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Health Management Technology News
  June 18, 2014
In this issue:
 
 How healthcare reform is challenging medical malpractice

 Housing the homeless is key to controlling costs

 CMS initiative helps people make the most of their new health coverage

 Medicine gets personal

 Time has come for single-payer healthcare

 5 recent stories on the Stark Law

What you need to know about ICD-10
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Seven Strategies to Improve Patient Satisfaction
Hospital reimbursements are now influenced, in part, by patient satisfaction scores. Read about seven areas to target in your hospital for happier, more satisfied patients.

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How healthcare reform is challenging medical malpractice

Though the impact of the Affordable Care Act (ACA) on medical malpractice insurance remains a bit of a puzzle, three insurance experts pieced together likely effects at an insurance conference for actuaries in late May.

Forecasting a coherent future from sparse data can be difficult, but it’s a skill casualty actuaries have gained through years of experience. There aren’t a lot of data yet – and the facts that do exist are subject to more political spin than usual. Still, two casualty actuaries and a veteran medical malpractice underwriter were able to use demographic and health industry trends to predict how the medical malpractice world could change over the next decade.

They gave their forecasts at the Casualty Actuarial Society’s Seminar on Reinsurance in New York, in a session titled “The Impact of the Affordable Care Act on Medical Professional Liability – an Update.”

Through early April, seven to eight million people had signed up for healthcare insurance through exchanges, noted Elke Kirsten-Brauer, executive vice president and chief underwriting officer of MGIS, a national insurance program manager for medical professionals. She said about one-fourth did not have insurance before; within a few years, more than 22 million people will gain health insurance.

Read the full article from Insurance Journal
here
 

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Housing the homeless is key to controlling costs

What remains outside our offices in Camden, NJ is exposed wet dirt: the patches of grass are faded from use, and the exposed brown ground has developed puddles, seeping up the water from a rainy day. Two weeks ago, New Jersey state and county officials cleared up the tents that housed homeless individuals once living there, displacing nearly 100 vulnerable individuals from their self-protected safety net for life on the streets: blue, plastic tents.

New Jersey spent more than $300,000 to evict people from their makeshift homes, nearly half the amount of money it would take to provide permanent housing and supportive services for thirty individuals over the course of a year. While some have ended up in shelter beds, a temporary “band-aid” to the problem, many others have been displaced from their communities, sleeping instead in abandoned buildings, moving under different highways, and seeking care in expensive hospital beds.

The destruction of tent city without any real planning or the provision of appropriate resources is unconscionable. There are alternatives. Cities and states around the country are investing in evidence-based solutions to homelessness that can permanently eliminate this human tragedy. Salt Lake City, Utah, and Phoenix, Arizona have ended chronic homelessness among veterans through a Housing First approach, proving that ending homelessness is possible and has bipartisan support. Homelessness does not need to exist in Camden, just as it doesn’t need to exist in Lower Merion or Philadelphia.

Read the full article from philly.com here  

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CMS initiative helps people make the most of their new health coverage

The Centers for Medicare & Medicaid Services (CMS) launched a national initiative “From Coverage to Care” (C2C), which is designed to help answer questions that people may have about their new health coverage, to help them make the most of their new benefits, including taking full advantage of primary care and preventive services. It also seeks to give health care providers the tools they need to promote patient engagement.

“Helping to ensure that new health care consumers know about the benefits available through their coverage, and how to use it appropriately to obtain primary care and preventive services is essential to improving the health of the nation and reducing health care costs,” said Dr. Cara V. James, director of the CMS Office of Minority Health. Dr. James noted that, “to achieve these goals, we need to make sure that people who are newly covered know that their coverage can help them stay healthy, not just help them get better if they get sick.”

C2C will be an ongoing project. As more and more people obtain coverage, there will be a continuous need to ensure that people have answers to questions they might have about their new coverage and are appropriately connected to the health care system to help them live long, healthy lives.

