Physicians' first-hand experience has no substitute, and Dr. William Cromie has maintained CDPHP's vision of including physicians in the governance of this health plan. Often, the plan and the physicians are faced with tough choices and collective compromises.
Physician peer interaction is only a click away thanks to online networking sites.
Technologies and wireless systems has vastly improved hospital communication, putting critical information in the hands of those caring for patients immediately.
Emergency departments (EDs) are a critical safety net for all Americans, and that net is becoming evermore threadbare. It's downright scary when you look closely at the reality of EDs today.
The World Health Organization's latest version of the International Classification of Diseases and Related Health Problems (ICD) will bring "the good, the bad, and the ugly" for nearly all who use this classification system. However, the biggest asset is that the latest version is much more detailed and organized than ICD-9.
An effective use of hospitalists is to have them available to free up general practitioners from hospital rounds. Appropriate use of hospitalists can also enable physicians to visit patients more than once a day in the hospital setting.
Ambulatory Surgical Centers (ASC) represent an unparalleled snapshot of the evolution of healthcare delivery, experts say. The surge in growth of ASCs nationwide affords patients the opportunity for non-emergent surgical and procedural services outside the hospital structure while also yielding cost-effective benefits for managed care organizations.
Earlier this year Susan Andrews, MD, evaluated a broken arm for a long-time patient in her family practice. Without leaving her Memphis office, Dr. Andrews conducted a complete history, assessed the injury and arranged a referral to an orthopedist, even though the patient was actually 2,000 miles away vacationing in the Caribbean.
Today's standard of care has morphed from comprehensive to catastrophic care. As the number of uninsured Americans has increased, so has the percentage of emergency room cases that aren't emergencies. As many as one-half of ER patients are there for routine treatment because they have nowhere else to go.
As patients take more ownership of their disease management regimens, hospitals are beginning to re-evaluate their processes-clinically, administratively and culturally.
SACRAMENTO-California's six largest preferred provider organizations (PPOs) have agreed to initiate quality-of-care measures to create a Health Insurance Report Card for the state, the first in the nation for PPOs.
Hospitals have made strides during the past decade to increase their inpatient survival rates. This is being accomplished at the same time that inpatient acuity (the severity of illness) has been steadily increasing.
The goals of the Patient-Centered Primary Care Collaborative (PCPCC) are hard to argue with. The coalition of employers and physician groups hopes to transform how primary care is organized and financed. It says patients will get better treatment, physician payments will be improved and value will be added for purchasers and consumers by allowing patients' family doctors to coordinate care. That coordination will depend on technology.
For years, surgeons and other specialists working at hospitals were at the financial mercy of administrators. While it was true that these physicians were the ultimate authority on clinical care, the decisions about equipment, more staff and other important aspects of treating patients were often out of their hands. With departments wrestling each other for precious few dollars, their requests were frequently denied.
As the concern about the long-term fiscal viability of Medicare continues to grow, so has the recognition that some of the services ordered by physicians-and subsequently billed to Medicare-might not be warranted.
As far as Michael Howe is concerned, the healthcare community should no longer question whether retail clinics are here for the long haul. The way he sees it, the criticisms about quality and continuity remain theoretical and spoken by a vocal minority. But even more so, the millions of consumers who are driving demand for retail-clinic services seem to have answered the question already.
Employers are putting more financial burden on employees in the form of higher copays and deductibles, however, in the physician's office, patients' cost concerns usually aren't discussed in advance of a particular treatment.
There is growing recognition that teenagers have healthcare needs that are distinct to their own age group-needs that pediatricians and primary care physicians are not always equipped to handle.
Virtually everyone agrees that properly incentivizing physicians-particularly rewarding the high-level performers-is critical to changing the direction of the U.S. healthcare industry. No single stakeholder can effect much of a change alone, however; if the industry is going to change, it will be with help from every direction and demographic.
A joint collaboration between a small hospital in Indiana and an Indianapolis-based picture archiving and communications systems (PACS) and complete radiology provider enabled the small hospital round-the-clock access to radiologist services. Upon its opening in October 2006, the Monroe Hospital in Bloomington, Ind., joined forces with the PACS and radiology provider to supply the facility with radiologists to cover all of the hospital's general and subspecialty radiology services through both on-site and remote radiologists.
The primary cost to patients with hospital-acquired infections is a prolonged stay and additional therapeutic interventions. But because of the high financial costs, there is increasing outside pressure to decrease infection rates.
The primary cost to patients with hospital-acquired infections is a prolonged stay and additional therapeutic interventions. But because of the high financial costs, there is increasing outside pressure to decrease infection rates.
As the managed care industry continues to consolidate, not-for-profit and provider-sponsored plans haven't lost their niche in the marketplace. They compete on demonstrated quality and the added value of community accessibility, which would, on the surface, seem to be exactly what politicians and healthcare advocates are begging for.
The administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require the Department of Health and Human Services (HHS) to establish national standards for electronic healthcare transactions. This includes assigning healthcare providers a National Provider Identifier (NPI), a 10-digit numeric provider identifier that will be used in standard electronic transactions, such as healthcare claims. As of a legislated date of May 23, 2007, each participating provider will have one and only one NPI, regardless of practice locations or settings.
With Administrative costs accounting for as much as 40% of all healthcare dollars spent, many states are seeking new and innovative ways to eliminate bureaucracy and red tape. One area receiving more attention is the resolution of billing disputes between providers and payers. In 2006, New Jersey and California implemented arbitration programs to resolve the growing aggregation of healthcare payment disputes.
