The Minimum Loss Ratio (MLR) mandate contained within the Patient Protection and Affordable Care Act of 2010 (PPACA) has created a myriad of compliance requirements for health plans. The most complex and potentially costly of these will be issuing rebates to members when a plan’s MLR falls below the minimum threshold.Many carriers do not have the infrastructure in place to accommodate the rebate mandate. Exacerbating an already significant challenge is the very real possibility that pending legislation and ongoing legal skirmishes will modify the way in which the PPACA-and the MLR mandate-is implemented and enforced. As such, initial and ongoing compliance will require a comprehensive retooling of critical business processes and deployment of enhanced and highly agile systems and solutions.Market ImpactUnder the PPACA, beginning in 2011 the MLR standard is 85 percent for large group carriers and 80 percent for small group and individual carriers. Failure to meet these minimum thresholds triggers the requirement that carriers issue rebates to subscribers. Those rebates must be paid directly to consumers who purchase individual policies or through employers for those who are in group or employer-sponsored plans.The anticipated impact of the rebate requirement on the carrier market is significant. The U.S. Department of Health and Human Services (HHS) estimates that 45% of consumers who have purchased individual coverage are in plans that do not meet the MLR mandate. Were the mandate in effect today, an estimated 9 million people would be eligible for rebates averaging $164 per person. In 2012 alone, rebates are expected to cost the industry $1.4 billion.There are some exemptions to the MLR mandate. For example, carriers that offer “mini-med” or “expatriate” plans are able to calculate their MLR differently than traditional plans, at least for 2011. As such, these plans are able to meet the 80% threshold by spending as little as 40% on direct medical costs.Waivers are also available to states that can demonstrate meeting the MLR would destabilize their individual insurance market.Under the PPACA, beginning in 2011 the MLR standard is 85% for large group carriers and 80% for small group and individual carriers.Many carriers whose plans are not exempt from the MLR are finding that they are ill-equipped to manage the rebate process, as their systems and processes lack the flexibility necessary to adapt to the complex rebate regimen. They are also finding it necessary to implement higher value-add initiatives to off-set the increased costs of complying with multiple PPACA provisions, such as guaranteed issue and elimination of lifetime limits.In calculating its MLR, a carrier must aggregate data by state and market over a three-year period. Earned premium adjustments must be made for:• Assessments paid to, or subsidies received from, federal and state high risk pools• Premiums associated with group conversion charges• Experience rating refunds• Unearned premiumsIncurred claims must be adjusted for such things as:• Group conversion charges• Unpaid claims between the prior and current years’ unpaid claims reserves• Change in claims incurred by not reported (IBNR)• Other changes in reserves• Any experience rating refundsUnder the MLR formula, plan activities that improve healthcare quality can be counted with incurred claims. These activities include case management, care coordination, chronic disease management, accreditation fees directly related to quality of care activities, and quality reporting, as well as IT to support these activities. Other acceptable quality initiatives include those designed to prevent hospital readmissions, improve patient safety, reduce medical errors and promote wellness and health activities.Activities which are explicitly not considered activities that improve quality include fraud prevention, retrospective and concurrent utlilization review, as well as the costs of maintaining provider networks and provider credentialing.Thus, the actual formula for calculating the MLR is:Incurred Claims + Activities to Improve Quality divided byPremium Revenue – Taxes & FeesWhen it comes to rebates, calculations are no less complex:Premium paid by enrollee – Taxes & Fees multiplied byMLR Standard – Actual MLRThe challenge is not just determining the amount of the actual rebate. It is tracking the customer data required in the event a rebate must be issued and ensuring that payments are issued within the mandated timeframe (no later than August 1 following the end of the MLR reporting period).Strategic ObjectivesFor health plans, successful compliance requires adapting existing work processes and infrastructures in a way that enables the efficient processing of rebates. It must be done in a manner that does not interfere too significantly with current business operations, and that allows carriers to take advantage of new opportunities available in a post-PPACA environment.Carriers must focus on executing strategies that ensure they have the processes in place to streamline the rebate process and convert it from a cost center to a marketing opportunity. These should focus on:• Understanding the rules and evolving responsibilities governing MLR calculations and rebates and