Archive for the ‘Reform’ Category

States Debating Innovative Approaches to Medical Malpractice Reform

med mal3From Arizona to Florida, state lawmakers are beginning to address medical malpractice reform. Rather than traditional caps on non-economic (so-called “pain and suffering”) damages, states are getting creative about the way they approach medical professional liability litigation reform.

In Arizona, for example, State Rep. Bob Thorpe of Flagstaff has introduced legislation which would require personal injury lawyers to be certified as a “medical malpractice attorney” before they could file suit against a physician or hospital. “The idea is to try to weed out the difference between good, legitimate attorneys that are practicing in the area of medical malpractice … from the ambulance chasers,” he said. Due to the complexity of the issue, Thorpe’s bill would also require that these cases would only be heard by judges who have been through special training in medical malpractice cases.

In Oregon, Gov. John Kitzhaber has taken an active role in trying to reduce healthcare costs in …

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Protected Patient Information in the Digital Era

Believe it or not, the HIPAA Omnibus has not had a major overhaul since the late 1990’s. The original Health Insurance Portability and Accountability Act was released in 1996. An updated expansion of the Act is set for official release later this week (the contents of the expansion were unveiled last week). The Act, which covers the transferability and security of private health information, for all intents and purposes, was written for the “paper” era, prior to the transformation of today’s digital and mobile age. As such, there were many outdated rules by which the privacy of patient information was not accounted for – such as the dissemination of data via the information “super highway” and mobile communication devices. However, the recent omnibus rule does not adequately address the complexity of today’s digital ecosystem, but it attempts to piece together parts that make the whole run more proficiently.

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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 care

These …

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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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Washington, the Election and the Future: What Should Americans Expect for the US Healthcare System?

In the upcoming edition of the Journal of Medical Practice Management, I authored an article entitled, “Four More Years”, which covered the results of the November election results, wherein President Barack Obama was elected to a second term in the White House and control of the Senate and House of Representatives was split between Democrats and Republicans respectively.  Perhaps more relevant to that column’s audience, and my audience here, I went on to offer my predictions as to how those election results will impact the healthcare industry and its various stakeholders in the coming years.

That column was written literally as the election results were coming in, which is not always the best time to editorialize or offer individual predictions about the future.  At that point in the game, there is typically still too much heated emotion and political competition that can easily prevent one from gaining a realistic understanding as to how the events transpiring will truly …

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Holidays . . . and Healthcare

It’s that time of the year again – leftover turkey and stuffing for lunch at the office, crowded streets around the malls which make afternoon commutes even worse, and the constant bombardment of messages about the latest technology products (on sale). It is also a reminder about the time we get to spend together as families as well as the joyous celebrations of the holidays and their traditions.

Holidays also suggest that there are healthcare related implications too – let’s call it “end-of-the-year planning for healthcare”. Perhaps you might have already gone through your insurance coverage election period known as “Open Enrollment” at work already (these typically occur in the mid-Fall, prior to the holidays).

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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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It is not all politics when talking healthcare

This past week held the first presidential debate between President Obama and hopeful Mitt Romney.  While the debate centered on domestic policy, each candidate at points spoke of the role that domestic issues have on U.S. global competitiveness, citing the US economy and unemployment as examples.  I believe that healthcare has an equal standing in this regards; a clear case can be made that our healthcare problems have a direct impact on US foreign policy.  This might be one of the few areas in the healthcare debate that both Mitt Romney and Barack Obama can agree.

Few disagree that certain domestic challenges have a direct and significant impact on US foreign policy.  Correspondingly, these domestic challenges limit what we can do outside of our borders.  Many people may cite issues like trade, education, and energy.  Healthcare should not be exempt from this conversation.  The current problems we are experiencing in healthcare (lack of access, poor quality, spiraling …

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Tax Implications of the ACA – Just Bad Timing Part II

The Affordable Care Act has many benefits. The costs of some of these benefits will not be known for a while.

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Building a Patient-Centered Model of Care

Over the past several years, the health care system has been attempting to define and create a “patient-centered model of care.” Most health policy experts, much less health care professionals, can’t seem to agree on what constitutes a patient-centered model of care. I think that a patient-centered model is less about discussing the comprehensive services offered to patients and is more about putting the patient in the middle of the relationship. A true patient-centered model surrounds the patient and provides a true coordinated personalized system of care.

In examining U.S. health care delivery, rarely are the words “coordinated,” “personalized” and “system” used in the same sentence ― much less actually delivered to patients.
Primary care medical homes (PCMH) were first developed several years ago in an attempt to develop a patient-centered experience. Even those physicians currently practicing in the PCMH model indicate that there are issues associated with the PCMH …

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