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Politics In the Health and Medical World
Health Care Mandate, Obama care, Massachusetts health care, Mitt Romney-Health Care
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Health-care changes may not all disappear even if justices overturn the law

Health-care changes may not all disappear even if justices overturn the law | Politics In the Health and Medical World | Scoop.it

By N.C. Aizenman, Published: March 22


Since the 2010 health-care bill became law two years ago Friday, it has launched fundamental changes to Medicaid, Medicare and the private health-insurance system relied on by millions of Americans.


Its most transformative — and controversial — provisions are not set to take effect until 2014, but a complex web of new rules has already extended coverage and expanded benefits across the country.


So what happens to the existing provisions if the Supreme Court, which will hear challenges to the law next week, ultimately decides to go with its most sweeping option: overturning the law in its entirety?


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The new health care law and you – Ask a doc! » peoplesworld

The new health care law and you – Ask a doc! » peoplesworld | Politics In the Health and Medical World | Scoop.it

by: RACHEL DEGOLIA
May 24 2012

CLEVELAND - A group of physicians here has formed a speakers bureau dubbed, "The New Healthcare Law and You - Ask a Doc!" With the help of staff from the Universal Health Care Action Network (UHCAN), the doctors began fanning out across the region this spring speaking to audiences of all kinds to inform people about the changes under way and new benefits from national health reform.


The Patient Protection and Affordable Care Act (ACA), referred to by some as "Obamacare," is being implemented over several years. Although the law was enacted in March 2010 and millions of people are already experiencing some of the benefits, most people are either unaware or misinformed as to its actual provisions.


At a recent meeting of AFSCME retirees, Drs. Rochele and Nathan Beachy, husband-and-wife family practitioners, shared their view of how the ACA is a big step toward transforming "our sick care system to a health care system." They described their personal "health care horror story" about their son who developed a brain tumor in his teens and who is now able to be on their insurance policy until age 26, thanks to the ACA.


The Beachys described the positive changes the ACA is bringing about in "care, costs and quality." They said, "No one should die for lack of insurance, no one should go bankrupt for getting sick, and payments will be tied to actual improvements in health."


Attendees at the AFSCME meeting were especially interested in learning about the 24 preventive services now available with no co-pay for Medicare beneficiaries under the ACA. They were very glad to get a checklist of these services, downloaded from www.healthcare.gov, so they could make sure their insurance companies and doctors abided by these new consumer protections that are also helping keep people healthy.

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Political Analysis: Washington has bigger fights than the ICD-10 debate

Political Analysis: Washington has bigger fights than the ICD-10 debate | Politics In the Health and Medical World | Scoop.it

AMA, MGMA letters to lawmakers suggest SGR alternatives

May, 29 2012
By: Chris Anderson


Letters sent last Friday to House Ways and Means Committee chairs Dave Camp (R-Mich.) and Wally Herger (R-Calif.) from the American Medical Association (AMA) and Medical Group Management Association (MGMA) suggest a number of different payment approaches aimed at a long-term solution to the current Medicare sustainable growth rate (SGR).
Both letters were submitted in response to a request from the committee seeking ideas on how to create new payment models.


“There is widespread agreement among experts and stakeholders that the existing physician payment system under the Medicare program is inadequate,” wrote Susan Turney, MD, president and CEO of MGMA. “Although Congress has repeatedly intervened to prevent rate cuts, it has never eradicated the formula that dictates these cuts.”

In the AMA letter, James L. Madara, MD, executive vice president of the AMA, lays out a number of different payment proposals that include rewarding doctors for quality and efficiency, developing new models of payment and suggestions for increasing patient involvement with care decisions while also addressing current regulatory roadblocks.


“Innovative payment models can give physicians the resources and flexibility to re-design care to keep patients healthier, better manage chronic conditions, improve care coordination, reduce duplication of services, and prevent avoidable admissions, and do so in ways that will control costs for the Medicare program,” wrote Madara.


