Archive for December, 2013

Healthcare Confidence Lessons from Target and PayPal

What type of healthcare facility would you rather put your personal health and financial information in the hands of? One like PayPal, who proactively reaches out to assure you its doing everything it can to protect your information, or one like Target, that alerts you to a breach several weeks after the fact? Health data breaches not only mean legal headaches and potentially very large financial penalties, but they also negatively impact a hospital’s brand, in turn causing …

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Healthcare Milestones for 2013

Now is the time of year when we look back at the highs and lows from 2013. In healthcare, there is a lot to talk about, but today we will focus on three important healthcare objectives. In 2013, the Healthcare Reform Act focused on changing reimbursement models and laid the groundwork for health insurance exchanges to commence in 2014. These changes led to three main milestones.

First, in 2013, provider integration flourished because of reimbursement changes. The bundled payment demonstration program commenced while payments to primary care providers increased. Bundled payments require providers to work together to treat a patient under a best practice protocol to reduce the costs so the providers can split one payment for the full delivery of care provided to the patients. As with most of the demonstration programs, bundled payments also require providers to report quality data to the Centers for Medicare and Medicaid Services (“CMS”). Similar to other programs this …

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What are the positive aspects of the Affordable Care Act?

The debate will continue for quite a period-of-time whether the Affordable Care Act achieved its objectives and was cost effective. While political parties and individuals posture the pro’s and con’s of the Affordable Care Act, there are some positive aspects.

Whether you loved or liked the previous healthcare insurance business model, the Affordable Care Act addressed three notable deficiencies. The following are those deficiencies and how the Affordable Care Act addressed them:

First – people with pre-existing medical conditions could not purchase insurance or it was cost prohibitive.

People with pre-existing medical conditions were not able to purchase insurance or the price was cost prohibitive. A number of individuals have pre-existing clinical conditions through no fault of their own. It could be a matter of genetics or other factors beyond their control. It is unreasonable to penalize individuals under these circumstances and put them at a financial disadvantage.

Second …

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2013: A Year of Debate and Delay

Historian Barbara Tuchman created Tuchman’s law: “The fact of being reported multiplies the apparent extent of any deplorable development by five- to tenfold (or any figure the reader would care to supply)”. That law applies directly to the events of 2013.

We started the year with tiptoeing away from a fiscal cliff. That political crisis would reappear later in the year, but the fear in January was that we would continue to kick this can of long-term budget deficits down the road. The problem is the major driver of Federal budget deficits is health care expenditures. Social Security, defense, and all other spending are projected to remain largely constant as a percentage of GDP. That means you could slightly lower future deficits by cutting other spending, but if health care costs aren’t addressed all long-term structural deficits will remain. Congress faces very few options in the current budget debate that would credited as reducing future Federal health expenditures …

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Still Work to do in EHR Adoption

Nearly 79% of primary care physicians are using some form of electronic health record (EHR) in their practices. This number continues to jump significantly from year to year. It surely is a testament to the innovative work that various sectors of the HIT industry have put into adoption efforts. It also speaks to the hard work that has been done by providers and their professional organizations to use Health Information Technology (HIT) tools to improve clinical outcomes for their patients. On the other side of the fence, there remains the 20% of providers who do not have EHRs. Medical Economics reports that, in 2012, among this group 48% said they did not plan to purchase an EHR. This is a 16% increase from 2011. These physicians are often referred to as “EHR holdouts”. Surveys show that most of these providers are the more elder physicians and physicians in small practices.

I am sure the term “hold out” is not meant to be derogatory but it could be interpreted by some that …

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