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Sunday, March 29, 2015
LIVE: Solar Impulse Airplane - In Flight from Myanmar to Chongqing - #RT...
We interrupt our regular blog posts to bring you some exciting information about Solar Impulse, a Live Feed from 10,000 feet at 30 kts at night powered by solar batteries capable of powering it around the world.
Doctors Needing Assistance Transferring from Fee for Service to Quality of Care Reimbursement
Doctors face tremendous hurdles attempting to convert a volume based, procedural fee system to the proposed method of quality and outcome based reimbursement. Physicians and consultants alike have long recognized the inflationary component of the old fee for service methods. What is not apparent in the new proposal is that it does not discard billing for procedures, but adds on a new algorithm which modifies the fee based upon other measures, currently in development. Much of the algorithm is still in development. The calculus depends upon big data analytics measuring outcomes and some vague measures of quality.
Some have been proposed, such as hospital readmission rates, length of stay measures and others. CMS' meaningful use criteria will play a role as a built in component of certified electronic health records. Some of these tools will not be available until 2018. The initial metrics proposed for healthcare are new and arbitrary, and have not yet been proven scientifically. There are agencies such as AHRQ who have formulated guidelines, long before changes in reimbursement methodology were proposed. Quaity issues must be a thing unto itself, unbound from payment methodology. Basing payment on quality of care remains a new algorithm.
Saturday, March 28, 2015
Kaiser ordered to pay woman more than $28 million
Founded in 1945, Kaiser Permanente is one of the nation’s largest not-for-profit health plans, serving approximately 9.6 million members It serves as one HMO model in the U.S. They promote themselves with the "THRIVE" icon in their marketing campaigns for the impact of wellness promotion in lowering health care costs while at the same time improving quality of life.
Fast Facts about Kaiser Permanente
Much of their financial stability can be assigned to a highly disciplined and organized approach to accessibility to expensive testing. These methods are monitored by utilization review departments. Kaiser is a ''super HMO' and as such has scaled many operations to higher levels of practice administration far above the 'grass roots' of practicing clinicians. In fact Kaiser clinicians (like so many other group practice clinicians) have preferred practice guidelines to which they must conform or face sanctions, and even dismissal if they disregard the guidelines.
At times these guidelines, do not serve quality of care well at all. They may save money for an organization in the short and/or long term, however many patients complain about restrictive guidelines interferring with their care. Sometimes it is minor annoyance, however cases such as this occur more than rarely. In this case the sanction was medico-legal to the tune of $ 28 million dollars.....paid for by a malpractice insurance carrier. This is another hidden cost of health care and is not accounted for in health finance analysis.
The story is carried in today's edition of the Los Angeles Times and the San Francisco Chronicle.
Kaiser Permanente is also under scrutiny for it's mental health program and is being accused of 'patient dumping into public health programs, with a class action lawsuit filed on behalf of their psychiatric patients.
California again slams Kaiser for delays in mental health treatment
Fast Facts about Kaiser Permanente
Much of their financial stability can be assigned to a highly disciplined and organized approach to accessibility to expensive testing. These methods are monitored by utilization review departments. Kaiser is a ''super HMO' and as such has scaled many operations to higher levels of practice administration far above the 'grass roots' of practicing clinicians. In fact Kaiser clinicians (like so many other group practice clinicians) have preferred practice guidelines to which they must conform or face sanctions, and even dismissal if they disregard the guidelines.
At times these guidelines, do not serve quality of care well at all. They may save money for an organization in the short and/or long term, however many patients complain about restrictive guidelines interferring with their care. Sometimes it is minor annoyance, however cases such as this occur more than rarely. In this case the sanction was medico-legal to the tune of $ 28 million dollars.....paid for by a malpractice insurance carrier. This is another hidden cost of health care and is not accounted for in health finance analysis.
The story is carried in today's edition of the Los Angeles Times and the San Francisco Chronicle.
Kaiser Permanente is also under scrutiny for it's mental health program and is being accused of 'patient dumping into public health programs, with a class action lawsuit filed on behalf of their psychiatric patients.
California again slams Kaiser for delays in mental health treatment
For the second time in two years, California regulators slammed HMO giant Kaiser Permanente for causing mental health patients, including some who were severely depressed or suicidal, to endure long delays for treatment.
The medical-malpractice option remains at times the only option for regulating and maintaining true quality of care issues outside the imaginary realm of algorithms and CMS edicts.
Friday, March 27, 2015
Senate Delays SGR Repeal Vote Until Mid-April
It seemed so simple as recently as one week ago when the U.S. House of Representatives passed a bill to revoked the 17 year old never used SGR bill of 1995.
Now here comes (or perhaps didn't come) the U.S.Senate.
Once again, the Medicare reimbursement crisis has turned into an exercise in brinkmanship that physicians would rather do without. However, they may yet escape a dreaded 21% Medicare pay cut next month.
Yesterday, in a rare display of bipartisanship, the House overwhelmingly approved a bill that repeals Medicare's sustainable growth rate (SGR) formula for physician pay and moves the program eventually from fee-for-service to pay-for-performance. That bill, which President Barack Obama said he is eager to sign, would avert a SGR-triggered pay cut of 21% for physicians that is set for Wednesday, April 1. It also would extend funding for the Children's Health Insurance Program for 2 more years.
Earlier today, however, Senate Majority Leader Mitch McConnell (R-KY) said the Senate will not vote on the SGR repeal bill until after it returns from an Easter-Passover break on Monday, April 13. McConnell said the Senate would make the legislation its first order of business.
