BHM Services
What's one thing you never see Grey’s Anatomy? A doctor sitting down at 3 am to dictate on a patient. Or write a note in their chart. I don’t even remember seeing a doctor on that show even look at a patient’s chart, let alone glean any valuable information from it. No one becomes a doctor because they love to document.
This week the New York Times ran an article about the top earners in healthcare- and perhaps a surprise to none, doctors did not top that list: administrators did.
Overcrowding in Emergency Rooms (ERs) has been an issue of great concern as of recent years. There are a myriad of reasons why the ERs are overcrowded and ways to overcome. Let’s have a look at them. Expand Hospital Capacity By increasing the bed capacity, overcrowding can drastically go down. When there are more beds, more emergency patients can be admitted. When the population of a country grows, then obviously the number of bed capacity should be increased to avoid overcrowding. Many times, hospitals are perpetually full with admitted patients boarded inReducing overcrowding the ERs. Boarding of inpatients in the ERs is unquestionably the leading cause of overcrowding. While this seems like a simple option, there are infrastructure, costs, and the redesign of processes, to name a few, which need to occur in order to successfully add bed capacity.
What do the ACA, ACO, FFS, DHS, and QHP all have in common? They are healthcare acronyms and most are related to the Affordable Care Act. The healthcare industry is not unlike any other industry or almost any aspect of our lives these days, especially with the advent of texting. There is always a shorter way to say something i.e. “BFF” – best friends forever or one of my favorites “*$” - Starbucks. By the way, the title “FFOF” is Fun Facts on Friday. The ACA, which is part of the “PPACA” - Patient Protection and Affordable Care Act of 2010, is regulated by “HHS” - the division of Health and Human Services, the “DOL” – Department of Labor and the “IRS” – Internal Revenue Service. HHS designates many responsibilities to “CMS” – the Centers for Medicare and Medicaid Services.
What do ASAM®, LOCUS®, CALOCUS®, and InterQual® all have in common? They are all level of care assessment tools, each with a different perspective. Level of care isn’t a new concept, but has gained in popularity in recent years. A level of care is used to indicate a level of intensity or severity and determine in what type of facility specific care should be performed. It is used to make sure the patient receives the right care in the right facility at the right time.
The Commission on Accreditation of Rehabilitation Facilities (CARF) was established in 1966 as an alternative to Joint Commission certification. Services provided by rehabilitation facilities are subtly specified in different ways than general hospitals. It’s fitting, then, that they have their own, more specified accreditation system for their services.
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.
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.
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.
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.