Standard Claims Could Save $7 Billion
April 30, 2010
According to a new stury in Health Affairs, standardized claims forms could save $7 billion a year in costs and free up four hours of practice time per-physician, per-week.
How messed up is the current system?
The new report says many sectors of the economy (e.g. retail, financial) operate with 100 full-time equivalents (FTEs) or fewer per $1 billion collected. That compares to median staff levels of 770 FTEs per $1 billion collected for physician practices – more than seven times the administrative burden.
The solution, according to the article, is mandating a single set of rules, a single claim form, standard rules of submission, and transparent payment adjudication—with corresponding savings to both providers and payers.
Having worked on the payer side for many years, I can assure you employers and health plans are well aware of these costs. However, the complicated system works in their favor. After having their claims rejected, many physicians and consumers simply give up and pay out of pocket.
The full article is available at www.healthaffairs.org
Everything Old is New Again
April 29, 2010
Remember HMOs? Introduced in the 1970s, consumers (stoked by the media) grew to hate them, so they became “health plans.”
Now we have “Accountable Care Organizations.” The health policy experts are trotting ACOs out as the next big thing.
ACOs are, in essence, capitated medical groups, aka “the delegated model.”
California, Florida, Arizona and some other states have had capitated medical groups for 25 years.
During the 1990s, private investors took an interest in them and began buying large capitated medical groups, like Friendly Hills in Southern California. For a variety of reasons, most of these speculative investments crashed and burned.
The delegated model has survived, however. Millions of people in CA and AZ get their health care through capitated medical groups and are quite happy with it. Probably 90% of them could not tell you the difference between their “doctor’s office,” their “medical group,” their “health plan” and their “insurance.”
Accountable care organization sounds better than managed care organization, but under the hood it is still the same old economy car.
Nurses Union Protests EMR Adoption
April 27, 2010
The California Nurses Association, one of the state’s largest unions, has launched a campaign against hospitals adopting electronic medical records.
When I first heard about this, I thought it was odd. Nurses should be for EMRs, right?
I have talked to many nurses who use EMRs and find them very valuable. So why is CNA protesting?
Here are three objections raised by the union:
1. “Workplace technologies are developed to increase employers’ control so they can maximize productivity…getting more work out of each employee and displacing employees.”
2. “The job of patient care will be redefined, privileging technical over clinical skills.”
3. “The hospital will hire more HIT specialists and fewer RNs.”
To see a six-page CNA brochure detailing their concerns about EMRS, see www.calnurses.org/research/pdfs/ihsp_tech_basics_sept_2009.pdf
Hospitals Say Reform Costly
April 26, 2010
Hospital executives are “scared to death” of the healthcare reform package, reports Greg Gillespie at Health Data Management.
A panel of hospital executives concluded that ”Providers are going to be paid less, whichever way you slice it.”
Gillespie reports that healthcare reform will expand the number of insured by an estimated 32 million citizens, half of which will be covered by Medicaid through the massive expansion of the program.
One hospital executive said his system system takes a loss of 50 percent on each Medicaid patient they treat.
In addition, the new legislation stipulates that hospitals will no longer be compensated for preventable readmissions of Medicare patients.
The full article is available at www.healthdatamanagement.com/blogs
US News Hospital Rankings Flawed
April 22, 2010
US News & World Report’s list of the top 50 hospitals in the US reflects the subjective reputations of the institutions and not objective measures of hospital quality, according to a new analysis reported in a medical journal.
The study reported that magazine readers “should understand that the relative standings of US News & World Report’s top 50 hospitals largely indicate national reputation, not objective measures of hospital quality.”
For example, the study found that many of the high-ranked centers scored poorly in providing evidence-based care for patients with MI and heart failure. Also, performance on Medicare’s core measures of MI, congestive heart failure, and community-acquired pneumonia were frequently at odds with US News rankings.
Of course, academic medical center executives will say their clinical outcomes are poorer because they get the sickest patients.
The full article title is “Popular Best-Hospital List Tracks Subjective Reputation, But Not Quality Measures.” It can be found at www.medscape.com
EMRs are Bad for You
April 21, 2010
The Huffington Post has a new “investigative” story that claims EMRs can cause patient injury and death.
The story says its reporting team identified 237 reports of “adverse events” associated with health information technology reported to the FDA over the past two years.
The story adds that “some experts worry” that the new stimulus funds (“$5 million per hospital”) will cause organizations to install EMRs “prematurely.”
Is this much ado about nothing? After all, some 97,000 people die every year in hospitals from preventable errors and infections.
Still, the story is good counterweight to much of the blind cheerleading going on in the business press about HIT adoption.
The story is available at http://huffpostfund.org
EHR Buyers Look to Smaller Vendors
April 20, 2010
A new report from KLAS, the EMR vendor rating organization, buyers are looking beyond the “top ten” software vendors (e.g. Allscripts, NextGen).
As noted in the current CMIO newsletter, this trend is especially true for small practices with one to five physicians, where 72 percent are considering solutions outside the best-known vendors.
The KLAS report also found that 32 percent of providers planning an EMR purchase are replacing an existing program. Many report their old system lacks key functionalities.
For the full article see www.cmio.net
Can CMS Handle The Reform Law?
April 18, 2010
Health Affairs has an interesting discussion on whether CMS will be able to successfully implement the new healthcare reform law.
The agency is currently drifting and leaderless, say the contributors. Bruce Vladek, HCFA administrator under President Clinton said the administration’s failure to nominate a new CMS administrator is “mind-boggling” and “almost incomprehensible.”
He noted that CMS spends roughly double what the Defense Department does, Scully pointed out: “Imagine if somebody went two years without a Secretary of Defense.”
Vladeck noted that CMS’s administrative funding suffers not just in Congress but also within the Department of Health and Human Services: “How can you compete with curing cancer, or preventing epidemics at CDC,” or catering “to a variety of constituency groups, which is most of what the rest of the department does?”
The full article is found at http://healthaffairs.org/blog/2010/04/13/cms-and-health-reform-a-health-affairs-blog-roundtable/
Insurers Seek Medicaid Contracts
April 15, 2010
The Wall Street Journal has an interesting story today about health insurers seeking to win Medicaid contracts.
United Health Group has released a report detailing a variety of managed-care strategies it says will help cash-strapped states solve budget problems.
United says that $366 billion in savings could be realized over the next decade with such techniques as improving coordination of care between doctors and moving patients out of nursing homes.
Note that Medicaid reimbursements vary from state to state. California is one of the lowest paying. Many hospitals complain that they lose money on every MediCal patient. In fact many hospitals have quietly stopped accepting MediCal patients.
Rural Imaging Centers Take Hit
April 14, 2010
Patients in rural areas and inner cities will have a difficult time getting medical imaging services involving MRI and CT scans because incentives in the new health law favor providing the services in hospitals, according to the Access to Medical Imaging Coalition (AMIC).
The AMIC is an advocacy group and they apparently they lost out to the hospital lobbyists in this tussle.
I once read that in Los Angeles County there are more MRI machines than in Canada. Of course, LA County has 8 million people. Now if there were more MRI machines in Beverly Hills than in Canada…that would be something.