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Forbes Insights: Getting From Volume to Value in Health Care
Download this Forbes Insight Report. This is the challenge of healthcare reform in this country.
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Value-based purchasing, where cost and quality are each integral parts of the equation, is now widely seen as a replacement for traditional fee-for-service reimbursement. For senior hospital and health system executives, the challenge is getting from the-way-things-have-always-been to the-way-things-will-be without tumbling into a fiscal chasm because of the-way-things-are-now.
Getting From Volume to Value in Health Care: Balancing Challenges & Opportunities examines the issues and concerns vital to chief executive officers, chief financial officers and chief medical officers who are charged with leading their institutions on that quest. While as a group they are cautiously optimistic and endorse the goals that value-based purchasing seeks to achieve, they know that the path is neither straightforward nor obstacle free.
See on www.forbes.com
Are meaningful use incentives worth the hassle?
It’s no secret that hospitals are unlikely to recover much of the money they spend on electronic health record (EHR) implementation through the meaningful use incentive program. But experts say hospitals need to watch out for the long-term costs associated with using EHRs. If technology initiatives are not planned effectively, these expenses may quickly swamp a hospital’s finances and have a much more lasting impact than the up-front money hospitals have to pay to get systems up and running.
Methodist Health System, a Texas group comprised of six hospitals and a network of ambulatory medical offices, has implemented EHRs throughout its system and is currently receiving incentive payments. But Pamela McNutt, the system’s senior vice president and CIO, said these payments only covered a fraction of the up-front implementation costs. When the total cost of ownership of the EHR system is added up, the meaningful use incentives may not actually be all that meaningful for the system’s bottom line.
See on searchhealthit.techtarget.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
JAMA Forum: A Tale of 2 Health Plans
Consider 2 plans for health coverage.
In plan No. 1 (the ACA), the approach is to help everyone under the age of 65 years who doesn’t have insurance coverage. Everyone who is really poor is offered Medicaid. Everyone else will be put into a regulated market.
In plan No. 2 (the Romney plan for Medicare), the approach is to change the way everyone over the age of 65 years gets health insurance. Everyone who is really poor is offered Medicaid. They—along with everyone else—will also be put into a regulated market.
The differences between the end points of the ACA and the Romney plan for Medicare are shockingly similar. With enough tweaks and some serious efforts at compromise, one could be accepted in exchange for the other. The powers of both competitive bidding and regulatory reform could be used.
We could stop demonizing the other side for trying to “end America” by seeking results that aren’t much different from our own.
I’m not optimistic. It’s an election year. And despite protestations that good policy is the goal, it seems far too often that politicians care more about winning elections than about Americans winning a better health care system.
See on newsatjama.jama.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
HCA, Giant Hospital Chain, Creates a Windfall for Private Equity
Under private equity ownership, HCA made an aggressive push for more revenue that sometimes led to conflicts with doctors and nurses over patient care.
Many doctors interviewed at various HCA facilities said they had felt increased pressure to focus on profits under the private equity ownership. “Their profits are going through the roof, but, unfortunately, it’s occurring at the expense of patients,” said Dr. Abraham Awwad, a kidney specialist in St. Petersburg, Fla., whose complaints over the safety of the dialysis programs at two HCA-owned hospitals prompted state investigations.
See on www.nytimes.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Legal Implications of Physician Relationships with Medical Supply and Distribution Companies | Physicians News
Increased federal investigation into alleged inappropriate arrangements between the pharmaceutical and medical device industries and physicians has led to significant scrutiny over certain “distribution” arrangements. Most recently, physician-owned distributorships (“PODs”) have come under attack. Inspector General Levinson recently outlined plans for the Office of Inspector General’s (“OIG”) nationwide study to determine the extent to which PODS supply spinal implants to hospitals and will evaluate, among other things, the proliferation of PODs and whether they offer any cost savings to hospitals. Proponents argue that PODs can result in reduced pricing on medical devices to hospitals because of the lower distribution costs and increased quality of products, including customization. Opponents, however, argue that PODs are nothing more than a mechanism used to reward physicians for referrals. PODs are just one of several ventures that have attracted physicians in the medical device supply chain. There are a number of laws and regulations governing these arrangements.
