reinventing health insurance brings challenges for hospitals
|
|
- Millicent Ford
- 8 years ago
- Views:
Transcription
1 reinventing health insurance brings challenges for hospitals 1
2 3 Introduction 4 01 / Containing costs while increasing access and quality 5 02 / Coordinating patient care 6 03 / Boosting training and development 8 04 / Planning for ICD Conclusion
3 introduction Insurance companies today are facing numerous challenges due to demographic shifts in the ages of populations, trends in transitioning toward virtual healthcare, and the effects that will be felt when the Affordable Care Act (ACA) sends an influx of newly insured Americans to healthcare providers beginning in In addition to providing coverage for millions of low-income Americans, insurers can no longer deny coverage for people with pre-existing conditions so the surge in new patient claims may be challenging. Significant changes are on the horizon for hospitals and healthcare providers in partnering with insurance companies to adapt to this new legislation. Hospitals have been major hubs of healthcare in America for many years. Part of the driving force behind the sweeping healthcare reform law was to unburden hospitals from providing patient care for free by requiring universal coverage and expanding Medicaid eligibility. But if lowincome Americans opt for high-deductible plans that have the most affordable premiums and they cannot pay their medical bills, then hospitals will still not be paid by those patients and may also struggle to make up for billions of dollars in ACA-mandated cuts to federal reimbursements. It remains to be seen how dramatically the ACA will affect hospitals, but there is no question that they will have to transform their operations to meet new challenges. On the positive side, hospitals could find themselves being paid by insurance companies for services they now provide free to uninsured patients. However, many newly insured patients may be people who have been putting off tests or treatments, and these new demands could put heavy burdens on hospital staff, physicians, and other healthcare providers who are already overworked. 3 3
4 01 increasing Containing costs while access and quality For insurance companies, the primary business shift resulting from healthcare reform legislation will be in focusing on patients rather than on sales. Some insurance companies are combining efforts to be more efficient by creating a private exchange network with a defined contribution approach. For example, Blue Cross and Blue Shield has begun creating retail centers throughout Florida that will not only sell health insurance, but also offer free screening and wellness facilities and health coaching. BCBS is also expanding their online presence to offer more health information on their websites, and they have established bilingual call centers to meet a new federal mandate requiring insurers to communicate with consumers in a linguistically and culturally appropriate manner. Making the process of serving patients more efficient enables insurance companies to focus more on disparities in healthcare and reach a broader audience. For hospitals, the dilemma is how to lower costs and boost efficiency while simultaneously increasing access to services. Hospitals will need to develop innovative strategies to adjust to getting paid less, but doing more for patients, says Pam Burnette, MBA, BSN, RN, director of healthcare product, Kelly. As a result of new healthcare legislation, hospitals will be transitioning from a model where earnings are based on volume to a model where they are rewarded more for the quality of care. Successful outcomes are going to be the most important measure of a hospital s performance. But because of funding cuts, government and private insurers will be paying hospitals less so providers need to find ways to drive efficiencies and contain costs while providing quality care to patients. The ACA doesn t spell out a definition of quality care, but the government will evaluate performance using patient satisfaction surveys and clinical outcomes, and offer financial incentives to hospitals that perform well. On the other hand, poor performance will result in penalties. Hospitals with excessive readmission rates and high rates of hospital-acquired infections have already had their Medicare reimbursements decreased. If their performance has not improved by 2015, they will see another reimbursement rate cut. 4
5 02 patient Coordinating care One way hospitals can focus on increasing efficiency and cutting costs is by establishing an accountable care organization (ACO) to accommodate the changing healthcare marketplace. An ACO is a group of physicians and other healthcare providers who come together to deliver services more efficiently and provide high-quality care to patients. The partners in an ACO must exchange health information across diverse systems in order to manage care, track patient histories, and analyze results. The technology required for a successful ACO may include a Health Information Exchange (HIE), business intelligence programs to analyze data in order to calculate reimbursements or make necessary upgrades, and healthcare portals that provide access to patient information. A properly designed and managed ACO gives healthcare providers the tools they need to share patient care data successfully and efficiently. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services, says Burnette. ACOs encourage collaboration by making hospitals and providers directly accountable to both patients and insurance companies. Some hospitals have followed an accountable care model for years, but the difference now will be volume. It s hard to predict the impact of having many people entering the market at the same time. Some hospitals are preparing to meet the demand by streamlining communications systems, hiring more bilingual workers, and implementing integrated delivery systems to treat more patients with primary care physicians instead of in emergency rooms. But this solution brings its own challenges because there is a shortage of physicians. According to the Association of American Medical Colleges, the nation could face a shortage of as many as 150,000 doctors in the next 15 years. The ACA may actually address the shortage of physicians, at least in the short term, because it requires the healthcare industry to move toward delivery systems that depend more on nurse practitioners and physician assistants for many tasks, says Burnette. Nurse-managed health centers (NMHCs) are a critical component of the ACA, and they use a mix of providers. The new systems that will become more common due to the ACA could soften the strain of a shortage of physicians. Putting all medical providers under the same umbrella, with the doctor as sort of a team leader and other caregivers reaching out to patients to manage their medical care, will hopefully improve the quality of patient care. 5