continuously monitoring for changes• Converting a fixed infrastructure investment into a predictable variable cost structure• Deploying integration pathways to ensure necessary data feeds and workflows• Deploying processes for interacting with members and employers to secure key data elements• Designing programs to leverage the rebate requirements as a means for up-selling to existing subscribers and re-engaging terminated onesFinally, any adaptations carriers make must be flexible enough to accommodate any future changes that may apply in the wake of legislative and legal challenges.HealthPlan ServicesHealthPlan Services (HPS) recognizes the challenges that carriers face in complying with the PPACA while replacing lost profits and capitalizing on emerging opportunities to strengthen revenues and market share. Partnering with HPS enables carriers to leverage the up-to-the-minute monitoring capabilities and understanding of both MLR policy changes and operational best practices provided by a trusted industry resource.HPS understands the many nuances of healthcare reform, and has leveraged that knowledge to create a suite of flexible rebate solutions that meet the unique needs of carriers confronted with the MLR rebate. Its full service offering is ideal for clients to whom HPS is already providing administrative services, while its stand-alone module offers a solution for carriers seeking only rebate processing support. Both feature multiple entry and exit points, including rebate refund and disbursement feeds.HPS’ rebate solutions are all about flexibility and compliance, offering multiple disbursement methods-paper check, ACH credit, credit card credit, pre-loaded debit card, credit on billing invoice-and electronic and paper statement options. HPS also provides a mechanism for gathering contribution rates for group plans, escheatment processingHPS understands the many nuances of healthcare reform, and has leveraged that knowledge to create a suite of flexible rebate solutions…
Using the much acclaimed Japanese theory of Kaizen as its basis, lean healthcare encourages hospitals to make small improvements to its processes on a continuous basis. This exercise not only reduces waste and increases efficiency, but also provides enhanced value to customers and boosts the healthcare facility’s bottom line.For example, applying lean healthcare in point of care testing might mean equipping nurses with two or more supply bins. As soon as all the supplies in one bin are used up, it could be sent for replenishment. Meanwhile, instead of anxiously waiting for fresh supplies, the nurses could use the supplies in the second bin. This approach would eliminate the need for overstocking, resulting in reduced storage space requirements and reduced waste.Thus, the same fundamentals that have made Kaizen a hit amongst manufacturers can help to create more efficient point-of-care diagnostics as well.Kaizen involves three levels of application: brainstorming, innovation and standardization.BrainstormingImplementing Kaizen for point-of-care testing requires extensive idea generation.To begin, the facility needs to identify the areas where maximum waste occurs. To pinpoint these, every event from the time a patient enters a hospital to the time when he is finally discharged should be examined.For example, instead of adding personnel to a department, upgrading the equipment used might prove to be an effective way to increase the number of patients treated by existing department members. In addition, upgrades may cost less than recruiting, training and making place for new specialists.Opposing this view, some caregivers believe that having less staff available for point-of-care diagnostics would create an unsafe environment for patients.However, lean healthcare addresses this by reducing only unnecessary tasks. In fact, crucial tasks would be made more efficient so that caregivers can deliver better quality treatment to their patients.InnovationBy using its property in innovative ways, a healthcare facility can increase customer satisfaction along with its own profits.Statistics show that surgeons are often overworked all week long while hospital beds go empty over the weekend. By performing more surgeries on a Friday, patients could be given recovery time on a weekend. In this way, surgeons could have a more relaxed week while patients would miss fewer days of school or work.Also, certain kinds of treatments involve a patient visiting multiple rooms for different tests and diagnoses. Having related rooms nearby reduces transit time, thus expediting the treatment. Creating multi-purpose rooms for point-of-care testing also saves space and helps a healthcare facility to expand.StandardizationStandard processes reduce errors and costs. For example, designing a uniform operation theater cart would reduce time spent in creating it. The standardization would reduce errors made by the preparation staff and avoid overstocking as well.This said, no solution is perfect since each healthcare facility and the industry as a whole keeps evolving. Staying true to the spirit of Kaizen, lean healthcare requires a hospital to make continuous improvements, while always bearing the patients’ welfare and its own processes in mind.
