Hospitals & Providers

When insurance exchanges come online, many new healthcare consumers will be members of minority populations with distinct needs.

The Patient Protection and Affordable Care Act specifically calls for and funds a "hospital readmissions reduction program" designed to help hospitals smooth the transition

Healthcare systems looking to innovate might do well to avoid completely open or closed models, according to research by the Innosight Institute, a not-for-profit think tank.

There's a consensus among commerical plans and federal officials that bundled payments are necessary, and have the potential to be a cost-saving strategy.

Programs need to not only prevent infections but also eliminate them.

Providers and payers appear to be moving steadily toward an accountable-care model of healthcare delivery, and competitive markets influence the development.

Medicare Advantage plans are evaluating best practices in risk adjustment for the upcoming health exchanges and accountable care organizations.

Current state policies vary greatly, however, and new standards for external review could drive up costs

As the struggle to halt healthcare costs continues, Maryland has uniquely managed to contain hospital reimbursement.

Private healthcare premiums increased by nearly 15% from $697 billion to $801 billion between 2005 and 2009, reports the National Institute for Health Care Management.

The Center for Studying Health System Change's visits to 12 metropolitan communities found that hospitals are using their clout to command high payment rate increases from private insurers.

As if operating a Medicare Advantage plan weren't complex enough, MA plan sales efforts can only take place within a very short window of time - October 1 through December 7, according to federal regulations.

Health clinics' role in the delivery system is likely to increase as previously uninsured individuals gain access to care.

Healthcare fraud costs Americans between 3% and 10% of each dollar spent.

Real-time, on-site claims processing will become as common as point-of-service transactions in other industries.

Insurance executives are observing a greater degree of anxiety among providers as they try to build their networks in an evolving era of healthcare.

Nursing home care can be delayed with community services

Employers have a new measure that compares health plan resources spending against quality to determine efficiency

The goal of Comparative Effectiveness Research appears to be something that everyone can agree on

Lack of insurance is seen as a major obstruction to healthcare equality, but it's certainly not the only obstacle

If the shortage of primary care physicians continues, the patient-centered medical home concept could come to an abrupt halt

Aging baby boomers will bring more people into Medicare, while reform will expand Medicaid

Now is the time for collaboration of payers, billers and providers to lead the industry by reducing inefficiencies

Controversy continues to swirl around Medicare's two-year-old policy of not paying for what it considers preventable hospital-acquired condtions. CMS has decided for now not to expand its list of 12 serious adverse events for which it does not reimburse hospitals.

Stakeholders seek uniformity of standards for several types of electronic health information transactions and specific operating rules, n one of which will be easy to implement.

The U.S. Department of Health and Human Services (HHS) has announced new federal investments in community-based practices led by nurse practitioners.

Clinician handwashing protocol varies widely. Standardized measures for monitoring handwashing are lacking and tracking costly hospital-acquired infections in relation to hand hygiene is spotty at best.

There seems to be a growing consensus among healthcare stakeholders that despite new reforms, something still has to give in the way care is delivered. Episode-based payment may be a viable solution. It is an intermediate step between fee-for-service, which historically leads to overuse or underuse of services depending on reimbursement, and capitalization, which moves all the risk to the provider.

Comparative effectiveness research is suddenly flush with fundings. Tucked in last year's American Recovery and Reinvestment Act was $1.1 billion to accelerate CER.

People over the age of 80 is the fastest-growing population sement in the United States, and they are also the most susceptible to falling through the cracks in the healthcare system.