Archive for May, 2012

Why Pay-for-Performance Falls Short of Impacting Cost Savings for the Healthcare System

Medicare is continually looking at developing approaches to reduce the rising cost of healthcare through demonstration programs or pilot projects. The goal is to find the right formula that reduces the cost of healthcare while improving the quality and accessibility of services. Achieving this goal is mission critical to our country’s future and is a daunting challenge. The national healthcare expenditure is forecast to grow at a compound annual growth rate of [1]6.8% over the next eight years (2011 – 2019) from $2.7 trillion in aggregate healthcare expenditures to $4.6 trillion over this period. To address this issue, creative solutions need to be developed that substantially move the country to reducing the cost of healthcare services.

One of these approaches to reducing the cost of healthcare while preserving the quality of services is Pay for Performance. The Pay for Performance model reimburses healthcare providers for following prescribed best practices clinical process …

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Do you know how your patients find you?

A patient who lives in a major metropolitan area such as Atlanta has many excellent choices about where they choose to receive their care. There are a plethora of orthopedic surgeons, hospitals, and rehab centers – many of which provide great care. The market is very competitive. This is a definite win for the patient; but what is the effect for providers? In a cluttered market, it has become increasingly challenging for providers to distinguish themselves and their services. Which leads us to the matter in question – Do you know how your patients find you?

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State Health Insurance Exchanges Moving Forward

As we all await the Supreme Court’s decision on whether the Patient Protection and Affordable Care Act (“Healthcare Reform Act”) requirement for each individual to purchase insurance is deemed constitutional or unconstitutional, the Healthcare Reform Act implementation continues. One of the touted purposes of the Healthcare Reform Act is to increase the number of insured individuals. In order to support this purpose, the Federal Government provided resources for individuals to access health insurance. Specifically, as of June 2011, 2.5 million young adults under the age of 26 were eligible for insurance coverage through their parent’s insurance, because the Healthcare Reform Act expanded insurance coverage eligibility to dependent adults under the age of 26. Starting in 2014, individuals who have income less than 133% of the Federal Poverty Level will be eligible for Medicaid coverage. Further, small employers, who serve as a critical resource for offering insurance to …

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Taxes – Do We Know One When We See One?

As we approach the half-way point of 2012, an important court case that will dramatically affect the healthcare industry is about to be decided. Next month, the United States Supreme Court is scheduled to decide the constitutionality of the Affordable Care Act. The Supreme Court has heard oral arguments on and may decide the following issues:

1) Whether the penalty for noncompliance with the individual mandate is equivalent to a tax.
2) Whether the individual mandate is legal.
3) Whether the individual mandate is illegal, whether the rest of the Affordable Care Act is also illegal or whether it is severable from the individual mandate.
4) Whether Congress illegally required states to expand the Medicaid program.

Unfortunately, due to the various burdens employers and state governments face in complying with the Affordable Care Act, not all of these issues may be decided as soon as we hope. If the Supreme Court determines the penalty for noncompliance with the individual …

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Consumers In For a Wild Ride and They Might Be Driving

Change in all its forms is one of the most important causes of individual stress. Health care providers are under pressure from all sides to change the way care is financed and delivered. The effect of these changes on individuals as consumers and patients is not yet clear, but what is clear is there are going to be significant changes in how individuals access and receive care. While the Affordable Care Act (ACA) will certainly affect an individual’s care most people will see these changes even if ACA were to disappear.

Changing consumer behavior is and has been the goal of almost everybody in health care. Individual behavior affects the incidence of disease while their behavior as consumers and patients affects the efficacy and efficiency of care. Changing provider payment mechanisms from fee-for-service to any of the many pay-for-performance reimbursement schemes is often justified as a means to give provider incentives to provide cost-effective care, but often the …

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Innovate or Die: Why Healthcare Must Embrace Innovation

Lisa Crymes, Guest Blogger for Elizabeth Richards

Innovate or Die. Companies (and industries) which embrace innovation and creative thinking are typically more dynamic and more successful than those that don’t. And, that dedication to innovation can be the difference between success and failure.

We have all heard of companies such as Eastman Kodak and Research In Motion (RIM) which were once market leaders but failed to embrace innovation. Then, there are entire industries such as railroads or some manufacturing facilities which were committed to “business as usual” and were intent on continuing down the same path. Because of their commitment to the status quo, they missed the opportunity to innovate. And, as a result, these industries were ill equipped to deal with new and emerging competitors in the marketplace.

Healthcare has not typically embraced innovation in many areas and now must innovate or die. Which healthcare players are at risk of becoming extinct? Which …

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Can Hospitals Bully Physician Practices to Use their EHR?

If the Affordable Care Act stands as-is (and it likely will, at least for accountable care), providers have a significantly higher burden to provide a full range of care to their patients. Their scope is broadening from providing care to an individual patient to that of an entire population. In order to deliver on the promise of improved, coordinated care (while also being expected to lower costs), providers are re-evaluating how information is shared across their overall care network. In particular, more attention is being focused on how technology be used for cost and quality metrics, provider network management, and care management.

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Bigger Not Better: America’s Obesity Epidemic a Stark Reality

An alarming stat came out this week: 42% of the population will be obese in 2030, rising from 32% today. And the costs associated with treating those people will exceed $550 billion over the next two decades. The report was presented this week at a conference sponsored by the CDC, titled “Weight of the Nation,” in Washington D.C., as well as published in the American Journal for Preventive Medicine.

If there was ever any question about the problem of obesity and the troublesome ripple effect it triggers on the body and our healthcare system, then this glaringly stark reality should surely settle the debate. We are a nation of fatties. Harsh, yes, but true. And we are in denial.

There are many reasons “why” but one is certainly the problem of awareness, rather lack thereof. And by “awareness” I mean two different types: 1) Consumers simply not knowing they are obese or the ramifications of obesity, either because of their socioeconomic conditions, location, education level, …

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Teamwork, Health Systems, HIT and the Chair

Day to day we are striving to clearly understand how EHRs and other health Information technology affects the workflows of provider practices and healthcare systems. The implementation of the technology is a start but the adoption is the more difficult part. Each practice is its own healthcare system. Whether it is efficient or a poorly run operation, it’s still a system with workflows. How do we optimize the workflow within the practice system? Just what is the template?

Teamwork. Well I guess we can’t stop there so let’s say successful teamwork. Actually there is no template that fits all situations, systems, and workflows. However, good teamwork among stakeholders can be a foundation for success in any system. Health Information Technology does not come out of the box ready for prime time. It does not adapt to the user, the user must adapt to the technology in most cases. That is why we train and upgrade and work with vendors to develop a highly functional product which is …

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Pharmacists: An Answer to the Health Access Problem .. and More

Improved access to healthcare was one of the main selling points of federal health reform. ObamaCare places a great deal of importance on expanding coverage with a special focus on advancing health wellness, preventative services and primary care.

However, there is an underutilized healthcare resource which is available to everyone … now.

That underutilized and often untapped healthcare resource is your community pharmacist. In Georgia and most other states, pharmacists are the most accessible healthcare professional.

From Dade County in the mountains of northwest Georgia to Camden County on the Georgia coast and from Maine to California, pharmacists are an untapped resource. Unlike physicians and hospitals which are usually located in more populated cities, community pharmacists are located in virtually every one of Georgia’s 159 counties and in most small communities throughout the US.

And, pharmacists are very knowledgeable healthcare professionals. After college, …

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