“The college diploma is the new high school degree.” That’s a well-known statement heard in the New York City of 2007 – and there’s a lot of truth to it. However, not everyone wants – or needs – to attend a four-year university to begin a career. Many people are turning to healthcare programs that feature rapid training time, lower tuition costs, and a faster path from school to the work force. Many of these schools offer new alternatives – such as a dental technician track and assistant nursing program – to the classic college degree.Healthcare programs: The career wave of the futureAmerica is getting older – and there are not enough workers to help her age well, just yet. The upcoming wave of Boomer retirements means a significant number of job vacancies, and an American economy that demands more skilled healthcare workers. And retirement isn’t the whole story: As the Baby Boomers reach their geriatric years, they will need skilled nursing care. As they retain more of their natural teeth, they will need skilled dentists and dental technicians. School programs that focus on allied health address that critical job and care gap by offering a quick path to a career.Higher tuition, more problems: Healthcare programs offer cost-effective alternatives to the traditional four-year system Money is often a would-be student’s biggest barrier to attending a nursing school or M.D. program. As tuition soars and students increasingly turn to private loans to finance their educations, many find school to be beyond the reach of their financial means. Allied health programs can offer lower-cost training courses, with classes that are relevant to the specific functions the student will perform on the job. After attending a career-focused allied health program, the newly graduated student can enter the job market proficient in the skills he or she will need to be a nursing assistant, medical assistant, or dental technician in New York City – or elsewhere in the nation. More importantly, the student can begin working without onerous loans.The experience gap: Addressed by healthcare program internshipsNew York City is a tough, competitive job market – witness the huge numbers of liberal arts grads working as baristas or waiters. Sources as varied as the U.S. Bureau of Labor Statistics, Penn State University, and The Guardian report that in today’s job market, education – and nothing but – is old hat. Employers want demonstrable, real-world experience, too. A healthcare program dedicated to the training of allied health professionals like nursing aids and dental technicians typically offers professional externships in the student’s field of study. For example, an aspiring dental technician might spend hours assisting chair-side in a private dental practice – or, a budding nursing assistant might clock in some hands-on work hours at the New York Presbyterian Hospital. This type of experience is career-focused, and can be put on a future job seeker’s resume.Many four-year colleges put an emphasis on a liberal arts education. What this means is that the academic programs demand exposure to many areas of human thought and achievement: science, mathematics, arts, languages, philosophy, and so on. So, a student might leave a four-year Ivy League school knowing Nietzsche backwards and forwards, but he or she can’t apply that skill to a specific career. Healthcare programs that focus on allied health careers – the catch-all term for jobs like nursing assistant, dental technician, and medical biller and coder – typically offer only courses that are relevant to the student’s eventual career. This saves the student time, and money. And, the hands-on skills taught in allied health care programs can’t be had just by going to the library, attending lecture, or studying texts. They must be practiced in real life settings before the student signs his or her first employment contract.Outsourced and right-sized: How the new economy makes healthcare school programs necessaryThe current American economy is service- and ideas-based, according to market periodicals such as BusinessWeek. The Internet makes the exchange and purchase of new ideas easy, and rapid. Unfortunately for U.S. workers, it makes ideas cheap, too. Some Americans remember the halcyon 1990s as a period of great economic growth. However, many of the ideas-based jobs such as computer programming and software engineering have since been outsourced to developing countries that boast cheaper labor.Service jobs are here to stay, for now. You can’t telecommute a restaurant meal or a tire rotation. However, most service-sector jobs require no education, and thus, offer only menial wages. Allied health careers, by contrast, offer significantly higher entry level wages, with only a short commitment to training time. As the United States economy continues to evolve from the labor economy of its inception to the service economy of today, more and more students – from Dallas to Los Angeles to New York – choose allied healthcare school programs to secure their working futures.
1) Nano-bots in Blood: Although Nano-bots are a long way from being used today, however, there is the possibility that we will see it in the future where these small robots can work like our own particular white blood cells and annihilate microscopic organisms and different pathogens. These miniature robots would work like their full-estimate equivalents with their own particular sensors and propulsion frameworks, and could perform little errands like conveying chemotherapy 1000 times more efficiently than utilizing drugs and it will not cause as many side effects as patient face in the present medications.2) Mind Transfer and Head Transplants: Ever since the beginning of mankind, we have all needed to live everlastingly, and one day that may progress toward becoming reality with organizations like Google and Brainpreservation.org searching for approaches to expand life by curing infection, safeguarding our brains in stasis, or actually saving on PCs or another cerebrum.While it might appear to be strange idea for a tech organization like Google to sign up and battle the healthcare fight, it makes perfect sense that that their CEO Larry Page might need to enhance his life and other’s around him thus they can understand life’s other intense difficulties in the upcoming future.3) Robotic Surgery/Pilot training program/Flight Simulator: Roswell Park Cancer Institute is rapidly reaching on the position of surgical training pioneers. This progress was benefitted by the innovative joint effort between the