Archive for the ‘Uncategorized’ Category

Facts About Exchange Premiums

One of the most disturbing aspects of the political battle over implementation of the Affordable Care Act is the degree of misinformation being generated by officials in a number of states. Over the summer Insurance departments in Florida, Indiana, Ohio, and Georgia have selectively released information on the cost of coverage in the health insurance exchanges that are misleading at best. They have all claimed that under the ACA people purchasing individual health insurance through the exchanges will face significantly higher premiums. In fact all of their analysis either misstates actual premiums (Indiana), compares exchanges premiums to a fabricated plan that no one can actually purchase currently (Florida), or finds a rare unidentified person who faces higher premiums (Georgia).

The ACA requires that beginning in 2014 premiums in the individual market be based only on age, location with in a state, whether a person smokes, and the plan. Premiums can vary by age by no …

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Anti- Kickback Drama and Why it is bad news for all Hospitals

Two of the nation’s largest for-profit Health Systems, Tenet and HMA, got themselves sued by the Federal Government under the Anti-Kickback Statute last week. The Anti-kickback statute, in a nut shell, prohibits Providers from paying for referrals on patients covered under the Federal Medicare or Medicaid program. The allegations of the complaint center around two pregnancy clinics located in Georgia, and the steerage of illegal immigrants from those clinics to these hospitals. The State of Georgia has also joined the lawsuit to recover it’s spent Medicaid funds.
I understand both Health Systems should be given the benefit of the doubt unless and until the allegations are proven true in court. However, the whistleblower in this case is a former CFO of one of these organizations, and these allegations are very severe. How does this happen in 2013? Is it possible that people, or the corporations they represent, believe they can get away with something like this? Wasn’t …

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5 Ways Healthcare Marketers Can Succeed in Today’s Technology Driven World

Technology is creating massive change and disruption that has forever altered the way consumers and businesses interact. The healthcare industry is no exception as we are seeing lighting fast innovation from data digitalization, mobile applications and self-service consumer platforms. Perhaps no other time in history has technology so rapidly changed how we learn, collaborate and communicate. Consider the wave of change with mobile advancements that saw the “pager” become a dinosaur to the Blackberry, only to be followed by the iPhone and smartphones overcoming the Blackberry. By the end of the year, they’ll be more mobile devices on earth than people. And more people are online than ever before socializing, searching and shopping, helping to generate 90% of the world’s data in the last two years alone. The consumerization of technology and the digitalization of data are fundamentally changing us.

All these changes have completely upended how marketing functions. …

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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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Atlanta is home to numerous healthcare information technology (“Health IT”) companies and serves as a Health IT leader in the Nation. Following the American Recovery and Reinvestment Act (“Stimulus Act”) and the HealthCare Reform Act, the Health IT market grew exponentially. Both laws dedicated billions of dollars to fund Health IT initiatives designed to spark innovative methods of delivering healthcare services by changing how healthcare is coordinated among providers and patients while reducing the costs to deliver clinical care. Some of these initiatives dedicated funds to encourage the adoption and implementation of electronic health records. Other programs provided direct funding for concepts that would change how healthcare was delivered. All of the funding and initiatives have driven significant economic growth in Health IT and caused a lot of companies to develop Health IT service lines. While the federal funding has been the carrot to foster Health IT …


Are Not For Profit hospitals on their way to extinction?

Has the Affordable Care Act reduced the differentiated value of services provided by Not For Profit hospitals that special tax exemptions will be eliminated? Therefore, the existence of Not For Profit hospitals will disappear and all hospitals will be considered For Profit. To appreciate how this is a real possibility, it is important to understand the purpose of a Not For Profit hospital. The purpose of a Not For Profit hospital is to serve families in the community that cannot afford medical care.  In exchange for this charity care, Not For Profit hospitals receive exemption from federal and state corporate income taxes, exemption from state and local property taxes, and access to tax-exempt bond financing. In addition, charitable contributions to Not For Profit hospitals are tax deductible for the donor. This allowed Not For Profit hospitals to live up to their mission of serving the community and being financially viable.

Now that the Affordable Care Act will provide …

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2015 is the new 2014

When the Affordable Care Act was passed in 2010 the year 2014 was designed as the first year in which all Americans would have access to affordable health care. It was not envisioned that all would take advantage of the opportunity, but that opportunity would be there. The Supreme Court ruling, complexity of the law, partisan politics, and the limits of time have combined to create a different health system in 2014: one that may yield very different opportunities for coverage for very similar individuals and families.

The Supreme Court upheld the law, but somehow found that an expansion in eligibility constituted a separate program. As a result states could chose whether to expand Medicaid or keep their old Medicaid program. The irony is that states whose taxpayers, employers, and health systems would most benefit from Medicaid expansion are the most likely to have decided decline that option. Those choices were mostly in response to political considerations rather than …

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Elevating Patient Safety

patient safetySince publication of the Institute of Health (IOM) report entitled “To Err is Human,” our healthcare system generally, and hospitals specifically, have tried to create, develop and nurture a culture of patient safety. The IOM reported almost 100,000 Americans lose their life each year due to preventable medical errors. In fact, according to the IOM, “More people die in a given year as a result of medical errors than from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516).”

Something must be done to reduce or eliminate medical errors that could have been prevented.

The IOM report further states, “This report describes a serious concern in healthcare that, if discussed at all, is discussed only behind closed doors. As health care and the system that delivers it become more complex, the opportunities for errors abound. Correcting this will require a concerted effort by the professions, health care organizations, purchasers, consumers, regulators …

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Will Healthcare be Ready for the 2020 Employer?

It’s no secret that the next seven years will see a huge increase in needs for patient care, as newly insured patients come into the system in 2014, and the healthcare needs of retiring baby boomers begin to escalate. How will the job market in Georgia weather these predictions? For that matter, how will job seekers first afford higher-level education that will qualify them for these 5 million job opportunities?

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Providers Beware of Suspect Joint Ventures

As the Healthcare Reform initiatives drive providers to think outside the box and evaluate new sources of revenue or integration models, the Office of Inspector General (“OIG”) last week shut down one potential proposal that many providers may have considered. Specifically, the OIG found in an Advisory Opinion that a management company assisting a provider in establishing a new service line could potentially violate the Anti-Kickback Statute and that the government could enforce penalties for such violation. The Anti-Kickback Statute generally prohibits anyone from knowingly or willfully providing any form of remuneration to another individual to induce the purchasing, ordering or referral of services that are billed to state and federal healthcare programs. Interestingly enough, in this proposal, the parties attempted to exclude state and federal beneficiaries to avoid any such violation, but the OIG took a broad approach when examining the proposed arrangement.

The …

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