Among the recommendations from the AMA are a request that Medicare create what is essentially a menu of different payment reforms and models during a transition period away from SGR and current fee-for-service payments. The new payment models should be broadened, the letter asserts, from the current shared savings and ACO programs to also include bundled payments, performance-based payments, global and condition-specific payment systems, warranties for care and medical homes.

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Ideal Medical Practices: Typical Electronic Health Record Use in Primary Care Practices and the Quality of Diabetes Care: don't count your chickens

Ideal Medical Practices: Typical Electronic Health Record Use in Primary Care Practices and the Quality of Diabetes Care: don't count your chickens | Politics In the Health and Medical World | Scoop.it

May 28, 2012

Typical Electronic Health Record Use in Primary Care Practices and the Quality of Diabetes Care: don't count your chickens
From the Annals of Family Medicine May/June 2012:

In this longitudinal observational study of primary care practices, we found that practices using an EHR for a 3-year period had a poorer quality of diabetes care at baseline, did not make more rapid quality improvements than practices using paper records, and had a poorer quality of diabetes care at the 2-year follow-up. via www.annfammed.org

Count me among those hardly shocked.

Many who advocate the expanded use of health IT appear to believe that health IT itself will catalyze improvements in care. While there may be a few narrow instances where this is the case, we believe that most current health IT systems have a long way to go before they encompass the functionality that would support robust ongoing improvement of care. Additionally, the success of health IT-enabled improvement depends critically on the skills of clinical and administrative staff in primary care settings to understand and use solid improvement methods—methods that need not rely solely on health IT to be effective. (Langley 2007)

Too many of the improvement plans I come across rely heavily on the oft-touted benefits of health information technologies. "We'll use our electronic health record to find gaps in care and this will improve our chronic care outcomes." or "With electronic health records we will reduce duplication of services and unnecessary testing and reduce costs."

Maybe.

But the results to date are not as encouraging as some marketing materials would lead one to believe.

In this controlled study, EMR use led to an increased number of HbA1c and LDL tests but not to better metabolic control. If EMRs are to fulfill their promise as care improvement tools, improved implementation strategies and more sophisticated clinical decision support may be needed. (O'Connor 2005)

As you consider interventions to improve outcomes for individuals and populations, consider carefully the strategies you will use to change work flow, who is doing what, and the very nature of the work being done. To achieve meaningful results we must change the way we work, not merely create an electronic version of the way we have always worked.

There are some good strategies that truly support overstretched and under-resourced primary care practices and their patients, but too many intitiatives just pile on demands, drawing clinicians further away from the people who need their time. (Bodenheimer 2008)

L Gordon Moore

Bodenheimer T. "Transforming Practice" N Engl J Med 2008; 359:2086-2089

Langley J, Beasley C. Health Information Technology for Improving Quality of Care in Primary Care Settings. Prepared by the Institute for Healthcare Improvement for the National Opinion Research Center under contract No. 290-04-0016. AHRQ Publication 

No. 07-0079-EF. Rockville, MD: Agency for Healthcare Research and Quality. July 2007.

O’Connor PJ. “Impact of an Electronic Medical Record on Diabetes Quality of Care,” The Annals of Family Medicine 3, no. 4 (July 1, 2005): 300–306.


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'Bath Salts' A Deadly New Drug With A Deceptively Innocent Name - Forbes

'Bath Salts' A Deadly New Drug With A Deceptively Innocent Name - Forbes | Politics In the Health and Medical World | Scoop.it

ForbesOnline, Lifestyle, 6/4/2012, Author, Melanie Haiken, Contributor


Can the headlines really have it right? Is there really a new drug that makes people so violent they bite each others’ faces off? I wish this was a News of the World headline that we could all dismiss, along with the stories of alien babies and women giving birth at 95. But in this case, the headlines do have it right — sort of.


Yes, unfortunately, there’s a new drug making its way into communities across the country and it’s really, really scary.


How scary? Well, in the incident described in the current headlines, a 31-year-old man, Rudy Eugene of Miami, attacked a 65-year-old homeless man, stripped off all his clothes, dived on top of him, and started chewing off his face. Eugene had a history of run-ins with the police, and had been accused of domestic violence, but his history hadn’t suggested a risk of public violence.