"I think there's every reason to believe it's going to pass the Senate by a very large majority," Reutersquoted McConnell as saying.
The decision to schedule a vote in April, which organized medicine had anticipated as a possibility, allows the 21% pay cut technically to take effect on April 1. It will apply to claims for all services rendered after March 31. However, physicians will not experience this big axe if the Senate approves the repeal bill and the president signs it by April 14. This new deadline arises from how the Centers for Medicare & Medicaid Services (CMS) pays Medicare claims.
By law, CMS and its claims processing contractors cannot pay clean electronic claims any sooner than 14 calendar days after receipt (29 days for hard copy claims). Accordingly, the Senate has until April 14 to approve the SGR repeal bill before CMS begins applying the 21% rate reduction to claims for services rendered on April 1 and beyond. In a best-case scenario, the Senate beats its deadline and all those April claims get paid at the rates in effect before April 1. Under the bill, Medicare rates would be frozen at their current levels until July 1, when they would bump up 0.5% for the remainder of 2015, with annual 0.5% increases from 2016 through 2019.
McConnell said he is counting on this 14-day claims processing window to spare physicians the ill effects of the 21% cut, according to Reuters.
Moans of Frustration From Organized Medicine
Congress has postponed SGR-triggered pay cuts for physicians 17 times since 2003, usually at the last minute. McConnell's decision to let the 21% cut kick in and then undo it retroactively in mid-April set off moans of frustration in organized medicine.
The American College of Physicians said it was "greatly disappointed."
"By not passing the bill, the Senate failed to join the House in enacting legislation to achieve historic reforms in physician payment while making other needed healthcare improvements," American College of Physicians President David Fleming, MD, said today in a news release.
Robert Wergin, MD, president of the American Academy of Family Physicians, told Medscape Medical News he was "disappointed, but not discouraged."
"The House vote (392 to 37) showed strong support — stronger than we anticipated — for a bill that ensures healthcare access for the elderly, the disabled, and children," said Dr Wergin. "It's got the right mix for a bipartisan agreement [in the Senate]."
Democrats and Republicans alike in the Senate generally agree that Medicare's SGR formula, designed to curb spending, should be replaced. However, some Senate Democrats would like to extend the life of the Children's Health Insurance Program for 4 years, instead of 2, and to remove language in the bill that restricts the use of federal funds for abortions. In addition, in a recent opinion-editorial piece published in Politico, Sen. Ben Sasse (R-NE) objected to how the legislation would increase the federal deficit by $141 billion, and other fiscally conservative Senate Republicans may rally around that position as well.
It was not clear to this reader why the Senate could not deal with this in a timely manner.
No one in medicine is surprised, and can wait another two weeks. After all we have waited 15 years, and hell has still not frozen over.
Thursday, March 26, 2015
What's a Hospital Without Beds? Much Better
What's a Hospital Without Beds? Much Better
Mar 23, 2015
- 4,500Views
- 288Likes
- 56Comments
Thursday morning, your father gets out of bed at 7:00 am to take a shower and to make himself breakfast. After watching the news he decides to do some work in the garden before he needs to drive to the hospital. Your mother will join him.They arrive at the hospital, walk to the department of cardiothoracic surgery and find your father's room.
When they enter the one-person room, your mother takes the chair. The only option left for you father is to lay down on the bed.
"Can you get me some water?" he asks.
He is a patient as of now.
While this might seem a bit odd to you, it happens every day. In healthcare we think we offer patient-centered care, but what we are actually doing is giving bed-centered care. Almost every part of the care we give takes place in the bed. Even though most patients (people!) are perfectly able to sit and walk, as soon as they enter their room on the department they turn into a dependent patient.
That's why three physiotherapists from the department of physical therapy (Shanna Bloemen, Yvonne Geurts and Frank Klomp) started a movement within the Radboudumc they've coined "Ban Bedcentricity". This is not a project or even a program, it's a way of thinking that changes the way we 'do' healthcare.
We often see 'the patient room of the future' with clean & slick interfaces on multiple screens, but still: the luxury bed in the center of the room as most important piece of furniture. Not only that, every screen you see is presented in such a way that you get the best view from the bed. Aside from the fact that a lot of patients that are currently treated in bed in hospitals will soon be treated in their homes in the near future, the bed will be come less important and will be used for it's purpose: to sleep.
Why is REshape involved in this? We innovate from a patient's perspective, together wÃth patients ánd healthcare professionals. We see lot's of opportunities for wearable technology, gamification and virtual reality regarding this topic and hope to enable patients to be more autonomous. Wearable technology to monitor patients even when they leave the department, gamification to motivate them to start moving and virtual reality for those who really can't move but can still benefit from the 'thought' of moving.
To be continued, but we would love to hear your opinion and advice on this below.
Make mine an Eames Chair
U.S. Houses passes Bill to revoke Sustainable Growth Reduction of 1995
U.S. Houses passes Bill to revoke Sustainable Growth Reduction of 1995 The Bill will now be voted on in the U.S. Senate.
It has been on the 'books' since 1995 and has never been used.
Contact your Senator now and tell him to vote to revoke the SGR.
Read the Bill Summary
It has been on the 'books' since 1995 and has never been used.
Contact your Senator now and tell him to vote to revoke the SGR.
Read the Bill Summary
- Send an urgent email to your senators reinforcing the need for SGR repeal now.
- Contact key senators still undecided on this most critical issue directly through their own social media channels and share with your own Facebook friends and Twitter followers as well.
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