Browsing: Healthcare Systems

Practice Transformation

It is time for healthcare providers to transform into practices that are able to deliver better care at a lower cost with higher patient satisfaction-the Triple Aim. This is what payers-both private and governmental-want. They have no other choice, as we shall see. Those providers who understand this and are willing to work with payers to meet these goals will probably be more successful as time goes on. The practice transformation will be long and hard but those who are willing to 'perspire' while focusing on the Triple Aim will succeed and the staff, both clinicians and support staff, may enjoy the journey as their patients become healthier.

It is my goal in this newsletter to explain why the transformation is necessary and to share some ideas about the ways that a practice may take in order to succeed. In newsletters in 2018 I will also address some other approaches that practices can take to be successful. Some of these will be based upon my experiences in helping clients to transform and others will come from literature that I read frequently as well as from my contacts with local provider networks.

In the late 1970's and in the 1980's payers began contracting with providers to form HMO's. The hope was that they could reign in the ever-rising costs of providing care. These costs were being passed on to businesses that provided health care to their employees and families as well as to individuals. Payers contracted with providers whom they thought could provide better care at lower costs. This arrangement did not work and patients were upset that they could not see providers of their choice. Costs continued to rise for payers and the costs of contracts with businesses continued to rise steadily. Businesses reacted by raising deductibles and copays in their contracts; more costs were shifted to employees and individual buyers. This rise in costs to individuals has continued to the present. One of the problems with HMO's and other narrow networks was that doctors were still being reimbursed as fee for service without much regard to quality of care. Today, the continued rise of costs to businesses and individuals can not be sustained or only the very well-off will have good health coverage.

Because the old models of insurance were no longer viable, private payers began to switch to paying for value in care provided. Some of the first examples of switching to value-based care were bundled payments for joint replacement surgery and the formation of Accountable Care Organizations. Two acts from the US Congress also encourage the gradual change to value-based care contracts. The first was the Accountable Care Act. This forced payers who sold products on the state insurance exports to pay for a minimum set of provider services and to provide preventive services at no charge to the patient. The act also established a web site that compared the value of different plans on the changes so that customers could purchase the plans with the best value. Businesses also purchased plans with at least the minimum amount of services.

MACRA (the Medicare Access and CHIP Reauthorization Act) starting in 2017 pressured providers to transition to providing services based upon value. Value indicators were established by the act and some of the reimbursements to doctors was based upon achieving benchmarks that are already defined.

I think you can see that for the foreseeable future private payers will continue to contract with providers based upon the value of services provided. Providers that provide the best services for the lowest costs will succeed with these payment models.

In my locale, Mercy Health of West Michigan and Blue Cross Blue Shield of Michigan have contracted together to provide care and an insurance product that is very affordable to individuals, including a Medicare Advantage product. Buyers of this product must use Mercy Health Physicians and one of four hospitals in the area. Mercy Health is able to deliver the quality of care that Blue Shield desires as Mercy Health doctors have been certified at level 2 or 3 NCQA Patient-Centered Medical Homes for quite some time. NCQA PCMH's have been shown to meet the Triple Aim. Mercy Health doctors have worked hard many years to achieve their certification as patient-centered medical homes. Blue Cross and Blue Shield have enhanced their reimbursements for having done so.

For primary care providers becoming certified as a PCMH makes sense economically, according to the article “PCMH accreditation: Is it worth it?” at medical economics. There are several different organizations that certify primary care sites as medical homes. In Michigan Blue Cross Blue Shield has been certifying sites as medical homes since 2009. Practices that qualify received enhanced reimbursements for services, as did Mercy Health doctors. NCQA, a federal department, also certifies sites as PCMH's nationally. I think that any primary care provider should explore becoming certified as a PCMH by checking with the payers with what they are contracted to see if there is additional reimbursement. CMS is considering expanding their definition of PCMH to include other certificates outside of their current demonstration project so additional practices can qualify for enhanced reimbursement under MIPS.

Another approach to reaching the Triple Aim is to focus on social determinants of patients. These include cultural background, income level, gender, age, etc. This approach is recommended in the article “Building a Population HEALTH Strategy that Physicians LOVE” in the October 2017 edition of MGMA Connection. Practices should focus on social determinants in order to overcome barriers to good health that an individual may face. Sometimes this will mean that a practice will want to have relationships with local non-profits that are able to provide resources for their patients that will influence the outcomes of the care that the provider gives. Two such agencies that I have experience with that I think would be useful are Meals on Wheels and The Salvation Army.

I recently visited my local Meals on Wheels program and found that one of their primary goals is to help their clients stay in their homes rather than being admitted to assisted living. Clients of Meals on Wheels have limited mobility and have difficulty preparing their own food, including having limited income. By providing nutritious meals every week to clients, the clients are able to stay in their own homes, which they value. Also, volunteers who deliver the meals are instructed to keep an eye out for any changes to their clients' health and report it.

I also went along with a registered nurse from Meals on Wheels to a client assessment at the client's home. The nurse not only collected information about income and family support, but also extensive information about the general health of the client, including number of falls in the past year. From my experience, I believe that a healthcare group may want to formalize a relationship with organizations such as Meals on Wheels as doing so may help in maintaining or improving the health of patients who are clients of such organizations.

Recent history shows that the fee for service model will be disappearing, at least in part, and replaced by value-based care. It will not be known for quite some time if this new reimbursements model will have a significant impact in slowing down the rise in healthcare costs. Patient-centered medial homes have shown that costs can be reinvented while care is improved. For the immediate future providers need to focus on the transformation to value-based care organizations and explore local resources that may be able to help their patients overcome barriers that impede the care that they provide.