University at Buffalo’s School of Engineering and Applied Sciences and RPCI’s Center for Robotic Surgery. Surgical methods have constantly required years of preparing, and up to this point, the vast majority of that preparations are done in a live environment. It might be more efficient to do robotic surgery in comparison of present practices.4) Holographic Images: Hospitals are a place to go whenever any treatment is needed. However, it is strange that in the United States, more than 2 million individuals are affected by hospital-acquired contaminations consistently, and 100,000 individuals die due to these kinds of infections. Furthermore, it costs almost $20 billion to treat these contaminations. One thing that can help significantly is the capacity to input information without really touching physical gadgets, for example, keyboards, mouse, and so on. Holographic images will possess the ability to bring a complete revolution in this area.5) Improved Blood-Test Experience: No one loves needles, particularly when you need to get pricked by an unpracticed phlebotomist. Awesome news! Organizations like Theranos have designed a perfect way for such people because if you want to run tests then you will just need micro-samples of blood which means that approximately 1/1,000th of normal blood will be drawn from your vein.6) Mitochondrial DNA Transfer: It is also known as “three parent baby”, this procedure disposes of an assortment of conceivably fatal diseases such as heart and liver failure, and deafness. Albeit numerous moral and ethical questions encompass the current U.K. approval of this procedure, the potential implications for future eras is limitless.7) Robotic Nurse Assistant: Unqualified or inefficient nurses can become problematic for patients. According to the survey, large portion of patients are harmed each year from moving or lifting in bed or due to the mishandling fall after surgery. There are numerous varieties from a full robot, for example, RIBA (Robot for Interactive Body Assistance) which has been developed by RIKEN and Tokai Rubber Industries and assisted hardware, for example, HAL (Hybrid Assistive Limb) robot suits conveyed by Cyberdyne.8) Artificial Retinas: The United States commonly characterizes somebody as legitimately visually impaired when the individual’s focal vision has degraded to 20/200, or the individual has lost peripheral vision so he sees less than 20 degrees outside of focal vision. Typical vision is 20/20, and individuals can see up to 90 degrees with their peripheral vision. An expected, 1.1 million individuals in the United States are considered lawfully visually impaired.This has prompted organizations like Nano-Retina to build up a complex and exquisite solution intended to reestablish sight of individuals who lost their vision because of retinal degenerative sicknesses. The small scale Nano Retina device, NR600 Implant, replaces the functionality of completely or partially damaged photoreceptor cells of eye and makes the electrical incitement required to initiate the remaining healthy and fully functioning retinal cells.9) Anti-Aging Drugs: The fantasy, day dream or a nightmare about long life or immortality, however you take it, might become slightly possible in future since Anti-Aging drugs will give you possibilities of living till 110s and 120s. In the year 2016, there was anti-aging drug test that reached to its trials and there were possibilities that these trials could see sicknesses like Alzheimer’s and Parkinson’s consigned to ancient history. Researchers now trust that it is quite possible to stop old age and help them live healthy into their 120s.10) Tooth Regeneration: This could be really very surprising and helpful advancement in healthcare if technology can actually bring answers to the tooth regeneration mystery. Brilliantly colorful fish found in Africa may hold the key to developing lost teeth. In a community oriented study between the Georgia Institute of Technology and King’s College London, specialists research on cichlid fishes of Lake Malawi in Africa, who loses teeth just to have another one slide into place. Their study, published in the Proceedings of the National Academy of Sciences, recognizes and highlights the qualities responsible of developing new teeth and may prompt the key to “tooth recovery” in people.11) Light bulbs that Disinfect and Kill Bacteria: Hospitals are known to be potentially harmful and dangerous place with so many individuals with various illnesses and bacteria. Indigo-Clean has now developed an innovation utilizing light that ceaselessly sterilizes nature, disinfect the environment and reinforces your present disease prevention efforts.12) Medical Wearables And Devices With Long Lasting Batteries: The requirement for power is a primary concern. Pacemaker batteries are regularly replaced after a costly surgery. With the help of technology, it will be possible for batteries to get speedier charging and they will last long which will cut the cost of battery supplies as well.13) Stem-cell Reconstructive and Plastic Surgery: Stem-cells have received the spotlight recently. However, there were some senseless and fraudulent claims of stem cell reconstruction in the past few years. After a long haul, there are finally some genuine and officially approved applications of stem cell reconstruction and plastic surgery that begun to surface in various fields.14) Augmenting Human Abilities: Perhaps, the most impressive show of healthcare innovation advancement is the video presented by Les Baugh who was controlling prosthetic arms with his mind. Through broad research, in the matter on how Les’ mind controlled his limbs, analysts could decide how mind dealt with these connections. With the help of that research, they could build up an innovation that would read his cerebrum movement and send the signs to limbs that finally controlled the engine elements of his prosthetic limbs.15) Health Informatics: More than half of US clinics utilize some sort of electronic records framework, however just 6% of them actually follow all the government orders, as indicated by a current survey of the University of Michigan. As indicated by scientists at the University of Chicago, half of medicinal services dollars are wasted on unnecessary record keeping forms. Electronic records have been appeared to save substantial amount of $37 and $59 million if large hospital follows right health informatics. It streamlines the therapeutic care process and brings down malpractice claims, and expands coordination between suppliers.
