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Four New Ways to Approach Opioid Use DisordersA new study has eye-opening findings on the use of buprenorphine induction in an opioid-dependent population with commercial benefit coverage.
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Bundled payments expected to reward providersCMS will begin demonstration projects to further test the promise of P4P by bundling payments for certain services as single case-rates
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When paperwork doesn't workThere is a growing records management crisis in the world of healthcare. Hospitals are awash with paperwork, as legal, payer and regulatory requirements steadily generate an increasing number of documents per patient visit. Unfortunately, most healthcare information technology (HIT) systems are wholly inadequate to meet these growing documentation requirements.
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The immeasurable value of EMRs for improved patient careAmong large physician practices and acute care facilities, physicians and healthcare executives widely recognize the value of electronic medical records (EMRs). However, physicians at small or individual practices are just beginning to use the technology, noting high implementation costs as a deterrent.
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Hospital redesign can offer patients the best clinical careStep into any newly designed hospital today and you just might do a double take. Lobbies, corridors and patient rooms look more like those in hotels these days, catering to patients and families with restaurant-like pagers, plush family seating that converts into beds and a menu of dining options that allows patients to order what they want and when.
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Patients Achieve Insulin Freedom with Tegoprubart ImmunotherapyEarly research shows the CD40L antibody tegoprubart is able to reduce insulin dependence in patients with type 1 diabetes after islet transplants.
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Data helps clinicians choose options in the patient's best interestHosptial program aligns high-cost clinical areas and financial strategies to realize benefits of the latest innovations
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Data helps clinicians choose options in the patient's best interestHosptial program aligns high-cost clinical areas and financial strategies to realize benefits of the latest innovations
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Data helps clinicians choose options in the patient's best interestHosptial program aligns high-cost clinical areas and financial strategies to realize benefits of the latest innovations
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Physician collaboration is key to successful disease managementThere are inherent challenges and opportunities for DM
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Prenatal ultrasound gathering momentum in disease managementFor more than three decades, clinicians have routinely conducted prenatal ultrasound screenings to detect congenital anomalies, multiple-gestation pregnancies, fetal growth disorders, placental abnormalities and errors in the estimation of gestational age. When managed care was born, executives realized the importance of providing benefit coverage for this test because they recognized prenatal ultrasound is one of the earliest tools in the disease management arsenal to promote fetal, neonatal, and maternal health. In an era where medical costs are surging, and in response, healthcare premiums of employers and their workers have climbed twice as fast as wages and inflation in 2006, the evidence-based benefits of prenatal ultrasound is gaining momentum and medical community recognition as a disease management tool.
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Administrative tasks simplified: Electronic transmission saves time, moneyThere is no doubt about it-transmitting claims and other healthcare information electronically saves time and money.
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False Claims Act looms for healthcare regulationThe False Claims Act (FCA), 31 U.S.C. 3729, et seq., is about to become the worst-kept secret of the healthcare industry. One of the nation's oldest statutes, the FCA has allowed the government to recover more than $3.1 billion in the first nine months of 2006, including an eye-popping $900 million dollar settlement with Tenet Healthcare-the largest FCA recovery ever. And, as if these staggering numbers were not enough to garner attention, as of January 1, 2006, entities that receive $5 million or more per year in Medicaid payments will be required to inform their employees about the FCA. Because employees are the most likely whistleblowers in an FCA lawsuit, the FCA's prominence in the healthcare industry should increase over the next few years.
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False Claims Act looms for healthcare regulationThe False Claims Act (FCA), 31 U.S.C. 3729, et seq., is about to become the worst-kept secret of the healthcare industry. One of the nation's oldest statutes, the FCA has allowed the government to recover more than $3.1 billion in the first nine months of 2006, including an eye-popping $900 million dollar settlement with Tenet Healthcare-the largest FCA recovery ever. And, as if these staggering numbers were not enough to garner attention, as of January 1, 2006, entities that receive $5 million or more per year in Medicaid payments will be required to inform their employees about the FCA. Because employees are the most likely whistleblowers in an FCA lawsuit, the FCA's prominence in the healthcare industry should increase over the next few years.