For another perspective on the transformation of healthcare to value-based organizations, you may want to read the article “The Road to Affordability: How Collaborating at The Community Level Can Reduce Costs, Improve Care, And Spread Best Practices” found in the Health Affairs Blog of November 14, 2017. It has some good examples of the transformations going on in other parts of the United States.

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Having Health Issues? How to Decide Between Urgent Care and the ER

Whether it's a painful ear infection, a broken bone, or some chest stains, medical issues can often arise when your doctor's office is closed. You can not always wait to get treatment, though, so getting to the emergency room (ER) or an urgent care center in your neighborhood is your best option. However, each facility is best suited to treat specific conditions, so it's important to know which to visit depending on your symptoms.

Urgent Care 101

You probably have a pretty good idea what an ER is – a 24-hour unit at your local hospital that treats life-threatening ailments – but you may not be familiar with what an urgent care center is. These facilities are equipped to treat less serious medical issues when your usual doctor is not available. They usually offer later hours than traditional medical offices and are open on weekends, although they typically are not open 24 hours a day. Unlike the ER, where the most critical patients are seen first, you can expect to be seen on a first-come, first-serve basis. Most health insurance plans also cover this type of care, so you may only be liable for paying a copayment.

What Can Urgent Care Handle

Your local urgent care center usually raises issues that do not require emergency assistance but can not wait a day or two for a general doctor visit. This may include injuries that result from a fall like sprains or broken bones, back pain, or cuts. These clinics are also equipped to treat a range of other issues, including animal bites, mild burns, eye irritation, severe cough or throat issues, mild asthma, allergic reactions, a fever without a rash, abdominal pain, vomiting, diarrhea, and urinary tract infections. Many centers have x-ray and blood test capacities, so they can diagnose a variety of conditions. In most cases, the doctor that you see will recommend that you follow up with your primary care physician or a specialist that is trained to deal with your ailment. Some facilities may also be able to perform minor procedures if necessary.

When You Should Go to the ER

In a medical emergency, time is always of the essence, so getting to the ER as soon as possible is key. You should call 911 or head to your local emergency room if you are experiencing symptoms that appear life threatening. These symptoms may include difficulty breathing, persistent chest pain, loss of consciousness, difficulty speaking, paralysis, seizures or convulsions, loss of balance, moderate to severe burns, vision loss, poisoning, severe headaches, or a fever with a rash. Men who are experiencing testicular pain and swelling, pregnant women with vaginal bleeding, and babies with a fever should also go to the ER. When it comes to accidents and falls, any severe head, eye, neck, or spine injuries should be treated at a hospital as well.

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Immediate Care or Hospital? Your Personal Guide

When you find yourself or a loved one hurt or sick and in need of a doctor's attention, it should be simple to know where to go. However, as we all know, there are always extenuating circumstances. Immediate care facilities are a great alternative to emergency rooms, but they are not always the right choice for every patient. When you find yourself facing a medical conundrum, it's best to find yourself armed with the proper situational knowledge beforehand so you turn to the right place in the heat of the moment.

It does not seem like a hard decision to make: you go to your primary doctor for minor ailments and to the emergency room when it's an issue of life or death. In the interim, when your primary office is closed or if you do not have one at all, you're on immediate care. Studies find, however, that rather than going to facilities of this nature, many people make hospital emergency departments their first choice before even considering anything else. While nurses and doctors at any location are always more than happy to help patients though they can, the excess flood of patients without serious injury or illness into hospital waiting rooms can place a lot of strain on a hospital staff. This, in turn, creates long wait times, which does not benefit anyone.

So, what role does immediate care play in the interim? Doctors at these facilities can determine whether or not the condition you're dealing with is really serious enough to merit a trip to the hospital. These facilities usually have more than one doctor on staff and place emphasizing on seeing each and every patient as quickly as possible, without detracting from the treatment of others. They're a particular boon for patients who do not have access to a primary doctor. Many IC facilities keep later hours than traditional offices do, so they're there for you when you need them.

Choosing to visit an immediate care facility does not mean that you are sacrificing the quality of treatment people associate with hospital emergency rooms. In fact, it's quite the opposite. All doctors receive the same training and are able to answer all your questions. You'll be met with many of the same diagnosis and treatment options available at your local hospital, so common ailments like skin rashes, diarrhea, and others can be handled here competently and more quickly. This leaves emergency rooms to tend to more serious issues, like hemorrhaging, broken bones, severe allergic reactions, loss of consciousness, and more.

Knowing that these facilities are well equipped to handle all your minor medical emergencies, you will save yourself time and do those seeking treatment for more serious ailments a favor.

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Advantages of X-Rays Using Ionizing Radiation

Radiation may differ in types, one among which is background radiation, which indicates ionizing radiation released from high energy particles we constantly get exposed to in our normal lives. Although, the amount of radiation may be small.

Electromagnetic radiation spectrum is partially responsible for background radiation. Both ionizing and non-ionizing components, including x-rays and gamma rays, and visible light and radio waves, respectively, may be involved in this. Gamma and x-rays are considered as ionizing radiation, since these hold the potential to drop a sufficient amount of energy into a body tissue. An electron is emitted by them from an atom, and the proteins or molecules of the tissue are changed.

Cosmic rays from all over the universe act as the ionizing radiation sources in our surroundings. The foods we eat or the air we inhale in our daily lives comprise some natural radioactive substances, which also are counted among these sources. Humans carry radioactive elements like potassium 40 or carbon 14 in their bodies, which is why they are weakly radioactive. And this is how they get exposed to background radiation.