Factoring is when a business sells its receivables for a service or product delivered to another business. Many people in the healthcare industry think that medical receivables can’t be factored because the “customer” is a person and not a business. But medical receivables can be factored because in most cases, your payment comes from Medicare, Medicaid, Blue Cross/Blue Shield, Aetna, etc. In other words, the payment is coming to you from a business, so the receivables CAN be factored.In the past, healthcare professionals could depend on efficient operations to keep
their cash flowing, but that often is not enough now. Increased costs and longer
times for insurance companies and Medicare to pay the bills are making it
impossible for them to keep their practices running smoothly.Most factoring companies do not factor medical receivables, but there are several
that specialize in this niche. They fully understand that accounts that are paid by
third party payors take more due diligence and more things have to be looked at
than with “regular” factoring. They know these receivables are filed and paid
differently by different states and then have elaborate payment methods and
computations. There are government and insurance regulations, delayed
reimbursements, HMOs, contractual allowances, multiple payors and many more
challenges that are only found in the healthcare industry. The factors who specialize
in your industry know all the lingo and terminology and will immediately understand
your needs.The healthcare businesses that will most easily be approved for factoring are: Acute
or Rehab or Specialty Hospitals, Physicians, Surgery or Imaging Centers, Dialysis or
Urgent Care or Rehab Centers, Ambulance companies, Medical Labs, DME/HME,
Osteopaths, Oral Surgeons, Pharmacies, Home Health Care and Workers Comp
Healthcare Providers and some Chiropractor groups.There are certain types of health related businesses that might be more difficult to
factor, mostly because the net collectable value from the private insurance
companies or government is too small each month for a factor to be interested.
These are small chiropractors, dentists, cosmetic surgeons and Lasik doctors (often
not covered by insurance) and some nursing homes because of credit problems.Medical receivable factoring companies all have different minimum monthly net
collectable amounts, so ask your broker for the one that will be able to help your
business. Some work with amounts as small as $35,000-$50,000, others have a
minimum of $200,000.Once your account is set up with the factor, you will receive up to 85% of the
invoices within hours of turning them in each week. When the bills are finally paid,
you will receive the rest of the amount owed, minus a small fee. The fee depends on
many things and will probably range somewhere between 2% and 6%.You will lose all the stress of not knowing when you will be paid for the work you
are doing. You’ll be able to pay all your vendors and staff on time, you’ll be able to
keep up with all your bills. You will even be able to hire more staff or buy more
equipment, because you’ll know you can accept more business.There have been instances when a medical business has been on the brink of
bankruptcy and decided to try factoring as a last ditch effort and it saved them.
They were able to turn everything around and are thriving now.Factoring should be considered as a tool for growth and management, not as a last
resort to save your business. Unless your practice has very expensive equipment or
diagnostic devices, your largest asset is its accounts receivables and these assets
can be used to keep your business running smoothly and growing.
A home based business that caters to healthcare needs can achieve strong growth. The growth of personalized healthcare and round the clock medical services has not been impacted by recession.Healthcare offers high business potential as it can render wellness products and services to millions of people. It can provide financial security through a successful business model.Demand for Medical Services: The current healthcare system is under tremendous stress to meet the increasing demands for primary geriatric care. A high percentage of the baby boomer generation is expected to head to retirement this decade. The increasing preference for primary care at home among the elderly has further pushed up demand for medical services. It is said that more than 10 million people in developed nations are to become seniors by the year 2020.The medical expertise provided can vary from non medical for assisted living services. Non medical services provide assistance for comfortable stay at home for the seniors. An assisted living facility provides passage for shift in stay for those unable to live at homes. The profit margins with the above business opportunity are growing tremendously.Healthcare Products and Profits:Healthcare products of home based business can extend beyond vitamin supplements. Antiaging products, calorie drinks and cosmetics find strong appeal with the health conscious population. Natural health beverages with ayurvedic products that work against stress and general ailments are popular. Certain healthcare companies offer opportunities for executives and franchises to sell their product.Low cost home based business can be initiated by taking advantage of the opportunities offered by many such companies. Product information can be gained for a nominal amount through coaching centres and teleconferences.Business and Marketing Potentials:Neighbourhood networking can help identify the potential distributors for healthcare products and you can strategically join hands with them and earn regular commissions. Sales training and lead generation skills can be learnt though business training programs offered by product companies.An independent distributor program can be undertaken for wellness products which are developed by professionals. Enrolment as a dealer for new calorie drinks and herbal products can negate the difficulty of working in a saturated environment.Dealers can promote and place orders for their products from home though a provided back office URL. Consumers can place orders through the dealer’s website to earn reward points and bonuses with discounts. Marketing needs of a healthcare business can be attended through distribution of wellness information, press release and educational data.