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EHRs not sufficient for data liquidityAn EHR is one technology within the health IT portfolio, which also includes e-prescribing, clinical decision support, messaging and alerting, telehealth, consumer health information portals and other technologies
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Small data creates backbone for medical homesMedical home providers gain tailored prescription data
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On Finance: Will managed care physicians see an advantage with the new Medicare Advantage?With the additional funding, there's a brighter future for MCOs
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Health plans can stay ahead of market curve with CRMDeveloping preferred relationships with members leads to increased market share for payers
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Insomnia symptoms can indicate underlying medical conditionsSymptoms of insomnia can be treated with several different drugs, but be aware of side effects.
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MCOs saddled with legal struggles when forming physician networksConflicting interests cause disputes over fairness, contracts and liability with MCOs stuck in the middle
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Six Sigma enters the healthcare mainstreamWhat do you do when you have exhausted all options for improving performance in an environment that is determined to protect the status quo? What do you do when your organization has reached the presumed limit of potential performance and has grown all too comfortable with its market lead?
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Choose your battles when resources are scarceIn America, we assume that we get what we pay for, whether it be food, clothing or healthcare. Given that healthcare consumes 16% of the Gross Domestic Product and we spend more per capita than any other nation on cutting-edge care, we expect improved outcomes and more bang for the buck. However, these expenditures do not rank the United States first, second or even third in terms of life expectancy, infant mortality, immunization, cancer screening and the like.
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Traveling abroad for treatment can be perilousIn an attempt to reduce healthcare costs, a U.S. company is encouraging its employees to go abroad for necessary medical or surgical care. A recent article in the Christian Science Monitor noted that Blue Ridge Paper Products in North Carolina is sending an employee to India for two surgeries that will cost about $20,000-far less than the estimated $100,000 for comparable procedures in the United States.
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Choose your battles when resources are scarceIn America, we assume that we get what we pay for, whether it be food, clothing or healthcare. Given that healthcare consumes 16% of the Gross Domestic Product and we spend more per capita than any other nation on cutting-edge care, we expect improved outcomes and more bang for the buck. However, these expenditures do not rank the United States first, second or even third in terms of life expectancy, infant mortality, immunization, cancer screening and the like.
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False Claims Act proves difficult to fightThe federal False Claims Act (FCA) is the government's primary weapon to combat fraud. It empowers the federal government to file actions against those alleged to have knowingly submitted false or fraudulent claims to the government. Since 1986, the Department of Justice has recovered more than $15 billion under the law.
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National Provider Identifier: Leveraging regulation to improve health plan operational efficienciesThe administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require the Department of Health and Human Services (HHS) to establish national standards for electronic healthcare transactions. This includes assigning healthcare providers a National Provider Identifier (NPI), a 10-digit numeric provider identifier that will be used in standard electronic transactions, such as healthcare claims. As of a legislated date of May 23, 2007, each participating provider will have one and only one NPI, regardless of practice locations or settings.
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National Provider Identifier: Leveraging regulation to improve health plan operational efficienciesThe administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require the Department of Health and Human Services (HHS) to establish national standards for electronic healthcare transactions. This includes assigning healthcare providers a National Provider Identifier (NPI), a 10-digit numeric provider identifier that will be used in standard electronic transactions, such as healthcare claims. As of a legislated date of May 23, 2007, each participating provider will have one and only one NPI, regardless of practice locations or settings.
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National Provider Identifier: Leveraging regulation to improve health plan operational efficienciesThe administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require the Department of Health and Human Services (HHS) to establish national standards for electronic healthcare transactions. This includes assigning healthcare providers a National Provider Identifier (NPI), a 10-digit numeric provider identifier that will be used in standard electronic transactions, such as healthcare claims. As of a legislated date of May 23, 2007, each participating provider will have one and only one NPI, regardless of practice locations or settings.
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Arbitration resolves billing disputes without costly litigationWith Administrative costs accounting for as much as 40% of all healthcare dollars spent, many states are seeking new and innovative ways to eliminate bureaucracy and red tape. One area receiving more attention is the resolution of billing disputes between providers and payers. In 2006, New Jersey and California implemented arbitration programs to resolve the growing aggregation of healthcare payment disputes.