X-rays

Be it visible light or x-ray, the two of these use straight lines to travel. A shadow is cast by the two when these come in contact with something solid.

As compared to visible light, x-rays carry more amount of energy. These can penetrate deeper into objects. Different body parts absorb x-rays to different levels. This results in appearance of shadows which make an x-ray picture.

More amount of x-ray beam is absorbed by bones, which are dense structures. On the other hand, there are soft tissues, which are less dense and absorb less amount of x-ray beam. Air will generally be seen as black on the x-ray image, whole metal objects will appear white. Usually, man-made x-rays generate electrically and need the x-ray machine to be switched on to come out.

Zero radiation comes out of the x-ray machine, if it is switched off.

A computable extra dose of radiation is provided by x-ray procedures to the annual background radiation exposure. Over the last few years, medical X-rays have contributed a lot to average population radiation dose. Improved imaging tests have surfaced with time.

Diagnostic Radiology Benefits

Diagnostic radiology is aimed at providing the radiologist with high quality images so the examination results could have been reported to the doctor. It is then only that he could assist in making you well-versed with the problem, thereby confirming if you are suffering from a particular disease or wound.

X-ray imaging techniques expose the patient to low risk, while offering fast and accurate results. Also, these are non-invasive and have come out to be an effective investigative technique.

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Healthcare Revenue Cycle Management Moving Ahead Into Advanced Stages Of EHR

REVENUE CYCLE MANAGEMENT: What's it mean? In a nutshell, it means taking steps to insure that you get paid for what you do and that you get paid in a timely fashion.

The revenue cycle starts when the patient calls your office for an appointment and your staff captures the patient's name, phone number, and possibly the name of their insurance company.

The cycle ends when the balance on their account is zero.

DATA GATHERING IS CRUCIAL

Some practices say they can not afford to take the time on the phone when the patient calls for an appointment to collect insurance information. That means that the practice does not get to verify the patient's insurance coverage before the appointment.

If you do not verify coverage before the patient presents, you have to hold up rooming the patient to verify the insurance when they check in. That's inefficient for everyone in the practice and often puts the whole schedule behind for the day.

Pre-visit eligibility verification is a best practice that every physician office should strive to accomplish. If you find out that the patient is not covered for the visit a couple of days before the scheduled appointment, you can contact the patient to either get informed information, or maybe even reschedule the patient if necessary.

You can submit all patients on a day's schedule in an electronic file and send it to a clearing house to verify eligibility for all appointed services (it's called “batching”). Doing so will reduce the volume of denied claims.

HOW ELIGIBILITY VERIFICATION HELPS

During a recent consulting engagement, a sampling of denials shown that 3,450 claims had been denied the first time that they had been sent through. That's a first-pass denial rate of 6.9%; the rate for better-performing practices is approximately 3%.

Approximately two-thirds of the denials (2,270) were because of eligibility issues.

The cost of managing those denials is approximately $ 25 per claim, which means that that group spends $ 18,900 every month to work denials that could have eliminated with an investment in batch eligibility for all scheduled appointments.

It takes four individuals in the billing office to work the denied claims for that practice.

Do you know your volume of denied claims and why they are denied?

USE THE CORRECT NUMBERS

Accurate patient registration and billing information is a critical first step. Getting the charge posted with the CPT service code and ICD-9 diagnosis code on a timely basis is the next step in the revenue cycle process.

Some practices hold their charge slips for a full day or even more. Sometimes they have someone cross referencing the appointment schedule against all the charge slips to be sure they have not missed charges, but that delays the charge posting and billing process by at least a day.

Most practice management systems have a “missing charge” report that automates the cross-check process so there is no added value for holding onto charge slips for a day; and, in fact, the process of holding charges increases the work load by forcing you to check each charge slip against the report, rather than simply hunting up the missed charge slips as identified by the report.

If you're not using the missing charge report function, find out why not and consider using it. If your practice management system does not have the function, ask if it can be added, or do a cost-benefit analysis on switching systems.

AUTOMATE MORE

The revenue cycle process is enhanced with electronic claim submission and electronic remittance payment posting.

Automated posting saves staff time and that time can be used to follow up on outstanding claims or overdue balances.

The quickest way to a zero balance is to automate those tasks that do not require your billing staff's expertise and to use that expertise to communicate with the payers as needed.

You can also shorten the revenue cycle by offering your patients online bill payment and e-statements.

E-statements cost less than 60% of the price of a paper bill to produce.

You pay your own bills online, why not invite your patients to do the same for your practice?

So, four steps to effective revenue cycle management:

  • Gather Data
  • Verify Eligibility
  • Use the Correct Numbers
  • Automate the Process as Much as Possible

That's the way to a zero accounts receivable balance!

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The ACA’s Senior Care Benefits: Post-Hospital Care

One of the chief problems with America's rising healthcare costs is that hospitals have a tendency to keep patients on for longer than necessary in order to bill for more care. The Federal government has already taken strong steps to prevent this kind of behavior – but as it turns out, the cure was, for some seniors, worse than the problem. Suddenly, hospitals were ejecting people when they were just barely stabilized, because the profit margins for holding a patient were plummeting.

The issue became so dramatic that a recent study revealed that one in five seniors was readmitted to a hospital within 20 days of being released – for the same problem they were originally admitted for! The Affordable Care Act ('Obamacare') aimed to reduce that number, as well as to improve care for seniors in the crucial post-hospital recovery phase.