Just as with our current economic meltdown, we should have seen our healthcare crisis coming. America has the most expensive and yet not the best healthcare in the world. Certain forces have been at work to create this perfect storm. While plans have been proposed to increase access to health insurance and streamline information sharing by digitizing medical records, government has failed to identify some elephants in the room that need to be addressed.LitigationWhat distinguishes American healthcare from that of all other first-world nations is the prevalence of litigation. Medical tourism is burgeoning because patients recognize its enormous cost savings. The same surgery done abroad can be one-tenth of the U.S. price. Absence of potential litigation accounts for the difference. The cost of drugs in general, and vaccines in particular, are astronomical because litigation has been factored into the price. Physicians in America order far more tests than those in other countries because of the fear of litigation. Any effort by congress to control healthcare costs must begin with tort reform. There has to be a cap on malpractice and adverse drug effect settlements. Any new government sponsored insurance needs to require arbitration in lieu of litigation.The Pharmaceutical IndustryYears ago, President Dwight Eisenhower warned the nation to beware of the military-industrial complex: the industry of war fuels the need to have more wars. A parallel can be seen in the pharmaceutical industry. Continual drug development with escalating cost is a self-perpetuating phenomenon. Antibiotic resistance is the pharmaceutical industry’s best friend. New antibiotics with increasing potency are constantly being developed to overcome drug resistant bacteria. As soon as a new antibiotic becomes marketable, drug sales representatives generously supply doctors with the new drug. This drug should actually be used sparingly and for specific drug resistant infections, but because of the convenience, doctors frequently give away and prescribe the new antibiotic, it becomes widely used, and the result is more drug resistance requiring even newer drug development. Somehow, this kind of drug overuse has to be controlled.The U.S. is the only country in the world that allows drug advertising. Choice of drugs should be left to the treating physician without the pressure of patient demand for the newest and most expensive version. Many new drugs are “me too” drugs, just slight modifications of older tried and true drugs. The difference is in cost, not efficacy. Advertising for non-prescription drugs constantly reinforces the notion that the only answer to any discomfort is a drug, a notion that has become as American as apple pie. Because of widespread advertisement, Americans unthinkingly take nonsteroidal antiinflammatories, which have potential serious side effects such as gastrointestinal bleeding and kidney failure, for such non-life-threatening conditions as the common cold. Risk outweighs benefit in these cases. We need to revert to banning drug advertising.Physician Behavior and TrainingAmerican physicians habitually order more tests than are necessary. Clinical guidelines based on research have helped assuage this wasteful behavior. For instance, years ago, research found that routine chest X-Rays were of no benefit for annual physical exams. Similar guidelines have been established for taking X-Rays for ankle sprains. Finding what are the most unproductive tests and establishing national guidelines for when to use them could help bring down cost.The price of our technological progress is the loss of clinical skills among the current generation of physicians. In an article entitled The Demise of the Physical Exam (Jauhar 2006), the author, a professor of medicine, expresses the prevailing view among today’s physicians: that the physical examination is “an arcane curiosity,” performed as a ritual that preceded their real tool for problem-solving– technology. For centuries, doctors have been taught to begin with a thorough history and physical examination followed by tests to finally arrive at the final diagnosis based on the total information gathered. The current method virtually eliminates the initial steps. Doctors perform a cursory history taking and physical exam, and then order the tests related to the patients’ symptoms to obtain a diagnosis. With this method, I have witnessed not only excessive waste from unnecessary tests but also the misdiagnoses of common conditions such as small bowel obstruction, congestive heart failure, and appendicitis. This sea change in medical practice constitutes one major reason why American healthcare has become so expensive and yet less than satisfactory. There is a dire need to retrain physicians to return to basics. And the need is urgent because the medical trainers are losing the very skills they should be teaching.Over half of the American public recognizes that the Western medical approach has limitations and seeks complementary and alternative care. Skeptics among the medical establishment scoff and explain away the trend by saying that these patients “weren’t very sick to begin with.” What they fail to recognize is that Western medicine, while having advanced treatments for advanced diseases, have far fewer remedies for early-stage disease, or, the “not very sick.” Traditional Chinese medicine teaches that illness begins with some dysfunction in the host that causes him or her to succumb to disease. Unlike the Western approach, which focuses only on disease, Eastern medicine also strives to restore the patients’ weakened function to regain health. Familiarity with this approach among primary care physicians could not only bring down healthcare cost but also enhance physician satisfaction with work. If the physician prescribed herbs for the common cold, there would be fewer cases of bronchitis, the leading condition for which antibiotics are overprescribed. If acupuncture or acupressure were first-line treatment for back pains and soft tissue inflammation, patients would improve. This would lead to fewer MRI’s ordered and fewer surgeries performed. If acupuncture and herbal therapy were first-line treatment for infertility, it would eliminate the enormous cost of in-vitro fertilization in many cases. In the past decade, the insurance industry has begun to recognize that some forms of complementary care obviates far more expensive treatments such as surgery and are adding them to its covered benefits. It is time for government-sponsored insurances to awaken to this fact.In the past decade, the number of medical school graduates entering family medicine and internal medicine training has dropped by half. The shortage of primary care doctors has led patients to overuse costlier secondary and tertiary care facilities such as emergency rooms and hospitals. Several factors account for physicians’ disenchantment with primary care. Compensation is low when compared with specialty careers. Bureaucratic paper work is daunting. Often primary care physicians are frustrated because they have no means within the Western paradigm to treat common conditions. The very reason for entering the medical profession, to help heal and relieve pain and suffering appears unachievable, and they see themselves as mere triage agents. If these physicians were able to use complementary and alternative medicine, the gratification of seeing their patients actually improve would certainly boost their level of job satisfaction.Other players are insurance and patients. The private insurance industry has recognized that prevention is more cost-effective than cure. Many offer prepaid health plans and cover routine physical examinations. Medicare, to date, retains its antiquated policy: coverage for disease and not prevention. It is time for Medicare to enter the 21st century. Patients used to pay the doctor directly for services. Now, usually a third party, the insurance pays. Now, no longer aware of costs, patients feel entitled. If they have insurance, every test and treatment should be covered. The media sensationalize such cases, portraying the patient as victims and insurance companies as demons for not covering exotic treatments that have a low prospect of cure. Such cases often result in litigation, of course, further driving up cost. It is time to educate doctors and patients alike about cost and to behave responsibly. Correct treatment requires correct diagnosis. This fundamental principle applies to finding solutions to our healthcare crisis.
