Can Transparency Improve Consumer Value?

A new study from Health Affairs discovered that consumers may be more likely to purchase a health plan that cost them more money.

Wait, what?

The study’s results imply that consumers shop for healthcare in the same mindset they use for everyday purchases: the more expensive something is, the more value it has. Unfortunately for those consumers, that isn’t necessarily the case. In healthcare, it seems, value and cost are rarely the same thing.

The Health Affairs survey was designed to test the theory that consumers would make better choices about healthcare, if they were provided with more helpful information. 1,421 employees were presented with varying formats of information about available health plans. In a “substantial minority” of responses, employees chose more expensive plans, stating that they believed the higher cost meant a higher quality plan.

Health care consumers want to visit high-quality doctors and hospitals, and many public report cards are available to help them compare providers. However, few report cards include information on cost, and there has been little scientific evidence to guide the presentation of that information to help consumers choose high value providers.

The conclusion Health Affairs came to, was that reporting the quality of a health plan is as important as reporting its cost. When those same employees were presented with information reporting on both aspects, they almost always tended to choose higher-value plans, rather than more expensive ones. This push toward transparency may be the key to helping consumers understand healthcare. Do you think it’s a step in the right direction, or does more need to be done?

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

New Medicaid Enforcement Worries Hospital Doctors

Some states are seeing an increase in a disturbing trend: Medicaid officials are denying coverage for emergency department visits because the final diagnosis of those patients is not considered to be an emergency situation. On paper, the concept makes sense. Why would Medicaid cover a patient going to a hospital for heartburn? The reality, however, is quite different.

For instance, a patient who comes to the hospital complaining of chest pain may be discharged with a diagnosis of heartburn. Medicaid could deny payment to the hospital for treatment of that patient based on the non-urgent diagnosis, even though a physician wouldn't know the chest pain is heartburn and not something more serious, such as heart attack, when he or she first sees the patient…

Medicaid is strapped for cash at the moment, and these decisions are a direct result of it. And while that is obviously a much bigger issue, we are already starting down a slippery slope. Now, hospitals are being forced to second-guess the handling of patients that exhibit symptoms shared by life-threatening and non-threatening conditions. According to Med Page Today,and an ACEP report, Medicaid is making these rulings based on the Billings algorithm, which Billings himself said was never intended to be used for this purpose.

It’s clear that something must be done to improve this situation, but what?

Obviously, hospitals want these new rulings to disappear. They’re currently working with patients under the looming threat that Medicaid payments won’t be approved. They are frustrated that Medicaid officials expect a patient to enter the emergency room with a diagnosis in hand – an obvious impossibility.

Meanwhile, Medicaid is desperate to cut spending, and denying emergency department payments for non-essential treatment seems like an easy fix. However, Medicaid has still done very little to address the ever-present (and growing) issue of fraud and overpayment.

What seems like the best solution to you? Should either side back down? Does the answer lie somewhere else entirely? Tell us in the comments below, and we’ll consider your responses in a future blog post.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

How Health Professionals Succeed at Social Media

We’ve often spoken about the health industry adopting social media, and now it seems that someone has been listening to those calls. Docs are flocking to social media in record numbers, outpacing other American adults by up to 22%. Now that they’ve arrived, however, it seems that there is some dissension on what to do with it.

Patricia Redsicker, a social media professional, looked at three well-known physicians to see how they were handling their online presence.

While they’re all very professional, both Dr. Oz and Dr. Rankin show a more like-able side on Facebook, while Dr. Gupta hardly gives his fans a chance to get to know him. However on Twitter, he is extremely personable, chats with people and seems to ‘listen’ to what others are saying as well.

Redsicker found very little variation between these well-known online presences, but we think she didn’t go deep enough. These doctors, though all experts in their own right, are more celebrity than professional at this point. We were curious to see what health workers at the lower ranks were doing with their new-found social media profiles.

Most of the professionals we located used what Kevin Pho, MD refers to as the ‘dual-citizenship approach.’ By maintaining a personal profile, and a professional ‘page,’ docs can enjoy the benefits of social media without risking compliance or HIPAA issues. Patients and colleagues would connect with the doctor through their professional page, while their family and friends could converse separately on their personal profile.

Other docs preferred a more drastic angle, opting instead to avoid a personal presence entirely, using their personal profile as their sole professional gateway. To us, it seemed that those docs utilizing the dual-presence system were almost universally more successful.

At the end of the day, social media is about creating a personable, but controlled, presence online, and we think that the dual-citizenship approach is more successful  for that purpose.

Are you a medical professional using social media? Tell us below how you handle the delicate issue.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Can We Afford To Cut Medicaid?