To that end, the ACA created a program called the Community-based Care Transitions Program (CCTP) that does exactly what its name suggests: it helps seniors that are leaving hospitals to transition to 'community-based care.' In other words, they manage a significant fund of money available to a large number of test communities, and they spend that money helping entrepreneurs build Community-Based Organizations (CBOs) that handle the transition from a hospital to any other form of caretaking.

Care Transitions

A 'care transition' is the formal term for 'moving from one location that provides medical care to another.' Care transitions have always represented a problem for the medical industry, because of the numerous ways in which vital medical information fails to transfer from one caretaker to another.

For example, at the hospital, you have a series of nurses, many of you see multiple times, and they take extensive notes about the details of your situation so that another nurse can step in without missing a beat. But those notes are rarely made part of your official medical record, and even if they are, there is no guarantee that your next caretaker will receive a copy of your medical record in time to start care – or at all!

Because such failures of information can lead to lapses in care, care transitions require extra attention – but all too often, either the hospital you are departing nor the new facility you are moving to will take responsibility for completing the transfer. Thus, the CBOs created by the CCTP take the job of care transitions, making it their sole job to ensure that your new facility and / or caretakers are the right people for the job, and that they get all of the information they need to properly care for you.

The Test Communities

Because this is a test program, not every community – and not even every major city – has a CBO that can help with a care transfer. If you're looking for one in your area, you can check the CCTP website map, which shows all 76 communities currently served by one or more CBOs.

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Medical Device Innovation – Save Human Lives to a Great Extent

Since the beginning when mankind began creating their space on Earth, there were a number of medical practices which were followed then by the people and other equipment used for the purpose of treating the people. As time passed by, we came up with improved technological advances which paved the right path for us to follow when it came to treating the one with illness, and the latest innovations were made in medical devices.

A lot of doctors, doctors and nurseries for that matter greatly believe in the fact that this latest medical equipment, without a doubt, plays a very serious role when it comes to saving one's life or diagnosing the patients with a disease.

It would certainly not be wrong to state the fact that various medical devices are being used to save a patient's life. So, we owe a great debt to such a cutting-edge technology that has made the impossible seem possible. If there were no technologies, we probably would not have been able to diagnose and cure the patient. Right starting from a thermometer to life saving machines, these are the medical devices that are used in clinics and hospitals.

Let's take a look at some of the medical equipment that you would find in almost every hospital. They are mentioned below:

Ultrasound Machine – One of the great medical device innovations that we have come up in the present time is the ultrasound machine. If we throw light on the term “ultrasound”, it is a procedure that makes the use of sound waves of high frequency so that an image of the part of the body can be created. For instance, a human heart and other organs inside one body can be scanned with an ultrasound machine. In fact, it's a risk-free test and one can not hear the high-frequency sound. When this machine was first invented, it was used to watch the image of a baby in a lady's womb, but with the help provided by medical invention, this machine soon started to be used for scan other organs as well.

Artificial Hearts – Has the very thought ever occurred in your mind that there would have been an invention of artificial heart someday or the other? You might be compelled to think how a heart can be artificial. But it's true because we, with the help of the latest technology, made this possible. This can certainly be regarded as one of the greatest medical device inventions in the medical history so far. An artificial heart is a device which is used to replace a human heart in one's body. In case heart transplantation is not possible, a human is implanted with an artificial heart.

There have been rapid innovations in the healthcare industry. The healthcare provides several various services like therapy, dental, medical, nursing, clinical sciences, pharmaceutical and many more. There have been many healthcare innovations in the world in diagnosis and treatment of varied diseases as they have picked up pace in the medical industry.

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Do We Have to Emphasize on Global Healthcare Challenges?

It's true that the average life span of humans has improved in the current times. Nothing can have the fact denied that the medical technology has really advanced and the various medicalventions have created the path for the latest diagnostic techniques, but also dealing with the minerals and chemicals in a cosmetic manner so that varied ailments and other diseases can be diagnosed and cured.

With the medical innovations already in place, some of the dangerous diseases have completely been eradicated and small pox is one of the examples of such a disease. Many health experts can be made contact with those who believe that it's of utmost importance to address the need related to public health rather than thinking about those problems which are somehow associated with a disease.

There can be a possibility that both public and public sectors may be investing a reasonable amount of money so that various new innovations can be made in terms of medical devices, but the requirements of providing quality health care may not be the same in some countries as there in others.

There are a number of global healthcare challenges that are connected with healthcare facilities. Why does it happen that those who do not require health care are the one who enjoy the most, whereas the poor people who look forward to getting some healthcare facilities or services often end up having some problem or the other? Those who are living below the poverty line simply can not get the access to basic healthcare services because their financial condition is not very strong. It is foreseen that this gap can become big if equal distribution of hygiene and healthcare is not taken into consideration. The fact is that the rich people often benefit immensely when compared to the displaced ones who go disregarded.

The health industry, without a doubt, has undergone various transformations and the fact that the average life of a human has almost increased by double in varied booming nations. Several technologies have been implemented by the doctors so that they can find a cure for an inoperable disease and save many lives. There are many experts in the healthcare industry who go by the notification that a huge part of the investments made is going waste without producing any result. But it should be made sure by the government and the healthcare agency that the invested amount of money should be used in the right manner.

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Planning Your Practice Future

Do you have goals for your practice? Do you have a strategic plan to help you reach your goals? Or does your practice have no aims, instead reacting to challenges as they arise, often wasting a great deal of time and effort? I believe that it is much better to plan. You are more likely to have firm goals in mind and are more likely to reach them. Also, with the experience of creating and executing plans, you are more likely to be able to handle unexpected challenges adroitly. As Nick Fabrizio stated in the article “Strategic Planning Gives Clear Direction” on ModernHealthcare.com September 2012, “Effective strategic planning will help prepare doctors and their medical groups for the myriad changes expected in tomorrow's healthcare environment.”