The explanation — if there is one — seems to be that bath salts can trigger a full-blown psychotic episode with extreme delusions.

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How medical practices get a return on CDI and better coding | ICD10 Watch

How medical practices get a return on CDI and better coding | ICD10 Watch | Politics In the Health and Medical World | Scoop.it

Let's forget about ICD-10 coding for a moment. Let's talk about how medical practices can make more money.


There's an urologist in South Carolina who figured it out:


"Two years ago Larry Rabon decided to do things differently. He was going to find every code that he was missing, and bill for that." (via Marketplace)


This isn't exactly found money. He has to work for it. He has a medical billing team (his family) dedicated to staying on top of how to code every diagnosis and procedure that Rabon is legally entitled to submit for reimbursement. And for all of this to work, he has to have the appropriate, specific documentation.


Deborah Grider, a senior manager at Blue & Co., emphasizes the role documentation plays. "If we don't document well, and we don't have the specificity, our medical necessity isn't going to be realized so we don't get paid," she says.

Now that's the stick. Without the proper documentation, there can be denials and suspended claims with requests for more information.

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AMA, MGMA letters to lawmakers suggest SGR alternatives | Healthcare Payer News

AMA, MGMA letters to lawmakers suggest SGR alternatives | Healthcare Payer News | Politics In the Health and Medical World | Scoop.it

AMA, MGMA letters to lawmakers suggest SGR alternatives

May, 29 2012
By: Chris Anderson
Letters sent last Friday to House Ways and Means Committee chairs Dave Camp (R-Mich.) and Wally Herger (R-Calif.) from the American Medical Association (AMA) and Medical Group Management Association (MGMA) suggest a number of different payment approaches aimed at a long-term solution to the current Medicare sustainable growth rate (SGR).


Both letters were submitted in response to a request from the committee seeking ideas on how to create new payment models.


“There is widespread agreement among experts and stakeholders that the existing physician payment system under the Medicare program is inadequate,” wrote Susan Turney, MD, president and CEO of MGMA. “Although Congress has repeatedly intervened to prevent rate cuts, it has never eradicated the formula that dictates these cuts.”

In the AMA letter, James L. Madara, MD, executive vice president of the AMA, lays out a number of different payment proposals that include rewarding doctors for quality and efficiency, developing new models of payment and suggestions for increasing patient involvement with care decisions while also addressing current regulatory roadblocks.


“Innovative payment models can give physicians the resources and flexibility to re-design care to keep patients healthier, better manage chronic conditions, improve care coordination, reduce duplication of services, and prevent avoidable admissions, and do so in ways that will control costs for the Medicare program,” wrote Madara.

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The importance of preparing for ICD-10 now - Healthcare Finance News

The importance of preparing for ICD-10 now - Healthcare Finance News | Politics In the Health and Medical World | Scoop.it

May 24, 2012 | Kelsey Brimmer, Associate Editor

ls Role of Analytics Post Healthcare Reform

CHICAGO – The stakes are high for the upcoming ICD-10 conversion and the consequences for organizations that don't properly prepare may be severe.

That was the message from Ann Zeisset, an independent consultant on ICD-10-CM/PCS and author for the American Health Information Management Association, during an interactive webinar Thursday, called "ICD-10: What you need to know about upcoming changes."

Throughout the webinar, Zeisset not only discussed what these consequences are but how to take the first key steps in ICD-10 implementation planning to avoid them.

In order to avoid future claims rejections, denials, delays in processing authorizations and reimbursement, compliance issues and improper claims payments, among other problems, healthcare providers must be working on Phase 1 of ICD-10 implementation, which includes an implementation plan and impact assessment, said Ziesset.

“We are expecting the final rule on ICD-10 on June 30. Until then, CMS tells us to continue planning and providing education,” said Ziesset. “If ICD-10 is extended another year, it’s because there are people who really need it to be extended. The more specific codes we’ll find in the new system will improve our ability to analyze and trend different issues. Also, we’ll be able to process claims for reimbursement easier and with more specific codes."

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