Archive for the ‘Uncategorized’ Category

The preliminary numbers look like the Affordable Care Act (ACA) is going to work as intended. Insurers were required to declare if they were going to and what plans and premiums they would offer in the individual exchanges by early May. In Georgia, seven insurers are participating in all or parts of the state. The premiums and plans they are offering resemble those currently offered by large employers.

A central question is whether the private insurance market as reconfigured by the ACA will be sustainable. A sustainable private insurance market is possible only if adverse risk selection is managed. Adverse risk selection is the fact that individuals with the highest demand for health insurance are those with the greatest health care needs. No insurance market can be sustained if the only people purchasing insurance are those about to file a claim.

Currently almost 95 percent of those with private health insurance coverage purchased that coverage through an employment-based …

Continue reading Signs Point to Yes »

What is” it” you ask? Healthcare Reform

The picture in Georgia appears to be pretty bleak. The State has chosen not to expand Medicaid. Early estimates predict the cost of Health Insurance on the exchanges may be 45% higher, than the ridiculously high cost Georgians are already paying for Health Insurance. Any chance of an affordable plan will likely come with a deductible of $5,000 or more. Employers are dropping coverage left and right in favor of the penalty, which in reality is not really a penalty because it is cheaper. Employers, who are opting to keep their group plans, are facing substantial premium and deductible increases, as well. It is not looking good for anyone, especially those who most need it, from a cost perspective.

However, the average member of society- the one who does not work in the industry- does not understand, and they are not ready for what lies ahead. My question to you as a Healthcare Leader is what are we doing about it? Our patients, …

Continue reading Does the General Public get it? »

It is hard to believe, but we are quickly approaching the second half of 2013. 2014 will have the greatest impact on the healthcare delivery system, because it is the year that the Healthcare Reform Act insurance requirements will be implemented. The insurance changes potentially expand patient coverage and offer new payer sources through the health insurance exchanges; ultimately, impacting providers’ reimbursement. As always, when the money sources change, what providers offer for services, staffing and allocation of resources adjusts. With all of these moving parts, below is a list of top 5 changes that need to be addressed by all providers.

1. Health Insurance Exchanges

In accordance with the Healthcare Reform Act, health insurance exchanges must be operational by January 1, 2014. Each State has an opportunity to either establish its own health insurance exchange or to allow the Federal government to administer the exchange. The health insurance exchange is …

Continue reading Top 5 Key Programs Impacting Healthcare »

As healthcare buzz goes, “Big Data” has got to be one of the most thrown around phrases of the moment, nipping at the heels of “Obamacare” and maintaining a slight edge over “patient engagement.” I’m also fairly confident it is one of the least understood phrases in healthcare right now. It is used in every part of the industry – from physicians to vendors to payers, and even by some patients. But, as with any industry, subtle shifts in definition occur as different groups throw the phrase around.

Continue reading The Big Deal Behind Big Data in Healthcare »

We are on the cusp of a new era of healthcare technology and services. The incremental reduction of reimbursement for services, anticipated increase of patient volume and reimbursement tied to clinical outcomes is the tipping point of driving healthcare providers to rethink their service delivery model. Healthcare is historically slow to change the manner they do business until it is tied to reimbursement. An example is the shift in the market when managed care was introduced driving organizations to change their business practices. The current market shift of tying clinical outcomes to reimbursement is forcing healthcare providers to explore how they need to change their business practices to be profitable and serve the community in a quality manner.

mHealth technology is quickly moving towards market adoption and commoditization. We are seeing numerous prototypes and proof-of-concept solutions where a smart phone with software and biometric sensors are delivering real-time …

Continue reading The next era of healthcare technology and services, converge to support a changing healthcare business model »

A recent study published in the New England Journal of Medicine* on the Oregon Medicaid program has elicited reactions fitting for that twilight zone at the intersection of academic research and politics. Kaiser Health News characterized the paper as serving a “Rorschach test for how partisans and health policy wonks view the health care law”**

Oregon did a limited expansion of Medicaid in 2008 by offering coverage to individuals who met income and other eligibility requirements and were winners of a lottery. That meant that about 30,000 adults were newly enrolled in the Medicaid program out of 90,000 eligible. The state thus created a classic experiment with a control group and a treatment group.

The study found significant differences in the two group’s access and utilization of health care, a substantial improvement in mental health outcomes for the Medicaid covered population, a significant reduction in financial strain on covered families and significant …

Continue reading Oregon Rorschach Tests »

“Everybody knows that kids need “baby shots” – immunizations that protect against once-common childhood diseases. The shots are required for school entry, so most children are up-to-date by the time that they are five years old. But what many of their parents and grandparents don’t realize is that adults need immunizations as well. And the adults lag far behind the kids in getting the shots that they need.” This quote from Daniel Blumenthal M.D. of Morehouse School of Medicine was stated to address a bill currently pending in the Georgia legislature which would permit pharmacists to administer adult immunizations that are currently off-limits. Today, pharmacists can administer flu shots for adults but many other shots must be given in the physician’s office.

Vaccinations are one of the few advances in science and health care that have been able to prevent and or eradicate certain diseases. Think about it! We take a pill for Hypertension but it doesn’t go …

Continue reading Expanding Privileges for Expanding Populations »

This is the most common question I receive after going through the arduous proposed 501(r) regulations with providers. Most of the proposed regulations for 501(r) 4-6 were released last summer; however, the IRS remained virtually silent until the end of April on proposed penalties for violating those regulations. The new proposed penalties will take a scaled approach similar to the penalties for HIPPA breach.

According to the proposed regulations a minor and inadvertent violation, which is corrected promptly, will not be considered a breach. Omissions, over the minor and inadvertent level, but not willful and egregious, which are promptly discovered and corrected, will be forgiven with correct disclosures. Only those violations found to be willful and egregious will result in remove of the 501(c)3 status.

Now before you celebrate and cancel your extensive implementation plans for your new improved and widely publicized FAP, let us think for a moment about what willful and …

Continue reading Will I really lose my 501(c)3 status? »

The state of Georgia’s health information exchange (HIE) has recently taken on new meaning for patients and providers, as the program looks to expand its network thanks to additional funding.

Continue reading Don’t Let the State of Georgia’s Health Information Exchange Confuse You »

In a complex regulated healthcare world, providers are constantly trying to ensure that they can remain viable and provide the best quality services to patients. However, the ever-changing regulations impact how providers are permitted to provide care, share information, bill for services, document services and where the services can be delivered. While the regulations constantly change the providers’ day-to-day behavior, two themes are consistent throughout the laws. First, providers will soon be paid based upon quality outcomes instead of the volume of patients treated. Second, providers will be driven to reduce costs related to delivering care to be viable. In order to achieve quality outcomes and reduce costs, the provider is not in complete control. In fact, providers can only accomplish quality outcomes and reduce costs when a patient is engaged and accountable for his or her healthcare.

Because of Accountable Care Organizations (ACOs), the hospital compare …

Continue reading Patient Engagement: A Providers’ Challenge »