Strategic plans, no matter what the business, have several common features. Most begin with a vision statement. For instance: Provide quality healthcare with a lower cost. This happens to be the number one challenge of healthcare providers according to a 2013 Medical Group Management survey. I believe that being patient-centered, providing quality care efficiently and improving the bottom line is a good vision for a practice.

Vision statements are very broad. Your strategic plan must include some details of what actions you need to take to reach your vision. The vision statement of a practice will remain stable from year to year but the actions will need to change every two to three years. In order to remain flexible to the changing environment of providing quality care strategic plans should be created to last two to three years. In the past strategic plans were written to last five or more years. The rapid changes occurring in all businesses require that strategic plans have a shorter life.

What might be some actions that could have been entrusted to provide care that is patient-centered, efficient while providing high quality, and improving the bottom line? One path to improve being patient-centered is to improve communication between physician and patient, helping the patient to set his own goals for his care. Improvement communication between other clinical providers and office staff also improves patient-centered care. Care that is more patient-centered is usually more cost efficient and leads to improved income for a practice. This has been shown in studies of patient-centered medical homes, one pathway to improvement in being patient-centered.

A path to improvement in efficiency, a part of my proposed vision statement, is advances in health information technology. It will be necessary to update practice management software and other HIT in a practice in the coming year to accommodate ICD-10 coding. With the new coding, practices will be better able to manage care at the population level, which will keep patients with chronic diseases healthier. Managing care at the population level is more effective, efficient and of higher quality.

Who should be involved in creating a strategic plan? According to the article “Reduce Healthcare Costs without Sacrificing Quality and Flexibility” in the March 2014 issue of MGMA Connection those involved varies by practice size, culture, management style and structure. “Team representatives could include an administrator, a physician, a clinician, information technology, and administrative support,” according to the article.

As stated earlier, strategic plans should have a life of two to three years. After writing yours, be sure to make sure all of your employees are familiar with it and understand it so that they can be effective in helping the practice implement it. I would recommend that practices review their strategic plan three or four times a year so that doctors and staff will keep the goals of the vision statement in mind.

After a team has created a strategic plan it will be necessary to create annual implementation plans that detail the practice is to achieve the goals set forth in the strategic plan. Implementation plans contain specific actions, who is responsible for seeing that the actions are completed, by what date the action will be completed and what indicators will be used to measure how effective the actions were in achieving the goals.

Currently I am working with a health department in developing an implantation plan for the coming fiscal year. One of the goals is to provide better community integration of prevention and treatment services for those with substance use disorders. Thus, one of the first actions could have to have a member of the heath department's prevention team to make contact with the primary care providers in the county by either mail or personal contact to provide information to the PCP about screening for substance misuse and to see how the health department can support the PCP in this effort. The implementation plan could set a nine-month goal of reaching out to 50% of the primary care providers in the county, as recorded in a spreadsheet.

I believe that actions detailed in an implementation plan are best carried out by a team using a well-defined strategy. For instance, if the action is to prepare a practice for the use of ICD-10 coding it will be necessary to use a team to oversee the details of the implementation of a plan to ready the practice for its use. The plan could use a Plan-Do-Check-Act strategy to be sure that coding staff and clinicians understand ICD-10 well, that HIT is upgraded and tested, that sufficient resources are set to cover the costs of it implementation and that communication about the implementation to all staff is effective. Results of the measurement phase of the strategy should be reported regularly to those exceeding the strategic plan.

Practices typically fall into one of three categories in regard to strategic plans. One, the practice does not have a strategic plan and reacts ineffectively and inefficiently to new problems and challenges. Two, the practice creates a strategic plan and then shelves it, never bothering to review it until the time arrives for creating a new one. Three, a practice creates a strategic plan and reviews it regularly to make sure the implementation plan is working towards achieving the goals set forth in the plan. Those who fall into this third category usually find their work much more satisfying and rewarding.

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Sources of Change

Some of us are very comfortable with change. For others, change is unwelcome and causes a great deal of anxiety. Organizations are very similar, I believe. I have read many postings and articles on healthcare sites about the stresses caused by the mandated changes in healthcare. Too, politicians love to rail against a wide variety of changes, especially if the politician is in the minority party at the time.

Change is a constant for organizations and for humans. Some changes are forced upon us, as the Physician Quality Reporting System (PQRS) is mandatory for those who provide Medicare Part B services and as buying health insurance is for adults in the US Other changes are voluntarily adopted by organizations to improve their services and products . An example for organizations is a group of healthcare providers becoming an accounting care organization (ACO). Many individuals want to lose weight. Not all are successful.

I believe that resistant change is unhealthy, for both businesses and individuals. Not responding to mandated changes can be costly. Individuals who do not buy health insurance face a tax penalty. Providers who do not strive to provide the best care, to excel at patient engagement, may lose patients to their competition.

Let us look at some organizational changes and their consequences.

This is a very critical year for providers involved in the PQRS program. Reporting in 2014 for eligible professionals is required by CMS or in 2016 reimbursements will be reduced by 2%. This can have a significant impact on providers who have a high proportion of Medicare or Medicaid clients. Those who are successful in reporting will receive a 0.5% bonus on their Part B Fee Schedule. The Medical Group Management Association (MGMA) provides an easy to use reference for its members that guides providers and staff through the steps of providing CMS with the necessary information to avoid the penalty in 2016. It lists four steps with links to resources necessary to finish each step:

1. Determine if you are an eligible professional (EP)

2. Determine if you will report on individual measures or a group of measures

3. Choose your registry from the approved list on the CMS site

4. Use the reporting wizard in your registry to report the data to CMS

Hopefully, you already are using a registry that is approved by CMS.

