Archive for January, 2012

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).

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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 …

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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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The Broccoli Theory

Just a catching title? Actually, no, it is a catch phrase for a legal question being used to argue against the Affordable Care Act (ACA). The phrase was born out of mouth of Judge Robert Vinson in the United States District Court in the Northern District of Florida during oral arguments in December 2010. To understand how Broccoli became associated with Healthcare Reform, a little background is needed.

The ACA litigation centers around the interpretation of the Commerce Clause, which appears in the United States Constitution. The Commerce Clause allows Congress to regulate industries, products, and activities in or affecting interstate Commerce. The question with regards to the ACA is whether or not the requirement for 30 million uninsured Americans to obtain insurance coverage, in order to spread the risk and reduce costs in the private insurance market, is regulation affecting interstate commerce, and therefore, within the scope of the Commerce Clause. If it is, and …

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Health Care Behavior

AMA News recently reported that patient visits to their physician have declined 4% since 2009 according to the Institute of Health Care Informatics.  Some believe this trend will continue even with health reform. The decline is partially contributed to a down economy and increased insurance deductibles. This significantly impacts the bottom line for physician practices and various forms of businesses that support the health care sector. Will this trend continue?

I think the answer to this question depends on the future of our health care system and how it supports the patient or how well the patient thinks it supports them. Patients are cutting  health care cost by planning less visits to their physician. On the contrary, the current health initiatives are depending on more  patient compliance that results in prevention and early diagnosis of chronic conditions .The current trend of decreasing visits is not supportive of the preventative health model but it tells us one thing. …

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WE ALL NEED TO GET A LAWN MOWER

It’s not what I say, but what you hear that has meaning for you. In all situations, clear communication is paramount to success and efficient operations. The ability to work together, understanding and leveraging different skill sets, leads to a better work flow.  Knowing your strengths and weaknesses, and knowing when the time and situation are right for turning over control to a trusted partner, will help strengthen your competitive advantage and greatly improve your chances of success in the most challenging sector of business.  We all need to get a lawn mower! 

If what you say and what people hear are two different things, you’re in trouble. Creating clear and concise channels for communication and protocol on top of a foundation of trust and confidence go a long way.  About the title of this post, I actually suggested, “We all need to get along more,” as in get along better, communicate better, find a balance of mutual respect.  But the person to whom I was speaking …

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Happy New Year and Hold On Tightly

Happy New Year! As we welcome in 2012, we should also be prepared to hold on tightly as this year will likely be full of change.

Later this year, we should have a historic decision about the two questions facing the Supreme Court of the United States regarding ObamaCare: 1) Can Congress require individuals to purchase of health insurance? And 2) Can the federal government force states to expand their Medicaid program?

If the Court upholds the Patient Protection and Affordable Care Act and its provisions, it will trigger a whole series of events and policies which must be implemented pursuant to the 2,700+ page legislation. One of those state triggers which must be implemented are state health insurance exchanges. These exchanges will allow individuals and small employers to purchase health insurance coverage.

The manner in which these exchanges are established and maintained is also of importance. Several states such as Massachusetts and California have adopted a …

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Top Ten Trends for Healthcare & Wellness in 2012

The Wall Street Journal recently published their annual “CEO Council” edition, where industry experts and members of the WSJ CEO Council addressed many of the challenges facing our country and world, including the global economy, international relations, energy resources, and of course, healthcare. Among the healthcare topics discussed, the top-two recommendations for improving our healthcare system were 1) prevention and awareness of chronic diseases; and 2) the advancement and importance of healthcare technology.
This article, among many others, got me thinking about what 2012 holds for our industry. Throughout this past year familiar themes rang clear, giving us insights to what will play vital roles for healthcare in our future. Below are my top ten for 2012:
1) Technology Will Lead the Way: No doubt that technology will pave a way for a better overall healthcare system, providing a more efficient and effective experience between consumers, healthcare providers, …

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