6 03 and Boosting training development Because the ACA will likely result in an explosion of demand for healthcare providers and services, and there is already a shortage of doctors and nurses, hospitals will need to anticipate shortages and design strategies for training and developing existing healthcare workers. One way hospitals can address these demands is by creating physician-led teams of licensed and unlicensed health professionals to provide an expanded scope of patient care, and also educating patients in ways to provide more of their own care. + Nurses, physical therapists, respiratory technicians, and other licensed healthcare personnel can be trained to provide care for uncomplicated medical issues, such as back pain, high blood pressure, respiratory and urinary tract infections, diabetes, and high blood pressure. + Unlicensed medical assistants can be trained to assume responsibility for coaching patients about managing chronic conditions, such as high cholesterol, diabetes, and high blood pressure. + Patients can be trained in the use of new diagnostic technologies to self-diagnose and administer their own medications for conditions, such as diabetes and cardiovascular diseases. The ACA requires hospitals to increase the ethnic and racial diversity of physicians, nurses, and other healthcare professionals to represent the new marketplace. To help meet this mandate, some hospitals have created resource groups to connect with an increasingly multicultural patient base by conducting health education and prevention screenings. Resource group staff often live in the communities they serve, so patients are more likely to trust them and follow their recommendations, says Burnette. For hospitals without resource groups, it will be important to increase the level of cultural competence training for their workers. The understanding of health varies by culture, and because hospitals will be treating increasingly diverse populations, they need to customize patient care to serve diverse cultures in addition to individuals. 6
7 + The ACA requires hospitals to increase the ethnic and racial diversity of physicians, nurses, and other healthcare professionals to represent the new marketplace. 7
8 04 Planning for ICD-10 One challenge the healthcare industry is facing has been on the horizon since before the ACA was even written. The International Statistical Classification of Diseases and Related Health Problems (ICD) is a medical classification list created by the World Health Organization (WHO). The ICD code set specifies different codes and sub-classifications that enable the tracking of diagnoses. The 17,000 codes in ICD-9 code sets have been in use for 30 years without being updated, so they use outdated terminology and are not specific enough to cover the hundreds of new diagnosis codes submitted each year. The current ICD-9 code sets will be replaced by 141,000 codes in ICD-10, and there are significant differences between the two sets. The deadline for implementing the new codes has been delayed twice already, and the new deadline is now October 1, There is no grace period, and opting out is not an option. If providers are not ready to use ICD-10 codes when the deadline arrives, insurance claims will be rejected and transactions will need to be resubmitted with the correct codes, thereby delaying reimbursements and affecting cash flow. Obviously this is a critical and necessary update, says Burnette. The switch to ICD-10 will help the U.S. healthcare system more accurately compare healthcare data with other countries and track data better to measure quality of care and improve clinical, administrative, and financial performance. But the transition from ICD-9 to ICD-10 is going to be a complex and costly process that will impact all providers. It will result in changes throughout the healthcare industry, from small clinics and laboratories to national health organizations. It will require significant planning, training, and upgrades to software and systems. This transition is a tremendous undertaking for the healthcare industry, and the challenge is compounded by adjusting to new ACA mandates. 8
9 + The transition from ICD-9 to ICD-10 is going to be a complex and costly process that will impact all providers. It will result in changes throughout the healthcare industry, from small clinics and laboratories to national health organizations. Pam Burnette, MBA, BSN, RN, director of healthcare product, Kelly Many healthcare providers have already begun planning for the shift to ICD-10, but there are several key considerations that can make the transition to ICD-10 more successful: + Develop a transition plan that involves both IT and business leadership. + Prepare a budget and secure a line of credit in case the transition significantly impacts cash flow. + Track current coding productivity, backlog, and accuracy for benchmarking. + Begin planning and budgeting for customer education and in-depth staff training. + Update or upgrade IT systems to handle the expanded character sets required for ICD-10. Providers should take full advantage of the delayed deadline to analyze the areas within the organization that will be impacted the most, and adjust plans accordingly, says Burnette. Waiting until the last minute to prepare for the transition to ICD-10 can put an organization in financial jeopardy and waste valuable preparation time. This overhaul involves so much more than just changing technology; this is an organization-wide business process transformation. Doing as much as possible now to get ready will ensure that operations continue efficiently throughout the transition. + Educate physicians and other providers about the increased demand for thorough and detailed documentation. 9
