Take steps to prepare for insurance exchanges
Health insurance exchanges, not unlike the ones already operating in Massachusetts and Utah, are expected to play an increasing role in individual and micro-group insurance distribution. These exchanges will not exist in a vacuum; they will touch every part of the healthcare system and require substantial changes to the way payers do business. Begin taking specific steps today ("no regret investments") to prepare for the risks and opportunities exchanges will create. These investments will enable payers to improve customer service, enhance decision-making and reduce administrative and care costs, no matter the result of reform legislation over the next few years. The ...
Payment reform redefines provider performance management
In the face of imminent payment reform and deliberate focus on quality and outcomes, health plans are increasingly turning to provider performance management as a strategy to provide an analytical framework for informed decision-making. This change in the health plan's approach to provider reimbursement is rooted in the need to move from traditional fee-for-service models to a payment model that accounts for providers adhering to best practice service delivery, and ultimately, to improving healthcare outcomes. Integrated provider performance management's true purpose is to ensure that the contractual obligations of payment and best practice service delivery are met between health plans and ...
Generation crossover profitability
The full-service, general hospital is evolving to a new conception. The growing clinical complexity, the need of performance transparency to evaluate quality, the rising costs and the increasing competition are questioning the old paradigm that any hospital could excel across a broad spectrum of clinical service lines. Most private hospitals have nowadays shrinking profit margins, and they are focusing on analyzing cost-accounting data to determine the profitability of patients and the different procedures they offer. This analysis is uncovering very profitable margins in certain activities, while pointing at other activities that are a clear loss to the center. This is ...
2010 Management Guide
Dealing with Survey Deficiencies After receiving 23 pages of citations and a threat of losing its license, a Texas ASC (that had gone three years without a state/Medicare survey) recognized its desperate situation. While many of the citations concerned the new conditions for coverage and multiple notes for the same deficiency, the center still needed to respond with corrections within 10 days. Typical of smaller facilities, the employees responsible for compliance activities are the same individuals involved in routine care. While intending to comply with regulations, patient treatment takes priority and administrative paperwork falls behind. In addition to their daily routine, management ...
ORs of Tomorrow Can Yield Pay-offs Today
The operating room (OR) of the future is closer than many facilities think. While the level of sophistication in equipment and technology depends upon a facility’s budget and ability to retrofit to accommodate exciting new developments in OR modalities, facilities should be aware of the changing dynamics of OR design and planning. The challenges of efficient and effective surgical planning are numerous, according to Charles Martin, AIA, and Lynne Shira, RN, BSN, both principals with the Seattle architecture firm NBBJ, who were part of the Designing High-Performance ORs, a day-long symposium presented by STERIS Corporation last October. Martin and Shira explain ...
Perfect Healthcare startups
Some months ago, an entrepreneur asked me which were the “qualities” that I valued the most in a healthcare start-up. It is really a fair question, but it has no easy answer. Investing is both a science and an art, and therefore it is difficult to categorize “qualities” that add up to the perfect company. There is no such thing as a “perfect” healthcare start-up. However, I will give it a try (this is highly personal, different investors may provide very different answers). These are the qualities I value the most: Compelling product or service that brings something new ...
Clinical consequences drive the need for pharmacy integration
THE INTEGRATION OF pharmacy and medical data has gone a step further into the coordination of services. A whitepaper published in March 2009 by several pharmacy organizations attributes a new focus on collaboration to an uptick in clinical consequences and costs of medication misuse and non-adherence; a shift from acute to chronic care; the increasing role of pharmacists; and the growing number and complexity of medications."Coordinating pharmacy and medical benefits paints a total picture of compliance without a gap in data, and thus, impacts outcomes," says Nita Stella, senior vice president, ActiveHealth Management, a care management company headquartered in New ...
Paying now and chasing later the worst way to counteract fraud
AS SHOWN BY several significant industry studies, fraud and abuse take an enormous bite out of national healthcare. According to a Thomson Reuters' October 2009 report, fraud costs $125 billion to $175 billion a year, accounting for nearly one-fifth of all healthcare dollars wasted—about 7% of healthcare spending overall. Other experts put the figure as high as 10%.Preventing funds from leaving the organization, rather than retroactively prosecuting those who took it, is critical, according to James Quiggle, director of communications for the Coalition Against Insurance Fraud, based in Washington, D.C."Once the money is out the door, it's very difficult to ...
Cost spiral slows, stays on upward path
Squeezed by the recession, U.S. health spending growth slowed from 6% in 2007 to 4.4% in 2008, the smallest increase in nearly half a century, according to a new federal report. Still, health costs hit $2.3 trillion, rising from 15.9% of Gross Domestic Product to 16.2% as economic output sagged.Experts say the slowdown in total spending doesn't necessarily signal any long-term flattening of the cost curve."History would say it's not sustainable," says Bob Campbell, the state government leader for Deloitte LLP. "As the economy turns, so do healthcare costs."PRIVATE AND PUBLIC SPENDINGFederal healthcare spending grew much faster than private or ...
Consumer experience provides worthwhile quality data
A FEW YEARS AGO, the idea that patients could anonymously post physician ratings on the internet had the medical community in an uproar. That's beginning to change now as stakeholders recognize consumers' growing interest in having more provider data in order to make smart decisions.When physician rating sites gained traction, doctors protested that survey sample sizes were too small and that patients used the sites as a bully pulpit to drown out the voice of the satisfied masses. Not surprisingly, insurers were reticent to jump into the ratings business at first because of HIPAA concerns, the threat of lawsuits and ...
Industry Updates
RiskMetrics Group questions legality of Novartis merger proposal to AlconRiskMetrics Group, Inc. (Ann Arbor, Mich.), a risk management and corporate governance...
Fera Pharmaceuticals now shipping erythromycin ophthalmic ointmentErythromycin ophthalmic ointment is now available after a previous market shortage,...
Oxford BioMedica acquires intellectual property rights for gene-based ocular productsOxford BioMedica UK Ltd. (Oxford, U.K.) has entered into a license agreement with...
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