Archive for February, 2012

CMS Changes in the Conditions of Participation Requires Hospitals to Act

On November 18, 2011, the Centers for Medicare and Medicaid Services (CMS) updated its guidance to and, although briefly, dramatically changed who could order rehabilitation services at a hospital. Now hospitals must review the initial guidance, the revised guidance described below and update its policies to comply with CMS requirements immediately. Hospitals that provide rehabilitation services must ensure that the delivery of services conform with the CMS Conditions of Participation. One such standard requires for the rehabilitation services to be delivered under the orders of a qualified and licensed practitioner acting within the scope of his license and authorized by the hospital’s medical staff to order the services in accordance with the hospitals’ policies and procedures. Hospitals rely upon practitioners in the community ordering services to generate revenues. This Condition of Participation seemingly did not appear to restrict the hospitals ability to receive …

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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 …

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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 …

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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 titled “ Iconic skier’s death points out the U.S. 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, …

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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 …

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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 …

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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 …

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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 …

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