10 Conclusion As the U.S. works to overcome the challenges of healthcare reform, the primary goals of hospitals, providers, and insurance companies are essentially the same to improve the availability and quality of healthcare and cut overall costs in the long term. But expanding insurance coverage to all Americans will increase demand for healthcare services in a marketplace where there is already a shortage of nurses and physicians. Workforce planning will be difficult until the healthcare industry has a better grasp of how new mandates will affect providers and patients. Despite the uncertainties, significant changes are on the way for the healthcare industry. To make these changes as seamless and efficient as possible, hospitals and providers need to assess their current business models, design and implement strategies to address policy reforms, and train and develop a high-performing health workforce that can meet marketplace demands. Rational reform of the healthcare industry will result in a more efficient healthcare delivery system and better outcomes for patients, even if the road to those results is a challenging one. Having a well-developed transition plan in place will help hospitals and providers overcome those challenges successfully. + Rational reform of the healthcare industry will result in a more efficient healthcare delivery system and better outcomes for patients, even if the road to those results is a challenging one
11 References DuBois, Shelley. Hospitals face whole new world under health law. USA Today, October 20, Frankel, Barbara, with Robyn Heller Gerbush and Stacy Straczynski. Hospitals, insurance companies, pharmas: Who benefits from the Affordable Care Act? DiversityInc, September Natale, Carl. Top 3 stories that shaped ICD-10 implementation in Healthcare IT News, ICD10Watch, December 26, Awarded the Gold Seal of Approval TM The Kelly healthcare specialty service was awarded the Gold Seal of Approval from The Joint Commission by achieving certification for Health Care Staffing Services (HCSS). This highly credible and reputable designation demonstrates our compliance with the highest quality and safety standards in the healthcare staffing industry. About Kelly Services Kelly Services, Inc. (NASDAQ: KELYA, KELYB) is a leader in providing workforce solutions. Kelly offers a comprehensive array of outsourcing and consulting services as well as world-class staffing on a temporary, temporary-to-hire, and direct-hire basis. Serving clients around the globe, Kelly provides employment to more than 560,000 employees annually. Revenue in 2012 was $5.5 billion. Visit kellyservices.com and download The Talent Project, a free ipad app by Kelly Services. Our healthcare specialty places professionals across all levels of healthcare in multiple disciplines, including medical laboratory, medical device, pharmacy and pharmacology, nursing, allied health, behavioral health, healthcare billing/coding, utilization, case management, occupational health, special education, and physical therapy. Want more information? Visit kellyservices.us/healthcare today. This information may not be published, broadcast, sold, or otherwise distributed without prior written permission from the authorized party. Kelly Healthcare Resources is a registered trademark of Kelly Services All other trademarks are property of their respective owners An Equal Opportunity Employer 2013 Kelly Services, Inc. Y1492A kellyservices.us/healthcare exit
the healthcare industry through mobility
reinventing the healthcare industry through mobility 1 3 Introduction 4 01 / Taking healthcare on the road 5 02 / Mobile healthcare keeps patients healthier 6 03 / Mobile healthcare streamlines and improves
More informationthe technology of healthcare
reinventing the technology of healthcare 1 3 Introduction 4 01 / Implementing electronic health record (EHR) systems 6 02 / Treating patients remotely via virtual healthcare 8 03 / Using mobile healthcare
More informationHospitals and the Affordable Care Act (ACA)
Hospitals and the Affordable Care Act (ACA) General Housekeeping If you experience any technical difficulties during the webinar, please contact GoToMeeting.com Corporate Account Customer Support at: 1-888-259-8414
More informationA NEW ERA FOR NURSING:
A NEW ERA FOR NURSING: How nontraditional roles are reshaping nursing careers PAM BURNETTE & GRACE PARANZINO INTRODUCTION /02 Today, nursing is no longer solely about caring for patients. It s about technology,
More information6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series
6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the
More informationTimeline: Key Feature Implementations of the Affordable Care Act
Timeline: Key Feature Implementations of the Affordable Care Act The Affordable Care Act, signed on March 23, 2010, puts in place health insurance reforms that will roll out incrementally over the next
More informationKey Features of the Affordable Care Act, By Year
Page 1 of 10 Key Features of the Affordable Care Act, By Year On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll
More information6 Critical Impact Factors of Health Reform on Revenue Cycle Management
6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the
More information6 Critical Impact Factors of Health Reform on Revenue Cycle Management
6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the
More informationHealth Care Reform and Its Impact on Nursing Practice
Health Care Reform and Its Impact on Nursing Practice UNAC-UHCP Convention Las Vegas, NV November 9, 2010 Katherine Cox AFSCME International What Have Your Heard? What Do You Think? How do you think the
More informationThe Impact of Healthcare Reform on Pharmacy Practice. Disclosure
The Impact of Healthcare Reform on Pharmacy Practice Thomas Buckley, MPH, RPh Assistant Clinical Professor University of Connecticut School of Pharmacy Disclosure Thomas Buckley has nothing to disclose
More informationWalden University Q & A continued from Webinar Todd Linden
Walden University Q & A continued from Webinar Todd Linden General Note: The answers to these questions are my opinion. The mountain of rules and regulations that will be produced from this legislation
More informationWhat is Healthcare Reform? Get a view of the future health care system in the US; learn. success factors for healthcare administrators?