There are several other mandatory programs that require major changes and challenges for providers in the coming year. Two of these are reporting on meaningful use stage 2 for electronic health records (EHR's) and preparing for the switch to ICD-10. Of these three, I believe that the most challenging and most important is the switch to ICD-10 coding as it can be very cost not to be ready on October 1, 2015.

As noted above, some organizations decide to make major changes in order to improve their services or their products. Healthcare groups are reorganizing as they look forward to changing reimbursements patterns. Two of these reorganization styles are patient-centered medical homes (PCMH) and accountable care organizations (ACO). Both organizational styles focus on improving the quality of opportunities while cutting costs to payers and becoming more patient-centered. Both organizational styles can reap significant rewards from payers if they are effective.

In the November 2013 edition of HealthLeaders various executives of provider groups reviewed their moves to adopt population level health analytics to improve the outcomes of their ACO's and, thus, improve the likelihood of sharing in any savings to the payer. Aric Sharpe, vice president of UnityPoint Health, an ACO in West Des Moines, Iowa, stated that, “We felt it necessary to build a platform where we can mesh together both claims data and data out of our electronic health records, because there's a lot more that's able to be learned in that type of environment. ”

Reorganizing to become an ACO or a PCMH is usually a decision made by executors along with their governing boards. The implementation of the reorganization is based upon documents detailing structures and goals agreed upon by non-payer or national organization and provider. The changes are driven from the top levels of the organization. A few very effective organizations also drive continuous change from the bottom up. That is, they take suggestions from front-line staff to improve services by making changes that are usually small and incremental. If an organization seriously undertakes to implement most of the suggestions that can be seen to improve quality (I know one organization that implemented 95% of the suggestions from front-line staff) the cumulative exit can greatly improve patient or client satisfaction and care and improve the bottom line.

In the May / June 2014 issue of MGMA Connection in the article “As Payers and Government Push for Quality Care, Staff Motivation and Goals Must Change”, Jennifer Gasperini, a senior representative of the MGMA Government Affairs body stated that CMS has expanded PQRS reporting and the Value Based Payment Modifier (VBPM) over the past two years. Further, she states that, “We can expect that trend to continue in the near-term future, particularly with regard to VBPM, which will affect all doctors beginning in 2017.”

Intermountain Healthcare in Salt Lake City takes this statement seriously. It is using clinical groups to identify disease areas for clinical focus. It then uses a Lean Six Sigma approach to drive improvements. It has trained over 900 of its over 3000 employees in this continuous quality improvement approach. Quality efforts are team based. Data is regularly collected on identified metrics. The measurement results are regularly reported back to the staff in order to improve outcomes even more by making adjustments to improvement strategies as needed.

I am previously involved in creating an implementation plan for the coming fiscal year at a nearby health department. The drive to improve the quality of the programs used to prevent the use of tobacco and drugs by individuals in the county is being led by members of a workgroup committee that is comprised of staff of the health department and by community members. One focus of the new implementation plan is to improve the monitoring of the outcomes by using an expanded set of quality indicators.

Bob Dylan was right when he sang The Times They Are A-Chanin ' . The next few years will see significant changes in healthcare. Some of these changes will be demanded by bodies external to the providers. The best providers will adapt to these demands as well as creatively foster change from within. These organizations will reap the benefits of improved patient satisfaction, improved patient outcomes and a much better bottom line.

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Benefits of Pediatric X-Ray Imaging

Medical imaging or x-ray imaging has contributed a lot to bringing improvement in the diagnosis or cure of different medical conditions, be it in kids or adults.

Medical imaging procedures are of varied types for children. These procedures differ in terms of the technologies and methods they implement. Ionizing radiation is used by radiography, fluoroscopy, and computed tomography (CT) to produce body images. As the name implies, ionizing radiation is one of the different kinds of radiation with sufficient amount of energy which may lead to DNA damage. It can even increase the risk of developing cancer in the patient.

The principle on which the three techniques mentioned above are based is the same ie passage of an X-ray beam through the body and absorption or scattering of a part of x-rays by the internal parts. The rest of the x-ray pattern is transferred to a detector which gets recorded or processed further via a computer.

The purposes of fluoroscopy, radiography and computed tomography (CT) are different. Radiography focuses on a single image which is recorded or stored to be assessed later. Fluoroscopy immerses display of an x-ray image continuously on a monitor so that a process or contrast agent path could be monitored in real-time. High radiation doses may be experienced by the patient in fluoroscopy.

The third exam is CT or computed tomography, which involves recording of x-ray images while the patient has the detector move around his body. Individual pictures are reconstructed by a computer into cross-sectional images of internal body parts. As compared to conventional imaging, a CT test may also involve a high dose of radiation, since numerous individual x-ray projections reconstruct the CT image.

Benefits of imaging:

X-ray imaging tests are known as one among the most vital tools that helps in different kind of medical procedures such as painless detection of any illness, interventional procedures like stents, placing catheters or some other tool inside the body, and medical treatment planning support .

An important imaging examination generally involves a small risk as compared to the numerous benefits it offers in terms of helping in diagnosis of a problem accurately.