Cloud computing has come a long way across various phases. Clients can utilize web-based tools or applications through a web browser just as if they were programs installed locally on their own computer. Healthinformatics the wiki of Florida State University says “The term ‘cloud’ was coined as a metaphor for the Internet which originated from cloud figures representing telephone networks, then later followed by depicting Internet infrastructures in computer network maps/diagrams.”Going back in time, we had the grid and utility computing, the application service provision (ASP), and then Software as a Service (SaaS). However, if you look back, the true concept of delivering computing resources through a global network is really rooted in the 60s. In the year 1969, J.C.R. Licklider through his article Intergalactic computer Network enabled the development of ARPANET (Advanced Research Projects Agency Network). He seemed to project a vision that everyone on the globe be interconnected and access programs and data at any site. Others give credit to computer scientist John McCarthy who proposed the idea of computation being delivered as a public utility.Since the 60s, cloud computing has evolved over a timeline. Web 2.0 being the most recent evolution. Point to note here is, the Internet only started to offer a significant bandwidth in the nineties. Hence cloud computing for everyone has been something of a recent development. If you have to trace a timeline it looks somewhat like this:1999 – Salesforce.com (delivering enterprise applications via a simple website)2002 – Amazon Web Services (providing a suite of cloud-based services including storage, computation and even human intelligence)2006 – Amazon Elastic Compute cloud EC2 (allowing small companies and individuals to run their own computer applications on a commercial web service)2007 – Google Docs (Web-based office suite, and data storage service)There are several other factors that have enabled cloud computing to evolve. These include the virtualization technology, universal high-speed bandwidth, and established standards of universal software interoperability.Increased storage, flexibility / scalability, and cost reduction are some of the valuable benefits that can be derived, as the prospect that almost anything can be delivered from the cloud, becomes more and more a reality. However security, data privacy, network performance and economics are still concerns that are being addressed through various models of cloud platform delivery such as the Private Cloud, Public Cloud, as well as the Hybrid Cloud solutions.This brings us to Cloud’s footprints into Healthcare. While, as we have seen above, cloud computing has been around for decades. Hospitals and healthcare systems only recently began to adopt the flexibility, interoperability and affordability of cloud technologies, especially as they implement plans to utilize the federal government’s $20 billion-plus Health Information Technology for Economic and Clinical Health (HITECH) financial incentive programs.The cloud computing model is very well suited to healthcare applications due to the volume and varied sources of information, that is necessary to be accessed quickly and from any location. After all you have lives at stake. Whether it is for maintaining health records, monitoring of patients, collaboration with peers, prescribing medication, even analysis of data, we will see more and more of healthcare tapping into the cloud. With more attention on the security aspects of Cloud, compliance to Data Privacy standards, advanced interoperability and data sharing, and with a proper DR in place, the cloud can have a real positive impact on Healthcare.