What is Healthcare Reform? Get a view of the future health care system in the US; learn about primary resources and tools for the healthcare administrator, and what are the success factors for healthcare
More informationMeaningful Use, ICD-10 and HIPAA 5010 Overview, talking points and FAQs
Meaningful Use, ICD-10 and HIPAA 5010 Overview, talking points and FAQs Providence Health & Services is committed to using technology and evidence-based practices to deliver the highest quality care in
More informationNational Healthcare Reform: Implications for Nursing Education and Practice
National Healthcare Reform: Implications for Nursing Education and Practice UMass Graduate School of Nursing Alumni Association Program June 4, 2010 Katharine London 2 Goals for Today s Presentation Explain
More informationmedical devices begin to drift into cloud melisa bockrath
medical devices begin to drift into cloud melisa bockrath Medical Devices Begin to Drift into the Cloud Since the invention of the first medical device more than a century ago, the design, complexity,
More informationHow Health Reform Will Help Children with Mental Health Needs
How Health Reform Will Help Children with Mental Health Needs The new health care reform law, called the Affordable Care Act (or ACA), will give children who have mental health needs better access to the
More informationHealthcare Reform: Impact on Care for Low-Income and Uninsured Patients
Competency 4 Healthcare Reform: Impact on Care for Low-Income and Uninsured Patients Updated June 2014. Presented by: Lewis Foxhall, MD VP for Health Policy Professor, Clinical Cancer Prevention UT MD
More informationHCR 101: Your Guide to Understanding Healthcare Reform
HCR 101: Your Guide to Understanding Healthcare Reform Are You Ready for Healthcare Reform? By now, you ve probably been hearing a lot about the Affordable Care Act (also known as healthcare reform or
More informationHow To Improve Health Care For All
TIMELINE FOR IMPLEMENTATION OF THE AFFORDABLE CARE ACT 2010: NEW CONSUMER PROTECTIONS Eliminated pre-existing coverage exclusions for children: under age 19. Prohibited insurers from dropping coverage:
More informationComputer-assisted coding and documentation for a changing healthcare landscape
Computer-assisted coding and documentation for a changing healthcare landscape Reality is, in this new ICD-10 environment, providers will have two options: a) work harder; or b) find a new way to do things.
More informationStable and Secure Health Care for America: The Benefits of Health Insurance Reform: Table of Contents
Stable and Secure Health Care for America: The Benefits of Health Insurance Reform: Table of Contents HEALTH INSURANCE CONSUMER PROTECTIONS... 1 STABLE AND SECURE HEALTH CARE FOR AMERICA... 2 HEALTH INSURANCE
More information3/28/2014. Spencer Berthelsen, M.D. Texas Club of Internists
Spencer Berthelsen, M.D. Texas Club of Internists April 4, 2014 Cost The US spends twice as much per capita as the average of other industrialized nations Institute of Medicine 30% of healthcare dollars
More informationOctober 15, 2010. Re: National Health Care Quality Strategy and Plan. Dear Dr. Wilson,
October 15, 2010 Dr. Nancy Wilson, R.N., M.D., M.P.H. Senior Advisor to the Director Agency for Healthcare Research and Quality (AHRQ) 540 Gaither Road Room 3216 Rockville, MD 20850 Re: National Health
More informationWhile health care reform has its foundation and framework at
CENTER FOR HEALTHCARE RESEARCH & TRANSFORMATION Policy Brief June 2010 The Patient Protection and Affordable Care Act at the State and Local Level While health care reform has its foundation and framework
More informationHEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS. April 10, 2014
HEALTHCARE REFORM CARE DELIVERY AND REIMBURSEMENT MODELS April 10, 2014 1 MARKETPLACE UPDATE 2 MARKETPLACE - ESSENTIAL HEALTH BENEFITS 3 MARKETPLACE - METAL LEVELS 4 WHAT IS THE HEALTH INSURANCE MARKETPLACE
More informationOHIO CONSUMERS FOR HEALTH COVERAGE POLICY PRIORITIES FY 2012-13. Medicaid Make Improvements to Improve Care and Lower Costs
OHIO CONSUMERS FOR HEALTH COVERAGE POLICY PRIORITIES FY 2012-13 Ohio Consumers for Health Coverage supports robust implementation of the Patient Protection and Affordable Care Act (ACA) in Ohio, making
More informationPractice Coding: Market Drivers and Demand Forecast
: Market Drivers and Demand Forecast Synopsis A long-standing shortage of qualified medical coders continues to persist nationwide. The greatest impact to date appears to be in larger organizations or
More informationWhat is an Accountable Care Organization. Amit Rastogi, MD President/CEO PriMed
What is an Accountable Care Organization Amit Rastogi, MD President/CEO PriMed Goals Why is U.S. healthcare undergoing dramatic change How reimbursement structures are likely to change What is the timeline
More informationBARACK OBAMA S PLAN FOR A HEALTHY AMERICA:
BARACK OBAMA S PLAN FOR A HEALTHY AMERICA: Lowering health care costs and ensuring affordable, high-quality health care for all The U.S. spends $2 trillion on health care every year, and offers the best
More informationStrengthening Community Health Centers. Provides funds to build new and expand existing community health centers. Effective Fiscal Year 2011.