It’s a hot-button issue, with passionate opinions and research on both sides: Will Medicaid budget cuts be the solution to the nation’s healthcare cost problem? In our last blog, we introduced the reasons behind the sudden interest in Medicaid, and hinted that we’d be spending more time investigating the most significant arguments on either side. Today, we’ll do just that, and then put the question to you.

Those in Favor: Cut Medicaid, or risk everything.

The state of Illinois is being elevated to the top of the Medicaid debate, with Governor Pat Quinn suggesting a drastic $2.7 Billion cut to the program this budget year. It seems like a dramatic gesture, but in thisDaily Herald interview, Quinn argues that the alternatives are far worse.

Aides say Quinn will suggest trimming projected Medicaid spending by $2.7 billion in the budget year that starts July 1. If they don't, aides warn, a backlog of unpaid bills that already stands at $1.9 billion will grow so large that doctors, hospitals and pharmacies may cut off services because the state can't pay for them.

"This is not something that we can blithely delay for another year," said Michael Gelder, Quinn's senior health care policy adviser. "We really fear the collapse of the program if that accounts payable balance grows by another penny."

Among the budget cuts are reduced payment rates for doctors, hospitals, and pharmacies, as well as more uniform health coverage, such as limiting eyeglass replacement to once a year.

Those Opposed: Don’t put our well-being at risk.

For many Medicaid-dependent families in the United States, the idea of budget cuts is a living nightmare. “The reality is that as hospitals would be forced to lay off staff, patients would face longer wait times and distances to receive intensive care as well as cutbacks in services,” says Parish Medical Center’s George Mikitarian. “We know this from experience, since last year, $500 million in Medicaid cuts led to major job cuts, with many hospitals reducing access to primary-care clinics, OB/GYN services, skilled nursing units and outpatient chemotherapy services.”

Several activist groups have formed in Florida, where citizens fear their family doctors will be pushed out of the state in search of better payments. Florida’s proposed budget cuts were inspired by a $2 Billion loss in revenue, leaving the state unable to pay healthcare costs.

So we are left with an unpleasant situation. Regardless of the final decisions made, someone will be losing out. The question is, which solution will result in the best opportunities for the citizens of the country? Tell us your opinion in the comments below.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Is Medicaid Getting the Axe?

In states across the nation, Medicaid funding is getting chopped in efforts to improve floundering government budgets. Among the most staggering cuts are those in Maine, which will remove $220 million from the Medicaid budget. Is this a solution that has become unavoidable?

Maine’s proposal comes on the back of bipartisan support at the congressional level. Experts insist that Medicaid has taken harder hits than this in the past, and that “The size of Maine’s Medicaid shortfall is substantial, but it pales in comparison to gaps in many other states.” In fact, Illinois is looking at closing a $2 Billion hole this year.

According to senators supporting the cuts, Medicaid has had this coming for a while. “Senator Syverson says Illinois has allowed people to collect Medicaid even though they don't meet the income requirement,” reads one article fighting for reform instead of cuts. “[They] aren't residents of the state, and some people even collect Medicaid under multiple names.”

Reform is on the top-of-mind in Maine, where Republican Governor Paul LePage calls for an end to “free lunches” for healthy young adults taking advantage of the system.

But LePage also wants to get at enrollment, and this is what makes him, at the moment, the most draconian of the governors when it comes to health policy. In his Jan. 24 state of the state speech, LePage argued that “we have encouraged people to rely on the taxpayers, rather than rely on themselves.” The cuts to enrollment, he argues, are necessary to shore up the state’s safety net so it can continue to care for its most vulnerable residents — children, elders and the disabled.

We’ll follow up, in our next post, with some more of the strong arguments for and against Medicaid cuts.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Inspiring Story Raises Questions About Health IT Costs

Evelyn Castle and Adam Thompson, two philanthropists in Nigeria, have been toiling to introduce new technology to needy hospitals in the African nation. The facilities, some of which see up to 50 births a day, are not equipped to handle the amount of data collection and storage that is necessary for an operation of their size. Previous efforts to introduce modern technology to these hospitals failed in the past, because the workers are not familiar enough with the tech to make use of it.

 “The people that are using our system are not exactly the most educated of people; a lot of people have never used a computer before. We have to start them with, how do you use a mouse,” Castle says. “Introducing a Microsoft or a Kaiser platform is not going to work for them. The software we use is a lot more simplistic and a lot more user friendly.” And for an NGO (non-government organization) like eHealth Nigeria, it doesn’t hurt that OpenMRS is free.

OpenMRS used in Kaduna, Nigeria

OpenMRS is an open source health records system, designed to be used by health facilities in underdeveloped countries. The software is extremely simplistic, easy to pick up, and completely free. Wired Magazine, who interviewed the innovative pair, has more information about their efforts, but we are more interested in the ramifications of this type of IT breakthrough.

Like the generic pharmaceuticals of the IT world, open source software provides IT solutions for problems that traditionally have large price tags. In addition to being a costless platform, open source software is also flexible and customizable; facilities can have the code altered to meet their specific needs.