Read the full CMS press release here  

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Medicine gets personal

A patient sits in a waiting room at Columbia’s Herbert Irving Comprehensive Cancer Center, referred to Columbia based on reported symptoms and a recent blood test. His nascent chart includes his age, birthplace, current medications, profession, medical history, and results of a recent MRI. An hour from now, that chart will also include a diagnosis and recommendations for an initial treatment plan.

The information in the chart will be used to shape and guide this patient’s care. But researchers such as Nicholas Tatonetti, PhD, assistant professor of biomedical informatics and director of clinical informatics for the cancer center, would like to know more—a lot more. Dr. Tatonetti works in a discipline known as network medicine, an integrated study of the entire network of biological processes at work in complex disease. He has his eye on the day when multiple levels of prediction, based on data from gene, protein, and metabolic interactions, in conjunction with clinical observations and understanding of disease and pharmacological processes, become the new standard of care: What do we know about this patient’s genome before he walks through the door? What are the particular molecular characteristics of his specific disease? How will it respond to treatment with the therapies available? What will be the medications’ side effects for him?

Read the full article from Columbia Medicine
here
 

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Time has come for single-payer healthcare

Recently, it has been reported that 7.5 million Americans have enrolled in Obamacare, many more than expected. Yes, it’s better than before: overall, Americans are insured, and insurance companies are no longer allowed to overcharge or deny coverage to the elderly and people with pre-existing conditions. Key issues persist, however: Some people still cannot afford adequate insurance or insurance at all. New issues have arisen as well: 14 million people are left scrambling after their plans were canceled, and others are ignored by the system all together. Going backward is not the answer. But clearly, the Affordable Care Act is not the answer either. So where do we go from here? According to prestigious organizations such as Physicians for a National Health Program, the American Medical Student Association and the California Nurses Association, the answer is clear: single-payer health care.

Single-payer health care is a system in which a single payer — in our case, the federal or state governments — fronts the cost for all health care. There is no insurance industry, and there are no insurance companies to deny people coverage. The system is funded by progressive taxes, so people pay exactly as much as they can afford and no more.

The ACA falls short of a single-payer system on several key points. First off, 29 million people still won’t have health care. Part of this is inherent in any system for which people must proactively sign themselves up — they won’t. Maybe they don’t know how to enroll, or as the Obamacare website demonstrates, enrollment will go awry. In addition, some people are lost in the gap between where their state’s Medicaid ends and Obamacare begins. For example, in states such as Virginia, where requirements for eligibility for Medicaid are notoriously strict, single men are not eligible for state-sponsored care under any circumstances. Obamacare has an income minimum, operating on the assumption that anybody below that minimum will be covered by their state. But as Virginia law demonstrates, this is not always the case. In a single-payer system in which every resident is automatically enrolled at birth, nobody will fall through the cracks.

Read the full article from The Daily Californian
here
 

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5 recent stories on the Stark Law

The following is a roundup of recent stories on the Stark Law.

1. King's Daughters Medical Center to Pay Nearly $41M in Landmark Case Ashland, Ky.-based King's Daughters Medical Center agreed to pay the government $40.9 million to resolve allegations made against it under the False Claims Act and the Stark Law.

2. New Bill Would Help Ensure Stark Law Applies to Medicaid The Medicaid Self-Referral Act of 2014, introduced by Rep. Jim McDermott (D-Wash.), seeks to provide clarification on the Stark Law and how it applies to Medicaid-designated health services.

3. Adventist Health System Self-Discloses Stark Law Violations Altamonte Springs, Fla.-based Adventist Health System disclosed it violated the Stark Law.

Read the full article from Becker’s Hospital Review here  

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June 2014  HMT digital book

White Papers

What you need to know about ICD-10

Seven Strategies to Improve Patient Satisfaction

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Industry News

AMA outlines ways to address physician shortages

AMA adopts telemedicine policy to improve access to care for patients

CMS: Opportunity to apply for Navigator grants

AMA adopts policy to define team-based medical healthcare

HHS: $300 Million in Affordable Care Act funds to expand services


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