more, to doing more with less, and finally doing less with less, are we finding healthcare on an unsustainable trajectory?

While healthcare has always …

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The One Billion Dollar Healthcare Innovation Challenge

Reducing the National deficit is a critical issue for everyone. Fundamental to addressing the deficit is tackling the rising healthcare costs. A 27.5% cut in reimbursement is looming for physicians in January 2012 while the Super Committee’s inability to reach agreement on proposed cuts may result in an automatic 2% decrease in Medicare reimbursement in 2013. However, merely reducing reimbursement rates does not address the issues that drive the increases in healthcare costs. Specifically, reducing providers’ reimbursement may not encourage providers to engage in best practice protocols that support better patient outcomes, thus, reducing readmissions in the hospitals. Likewise, reimbursement cuts may have little impact on encouraging providers to electronically exchange medical records to support clinical care coordination and minimize duplicate procedures. Instead, reimbursement cuts may deter individuals from becoming healthcare providers which reduces access to …

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Give Physicians a Chance to do Something About Improving Healthcare

For a number of years federal laws and legislation related to anti-kickback restrictions, often referred to as “Stark Laws”, have restricted the ability for physicians to own inpatient healthcare facilities, such as acute-care hospitals, long-term care facilities, etc.  The primary impetus behind the Stark Laws was to limit the ability for physicians to refer patients to an entity that the physician has a financial interest of some sort; this could include equity ownership, creditor or incentive-based compensation arrangements based on referrals.  In case you are not familiar with the inner workings of the healthcare industry, this is generally referred to as “self-referrals”.

Just recently the Centers for Medicare and Medicaid Services (CMS) released a “final rule with comment period” relating to regulations around physician-owned hospitals.  The changes were relatively minor, making slight modifications to the “process through which physician-owned hospitals …

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The Direction of the U.S. Healthcare Services

The delivery of U.S. healthcare services is going through a profound change. Yet this change is occurring in the background and not apparent to the general public. The driving force behind this change is payment reform to healthcare providers for medical services delivered. The underpinning of this change is the reduction of cost in the delivery of healthcare services to make it more affordable. The initial step of payment reform has been the reimbursement models of Bundled Payments and Accountable Care Organizations. These new forms of reimbursement are forcing healthcare providers (hospitals, physicians and other care delivery services) to re-examine and redefine the delivery of services and working relationships. The changes being initiated are positive and took something extreme like payment reform to push organizations to look at how healthcare is delivered and make changes in the manner business is done. The outgrowth of these changes will be positive for our society by …

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What Will Employers Do?

Employer responses to the changes in the health insurance market created by the Affordable Care Act (ACA) will shape the health care financing system. While most analysts project that the total number of Americans covered through an employment-based health plan will not change very much after ACA is implemented, some have argued that employers will drop coverage en masse. The final determination which of these two viewpoints is correct will depend upon how the law will be implemented: neither the Federal government, nor the vast majority of the states have progressed far enough in the planning process to fully assess the effects of the law. It is possible however to understand the implications of the ACA on employer decision making and the implications for individuals in the future health care delivery system.

A common sense approach to projecting the choices employers will make after ACA is implemented is to understand the choices employers make in the current …

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3 Things that Will Move the Telemedicine Needle

Advances in information technology are transforming medical care by changing the way that health is delivered and how people access clinical services.  One technology on the forefront of this revolution is telemedicine, defined as the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status.  As stated in past HealthFlock posts, examples of telemedicine at work today in Atlanta and elsewhere are prevalent:  emergency medical personnel transferring medical information and images from ambulances to hospital emergency rooms, video consultations between a physician specialist and her patients, and healthcare providers using remote monitoring to track changes in important patient vital signs in their homes. 

By diminishing the impact of time and distance, telemedicine expands capacity and makes it easier for patients to be seen and treated.  It can decrease the costs of care delivery and support greater …

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New Safety Efforts aimed at Health Information Technology

The Institute of Medicine (IOM) recently released recommendations  to the Dept of Health and Human Services to establish guidelines and processes for consumers and technology vendors to report Health Information Technology (HIT) related adverse events. This provides  an avenue to report injuries and deaths associated with the utilization of the technology. It reminds me of the old science fiction movies where the machines take over. Death from Health Information Technology? ” The Attack of the EHR” may be the next big cinema event. All Jokes aside, this is a serious concern as we seek the interoperability of Health Information Technology. Privacy, security, and safety of the patient and the patient’s information is an ever present issue that requires our attention.

There are documented incidents of Health Technology failures  and human failure associated with HIT which have caused harm.  Here are a few possible scenarios.  When utilizing order entry in an EHR system …

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Reform: It all comes down to one vote!

With the Supreme Court back in session, one of the hot button items on their agenda is whether or not to hear one of the two petitions pending for a ruling on the constitutionality of the Accountable Care Act (ACA). It is unclear whether the Court will hear both petitions, combine the petitions, or choose to hear just one. However, most Court watchers believe that the Court will hear something, and it will happen soon.

Oral arguments will likely take place in the spring with a decision set for June or July 2012. There are a couple possible outcomes. The Supreme Court could hold the entire act to be constitutional. In that case, the provisions and deadlines of the act would proceed as laid out, unless a new Congress were to repeal all or some of the Act prior to the inception of the deadlines. The Supreme Court could also hold parts of the Act Unconstitutional, such as the individual mandate, while leaving other parts of the Act in tact. In this case, Congress would need to …

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Newly Released Healthcare Paper Underscores Importance of Technology, Innovations & Consumer Access and Participation

Healthcare professional Jane Sarasohn-Kahn of THINK-Health recently published a CHCF (California Healthcare Foundation) paper entitled, “Primary Care, Everywhere: Connecting the Dots Across the Emerging Healthcare Landscape.” The paper addresses today’s evolving landscape as we ready for an influx of millions of new patients into a system of traditional, primary care providers that can’t possibly provide adequate services to meet the rising demand. Sarasohn-Kahn offers insights into many innovations and technologies that are currently in place (or on the horizon) that will help offer a more holistic, connected healthcare experience for consumers as opposed to the isolated, traditional approach of services taking place only through hospitals, clinics and doctor offices.

Particularly, the paper notes the importance of technology and innovations giving consumers more access and participation to empower them about their healthcare, clearly a familiar theme that this blog …

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Creating 21st Century Solutions in Healthcare

At the Center for Health Transformation, we are working hard to create a 21st Century Intelligent Health System that can save lives and saves money for all Americans. However, it seems like every time we make a little progress, we must overcome a new challenge.

Take electronic prescribing and electronic medical records (EHRs).  Both rely on cutting-edge technology to provide better healthcare for patients.

We know that e-prescribing and EHR systems are safer and more cost effective than paper prescriptions and paper health records.  The state and federal governments are even creating incentives for doctors and hospitals to move away from traditional paper.

And, it is working. We are seeing more and more physicians making significant investments of time and resources as they embrace electronic systems.  According to Surescripts which provides the infrastructure for e-prescribing, by the end of this year, more than half of the prescriptions issued in our nation …

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