OpenMRS has an impressive list of features, for free software, though it lacks some of the bells and whistles that modern hospitals would be used to. And, while it may be the perfect solution for around a hundred facilities, it likely can’t hold up on the scale of larger hospitals. Most interestingly, however, is the fact that the recent HHS competitions to revitalize Health IT development may be headed in the open source direction.

If the overall goal of re-inventing health technology is to save money and improve efficiency, doesn’t this type of software seem like a good option?

Does your facility use any free or open source software? We’d love to hear about it. Leave a comment below to tell us about your experiences.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Will Prize Incentives Be Enough to Improve Healthcare?

As part of an attempt to bring about improvement and innovation in healthcare, Health and Human Services has launched the aptly-named Investing in Innovation (I2) Initiative. The core of the initiative is a series of challenges that ask software developers to solve a standing problem in the health industry.

The first challenge, which concluded in December of 2011, sought to solve the sometimes rocky transition from hospital to home. The challenge requirements were extensive, but nevertheless, it was tackled by a large number of developers. The winning solution, Axial Transition Suite, serves as an interface between patients and caregivers, allowing both parties to easily communicate and monitor the post-treatment process.

HHS’s second challenge was announced at this week’s Care Innovations Summit. This time, developers are tasked with providing a solution to the tricky process of scheduling post-release follow up appointments. This is an important part of the treatment process that many at HHS feel is too often ignored.

Without question, this is one of the most ambitious moves by HHS in some time, and the introduction of consumer-focused challenges is sure to raise awareness about some of these problems. So far, the initiative has had a solid response, but winning solutions have yet to be implemented.

Tell us in the comments below, if you feel that the I2 Initiative has the potential to answer any of healthcare’s biggest problems. Have you participated in any of the challenges? We’d also love to hear about your experience and solutions!

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Healthcare Needs to Embrace Social Media, But With Caution

“I won't tell you that you have to join Facebook or set up a Twitter account,” says ECRI Institute Director of Risk Management Publications Paul Anderson, “but your patients and staff are using these tools.” In the above video, Anderson explains that there are risks involved in adopting social media in the health industry, but the benefits far outweigh any privacy concerns. Community outreach, patient support, communication, and education are some of the biggest topics in the industry, but ECRI’s recent report, Social Media in Healthcare, found some deeper information as well. We’ve summarized some of ECRI’s findings in today’s blog, but the full report can be found here (free registration required).

What Are Health Facilities Doing in Social Media?

Perhaps the first thing to look at in any conversation about your business is, what are our competitors doing? The answer to that, as far as social media goes, is apparently, ‘a lot.’

ECRI’s report found that, as of June 2011, there were 3,952 social media sites for hospitals in the U.S. That includes 1,018 Facebook pages, 137 blogs, and 548 YouTube channels. YouTube has traditionally been a popular channel in the health industry, because video lends itself well to education and community outreach. Most of the information shared on these channels centers around

• Organizational news and services
• Sharing general news
• Community events
• Success stories and
• Customer outreach

It’s Not Just About Marketing.

Of course, a large part of social media is advertising, but in the health industry, there are far nobler purposes behind the push. The ECRI report contains an in-depth look at some of the more common examples, and references a list of 140 uses for Twitter, which include

…recruiting blood donations, communication during disasters, weight management and support, epidemiological tracking, arranging outpatient care, realtime satisfaction surveys, averse event reporting, and food and product safety alerts.

So, What’s the Plan?

The first step in adopting a social media strategy, according to ECRI, is to plan, plan, and plan. Every aspect of your social presence needs to be clearly defined from the outset, in order to ensure that you are less likely to fall victim to privacy or compliance failure. ECRI also stresses the importance of introducing social media training into basic HIPAA Compliance Training. As the world moves further and further into a tech-oriented landscape, it’s a point we can’t help but agree with.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Health Execs Ignore the Biggest Pot Hole on the Road to the Future

Healthcare Reform may be the single biggest issue on the horizon for the health industry, but health executives seem to be planning on simply driving around it. According to a recent survey from Towers Watson, reform is the last thing on these execs’ minds.

The Towers Watson survey presents some very interesting statistics, and they all point toward the same conclusion. Health execs are aware of impending reform changes, and they know that the future of the industry will be drastically changed in the next three years.

For example, fully 93% expect cuts in reimbursement levels, and 67% anticipate a shift in the payer mix, with fewer private payers. Just over three-quarters (77%) agree they will need a wider range of skills among their staff. And three-quarters (75%) expect a higher ratio of outpatient to inpatient care, as well as an increased need for primary care capabilities.

However, on the lower end of the survey, the results show how little effort is being put into developing strategies for dealing with these changes.

