Archive for the ‘Reform’ Category

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.

Continue reading Can Hospitals Bully Physician Practices to Use their EHR? »

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, …

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

Last month, ObamaCare had its day (or days) in court. The case … NFIB, et.al. vs. Kathleen Sebelius, et.al. will be the most celebrated Supreme Court cases in modern history.

The Supreme Court heard six hours of oral arguments over three days. That is unprecedented.

There are 26 states that are suing the federal government. That is unprecedented.

The Supreme Court’s decision will impact over twenty percent of the US economy. That is unprecedented.

But what happens if the Supreme Court does strike down all or part of ObamaCare? We better have “Plan B” ready to go.

We all know that our healthcare system is broken. However, we can’t all seem to agree on how we reform or transform our healthcare system. Here is my short list of those things that the Congress should consider if the Supreme Court strikes all or part of ObamaCare:

• Make significant changes to the way we litigate medical professional liability cases. Physicians today order too many tests, prescribe …

Continue reading NFIB vs Sebelius: The Supreme Court and ObamaCare »

Later this month, fellow AJC blogger Mark Reiboldt and I will be presenting to financial executives and other healthcare leadership at the Dixie Institute for the Healthcare Financial Management Association (HFMA) on February 23.  Our topic examines how healthcare reform is taking shape today, particularly around accountable care and the coordination of care.  Specifically, we examine growth and what caregivers must consider in order to remain competitive in an evolving marketplace.  For today’s post, I thought I would highlight some of those points and why leaders in the industry cannot just sit idly on the sidelines today.  Inaction will likely have a much larger detrimental effect than any misstep made along the way to an integrated system.

Accountable Care Organizations (ACOs) are the latest rage in healthcare.  You cannot attend a conference, seminar, or even inter-company meeting without hearing the muttering of those words when talking reform. …

Continue reading Growth in an ACO World »

Mental health disability is on the rise. The American Journal of Public Health recently reported a study which shows a 2.7% increase in self reported  mental health disability among the non-elderly. The researchers attributed this increase  to the impact of factors including socioeconomics and mental health literacy.  It is also well known that people with chronic diseases  are more prone to mental illness. This speaks to a growing need for mental health evaluation and treatment but most of all prevention. Well that’s a easy one. Every body just stop what you are doing; take a deep breath; and just relax! Well anyone who has ever suffered from clinical Depression or Anxiety will tell you ’ it is not quite that easy’.

You may have heard of the Social Economic  Determinants of Health. This concept speaks to the many factors in our environment outside of our physical bodies that attribute to our health. When it comes to Mental health the stressors of our day to day …

Continue reading An Awareness of Mental Health »

In general, the letter requests that the IRS make Part V, Section B optional for 2011 (as the IRS did for 2010) to allow additional time to work through the application of these rules to a diverse group of charitable hospitals, to eliminate redundancies that have no clear relationship to the statutory requirements of the law or that do not result in a clear benefit to the public, and to simplify reporting for increased understanding (and to eliminate unneeded paperwork).

Continue reading Red Tape -Why does an Undermanned Agency Create Unnecessary Work? »

It’s not what I say, but what you hear that has meaning for you. In all situations, clear communication is paramount to success and efficient operations. The ability to work together, understanding and leveraging different skill sets, leads to a better work flow.  Knowing your strengths and weaknesses, and knowing when the time and situation are right for turning over control to a trusted partner, will help strengthen your competitive advantage and greatly improve your chances of success in the most challenging sector of business.  We all need to get a lawn mower! 

If what you say and what people hear are two different things, you’re in trouble. Creating clear and concise channels for communication and protocol on top of a foundation of trust and confidence go a long way.  About the title of this post, I actually suggested, “We all need to get along more,” as in get along better, communicate better, find a balance of mutual respect.  But the person to whom I was speaking …

Continue reading WE ALL NEED TO GET A LAWN MOWER »

A report out today says that 2.5 million more young Americans have health insurance. This is attributed to the health reform act. A significant achievement but much more work has to be done. Over 16% of people living in America are now uninsured which is up from 13% in 2000. Most of the loss is in the employment insurance sector because of the high unemployment that we have experienced over the past few years. So it seems to be some progress but it is overshadowed by the economic state of this union.

The need for significant changes in the US health system is becoming more and more of a needed priority. Medicare is threatening an across the board payment reduction of 27% in 2012.  Every year this time doctors are lobbying and gritting their collective teeth in hopes that  these type of cuts can be averted. Low reimbursement along with high demands are literally driving some would be physicians and other health care professionals to choose other careers.

That’s the …

Continue reading Happy Holidays and Medicare cuts for the New Year! »

For a number of years federal laws and legislation related to anti-kickback restrictions, often referred to as “Stark Laws”, have restricted the ability for physicians to own inpatient healthcare facilities, such as acute-care hospitals, long-term care facilities, etc.  The primary impetus behind the Stark Laws was to limit the ability for physicians to refer patients to an entity that the physician has a financial interest of some sort; this could include equity ownership, creditor or incentive-based compensation arrangements based on referrals.  In case you are not familiar with the inner workings of the healthcare industry, this is generally referred to as “self-referrals”.

Just recently the Centers for Medicare and Medicaid Services (CMS) released a “final rule with comment period” relating to regulations around physician-owned hospitals.  The changes were relatively minor, making slight modifications to the “process through which physician-owned hospitals …

Continue reading Give Physicians a Chance to do Something About Improving Healthcare »

The delivery of U.S. healthcare services is going through a profound change. Yet this change is occurring in the background and not apparent to the general public. The driving force behind this change is payment reform to healthcare providers for medical services delivered. The underpinning of this change is the reduction of cost in the delivery of healthcare services to make it more affordable. The initial step of payment reform has been the reimbursement models of Bundled Payments and Accountable Care Organizations. These new forms of reimbursement are forcing healthcare providers (hospitals, physicians and other care delivery services) to re-examine and redefine the delivery of services and working relationships. The changes being initiated are positive and took something extreme like payment reform to push organizations to look at how healthcare is delivered and make changes in the manner business is done. The outgrowth of these changes will be positive for our society by …

Continue reading The Direction of the U.S. Healthcare Services »