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Health Reform

Bundled Payments: Rewarding Quality and Value

April 16, 2014 by Linda Ringquist

Transformation to bundled payments

The Medicare reimbursement system is in the process of transforming healthcare as we know it from a traditional fee-for-service model to a system that rewards based on quality, care coordination, accountability, and healthcare cost savings. Here's an outline of benefits and risks.[read more]

Time Thieves

April 15, 2014 by Kathy Nieder

Currency of time

Age forces the recognition that time is the true currency of our lives. When people waste it for you, it is frustrating and angst producing. One of the underlying tragedies of physicians’ daily lives, especially in primary care, is the theft of our time, stolen away by the health care system.[read more]

ICD-10 Delay: Does ICD-10 Lack Clinical Value?

April 13, 2014 by Abby Norman

ICD-10 delay

ICD-10 was delayed once again as part of a bill that was meant to fix the physician reimbursement issues with Medicare. Incidentally, pushing out the date for ICD-10 implementation pleases many physicians. Some have gone so far as to say, on record, that ICD-10 lacks clinical value.[read more]

Should Step Therapy and Prior Authorization Be Outlawed?

April 9, 2014 by David E Williams

photo: torbakhopper / photopin cc

Step therapy and prior authorization are legitimate and even necessary tools. This doesn’t mean that these approaches shouldn’t be scrutinized. Balancing cost, quality, access and convenience in today’s healthcare system is not easy. Making things better requires something more than legislating further restrictions on health insurers.[read more]

Dual-Eligibility: An Overworked and Overlooked Population?

April 9, 2014 by Abby Norman

dual eligibility

9 million Americans are covered by both Medicare and Medicaid and are part of a unique community of healthcare consumers known as the dual eligible. Dual-eligible beneficiaries often have complex health conditions and may be low income, meaning that their access to healthcare would be greatly limited if not for their dual-eligibility for coverage.[read more]

Providers: Shifting Landscape and Mindset

April 8, 2014 by Linda Ringquist

shifting landscape for healthcare providers

As a result of the Affordable Care Act as well as other healthcare legislation, a shift is occurring in healthcare from the provider’s perspective. In order just to survive (not even prosper), physicians are changing the way they conduct business and choosing which patients will be seen.[read more]

Reducing Documentation Costs for Physician Practices

April 7, 2014 by Andy Salmen

reducing documentation costs

Documentation costs for physician services can represent a very significant expense. Upcoming changes to billing and coding, along with the implementation of the Affordable Care Act, will make hospitals and physician practices turn to efficiency improvements as a way to cut costs, without cutting the quality of services.[read more]

Treating Patients Rather Than Primary Diagnosis

April 7, 2014 by Tim Kilpatrick

treating patients over diagnoses

It will be a significant transformation for hospitals to treat the entire patient. But the most significant impact on healthcare costs, health and quality may come from treating the entire patient and realigning the healthcare system to support this. We may soon find out how much improvement is possible.[read more]

Causes of the Crisis in Primary Care

April 2, 2014 by Stephen Schimpff

What's causing the crisis in primary care?

Primary care physicians (PCPs) have too little time per patient which means too many referrals to specialists, too little time listening and thinking, no time to delve into the stress or emotional causes of many symptoms and substantial frustration by PCP and patient alike.[read more]

Obama Announces Consumers Can Keep Health Insurance Plans 2 More Years

April 2, 2014 by Linda Ringquist

President Obama announced earlier this week that consumers with healthcare plans that do not comply with the new law will be able to renew their plans for another two years. Previously, the extension was believed to be one year at best, so this announcement came as quite a relief for many with transitional coverage.[read more]

GAO Report on Health Information Exchange Focuses on Standards

April 1, 2014 by Chad Johnson

GAO report / shutterstock

Last week the Government Accountability Office (GAO) released a report for Congressional Committees. The 44-page report highlights for Congress some of the known problems that exist for many HIE organizations: standards, privacy, patient matching, and costs.[read more]

A New Form of Insurance Denial of Coverage

March 29, 2014 by Kathy Nieder

Meds not covered by insurance / shutterstock

This week a new level of insurance denial has been breached. Now medications are deemed “experimental”. Somehow pharmacy benefit managers have confused off-label with experimental. Why would they do that? Simple: off-label use isn’t excluded on a patient’s insurance but experimental is.[read more]