In terms of their top three greatest business challenges over the next two to three years, respondents cited managing costs (72%), improving quality of care (56%) and managing changes in the payer mix (25%). Far fewer, though, cited collaborating with local providers on community health and wellness services (18%), arguably a critical focus for the future.

What do you see as the primary motivations behind this lack of interest? Do you think the executives are running on a play-it-by-ear mentality? Are they just waiting to see what everyone else is going to do? Tell us your opinions in the comments, and we may respond to some of your ideas in next week’s blog!

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Stock photography by brunette808-STOCK. Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

What Will Healthcare Look Like at the End of 2012?

There is a lot in the health care industry riding on June’s Supreme Court ruling, but the Affordable Care Act isn’t the only thing affecting the future of health care. Looking at continuing trends from 2011, and input from some of the internet’s best medical IT writers, here are five big topics that will dictate the fate of health care throughout this year.

There will be an increase in social media, and social media compliance risks.

Unfortunately for the medical industry, new technologies and compliance breaches go hand-in-hand. 2011 saw a rapid growth in medical professionals using social media for promotion, education, and awareness, and their successwill lead others to follow in their example. As that experimentation continues, mistakes are inevitable.

Technology is growing faster than compliance.

As we’ve reported in the past, Health and Human Services is moving too slowly to keep up with the technology that medical facilities are using. Nothing seems to show that this trend will change over the next twelve months. Over 2012, health facilities should be extremely careful, and should make every effort to triple-check that their efforts are remaining compliant. Any outsourced data or work should be handled by compliance experts.

Artificial Intelligence will improve health diagnoses.

“Siri and IBM’s Watson are starting to be applied to medical questions,” says Daniel Kraft M.D. of Singularity University. “They’ll assist with diagnostics and decision support for both patients and clinicians. Through the cloud, any device will be able to access powerful medical AI.” Cloud computing, Big Data, and AI’s are working together to bring about huge improvements in the way physicians look at and interpret medical data. We expect more effort to be put into rigid controls and compliance in this field, so the industry can make better use of it.

Electronic Medical Records (EMR) will likely go extinct.

Despite creating massive shockwaves in the early part of 2011, the very legislation that created them is most likely going to end them. TechTarget’s Brian Eastwood explains that “…while an EMR does let a physician track patient data and improve his or her care quality, it's an electronic health record (EHR) that can be shared among caregivers and accessed by patients. Given the emphasis that's expected to be placed on data exchange in meaningful use stage 2, don't be surprised to see EMR technology go the way of the dodo.” Along with EMR’s, Eastwood expects HIS and CIS tech to be replaced by the end of the year.

3D printing will become crucial in the medical field.

What started out as a fabrication tool is already making waves in the health industry. In theory, a computer system with a 3D printer could be capable of crafting perfect prosthetics, or even stem cell-based replacements, for damaged skin or limbs. “In the future we’ll probably use 3Dprinting and stem cells to make libraries of replacement parts. It will start with simple tissues and eventually maybe we’ll be printing organs.”

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Health Technology Critics Are Missing the Point (Part 2)

Modern smart devices effectively put personal computers in the pockets of a hospital’s entire staff. Along with that convenience comes the siren call of workplace distractions. It is all too easy to whip out a phone for a quick text, a few Facebook posts, and a round of Words with Friends on the job. While that may not be the end of the world in other office positions, a poorly timed conversation in healthcare could be the difference between lifeand death.

A recent email blast from Plexus Institute entitled "Do Electronic Devices in Health Care Present New Risks for Patient Safety" resonated with me on a very deep level, confirming suspicions gathered from informal conversations across the country. Fifty-five percent of perfusion technicians admitted having cell phone conversations while monitoring machines--and half had texted during surgery. Then a New York Times story by Matt Richtel highlighted a malpractice case in which a neurosurgeon made more than 10 personal calls during surgery to family members and business associates.

Phone calls during surgery? Texting while checking on patients? Those seem like fairly large red flags begging for regulation. As it turns out, those regulations already exist, they just aren’t enforced. “Managers are noticeably absent from the front line. It happened very slowly over a long period of time; their workload increased and changed, demanding that they spend more time in meetings and their offices,” says Hospital Impact’s Kathleen Bartholomew. “While most hospitals have a policy regarding the use of technology for personal reasons during work, very, very few actually enforce that rule…If it's not enforced, then it's not a rule. It's the norm.”

This is yet another case where simple education and enforcement would make the world of difference. Social media, if handled in perfect conditions, could provide medical professionals with the opportunity to communicate large concepts in real-time. Physicians could provide the medical advice that consumers are looking for, but accurately. They could share updates, pharmaceutical recalls, and outbreak information in a timely way.

There are plenty of good arguments against new technologies, but at the end of the day, it comes down to using technology in the best possible way, not just sweeping it under the rug.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.