Information for Patients

According to what FDA recommends, a person's health needs should be very carefully examined before he undergoes any kind of medical imaging test. A physician should suggest that this test is necessary for figuring out the patient's exact condition. The small risk that the medical imaging test poses the patient to is overshadowed by the benefits it offers. Doctors and researchers should still try to find out measures to minimize the small risk.

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How Digital Imaging Upgraded X-Ray Imaging?

It was in the 1980s when digital imaging techniques got introduced to x-ray and analog to digital converters got introduced to conventional fluoroscopic image intensifiers. X-ray has seen resurgence and enhancement in itself ever since digital imaging has come into force. The digital x-ray images now come out sharper as well as clear as compared to the images produced in the analog form.

With the advent of digital technology, numerous fluoroscopic x-ray procedures have seen significant improvements in them. Digital technology has also shown its impact on angiographic procedures for having a look at blood vessels in kidneys, brain, legs, arms and heart.

According to the belief of experts, conventional x-ray techniques may also get upgraded to digital technology in the coming 10-15 years. In fact, film screen systems are also expected to go digital in this time period.

At present, a technology dubbed phosphor plate is available online. These help ensnare the x-ray energy and need an intermediate processing step so that the stored information could have been released to turn into a digital image.

How digital technology proves its worth to different kinds of x-ray systems?

Just akin to film, x-rays with lower dose may help in achieving a high quality x-ray image. Once these images are produced, computers can be easily used to manipulate or improve these pictures. Beside, these images can be sent to other workplaces or computer monitors through a network. Since, the same helps people when it comes to sharing the retrieved information or diagnosing different medical conditions.

Compact optical disks help doctors archive the digital images. They may also use digital tape drives which help them save hugely on storage space. This also aids in saving on manpower required for a conventional x-ray film library.

An electronic archive may be brought into use when it comes to retrieving digital images for some future reference.

Further, there are a few modalities which can show less acute diseases such as small breast cancers or calcifications only when they have a significant high resolution film. However, these are not into the picture as yet.

But, such digital detectors with such high definition are being developed and it is expected that these will be available in near future. For now, digital imaging is being used in an equivalent manner as a high resolution film would be used, be it in the field of breast biopsy systems or in breast imaging.

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What Costs Can Providers Expect to Face After ICD-10 Implementation?

Yes, as we head into the final stretch of the inevitable ICD-10 transition, there will be more and more talk about the costs of buying into new systems or upgrading systems and of the penalies for not being compliant. But little is being said about the costs that providers can expect to face after implementation, and those costs are not anything to sniff at.

Reduced Workflow Equals Reduced Cash Flow

Do you want the good news or the bad news first? The bad news, alright!

The bad news is providers should prepare for major headaches, reduced productivity, and extremely a disruption to their revenue cycle as staff is forced to spend more time looking up diagnosis codes and dealing with the mountains of new clinical documentation as well as delays in processing medical claims.

The American Association of Professional Coders (AAPC) published a whitepaper thatave some numbers on what providers can expect as far as delays come October 2nd. They estimate that coding time may increase per record from 12-15 minutes to 33 minutes and turnaround time may increase from 69 days to 139 days.

Obviously not every physician's office will be affected similarly, but all can expect some interruption to workflow.

The good (ish) news is that there are some ways providers can prepare themselves for these delays and disruptions in revenue:

  • Before you know how hard a hit you might take, you've got to know where you currently stand. Do you know what your current average coding and turnaround times are? If not, consider developing some test cases and creating projections to figure out your expected increase in time. Knowing that you can expect your coding times to double will help you determine if you have enough staff currently to handle the increased workload. This first step will allow you to gain insights into the kind of training, staffing and emergency funds you may need after implementation.
  • Get in contact with your software vendor, if you have not already, and talk to them about their testing plans. If you make sure now that they are capable of processing claims using the new codes, this will facilitate a seamless transition (or as seamless as possible) and cut your delay times.
  • Tackle those unspecified ICD-9 codes now because after the 1 st , unspecified ICD-10 codes may not cut it and healthcare payers are apt not to fully refund or at all. Physicians need to work with their coders and give necessary information so all codes moving forward are as specific as possible.
  • We were not kidding when we mentioned an emergency fund a little while ago. It's a good idea to start saving now and create a fund that will soften the potential financial blow felt by these pending delays. You may also consider starting another line of credit.

Prepare for More Denials

The Centers for Medicare and Medicaid Services (CMS) has predicted a whopping 100 to 200 percent increase in denial rates. Needless to say, these denials have the potential to lengthen accounts receivable cycles by an extra 30-50%. We'll wait for you to recover and maybe grab a beverage.

Although this news reeks of doom and gloom there is something doctors can do now to combat this problem. By appointing a restricted relation who sole responsibility is to track all denials and communicate with payers, doctors will not have to spend precious time in the future determining why claims were denied.

This point person should have sufficient knowledge of medical concepts and the medical billing process so that they can understand why claims are denied and fix the errors in documentation. It would also be great if this person has the ability to spot trends in denials because this will shorten the learning curve on how to submit claims properly.

Will You Require Extra Staff?

Even if you spend adequate time and budget for training, the theme here is you can still expect some delays as everyone gets up to speed after implementation. As your current staff volunteers more time on coding and tracking claims, they will naturally be able to spend less time on other day-to-day tasks, and you may need to consider hiring new or temporary staff to cover this workload. Sadly, there is not really any way around this potential expense. But good for you for creating that emergency fund.

Updating Software Indefinitely

You can expect yearly updates to your software and the costs associated will depend on whether or not your system is cloud-based or hosted on your own server. Cloud-based vendors are typically less expensive than client-server based vendors who usually require paying IT professionals to not only install but constantly test and maintain systems.

