Telemedicine / Telehealth – Current Uses and Reimbursement
What’s better than knowing you can connect a provider with a patient even when that patient lives in the most rural of places? Telemedicine is an innovative and resourceful communication tool that integrates communications with modern day electronics allowing for the provider and patient to be in different locations during scheduled appointments. Products such as real time audio/video, email and smart phones are just some of the products being used in this delivery of services. The term telehealth which also encompasses telemedicine is a broader definition of remote healthcare that can include non clinical usage such as continuing education and training for providers to support healthcare services.
Obamacare & Murphy’s Law | Did It All Go Wrong?
Pundits began outlining the downfall of Obamacare as soon as the President was elected in 2008. Now that many programs have come to fruition, many folks who originally voiced concerns are tallying up the negative outcomes.
Show Me the Money | Profitability Through Value-Based Purchasing
Summary: Are you ready for a shift in risk from payer to provider? Will you be ready for value-based purchasing when it becomes required? Are you utilizing other reimbursement models such as bundled payments, Accountable Care Organizations, and Population Health Management?
From a provider perspective, healthcare reform is aimed at tightening the purse strings, working more efficiently, reducing waste, and improving quality. The shift of risk has begun which will transform healthcare from a fee-for-service to fee-for-value. When the ultimate transformation ends, is still uncertain. As such, fee-for-service is still being utilized and providers are still generating profits and revenue based on the volume mentality while simultaneously trying to transition to a volume and quantity mentality. Juggling the opposite ends of the spectrum is no easy task.
The Importance of Drug Utilization Review
One of the most costly and complex elements of today’s healthcare system is prescription drugs. For each state, there are tools and resources for hospitals to review prescription drug use and make sure it’s in line with Medicare’s program.
Understanding Utilization Review
When a patient needs medical treatment of any kind, their insurance company needs a way to establish how much they’re going to pay for the services. An insurance company may review a treatment or procedure to determine if it is appropriate, and therefore, if they’ll cover the cost. If an insurance company denies coverage, a patient or healthcare provider can appeal the decision.
Risk Management 101 | Types of Risk
Before we can even begin to talk about mitigating risk, we have to know the types of risk out there. Risk Management is an integral part of any healthcare system.
Shifting Risk: A Pharmacy Perspective on Value-Based Purchasing
Summary: In this article we will discuss Value-Based Purchasing and how it impacts the Pharma industry in particular.
According to an issue brief by Deloitte Center for Health Solutions, Value-based pricing for pharmaceuticals: Implications of the shift from volume to value, a shift in risk is occurring in the pharma industry as a result of healthcare legislation, culminating with the Affordable Care Act (ACA).
5 Aspects of CMS’ 2015 Proposed IPPS Regulations
On April 30, 2014, CMS announced proposed IPPS regulations to become effective January 1, 2015. The ruling covers: Hospital Value-Based Purchasing Program, Hospital Readmissions Reduction Program, Hospital-Acquired Condition Reduction Program, Quality Reporting Programs, and Wage Index – Updated Labor Market Areas.
CMS just announced proposed regulations to become effective January 1, 2015. These regulations further the goals of the Affordable Care Act: increasing patient outcomes and reducing healthcare spending. These proposed regulations are Medicare specific and, if approved, will be applicable to general acute care and long-term care hospitals.
5 Healthcare IT Risks in 2014
In the last few decades, increasing availability of technology in healthcare has lead to some amazing advances, both for physicians and patients. Documentation for physicians is well on its way to becoming more streamlined, thanks to the interconnectivity of electronic health records, and the potential for “One patient, one record” only becomes more of a reality with each new innovation.
The Impact of Reducing Avoidable Readmissions Infographic
What is the impact of reducing avoidable admissions and readmissions? What are you doing to track admissions and readmissions? Have you isolated the primary causes of avoidable readmissions? Do you have a game plan in place? Are you prepared to begin tracking additional readmission conditions beginning in 2015? Have you established relationships with primary care to ensure a smooth transition and continued care coordination? Are you currently being assessed penalties due to readmission rates being too high?