Implementation Timeline Reflecting the Affordable Care Act 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access
More informationOHIC Approves Commercial Health Insurance Contracts, Rates and Rate Factors Next Step in Implementation of Affordable Care Act in Rhode Island
PRESS RELEASE FOR IMMEDIATE RELEASE Contact: Nicole Renzulli, Administrative Officer (401) 462-9639 nicole.renzulli@ohic.ri.gov OHIC Approves Commercial Health Insurance Contracts, Rates and Rate Factors
More informationProgram Objectives 9/2/2014. Affordable Care Act: Smooth or White Waters Ahead? History of Healthcare Reform
Affordable Care Act: Smooth or White Waters Ahead? Kathleen Bradbury-Golas, DNP, RN, NP-C, ACNS-BC Assistant Professor, Felician College Family Nurse Practitioner, Virtua Atlantic Shore Family Practice
More informationFederal Health Reform FAQs
Federal Health Reform FAQs Individuals 1. What is an exchange? An exchange, as created under the Affordable Care Act (ACA), is a place where consumers can purchase subsidized health insurance coverage.
More informationEnhancing patient care in rural communities
Enhancing patient care in rural communities Improving care, managing costs Affordable information technology Rural hospitals fill a tremendous need in communities across the country but face unenviable
More informationThe Patient Protection and Affordable Care Act. Implementation Timeline
The Patient Protection and Affordable Care Act Implementation Timeline 2009 Credit to Encourage Investment in New Therapies: A two year temporary credit subject to an overall cap of $1 billion to encourage
More informationA CONSUMER'S GUIDE TO CANCER INSURANCE. from YOUR North Carolina Department of Insurance CONSUMER'SGUIDE
A CONSUMER'S GUIDE TO from YOUR North Carolina Department of Insurance CONSUMER'SGUIDE IMPORTANT INFORMATION WHAT IS? Cancer insurance provides benefits only if you are diagnosed with cancer, as defined
More informationHow Outsourcing Significantly Reduces Accounts Receivables, Improves Collections and Decreases Denied Claims...All Within 30 Days
How Outsourcing Significantly Reduces Accounts Receivables, Improves Collections and Decreases Denied Claims...All Within 30 Days Page 1 The fast-paced healthcare industry is becoming competitive and organizations
More informationHealthcare Reform Opens Up Middle-Market Opportunities
WWW.IBISWORLD.COM April 2013 1 April 2013 By IBISWorld Analysts Douglas Kelly & Anna Son A changing healthcare landscape and increasing demand are spurring potential deal opportunities in related industries.
More informationRunning Head: COST-CONTROLLING MEASURES OF THE A.C.A. 1. Lesser Politicized Cost-Controlling Measures of the Affordable Care Act: Literature Review
Running Head: COST-CONTROLLING MEASURES OF THE A.C.A. 1 Lesser Politicized Cost-Controlling Measures of the Affordable Care Act: Literature Review Robin Persun Excelsior College COST-CONTROLLING MEASURES
More informationState and Federal Health Care Reform Update. Universal Health Care Foundation of Connecticut
State and Federal Health Care Reform Update Universal Health Care Foundation of Connecticut Linda Dahlmeyer, CPA Vice President for Finance and Administration ldahlmeyer@universalhealthct.org Jill Zorn,
More informationMarch 2014. 110 Stockton Street Charleston, WV 25387 (304) 558-0416 www.ddc.wv.gov
March 2014 110 Stockton Street Charleston, WV 25387 (304) 558-0416 www.ddc.wv.gov The Affordable Care Act and People with Developmental Disabilities The Patient Protection and Affordable Care Act (ACA)
More informationStrengthening Medicare: Better Health, Better Care, Lower Costs Efforts Will Save Nearly $120 Billion for Medicare Over Five Years.
