Archive for August, 2013

Less than One Month to Go and Counting

Healthcare providers, healthcare clearinghouses, health plans (“Covered Entities”) and their business associates all have less than one month to go before they are required to be in compliance with the enhanced privacy and security requirements that became final and effective on March 26, 2013. The compliance deadline for “Covered Entities” is September 23, 2013. For many, there is a lot of work to be completed before the compliance deadline arrives.

On the privacy side, Covered Entities need to update the Notice of Privacy Practices. On the Notice of Privacy Practices (“Notice”), Covered Entities need to ensure that the following notifications have been included in the Notice: (1) if a patient pays out of pocket for a visit in full and request a restriction on disclosing the PHI to the health plan the protected health information related to the services would not be disclosed; (2) most uses and disclosures of psychotherapy notes require an authorization; (3) most uses …

Continue reading Less than One Month to Go and Counting »

Facts About Exchange Premiums

One of the most disturbing aspects of the political battle over implementation of the Affordable Care Act is the degree of misinformation being generated by officials in a number of states. Over the summer Insurance departments in Florida, Indiana, Ohio, and Georgia have selectively released information on the cost of coverage in the health insurance exchanges that are misleading at best. They have all claimed that under the ACA people purchasing individual health insurance through the exchanges will face significantly higher premiums. In fact all of their analysis either misstates actual premiums (Indiana), compares exchanges premiums to a fabricated plan that no one can actually purchase currently (Florida), or finds a rare unidentified person who faces higher premiums (Georgia).

The ACA requires that beginning in 2014 premiums in the individual market be based only on age, location with in a state, whether a person smokes, and the plan. Premiums can vary by age by no …

Continue reading Facts About Exchange Premiums »

The Healthcare Reform Law that Inequitably Treats Healthcare Providers

A recent article published in Modern Healthcare[1] highlights how CMS interpreted a rule within the healthcare reform law that is putting healthcare providers at greater financial risk. To summarize, healthcare providers could incur unreimbursed costs for services delivered to a consumer that has discontinued paying their insurance premium. See below for a detailed description of this scenario.

It appears that the business of delivering healthcare to a community is becoming more financially challenging. When you consider the increasing number of patients looking for care, reimbursement rates declining, no limits on malpractice suits and increasing regulatory burdens, it should be no surprise that in the future we see more healthcare providers filing for bankruptcy, looking for a financial bailout, selling their business, delivering limited services or discontinuing operations.

Here is the scenario that puts healthcare providers at greater financial risk due to CMS’s …

Continue reading The Healthcare Reform Law that Inequitably Treats Healthcare Providers »

A New Vehicle in Healthcare – Something that Isn’t Just Words

A survey came out recently that stated that half of patients haven’t had their doctors talk to them about healthcare reform.  With only two months until the beginning of the open enrollment period (October 1, 2013), there exists a significant knowledge gap for many Americans on what reform means for them and their families.
Whether you can squarely fault doctors for failing to inform their patients of these changes (as their trusted healthcare experts) is uncertain.  As an administrator in the field who works daily with physicians, I believe one measure stemming from the Affordable Care Act that all should know something about–whether or not you doctor mentions it to you–is the concept of a “patient-centered medical home” (Medical Homes or PCMH).  More than just a physical location, a medical home is a philosophy that places the patient at the center of care delivery where his or her care is coordinated, accessible, and focused on quality and safety.  It requires a …

Continue reading A New Vehicle in Healthcare – Something that Isn’t Just Words »

Anti- Kickback Drama and Why it is bad news for all Hospitals

Two of the nation’s largest for-profit Health Systems, Tenet and HMA, got themselves sued by the Federal Government under the Anti-Kickback Statute last week. The Anti-kickback statute, in a nut shell, prohibits Providers from paying for referrals on patients covered under the Federal Medicare or Medicaid program. The allegations of the complaint center around two pregnancy clinics located in Georgia, and the steerage of illegal immigrants from those clinics to these hospitals. The State of Georgia has also joined the lawsuit to recover it’s spent Medicaid funds.
I understand both Health Systems should be given the benefit of the doubt unless and until the allegations are proven true in court. However, the whistleblower in this case is a former CFO of one of these organizations, and these allegations are very severe. How does this happen in 2013? Is it possible that people, or the corporations they represent, believe they can get away with something like this? Wasn’t there one …

