Archive for December, 2012

The Fiscal Cliff and Healthcare

Today, Secretary Geithner informed Congress that the United States would hit the debt ceiling limit on Monday, December 31st. The following day, absent successful Congressional intervention, Physicians will incur a twenty-six and half percent (26.5%) reduction in Medicare Reimbursement. And yet one day later on January 2nd, if Congress fails to address the “fiscal cliff”, healthcare providers will incur a two percent (2%) reduction in Medicare payments. The two percent (2%) decrease is projected to save over $11 Billion from the Medicare program in 2013 alone. So while many Americans are focused upon the potential increase in taxes, healthcare providers must evaluate how to address these dramatic pay cuts.

Each year, physicians demand for Congress to correct the Medicare Sustainable Growth Rate (“SGR”) to prevent this significant decrease in Medicare reimbursement. Each year, the physicians have successfully obtained a delay in the implementation of the payment …

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Healthcare Delivery and Care Coordination Changes on the Horizon

With the implementation of the Patient Protection and Affordable Care Act (PPACA), the delivery of healthcare will transform in the near time horizon. These changes are driven by necessity. There are three key dynamics changing what healthcare will look like in the near future:

  1. Growing patient demand – increasing number of baby boomers going on to Medicare and the uninsured receiving medical coverage
  2. Declining number of physicians
  3. Reduction of reimbursement to healthcare providers

How the market responds to these dynamics is evolving though it will require a convergence of technology with a broader range of healthcare services.


Technology provides the infrastructure to support scaling of solutions. It will also be an enabler of delivering quality healthcare in a cost effective manner. Here are some examples of how technology is used today and we can anticipate expansion:

  • Telemedicine – Neurologist are on-call using a computer with a camera and live video feed …

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Demystifying Georgia’s Plans for Health Insurance Exchange

Healthcare consumers have been hearing a lot about 2014 lately, especially with regard to what their health insurance options will be. Most know that in just over 12 months, a big change is coming to the health insurance landscape, but I’m willing to bet that the majority of that “most” doesn’t yet have a firm grasp of what a health insurance exchange is, what it will look like in Georgia, and how it will benefit their pocket books.

As an average healthcare consumer, here is my brief attempt to demystify this term, and to break down its implications for Georgia citizens.

What is a Health Insurance Exchange?
According to Kaiser Health News, a health insurance exchange (also referred to via the HIX acronym) is a state-specific marketplace/website “where individuals and small businesses can shop for coverage, which will take effect on Jan. 1, 2014, and also find out whether they are eligible for federal subsidies or for Medicaid.”

States can choose to either set up …

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Not Yet Ready It’s Time To Get Set

In 2012 most of the big questions surrounding the Affordable Care Act (ACA) were answered in 2012. The biggest questions were settled with the Supreme Court ruling in June and the election results in November. Those two events determined that the ACA will be the law of the land and will shape the future of the health care financing and delivery system. The actual shape of the health care delivery system will be determined in 2013.

In the coming months decisions by HHS, the State of Georgia, insurers, and providers will determine access to care, the cost of health care, and the health of the population.

The largest decision with respect to access to care will be the states choice on Medicaid expansion. If the state participates in Medicaid expansion the percentage of Georgians without health insurance will fall from 22 percent to less than 9 percent. Without Medicaid expansion the ACA reduces the uninsured to about 18%. Medicaid expansion is expected to cover between …

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Washington, the Election and the Future: What Should Americans Expect for the US Healthcare System?

In the upcoming edition of the Journal of Medical Practice Management, I authored an article entitled, “Four More Years”, which covered the results of the November election results, wherein President Barack Obama was elected to a second term in the White House and control of the Senate and House of Representatives was split between Democrats and Republicans respectively.  Perhaps more relevant to that column’s audience, and my audience here, I went on to offer my predictions as to how those election results will impact the healthcare industry and its various stakeholders in the coming years.

That column was written literally as the election results were coming in, which is not always the best time to editorialize or offer individual predictions about the future.  At that point in the game, there is typically still too much heated emotion and political competition that can easily prevent one from gaining a realistic understanding as to how the events transpiring will …

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In the Spirit of Giving and the Holiday Season, I thought I would take a look at what our local hospitals give each year in the form of charity care. I searched the internet for statistics on charity care. I do not want to specifically identify a hospital, because I did not receive permission to do so. However, you can easily access the information on most hospitals websites.
This is what I found: I only had to look at four hospital systems to find a half a billion dollars in free care!! Some larger facilities are providing hundreds of millions of dollars of care each year, while smaller facilities are providing in the high millions. We can all always do more, but what other industry can you name that provides such a high level of free service to its patrons? Sure people fall through the cracks, sure there is room for improvement, but a half a billion dollars in charity care that is amazing! It is something every person who works to support this industry should be very proud …

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New Care Models – 3 Trends for mHealth in 2013

I spent a good part of the last week at the mHealth Summit in Washington learning how mobile technologies (cell phones and the like) are reshaping healthcare.  If you have a smartphone, this won’t be news to you.  I feel like there is an app for most everything health-related now.  You can be sure that every pound lost, mile run, and health question asked can be recorded, tracked, and answered through your cell phone.  The wave of health apps isn’t just for consumers though; clinicians are also part of this trend and are changing the way they practice medicine.  For example, the app MIM allows a radiologist the ability to use an iPhone to take, store, and share an x-ray in any environment.

Some of the most exciting innovations are happening at organizational and system levels.  In conjunction with the Summit, the trade association HIMSS provided a roadmap for the industry (one of our own HealthFlock’s own blogger Marcus Gordon was a contributor).  When looking at …

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Breaking Down Healthcare Silos: The Need of Healthcare Integration

dataThe American healthcare system … isn’t. It isn’t a “system.”

Patients have multiple providers. These providers rarely interact. The payment system operates in silos. And patient care isn’t coordinated.

This disjointed system is not a new challenge. In 1965, the federal government created Medicare, a program which provides coverage for certain services. Medicare Part A covers inpatient hospital services. Medicare Part B covers outpatient care like physicians’ services.

Forty years later, in 2006, the government launched Medicare Part D, which covers prescription medications. But the original Medicare program created payment and data silos for Parts A and B. Today, Medicare Part D is administered by private pharmacy benefit managers (PBMs). And the three parts (Medicare A, B and D) rarely talk to each other or share information.

So, that’s the public sector.

The payment and health information silos, unfortunately, also exist in the private sector. Most of us …

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2013 Top Ten Trends for Healthcare & Wellness

The healthcare and wellness industry has had quite a busy and interesting past year, certainly highlighted by the Supreme Court’s upholding of the Affordable Care Act this past June. The changes this law will spur, coupled with advances in technology and consumer empowerment, will continue to drastically reshape our healthcare and wellness landscape. 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 trends for 2013:

1) Technology Paves the Way: No doubt that technology will continue to pave the way for a better overall healthcare system, providing a more efficient and effective experience between consumers, healthcare providers, insurers, and healthcare and wellness businesses. Of course technology will enable our antiquated processes to be better but technology will also propel consumers to have more engaged and interactive experiences with not only their doctors and …

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