Hospitals & Providers

Hospitals are ramping up efforts to improve their medication data collection methods in an attempt to reduce the number of preventable adverse drug events that occur annually. They are establishing guidelines for collecting complete drug and allergy histories and comparing those histories with new medications when patients are admitted to a hospital.

In the past two years, not-for-profit hospitals have faced increasing scrutiny from a variety of sources. Lawsuits alleging unfair billing practices for the uninsured, congressional hearings regarding hospitals' tax-exempt status, federal and state legislative policies regulating hospitals' provision of charity care and front-page articles in major newspapers outlining overly aggressive efforts to collect payments from uninsured patients have all conspired to put this healthcare sector on red alert.

In an effort to bring healthcare costs under control, the Bushadministration has embarked on a strategy to persuade health plansand hospitals to offer transparency of pricing structures andquality data.

Hiring and retaining good employees are priorities for nearly everycompany in every industry. After all, employees are the heart andsoul of an organization. Nowhere is this truer than in healthcare,where clinical staff provide a personal, caring touch to patientsand their families when they need it most.

Leading hospitals are increasingly using well-designed hospitalist programs in their struggle to improve patient care and conserve resources. An appropriately structured and incentivized hospitalist program can be the catalyst for meeting and improving core measures, promoting best practices and meeting pay-for-performance goals.

PAY-FOR-PERFORMANCE (P4P) contracting has introduced the concept of value purchasing by payers.

The goal of project management and performance improvement as it applies to large healthcare systems is to reduce variability in the way care is provided. One desired result is patients becoming more independent in taking care of themselves. With better self-reliance, they are less likely to make trips to the emergency room and less likely to wind up in the ICU. The best benefit is that patients receive the highest standard of care possible when a hospital is providing effective, efficient healthcare.

Healthcare managers, administrators and doctors often confuse the phrases "utilization review" and "utilization management." The healthcare business uses the two interchangeably, however understanding their nuances helps clarify their meaning.

From electronic health records to stem-cell research, a new wave of technologies, medicine and other breakthroughs promise to transform the way hospitals and health systems deliver care over the next five to 15 years. Alternative capital arrangements are gaining in popularity because traditional financing is becoming more problematic for many institutions. Yet finding the capital to invest in these clinical advances and to improve healthcare delivery is a growing challenge for many not-for-profit healthcare providers.

Patients' expectations regarding their physicians and their overall healthcare experience have changed significantly over the past decade. With their desire to become more empowered healthcare consumers and their growing intolerance for physicians who habitually run late or surgeons who are poor communicators, the attitudes and desires of patients are beginning to influence practices and procedures at physician offices, hospitals, and medical practices nationwide.

In making the EHR available and successful, it is important to ensure that the information received belongs to the intended patient.

It is no surprise that many healthcare organizations are content with the status quo. But is the status quo good enough? According a World Health Organization report from 2000, the United Status spends more on healthcare than any other country in the world, but only ranks 37th in health system performance.

Each non-English-speaking person who walks through the door represents a potential malpractice suit.

The New Prescription Drug Benefit UnderThe Medicare Modernization Act

More Americans than ever before are using mental health services, yet more than a third of those who need treatment are not getting it. These are among the key findings of a new study, "Therapy in America 2004."

One of the biggest drains on productivity is presenteeism, a term used to describe "the working sick"-employees who are at work but who aren't as productive as usual.

It’s advisable to have a joint operations agreement about how the program is run and what the outcomes should be.

Baptist Hospital in Pensacola, Fla., recipient of last year's Malcolm Baldrige National Quality Award, recently did an analysis to determine how much it would cost to duplicate internally the inpatient management services provided by Cogent Healthcare. It was found that the basic cost difference would be within $50,000 of what it was paying, but when Baptist looked at the long-term costs of hiring additional full-time employees and expanding its information management systems, the costs quickly grew beyond what it was willing to pay.

Because of external demands for quality information, the ability to utilizetechnology to compile and analyze data is an important task for organizations.As is often noted, these quality demands are particularly important undernew pay-for-performance (P4P) initiatives. Last year, a large health planin California became one of the first in the nation to award P4P bonusesto physician groups in its provider network. It paid a total of $28 millionin bonuses to 80 physician groups.

The healthcare industry appears poised on the brink of establishing a nationally recognized pay-for-performance standard that will reward those healthcare providers who demonstrate quality-of-care improvement, while penalizing those unable to deliver results that meet the established criteria. This pay-for-performance (P4P) initiative is largely a response to employers and consumers, who are increasingly inundated with data about what constitutes quality, as their healthcare costs increase. The resulting consumer and media outcry, coupled with reports of medical errors, turned the healthcare industry on its head, compelling regulators, watchdog organizations and healthcare associations to establish financial incentives to drive improvements in the quality of healthcare being delivered.

WITH THE GROWTH OF specialty pharmacy-therapeutically promising, high-cost, and typically injectable bioengineered drugs-it’s time for plan sponsors to revisit the proven managed care techniques of prior authorization and formulary management.

Commonly, employees who are good at daily tasks get promoted to supervisory roles.

The contracting department is essential to control and maintain the detials of specific payment terms

Health plans and employers are called on to help improve consumers' ability to locate and retrieve quality data on the Internet

A national health system recognized that its internal process was not improving

An ASP-based system, coupled with overall proces improvements, can reduce denials, collection costs and bad debt

After assigning priorities, structured teams and outside facilitators improved a Chicago hospital's bottom line

Conflicting interests cause disputes over fairness, contracts and liability with MCOs stuck in the middle

A facility futures analyst offers clarity in identifying and resolving hospital planning issues

Hosptial program aligns high-cost clinical areas and financial strategies to realize benefits of the latest innovations