Strengthening Medicare: Better Health, Better Care, Lower Costs Efforts Will Save Nearly $120 Billion for Medicare Over Five Years Introduction The Centers for Medicare and Medicaid Services (CMS) and
More informationWest Virginians for Affordable Health Care. The Affordable Care Act: What It Means for Nurses and Future Nurses
West Virginians for Affordable Health Care The Affordable Care Act: What It Means for Nurses and Future Nurses The Affordable Care Act: What It Means for Nurses and Future Nurses Prepared by Renate Pore
More informationReview of the Affordable Health Choices Act (Kennedy Bill)
Review of the Affordable Health Choices Act (Kennedy Bill) Below is a review of those measures contained in the Affordable Health Choices Act introduced by Senator Edward Kennedy (D-MA) via the Senate
More informationHealthcare Billing Guide:
Healthcare Guide Healthcare Billing Guide: Strategies to Master Insurance and Billing Published by www.dorlandhealth.com Tips on Understanding Your Medical Bill 1 Healthcare Billing Guide: Strategies to
More informationBRAVE NEW WORLD: OVERCOMING NEW HEALTHCARE CHALLENGES WITH TOP IT TALENT
HEALTHCARE CHALLENGES WITH TOP IT TALENT Massive change is on the horizon for your healthcare organization in fact, it has probably already started. For years, industry organizations have departmentalized
More informationUnified Patient Information Management Improving the Way Patient Data is Accessed, Exchanged and Managed
Unified Patient Information Management Improving the Way Patient Data is Accessed, Exchanged and Managed CONTENTS Introduction... 1 The Impact of Poor Patient Information Management... 2 The Solution:
More informationClinically Integrated Networks and Accountable Care Organizations
Clinically Integrated Networks and Accountable Care Organizations 1 Do Nothing 2 Become Someone s Employee 3 Join a Network Provider The wake up call is for POPULATION health management managing clinical
More informationTop 10 Issues for Health Plans - Strategic & Operational Priorities
Top 10 Issues for Health Plans - Strategic & Operational Priorities Thomas Carleton, Sr. Director, Health IT & Analytics Mosaic Health Solutions (BCBS NC) Nancy Wise, SVP, Strategic & Regulatory Consulting
More informationTHE KANSAS AFFORDABLE CARE ACT IMPLEMENTATION. Linda J. Sheppard November 6, 2014
THE KANSAS AFFORDABLE CARE ACT IMPLEMENTATION Linda J. Sheppard November 6, 2014 The Kansas Market Approximately 348,000 Kansans are uninsured - 12.3% of the state s population 44,130 are children, but
More informationTracking the Operational and Financial Health of US Physician Practices
THE SECOND ANNUAL Tracking the Operational and Financial Health of US Physician Practices -2014 EDITION- sponsored by in partnership with www.carecloud.com/ppi 1 THE PRACTICE PROFITABILITY INDEX 2013 Edition
More informationTopic: Nursing Workforce Snapshot A Regional & Statewide Look
Topic: Nursing Workforce Snapshot A Regional & Statewide Look Nursing Workforce in Texas 184,467 registered nurses (2011) Median age of RN is 47 (2011) Gender 89% Female and 11% Male (2011) Race/Ethnicity
More informationReconciling the Great Healthcare Consumer Paradox: Are consumers willing to change to get what they want?
Reconciling the Great Healthcare Consumer Paradox: Are consumers willing to change to get what they want? 2 The Affordable Care Act (ACA) will introduce approximately 51 million people to the individual
More informationHow To Get A Blue Cross Code Change
OVERVIEW 1. What is an ICD Code? The International Classification of Diseases (ICD) code set is used primarily to report medical diagnosis and inpatient procedures. ICD codes are mandated by the Centers
More informationPresented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION
Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION At the end of this session, you will be able to: Identify ways RT skills can be utilized for
More informationGetting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM. David Johnson jdjohnson@rcmd.com November 15, 2012
Getting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM David Johnson jdjohnson@rcmd.com November 15, 2012 0 Topics for Discussion 1. Recap of Supreme Court Decision on Affordable
More informationOhio Health Plans. Maximizing best practices & leading reform efforts. Search. Ohio Association of Health Plans
Ohio Association of Health Plans File Edit View History Bookmarks Tools Window Help http://www.oahp.com Ohio Health Plans Search Maximizing best practices & leading reform efforts HELPING OHIOANS GET NEEDED
More informationFinding Value and Cost-Savings through the Outsourcing of Medical Billing Services
Finding Value and Cost-Savings through the Outsourcing of Medical Billing Services Introduction Medical practices everywhere have had to adapt to many changes over the last few years. From HIPAA compliance
More informationPreliminary Health Insurance Landscape Analysis
Preliminary Health Insurance Landscape Analysis Prior to addressing some of the issues listed under Section 3.1 3.5 of the HRSA State Planning Grant report template, here is some of the information available
More informationSOMETHING OLD, SOMETHING NEW: TEXAS TWO HIGH-RISK POOLS
July 19, 2010 Contact: Stacey Pogue, pogue@cppp.org SOMETHING OLD, SOMETHING NEW: TEXAS TWO HIGH-RISK POOLS Thanks to national health reform, Texas now has two separate high-risk pools that offer health
More informationWHITE PAPER. 9 Steps to Better Patient Flow and Decreased Readmissions in Your Emergency Department
Communication Solutions WHITE PAPER 9 Steps to Better Patient Flow and Decreased Readmissions in Your Emergency Department Increase patient satisfaction and reduce readmissions all while building loyalty,
More informationANA ISSUE BRIEF Information and analysis on topics affecting nurses, the profession and health care.