If you have been considering switching your EHR system and are looking for a way to cut operational costs in the future, you may want to consider going with a cloud-based vendor, like, now.

There's no denying that the ICD-10 transition is going to be disruptive, that's just a given. But the more you know about what to expect before, during, and after, the more you can prepare yourself and lessen the blows.

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The Healthcare System in France

The health care program in France is bolstered by an insurance policy established in 1945 and provides cover for 80% of the population. It was originally created to cover those in employment to provide “sécurité sociale” or social security but has since been expanded to cover all citizens under the principle of “couverture maladie universelle” or universal health coverage.

An overview of the healthcare infrastructure in France

The health care system in France is totally subsidized by the government by virtue of a fund and is therefore free. The fund is infected with personal income taxes from income earned by the working population and allows for the lack of income, the effects of wage changes and movements to offer all citizens the opportunity of having access to medical treatment when the need arises.

Role of the State

The state ensures that people have access to the health insurance scheme, the types of health care eligible for financing and exceeds the role of entities involved. Public safety is the state's priority and so is planning for the number of hospitals and sizes as well as the provision of specialized wards.

Hospitals available

There are two types of hospitals – the public sector hospitals and the private hospitals. The first category hospitals provide 65% of available beds. Because they are public, these hospitals are charged with the supply of continuous care for patients as well as being responsible for ongoing training and training of both patients and staff. The second category or private hospitals are motivated by profit and they focus attention mainly on income learning activities such as surgery. They levy a charge for their services in order to obtain and augment their finances.

Health professionals

Doctors and doctors are employed in the public and private sector hospitals and 97% abide by the provisions of the “Tarif de convention” or tariff references which set the amount of costs involved for the kind of medical treatment rendered. Health professionals as well as clinics and hospitals that choose not to conform to the tariffs, are required to display their prices, so people can decide whether or not to avail themselves to treatment.

In France, there are 3.37 doctors per 1,000 people.

Healthcare procedure

Initially, the patient approaches the medicin traitant or general practitioner who has been registered as the physician responsible to coordinate the patient's treatment. Should for any reason, the physician or substitute is another doctor may be consulted by the patient after consulting the cause d'assurance or staff at the register. The patient is at liberty to change his / her physician and in the process, retains the entitlement for reimbursements for the type of treatment given.

Funding the health scheme

Funds for the healthcare system in France is obtained from the income of the working population with the following percentages:

  • An employee's contribution towards his / her healthcare compensation is 21% made up of 12.5% ​​contributed by the employer and 0.75% by the employee. The balance is obtained from a social security tax collected from the employee.
  • The contribution by the employer and employee along with the social security tax make up 60% of the health care fund remitted to government.
  • The balance of the fund is obtained from indirect taxes on alcohol and tobacco.

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Remote Monitoring: A Telemedical Success Story

One of the most powerful forces sculpting the warp and woof of the medical industry is CMS – the Center for Medicare and Medicaid Services. Their policies on who gets reimbursed how much for what have a massive effect on the economic incentives for medical facilities. So when CMS decides that they're going to pay less for services offered to someone who was readmitted after a recent visit for the same problem, suddenly the drive to actually solve a problem becomes much stronger.

Moreover, the drive to monitor each patient and make sure that their post-procedure plans are going smoothly is stronger as well. That's why Vidant Health, one of many telemedicine companies that offer remote monitoring services to hospitals and other facilities in North Carolina, offers wireless routers that come with peripherals that include:

• A scale that automatically reads and reports weight, BMI, body water content, and more,
• A fingertip clasp reads and reports blood oxygen and pulse rate,
• An armband that takes and reports blood pressure,
• And several more.

Their products are not cheap to make, but they allow physicians to perform 'maintenance' like adjusting medication dosages and timing or offering counseling for stress, sleep loss, or other common post-procedure problems – all without leaving their office.

What's the upshot? How about a 74% reduction in readmissions for patients with diabetes, congestive heart failure, high blood pressure, and other serious chronic conditions?

Taking Insult from Injury

In another telemedical success story, the University of Pittsburgh Medical Center has, for the past few years, been giving patients who were grievously wounded a cheap digital camera. Each day at first, and every few days as time passes, they take a picture of their wound. That picture is then examined asynchronously by doctors who examine it for signs of infection, misalignment, or other potential problem. If anything seems wrong, they call the patient to talk about what can be done to keep things from getting worse.

Education In Real-Time

Perhaps one of the most unexpected effects of telemedical devices in the home is the opportunity it affords nurses and doctors to educate their patients on the proper use of their health care equipment. For example, Sharp Rees-Stealy Medical Group in San Francisco puts sensors in all of the inhalers they pass out. Each time an inhaler is used, it reports back to the doctor the time used and the duration of the activation.

The result? Patients who forget their primary inhaler and are forced to drop back on their emergency inhaler receive a friendly email from their nurse reminding them that they need to be more conscientious about their primary. More aggressively, patients with a history of missing their primary will start to receive text messages informing them that it's time to put them to use. They report that breathing struggles are greatly reduced with the system in place.

Improvements Can Be Made

Of course, as with any complex system, room for improvements exists. Many medical facilities report that, when first installed, the sheer amount of data the remote monitoring equipment produces is overwhelming. It can take weeks or months to fine-tune the algorithms so that only genuine 'red flag' signals appear on the screens of nurses and practitioners. But even with these minor hiccups, remote monitoring remains one of telemedicine's most unequival success stories.

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