Continue reading Anti- Kickback Drama and Why it is bad news for all Hospitals »

More Unintended Consequences of Federal Health Reform

health reformThe implementation of the Affordable Care Act also known as ObamaCare has caused some interesting responses and reactions within the medical community. Most of those reactions are the direct opposite of the stated goals of ObamaCare.

Let’s look at the goals of ObamaCare and how the healthcare system and healthcare professionals are responding to the increased role of the federal government in healthcare.

First, ObamaCare promised improved access to care for the nearly 50 million uninsured Americans. However, the reality is that more physicians are either leaving private practice, retiring early or getting out of medicine entirely. A national survey conducted this summer by the nation’s third largest healthcare staffing company, Jackson Healthcare, indicates that fewer doctors are in private practice — 52 percent in 2013 vs. 56 percent in 2012. The survey also found a significant shift with physicians leaving their own practice to become hospital employees – a 26 percent …

Continue reading More Unintended Consequences of Federal Health Reform »

5 Ways Healthcare Marketers Can Succeed in Today’s Technology Driven World

Technology is creating massive change and disruption that has forever altered the way consumers and businesses interact. The healthcare industry is no exception as we are seeing lighting fast innovation from data digitalization, mobile applications and self-service consumer platforms. Perhaps no other time in history has technology so rapidly changed how we learn, collaborate and communicate. Consider the wave of change with mobile advancements that saw the “pager” become a dinosaur to the Blackberry, only to be followed by the iPhone and smartphones overcoming the Blackberry. By the end of the year, they’ll be more mobile devices on earth than people. And more people are online than ever before socializing, searching and shopping, helping to generate 90% of the world’s data in the last two years alone. The consumerization of technology and the digitalization of data are fundamentally changing us.

All these changes have completely upended how marketing functions. Marketing …

Continue reading 5 Ways Healthcare Marketers Can Succeed in Today’s Technology Driven World »

Not-for-Profit Hospitals Must Prepare for Reimbursement Shift toward Quality over Quantity

Guest Blogger Donna Fincher, Marketing Manager at Diversified Account Systems of Georgia, Inc.

Hospitals and other healthcare providers have been measuring the value of their services based simply on the numbers of patients they treat for generations. Today incentive changes imbedded in the Patient Protection and Affordability Act are forcing hospitals and physicians to reevaluate their methods of measuring and proving the value of the care they provide.

Historically, full hospital beds and busy physician schedules drove the success of providers; however emerging trends in the industry are leaning toward higher reimbursement levels for better quality services. In short, both government and commercial payers are beginning to reward providers who see patients less often because their original treatment plan was better and more comprehensive resulting in fewer office visits and hospital stays for those patients.

Medicare has already implemented a strict readmissions policy with …

Continue reading Not-for-Profit Hospitals Must Prepare for Reimbursement Shift toward Quality over Quantity »


Atlanta is home to numerous healthcare information technology (“Health IT”) companies and serves as a Health IT leader in the Nation. Following the American Recovery and Reinvestment Act (“Stimulus Act”) and the HealthCare Reform Act, the Health IT market grew exponentially. Both laws dedicated billions of dollars to fund Health IT initiatives designed to spark innovative methods of delivering healthcare services by changing how healthcare is coordinated among providers and patients while reducing the costs to deliver clinical care. Some of these initiatives dedicated funds to encourage the adoption and implementation of electronic health records. Other programs provided direct funding for concepts that would change how healthcare was delivered. All of the funding and initiatives have driven significant economic growth in Health IT and caused a lot of companies to develop Health IT service lines. While the federal funding has been the carrot to foster Health IT growth, …