Practice Management

With its first phase of certification rolling, the CertificationCommission for Healthcare Information Technology (CCHIT) willconcentrate on maintaining its momentum while moving to the realmof inpatient electronic health records (EHRs) in its secondcertification phase, followed by the evolving EHR networkinfrastructure in phase three.

Privatization of Medicare Part D has led to the emergence of manyplayers, both large and small. Navigating CMS regulations andsubsequent guidance has resulted in some administrative burdens, aswell as the inability to employ many managed care techniques, sayexperts.

Building and applying the technology of the electronic healthrecord (EHR) is a decidedly non-magical process far more complexand less instantaneous than just making the paper disappear into awastebasket. Quality concerns about EHR systems must be addressed,which is why the Certification Commission for HealthcareInformation Technology (CCHIT) exists. A voluntary, private-sectorinitiative based in Chicago, CCHIT was established in 2004 tofoster the adoption of robust, interoperable health IT in theUnited States through product certification. In 2005, CCHITreceived a three-year contract from the Department of Health andHuman Services, making it the key entity to develop and evaluatecriteria for the testing and certification of EHR systems in theUnited States.

Sure, e-mailing your doctor about that tickle in your throat or therecurring rash on your arm sounds like a great deal-noappointment needed and no copayment. But what if there is a pricetag, albeit small, to e-mail your doctor about non-urgent medicalproblems? Would you still choose this communication vehicle?

Electronic Health Records (EHRs) are the future of health information management, and today the calls for a massive industrywide transition to EHRs are even louder.

The push for electronic health records (EHRs) and their physician-originated counterpart, electronic medical records (EMRs), gained significant momentum in 2005. In fact, today's discussions now include subcategories to distinguish the interests of one group over another. We can expect the implementation of some versions of the EHR?including portable EHRs, payer-based EHRs, ambulatory EHRs and inpatient EHRs?to become more widespread.

Are pharmacy benefits managers (PBMs) that rely onrevenue-generating mail-order prescription service going to get arun for their money as 90-day retail programs hit the marketplace?Walgreen Health Initiatives (WHI), a PBM headquartered inDeerfield, Ill., is not particularly bothered by the new retailproduct. WHI launched Advantage90, a 90-day retail fulfillmentprogram, in late 2003 with more than 26,000 pharmacies nationwidenow participating in the program.

Each year roughly 700,000 Americans suffer a new or recurrent stroke, a condition that arises when blood flow to the brain is disrupted. Nearly a quarter of those incidents are fatal, making stroke the third-leading cause of death behind diseases of the heart and cancer.

News that Blue Cross and Blue Shield affiliates have begun funding the formation of Regional Health Information Networks (RHIOs) should serve as a wake-up call for all managed care organizations (MCOs).

If misery loves company, then Beverly Thomas of Carbondale, Ill.,isn't alone. She is one of thousands of dual eligibles(beneficiaries covered by both Medicaid and Medicare) who went tothe pharmacy after January 1, 2006, only to find that it would notfill their prescriptions. Unfortunately, her medication for mentalillness is so critical that if she misses even a day, she could behospitalized. With the help of Southern Illinois Regional SocialServices, Thomas got squared away, but admits she still is confusedabout how the new Medicare Part D benefit operates.

WASHINGTON, D.C. -- Some pharmaceutical companies are dropping Patient Assistance Programs (PAPs) for seniors who enroll in the Medicare drug benefit program. They fear they'll be hit with fraud charges by the Office of the Inspector General (OIG) at HHS if they provide free or low-cost drugs to Medicare beneficiaries enrolled in prescription drug plans.

WASHINGTON, D.C. -- The main Bush administration proposal for dealing with the high cost of healthcare and rising number of uninsured is to create a new commission. In his State of the Union address in January, President Bush called for a new bipartisan panel to propose changes that will equip Medicare, Medicaid and Social Security to deal with the millions of baby boomers headed for retirement.

In 2005, Medicaid surpassed Medicare as the largest government healthcare expenditure, and it is the fastest growing population of covered lives, say industry experts.

The New York Times reports that patients in New York City often have trouble securing a reimbursement for a $75 visit to the nutritionist, who counsels them on controlling their diabetes.

Government, Employers, medical associations, payers, and many others are part of a nationwide momentum toward making electronic health records (EHRs) a reality. President Bush has cited the necessity to create EHRs, leading politicians of both parties have issued joint statements, and some states have accelerated activities. A number of initiatives by the Department of Health and Human Services (HHS), standards development organizations, and other groups are moving several issues ahead.

When cultures enter Renaissance periods, new learning and ideas create transition. Heightened interest in the workings of pharmacy benefit management and subsequent changes in business philosophy represent a Renaissance for managed care. All key stakeholders will feel the ripples of change: payers, physicians, pharmacists, patients and pharmaceutical companies.

The rise of the healthcare consumer, pay for performance and the focus on care management and prevention will not just be blips on managed care executives' radar screens this year. They will not only need to address these issues, but build a framework around them for long-term sustainability, according to PricewaterhouseCoopers.

Establishing and managing a RHIO is a little like promoting world peace.

EMRs can add to a practice's bottom line

The amount of fraud and abuse in the U.S. healthcare system is staggering and continues to grow at an exorbitant rate. Many factors contribute to this growing incidence of insurance fraud. For example, an ever-increasing volume of transactions, antiquated procedures that were not established to assume that fraudulent claims would be made, and complex and multiple reimbursement methodologies that open insurers to the risk of inappropriate claim payments because of fraudulent and abusive billing practices.

For some insurers, television ads have taken center stage.

Washington--The roll-out of the new Medicare drug benefit and expansion in the Medicare Advantage (MA) program is prompting the Centers for Medicare and Medicaid Services (CMS) to develop a comprehensive strategy to assess the risk of "improper payments" to MA plans. In the coming year, CMS will take a series of steps to measure the accuracy of these payments and address potential risks, beginning with a review of whether all required data is submitted for accurate monthly payments to plans. The agency will examine whether beneficiaries are eligible to enroll in a plan, how payments are made and what occurs when a beneficiary's enrollment is terminated.

Medicare Part D is the first large scale example of a true consumer healthcare product

We all seem to be taking a wait-and-see approach.

Early in his career, Lyman Dennis, chief information officer (CIO), Partnership HealthPlan of California (PHC), was project manager of a grant from the National Institutes of Health to develop a system that planned diets.

National Reports— While Katrina has disrupted healthcare for millions of people, one beneficial outcome may be more public and private efforts to develop a national electronic health records (EHR) system.

National Reports— While Katrina has disrupted healthcare for millions of people, one beneficial outcome may be more public and private efforts to develop a national electronic health records (EHR) system.

Read more about backing up your data.

Read more about benefit policies to aid victims

Early in his career, Lyman Dennis, chief information officer (CIO), Partnership HealthPlan of California (PHC), was project manager of a grant from the National Institutes of Health to develop a system that planned diets.