ANA ISSUE BRIEF Information and analysis on topics affecting nurses, the profession and health care. Health System Reform: Nursing s Goal of High Quality, Affordable Care for All Key Points Nursing has
More informationProvider Revenue Cycle Management (RCM) and Proposed Solutions
Provider Revenue Cycle Management (RCM) and Proposed Solutions By: Ranjana Maitra General Manager, Manufacturing & Healthcare Vertical Executive Summary It takes more than world-class service to be competitive
More informationA Guide to Employer-Managed Care: On-Site Clinics and Wellness Centers
A National Insurance Services White Paper A Guide to Employer-Managed Care: On-Site Clinics and Wellness Centers 2013 National Insurance Services of WI, Inc. Health cost increases prove unsustainable The
More informationDisclaimer HEALTHCARE REFORM 8/18/2015. CS EYE - Compliance Specialists, Inc. Compliance, Medicare Advantage and Accountable Care Organizations
HEALTHCARE REFORM Compliance, Medicare Advantage and Accountable Care Organizations Jon Weeding President CS EYE CS EYE - Compliance Specialists, Inc. Outsource compliance and medical billing Assisted
More informationIowa Health and Wellness Plan Outreach Toolkit for IowaCare Providers. November 2013
Iowa Health and Wellness Plan Outreach Toolkit for IowaCare Providers November 2013 Dear IowaCare providers, The Iowa Department of Human Services is eager to support outreach efforts to publicize the
More informationICD-10-CM TRANSITION PREPARE FOR CASH-FLOW IMPACT WHITE PAPER
ICD-10-CM TRANSITION PREPARE FOR CASH-FLOW IMPACT AN WHITE PAPER Executive Summary Effective October 1, 2015, home health agencies must begin using ICD-10-CM medical codes instead of the current outdated
More informationAvoiding Rehospitalizations in LTC Chris Osterberg, RN BSN Pathway Health Services
Avoiding Rehospitalizations in LTC Chris Osterberg, RN BSN Pathway Health Services Objectives Understand the new consequences to hospitals for discharged clients being re-admitted within selected time
More informationHow To Transition From Icd 9 To Icd 10
ICD-10 FAQs for Doctors What is ICD-10? ICD-10 is the 10 th revision of the International Classification of Diseases (ICD), used by health care systems to report diagnoses and procedures for purposes of
More informationSimple answers to health reform s complex issues facing every employer, and what you can do now to protect your business and your future.
Simple answers to health reform s complex issues facing every employer, and what you can do now to protect your business and your future. If you have any questions, please contact: Health Reform: A Guide
More informationNurse Practitioners as Leaders in Primary Care: Current Challenges and Future Opportunities
Nurse Practitioners as Leaders in Primary Care: Current Challenges and Future Opportunities National Conference of State Legislatures Louisville, KY July 27, 2010 Tine Hansen-Turton, MGA, JD CEO, National
More informationSession 4: Understanding Data Behind the Complex New World of Health Care Involving IDNs and ACOs. Laura Jenkins Jirele
Session 4: Understanding Data Behind the Complex New World of Health Care Involving IDNs and ACOs Laura Jenkins Jirele PMSA Virtual University PMSA Virtual University is conducting this four part webinar
More informationExpert Support Navigating Health Exchanges
Expert Support Navigating Health Exchanges 2 HealthAdvocate Health Insurance Exchanges: Health Advocate Can Help Support You Introduction Health Advocate has received many questions regarding the impact
More informationYOURCHOICE ONSITE HEALTH AND WELLNESS CENTER
YOURCHOICE ONSITE HEALTH AND WELLNESS CENTER Proposal Highlights The focus of this proposal is to establish a Public/Private partnership to create an onsite health and wellness clinic for the employees
More informationPreparing for the ICD-10 Transition By Melody W. Mulaik President: Coding Strategies, Inc.
Preparing for the ICD-10 Transition By Melody W. Mulaik President: Coding Strategies, Inc. On October 1, 2014, after more than 30 years with the ICD-9-CM coding system, the U.S. healthcare industry will
More informationRoss D. Seymour, MTPM
Health Care Reform and Funding Incentives Ross D. Seymour, MTPM HIPAA Certified Project Manager Orange, California Disclosure This presentation was current at the time it was published. Medicare policy
More informationFrequently Asked Questions about ICD-10-CM/PCS
Frequently Asked Questions about ICD-10-CM/PCS Q: What is ICD-10-CM/PCS? A: ICD-10-CM (International Classification of Diseases -10 th Version-Clinical Modification) is designed for classifying and reporting
More informationMARCH 2014 www.calhospital.org
Critical Roles: California s Allied Health Workforce Follow-Up Report MARCH 2014 www.calhospital.org Background In February 2011, the California Hospital Association (CHA) Workforce Committee released
More informationUnderstanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule
Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule Many physician practices recognize the Health Information Portability and Accountability Act (HIPAA) as both a patient
More informationHealth Insurance Reform at a Glance Implementation Timeline
Health Insurance Reform at a Glance Implementation Timeline 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access
More informationUsing Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare
December 2010 Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare CONTENTS Background... 2 Problems with the Shared Savings Model... 2 How
More informationHEALTH CARE R E F O R M
HEALTH CARE What does the Affordable Care Act mean to you? HEALTH CARE On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law. This marked the beginning of health care reform.
