We Can Provide Better Healthcare at Lower Costs

heartbeatAs the healthcare world braces for the cost and regulatory implications of ObamaCare, there are other changes approaching on the horizon. An information technology boom is underway that could impact us all.

Healthcare is playing catch up with respect to incorporating technology into the workflow patterns of healthcare workers including physicians and nurses. Transportation, corporate America, small family businesses and even state and local governments have adopted technology solutions.

The airline industry became more efficient by using on-line reservations, on-line check-in and kiosks at airports for boarding passes. McDonald’s and most other fast food restaurants have used technology to more effectively manage workers and the workflow process resulting in better service for their customers. The banking industry embraced technology in a big way as more Americans are using on-line banking services, ATMs and mobile solutions which in turn make banks more efficient and gives …

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Community Insurance for the People

We are all probably aware of the Medicaid expansion that is occurring across the country. There is also a simultaneous expansion occurring among private insurers and employers. So goes Medicaid, so goes the rest of the insurers. The changes brought about by the American Recovery and Reinvestment act and the Patient Protection and Affordability Care Act seemed to have moved this country in another direction. This not only affects health it also will impact workforce development and economics. For better or worse, things are certainly changing.

Insurance companies are expanding their Accountable Care Organization (ACO) networks in a fast paced move to change the way physicians and other providers are paid. As these insurers move more into the Medicaid market with Health Insurance Exchanges and other products they have an opportunity to change our broken health care system to a more financially successful entity with better clinical outcomes. I remember when “health reform” …

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Picking a Medicare D Plan is Nearly Impossible; You Must Do Your Homework

GUEST COLUMNIST:  Steve Cohen, MD, Internist at WellStar Cobb Medical Group

Are you willing to spend less than an hour of your time so that you or your loved ones on Medicare can save hundreds to thousands of dollars every year? If the answer is yes, you need to read about www.medicaredrugsavings.org, a website reviewed by Clark Howard, where you can learn to lower your medical costs.

The Medicare Drug Law of 2006 was a boon to the Medicare population. Before the passage of this law the US government did not pay for prescriptions. Since that time people on Medicare (those over 65 as well as people with certain disabilities) have been able to sign up for Medicare D plans (which cover outpatient medicines) or Medicare Advantage plans (essentially HMOs or PPOs which pay for medicines in addition to the hospital, physician and other outpatient bills).

Under traditional Medicare, the government directly pays the provider for rendered medical services. In contrast, private …

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Healthcare Technology Empowering People Daily

Rarely do I use the venue of HealthFlock to talk about my company SoloHealth. I usually try to provide a relevant and informative perspective on the trends, individuals, companies and ideas shaping the healthcare technology landscape. But, if you’ll indulge me, I’d like to tell a SoloHealth story. During a recent Friday team meeting, an individual shared a personal experience that quite literally embodied what our company mission is all about, what we strive for here every day. And it came from an intern.

Jared Nuessen has been our marketing analytics intern at SoloHealth since May. Don’t let the title of “intern” fool you as Jared has several years of real-world experience as an engineer and researcher, including with a bio-tech startup. He came to us via the Kelley School of Business at Indiana University, where he is a graduate assistant at the Indiana Business Research Center, and is returning to that role the first of September.

Jared was scheduled to give us a …

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Less than One Month to Go and Counting

Healthcare providers, healthcare clearinghouses, health plans (“Covered Entities”) and their business associates all have less than one month to go before they are required to be in compliance with the enhanced privacy and security requirements that became final and effective on March 26, 2013. The compliance deadline for “Covered Entities” is September 23, 2013. For many, there is a lot of work to be completed before the compliance deadline arrives.

On the privacy side, Covered Entities need to update the Notice of Privacy Practices. On the Notice of Privacy Practices (“Notice”), Covered Entities need to ensure that the following notifications have been included in the Notice: (1) if a patient pays out of pocket for a visit in full and request a restriction on disclosing the PHI to the health plan the protected health information related to the services would not be disclosed; (2) most uses and disclosures of psychotherapy notes require an authorization; …

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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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The Healthcare Reform Law that Inequitably Treats Healthcare Providers

A recent article published in Modern Healthcare[1] highlights how CMS interpreted a rule within the healthcare reform law that is putting healthcare providers at greater financial risk. To summarize, healthcare providers could incur unreimbursed costs for services delivered to a consumer that has discontinued paying their insurance premium. See below for a detailed description of this scenario.

It appears that the business of delivering healthcare to a community is becoming more financially challenging. When you consider the increasing number of patients looking for care, reimbursement rates declining, no limits on malpractice suits and increasing regulatory burdens, it should be no surprise that in the future we see more healthcare providers filing for bankruptcy, looking for a financial bailout, selling their business, delivering limited services or discontinuing operations.

Here is the scenario that puts healthcare providers at greater financial risk due to CMS’s …

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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 …

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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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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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