Archive for the ‘Management’ Category

Picking a Medicare D Plan is Nearly Impossible; You Must Do Your Homework

GUEST COLUMNIST:  Steve Cohen, MD, Internist at WellStar Cobb Medical Group

Are you willing to spend less than an hour of your time so that you or your loved ones on Medicare can save hundreds to thousands of dollars every year? If the answer is yes, you need to read about, a website reviewed by Clark Howard, where you can learn to lower your medical costs.

The Medicare Drug Law of 2006 was a boon to the Medicare population. Before the passage of this law the US government did not pay for prescriptions. Since that time people on Medicare (those over 65 as well as people with certain disabilities) have been able to sign up for Medicare D plans (which cover outpatient medicines) or Medicare Advantage plans (essentially HMOs or PPOs which pay for medicines in addition to the hospital, physician and other outpatient bills).

Under traditional Medicare, the government directly pays the provider for rendered medical services. In contrast, private …

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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 …

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The Secret Sauce of Healthcare Reform

There’s a lot going on with healthcare reform.  The thousands of pages that outline the Affordable Care Act are intimidating for any lay person and even some experts to understand.  Its aim though is relatively simple:  better patient care, improved population health, and lower costs.  But how do you really achieve that?

There are a number of exciting initiatives that are underway to reach this triple aim.  Yet, from my perspective, I would argue that the secret sauce of healthcare reform centers on case management.  Case management can be defined as the coordination of health services across different providers and locations to promote quality, cost-effective outcomes for patients.  At its heart is a case manager or care navigator.  (Not to be confused with “exchange navigators”; the Feds released a proposed rule last week that defined the eligibility of people who are tasked with providing guidance to people enrolling in the federal health insurance …

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Is the Healthcare IT companies’ announcement of seamless interoperability marketing hype or a social awakening?

At the recent HIMSS trade show, six large healthcare IT companies (McKesson, Cerner, athenahealth, Allscripts, Relay Health, Greenway Medical Technologies) announced the formation of a not-for-profit company called CommonWell Health Alliance. The purpose of this organization is to create frictionless movement of patient-centered data across all settings of care and among all health care IT systems[1].

This is a profound announcement from companies that did not embrace the frictionless movement of data across systems within an acute care setting let alone outside the four walls of a hospital. This is great news for all of those organizations that lacked the clout or financial assets to interface their best of breed systems with the large name brand solutions. Historically, the price and effort of sharing data with the larger acute care vendors was cost prohibitive. The price and effort became a barrier to entry keeping best-of-breed competition out of a healthcare provider’s …

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A Good Time for ICD-10?

Is this a good time for ICD-10? Providers are mandated to implement ICD-10 for outpatient diagnosis coding by October 1, 2014. This could not be at a worse time for healthcare organizations especially small practices. ICD-10 diagnosis codes are used by your provider to describe your illness and are submitted to insurance companies for payment. Providers currently use an older version called ICD-9. ICD-10 will increase the number of available diagnosis codes from 13,000 to 68,000. Medical Economic journal recently estimated the cost per practice to be $83,000-$2.7million according to the practice size.

The American Academy of Family Physicians (AAFP) recently indicated that providers should not have to bear the economic burden of upgrading to ICD-10. Upgrading requires practice management IT system changes that can be expensive for providers at a time when they are already spending big bucks to implement and upgrade their electronic health records. Meaningful Use Stage II is …

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Healthcare Payment Reform Redefines Healthcare IT Solution Requirements

Healthcare payment reform is a work in process. The Centers for Medicare and Medicaid Services (CMS) Innovation Center is rolling out various test projects to identify how to bend the curve of healthcare costs while improving quality outcomes. These projects are gravitating towards a common underlying reimbursement theme, a fixed payment for services covering the episode of care (ambulatory, acute, and post-acute services) with a linkage to quality outcomes. Present healthcare IT solutions do not meet the anticipated needs of the market for this new form of reimbursement. There are two key requirements a healthcare provider’s IT solution needs to provide:

  • Episode of care (ambulatory, acute and post-acute services) integrated platform supporting the data acquisition, measuring and monitoring of total services delivered
  • Financial accounting system to forecast, measure and manage the distribution of a fixed payment to various providers participating in the episode of …

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Transforming Healthcare One Medicare Patient at a Time

teamAs we ring in the New Year, many features of the Accountable Care Act (ObamaCare) will begin to take shape. State Benefit (Insurance) Exchanges will begin to unfold. The Medicare and Medicaid Innovation Center within HHS will continue to examine and support promising models of care delivery. Cost containment programs like Accountable Care Organizations (ACOs) will begin to reshape the way Medicare pays for healthcare services.

So what are Accountable Care Organizations (ACOs)?

ACOs are organizations created by either groups of doctors or hospitals that improve quality measures in five key areas that impact affect patient care:
• Patient (caregiver) experience and satisfaction;
• Care coordination;
• Patient safety;
• Preventive health; and
• At-risk population health management.

HHS wants to improve the quality of care Medicare patients receive. ACOs are seen as a way to drive improved care through better coordination of healthcare …

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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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The Affordable Care Act is solidified with the election – Healthcare providers will need to accelerate their plans for payment reform

The recent reelection of President Obama solidifies the future of the Patient Protection and Affordable Care Act (PPACA). A number of healthcare providers (hospitals, physicians, post-acute services, etc.) sat on the sidelines awaiting the outcome of the Presidential election to determine if they needed to start rethinking their business model and what changes are required. Now that we have the answer the PPACA is here to stay, healthcare providers are starting to reassess how they need to redefine their businesses and strategic business relationships.

An underlying principle that all healthcare providers will base their strategic planning against is that the demand for healthcare will rise and the level of reimbursement will decline.  Various payment models are being tested by CMS, and we can expect more variations over the next year or two. With the power of the PPACA, CMS can rapidly adopt a payment model that demonstrates effective results reducing costs and make it a …

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Do Healthcare Providers need to invest in more information technology or focus on leveraging existing information?

Healthcare providers today continue to invest and expand their information technology footprint to meet increasing demands of data. As we hear about healthcare provider financials put at risk due to RAC (Recovery Audit Contractor) audits, self-reporting appropriate use of ICDs (Implantable Cardioverter Defibrillator), pay-for-performance, Bundled Payments for episodes care, Accountable Care Organization, etc., there is an increasing expenditure of technology to meet these growing information demands.

Given the enormous amount of information presently collected at the patient, physician and procedure level, is the issue that healthcare providers are not collecting enough data to support these ever growing and changing business needs?

I would make the argument that the existing information platform for most healthcare providers collects more than sufficient information allowing organizations to measure their operational performance and address both the present and upcoming …

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