Archive for the ‘Reform’ Category

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 …

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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 …

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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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Body Blow or Flesh Wound? Mandate Delay Hurts Access

The big news of the week was the delay of the employer mandate in the Affordable Care Act, which required businesses of 50 or more employees to offer affordable health insurance for someone who works at least 30 hours a week or face an annual penalty.  The Obama administration acted abruptly in its announcement to push the mandate back one year to 2015 and beyond next year’s midterm election.  It was explained that businesses needed more time and clarification on the rules in order to properly comply with the new requirements (i.e., many business owners/leaders were incredibly unhappy with these provisions).

The action by the Administration does not technically postpone other central provisions of the law.  Yet, it does question if other central tenets–like the health insurance marketplaces in the states–will be ready by January 1, 2014.  Whether the employer mandate continues to morph from its current form or simply be delayed, it is certain that this action by the …

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Across the Globe, Similar Challenges and Solutions Exist in Healthcare

As I continue to interface with healthcare organizations around the world, the same challenges exist. At varying levels, whether a Country has a Nationalized/Universal healthcare program (Japan, UK, Taiwan) a Privatized healthcare program (U.S.), or a hybrid model (Singapore), key stakeholders are all faced with addressing fundamental issues – driving down cost, making healthcare more accessible, finding ways to improve patient outcomes, and ultimately improving the quality of care for their citizens.

These past few weeks I’ve had the honor of presenting at the Connected Health Asia Conference in Singapore and to the Japan Pharmaceutical Manufacturer’s Association in Tokyo. And, a few overarching themes pervaded most of my discussions.

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Defensive Medicine: More Than Just Another Extra X-Ray

med mal 4Defensive medicine occurs when physicians order tests, procedures or consultations of doubtful clinical value in order to protect themselves from costly and frivolous malpractice suits. Doctors detest the very thought of being sued so they find every means possible to avoid litigation.

And that includes ordering numerous unnecessary and expensive tests and procedures.

While not all Georgia physicians practice defensive medicine, the overwhelming majority do. According to a recent survey conducted by Oppenheim Research, 82 percent of Georgia doctors say they perform unnecessary tests, procedures and referral consultations exclusively to avoid a medical malpractice claim.

A 2010 Gallup Poll of physicians found that one-in-four healthcare dollars is spent on defensive medicine. A great deal of money is “wasted” on the practice of defensive medicine. Last year, Georgians were subjected to $14 billion of unnecessary tests, procedures or consultations with little or no clinical or …

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Memorial Day and the Healthcare Connection

Memorial Day is a time to reflect – to thank our service men and women who have so bravely sacrificed in order to defend our moral virtues across the globe. It is also a day to recognize that on the battlefield, decisions are often made with both gut instinct and decades of experience and data. This also holds true for health related decisions in the field – and off of it – where real time data, previously not available to clinicians, help make the healthcare decision-making pathway much more conclusive.

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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 exchanges)

Care …

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The Importance of Innovation in Healthcare

r&dIn 1955, Dr. Jonas Salk announced to the world that he had developed a vaccine for poliomyelitis (or polio) and the world was forever changed. No more would there be the need for polio wards or iron lungs. Innovation is hugely important in healthcare.

Just 25 years ago, if a patient came to a hospital with a heart attack, the best that could be done for the patient was to inject morphine for pain and lidocaine, which doctors believed would prevent dangerous irregular heartbeats … and hope and pray for the best. Now, as a result of medical breakthroughs like statin therapy to treat the progression of atherosclerosis, the American Heart Association indicates that we have seen a near 40 percent reduction in deaths due to coronary artery disease since 1998.
In 1989, at the International AIDS Meeting, Dr. Samuel Broder declared that AIDS was a chronic condition and that treatment of the disease meant that AIDS was no longer an automatic death sentence. Medical breakthroughs are …

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Connected Everywhere – from Hospital to Home to Pod

The HealthFlock team of experts has done an excellent job of outlining the factors that constrain, as well as offering solutions to help cure, our healthcare system. While the adaptation of technology in healthcare has been slowed due the fractured core of our healthcare ecosystem, inevitably, it will be technology that will drive forward the changes necessary for it to survive – and thrive. Building a more connected healthcare network will drive down costs and improve the overall delivery of care – from the hospital to the home to a free-standing pod.

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