More informationACO s as Private Label Insurance Products
ACO s as Private Label Insurance Products Creating Value for Plan Sponsors Continuing Education: November 19, 2013 Clarence Williams Vice President Client Strategy Accountable Care Solutions Today s discussion
More informationU.S. HEALTHCARE REFORM
U.S. HEALTHCARE REFORM It s Impact on the Future Talent & Recruiting Needs of Healthcare Providers September 18, 2012 1 PANEL DISCUSSION FACILITATOR Carl Kutsmode Partner at talentrise Talent Acquisition
More informationSNOHOMISH COUNTY BLUEPRINT :: HEALTHCARE 1
SNOHOMISH COUNTY BLUEPRINT :: HEALTHCARE 1 Washington State Snapshot Healthcare is a fundamental and flourishing segment of Washington s infrastructure that allows individuals to study, work, and participate
More informationHEALTH POLICY AFFORDABLE CARE ACT AND STATE MEDICAID CHANGES. NEW Members Conference of the Illinois General Assembly November 27-28, 2012
HEALTH POLICY AFFORDABLE CARE ACT AND STATE MEDICAID CHANGES NEW Members Conference of the Illinois General Assembly November 27-28, 2012 Robert Kaestner, PhD Institute of Government and Public Affairs,
More informationGreat Expectations: Why Pharma Companies Can t Ignore Patient Services
Accenture Life Sciences Rethink Reshape Restructure... for better patient outcomes Great Expectations: Why Pharma Companies Can t Ignore Patient Services Accenture Research Note: Key findings from a survey
More informationuninsured RESEARCH BRIEF: INSURANCE COVERAGE AND ACCESS TO CARE IN PRIMARY CARE SHORTAGE AREAS
kaiser commission on medicaid and the uninsured RESEARCH BRIEF: INSURANCE COVERAGE AND ACCESS TO CARE IN PRIMARY CARE SHORTAGE AREAS Prepared by Catherine Hoffman, Anthony Damico, and Rachel Garfield The
More informationNon-Group Health Insurance: Many Insured Americans with High Out-of-Pocket Costs Forgo Needed Health Care
Affordable Care Act Non-Group Health Insurance: Many Insured Americans with High Out-of-Pocket Costs Forgo Needed Health Care SPECIAL REPORT / MAY 2015 WWW.FAMILIESUSA.ORG Executive Summary Since its passage
More informationThe Patient Protection & Affordable Care Act: Next Steps in Maine. February 8, 2013 1
The Patient Protection & Affordable Care Act: Next Steps in Maine February 8, 2013 1 Maine Medical Association Voluntary membership association of over 3,600 Maine physicians, residents, and medical students
More informationHow Will Health Reform Help People with Mental Illnesses?
Judge David L. BAZELON CENTER for Mental Health Law How Will Health Reform Help People with Mental Illnesses? An analysis of the Affordable Care Act passed by Congress in 2010 and how it will affect people
More informationRegulatory and Legislative Action Since the September 2010 Membership Meeting:
MEMBERSHIP MEETING January 19, 2011 Delivery System Reform: Healthcare Workforce Issue: The passage of health reform will bring millions of newly insured individuals into the system and drive patients
More informationKey Provisions Related to Nursing Nursing Workforce Development
Key Provisions Related to Nursing The newly released House bill, the Affordable Health Care for America Act (HR 3962), clearly represents a movement toward much-needed, comprehensive and meaningful reform
More informationHow the Affordable Care Act Affects Workers Compensation Part Two
How the Affordable Care Act Affects Workers Compensation Part Two By Mark Noonan Part one of this series examined the potential impact of the Affordable Care Act (ACA) on workers compensation and general
More informationChildren s Special Health Care Services and Michigan s High Risk Pool Issue Brief March 2012
Children s Special Health Care Services and Michigan s High Risk Pool Issue Brief March 2012 Executive Findings The Michigan Department of Community Health, Children s Special Health Care Services Division
More informationHealthPartners: Triple Aim Approach to ACO Development
HealthPartners: Triple Aim Approach to ACO Development Brian Rank, MD Medical Director, HealthPartners Medical Group October 27, 2010 HealthPartners Integrated Care and Financing System 10,300 employees
More informationTalking with Health Care Entities about Value: A Tool for Calculating a Return on Investment
Talking with Health Care Entities about Value: A Tool for Calculating a Return on Investment Overview Doctors, hospitals, and other health care providers are under increasing pressure to improve quality
More informationGlossary of Frequently Used Billing and Coding Terms
Glossary of Frequently Used Billing and Coding Terms Accountable Care Organization (ACO) Accounts Receivable Reports All Inclusive Fees Allowances and Adjustments Capitation Payments Care Coordination
More information