What role does the Drug Enforcement Administration (DEA) have in patient healthcare? Is DEA involved with your physician’s medical practice or does DEA simply track prescription drugs? Why does DEA investigate and prosecute some doctors? What does DEA look for and how are they scrutinizing the professional activities of healthcare providers? Unfortunately, many physicians as well as patients do not understand DEA’s role in healthcare. Physicians know they receive a DEA registration number to prescribe controlled substances, but then what? DEA is responsible for enforcing the Controlled Substances Act which encompasses scheduled pharmaceuticals. DEA enforces and investigates a variety of medical business activities which are involved in the prescribing process.As a recently retired DEA Assistant Special Agent in Charge, I have first-hand experience investigating physicians and other healthcare personnel. As a DEA investigator, I would launch investigations into medical practitioners who prescribed controlled substances without a legitimate medical purpose and outside the usual course of professional practice. While prescribers understand the initial need to register with DEA for prescribing rights, there is a lack of training and information regarding best practice measures from a DEA regulatory standpoint. This leads to problems between physicians and DEA, but can also lead to problems between physicians and their patients when prescribing narcotics for pain.A fact few people know is there is a direct link between prescribing opiate pain-killers and heroin use. The explosion of the heroin abuse epidemic is a direct result of the abundance of prescriptions that have been written for opiates or “pain-killers” over the past two decades. Due to the stringent controls and the negative media attention placed on the abuse and diversion of opiate medications, practitioners have become reluctant to prescribe them, even when prescriptions may be warranted. This exemplifies a misunderstanding of DEA’s role and federal regulations. After talking with physicians throughout the country, I have determined there is a gross misunderstanding and overall lack of knowledge regarding what activities may trigger a DEA investigation. As a result, physicians may not prescribe legitimately justified opiates in fear of being investigated. Patients are thereafter turning to the alternative of heroin to manage their pain. As a result, the number of individuals with addictions is growing and people are dying.Physicians can protect themselves by taking the appropriate steps and measures during the course of patient treatment. Some physicians question DEA’s expertise in medical treatment. How do DEA investigators determine the best course of treatment if they are not doctors themselves? To ensure DEA does not impair medical treatment but also identifies illegitimate prescribing, medical experts are retained during investigations and often testify on behalf of the government. The medical experts review the treatment methods and patient charts to establish if the controlled substances were prescribed with a legitimate medical purpose.I am confident additional training in DEA Regulatory Policy can help physicians remain compliant and ultimately result in better care for their patients. DEA does not direct physicians how to practice medicine, but rather ensures prescribers are completing steps necessary to justify prescribing controlled substances. This is one of the primary roles DEA has in patient healthcare. DEA works to ensure medical practitioners are prescribing narcotics responsibly and in accordance with Federal regulations, for their safety and the safety and well-being of their patients.
The current healthcare reform debate must bring up some bad memories for former President Bill Clinton. He, with the help of then-First Lady Hillary Clinton, tried to enact their own bill to reform the health insurance industry early in his first term. Their attempts failed to receive enough support from his party and failed; the Democrats then suffered a humiliating defeat in the 1994 mid-term elections. Yesterday, he visited the Senate to encourage the Democratic party to vote in favor of reform. His primary hope is that President Obama and congressional Democrats don’t repeat his mistakes; namely, a legislative process that continued to drag on.Clinton told the senators that it is imperative that the current combination of tens of millions of uninsured people and expensive health insurance plans must change as soon as possible. While he didn’t touch on specifics, such as the public option or the amendment that bans abortion coverage from subsidized health insurance, Clinton implored them to not let the perfect be the enemy of the good. From his experience, he came to believe that it would have been better if Democrats had passed some form of healthcare reform in the early 1990s–even if it wasn’t ideal–as opposed to allowing the problems to fester for the past decade-plus. Some are worried that it is far harder to modify a law once it’s in place, as opposed to amending it on the legislative floor. Their concerns are valid, but Clinton warned them of his own travails.So far, important Democrats have been following Clinton’s strategy on health insurance. Speaker of the House Nancy Pelosi had representatives working a rare Saturday night shift in order to get the bill passed, and included several compromises. Meanwhile, Senate Majority Leader Harry Reid has vowed to have passed a reform bill by Christmas. Ever since the inauguration, the Obama administration has pushed Congress to get a healthcare reform bill on his desk and signed by the end of this year, even to the detriment of other domestic priorities like the recession. Clinton claims that successful reform will actually help the economy, by decreasing the crushing cost of a health insurance plan for many Americans. Presumably, consumers could then use the money they save on premiums for spending, thereby increasing our GDP. However, Republicans are planning to debate the healthcare reform bill for as long as possible, for weeks months if necessary. It is somewhat suspicious that supporters want to move such important (and long) legislation through Congress so quickly. Some legislators have even failed to read the nearly 2,000-page bill–although maybe their aides have.Will Bill Clinton’s speech help get healthcare reform passed? He is a polarizing figure, but is greatly respected and admired among his own party. Negotiating the release of two North Korean hostages earlier this year proved that he still has political clout with the general public. His own attempt at reforming the health insurance industry gives him the ability to give helpful advice on the pitfalls; however, his baggage gives conservatives more ammunition in their fight against reform. In Clinton’s era, Republican groups and health insurance providers were successful in scuttling healthcare reform by claiming that it will negatively impact Americans’ existing health insurance plans –the famous “Harry and Louise” ads are a case in point. Back then, Clinton was also more adamant about enacting a single-payer health insurance plan, which allowed opponents to stoke the public’s fears of socialized medicine and governmental takeover. This time, such a comprehensive government-run program is a non-starter, but even the scaled-down public option (for the uninsured and those with pre-existing conditions) is untenable for many. They are again threatening the seats of conservative “Blue Dog” and moderate Democratic politicians. Both sides learned lessons from the last healthcare reform fight; the only thing that remains is who will win this time.