See on www.physiciansnews.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Texas Attorney General Indicts Orthodontist for Health Care Law Fraud in State and Federal Probe
Dr. Michael David Goodwin, 63, an orthodontist who practices in Amarillo, Texas, and Crown Point, Indiana, has been charged in a federal indictment with 11 counts of health care fraud, alleging that he defrauded the Texas Medicaid program of approximately $1.5 million, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.
According to the indictment that was returned by a federal grand jury today, approximately 90 to 95 percent of Goodwin’s orthodontics’ patients were Medicaid beneficiaries. The Texas Medicaid program provides orthodontic services for Medicaid beneficiaries who fit the following criteria: 1) children who are 12 years old and older with severe handicapping malocclusions; 2) children who are up to 20 years old with cleft palate; or 3) other special medically necessary circumstances, including crossbite therapy and head injury involving severe traumatic deviation.
See on www.oag.state.tx.us
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
US Attorney’s Office – W. Dist. MO: Psychologist Pleads Guilty To $1 Million Health Care Fraud
David M. Ketchmark, Acting United States Attorney for the Western District of Missouri, announced today that a psychologist practicing in the Lebanon, Mo., area pleaded guilty in federal court today to engaging in a $1 million scheme to defraud Medicare and Medicaid.
Rhett E. McCarty, 67, of Lake Ozark, Mo., pleaded guilty before U.S. District Judge Howard F. Sachs to health care fraud and to forgery.
McCarty is a licensed psychologist and private practitioner who provided psychotherapy services to recipients of both Medicare and Medicaid in their homes in the Lebanon area.
Between Sept. 17, 2008, and April 5, 2012, McCarty submitted Medicare and Medicaid claims for daily or near daily psychotherapy services to 19 beneficiaries for which he was paid $1,276,334. Although McCarty did provide some services for most of these beneficiaries, he admitted that he did not see those beneficiaries more than once a week. McCarty also admitted that, based on an estimate of the services he did provide, the amount he was paid by Medicare and Medicaid for services he did not provide to these 19 beneficiaries was $1 million.
McCarty also admitted that he forged (or caused another person to forge) the signatures of five of the beneficiaries on patient sign-in sheets in order to obtain $418,507 in Medicare and Medicaid payments.
By pleading guilty today, McCarty must forfeit to the government $1 million, which represents the proceeds of the fraud scheme.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
US Attorney’s Office – Idaho: Caldwell Optometrist Pleads Guilty To Defrauding Health Care Benefit Progtams
BOISE – Christopher Card, 59, of Caldwell, Idaho, pled guilty in United States District Court today to a superseding information charging him with one count of executing a scheme to defraud health care benefit programs, U.S. Attorney Wendy J. Olson announced. Card is a licensed optometrist in Idaho and the former owner, manager and care provider at Total Vision, P.A., in Caldwell.
According to the plea agreement, on various dates between 1993 and August 31, 2010, Card executed a scheme to defraud Idaho Medicaid, Medicare, Blue Cross of Idaho, Regence Blue Shield of Idaho, and the Rail Road Retirement Board (RRB), by making false statements, and by submitting false, fraudulent, and fictitious claims for reimbursement to these health care benefit programs. The total loss to the health care benefit programs and the restitution agreed to by the parties is $1 million.
According to the plea agreement, Card fraudulently billed health care benefit programs, especially Medicaid and Medicare, for false diagnoses, including glaucoma, acquired color deficiency (color blindness), tension headaches, macular degeneration, treatment of eye injuries and removal of foreign objects from the eye. Card billed for testing that did not actually occur and for testing results that were falsified or altered. He admitted that in late October 2008, he altered his fraudulent diagnoses and billing practices when he learned that federal and state health care fraud investigators interviewed a former employee.
According to the plea agreement, 18 patients identified in the original indictment were diagnosed by Card with glaucoma or glaucoma-related conditions. All were subsequently examined by other doctors; only one was determined to actually have the glaucoma or glaucoma related diseases that Card had diagnosed. Card falsely diagnosed the 18th patient, and others, with acquired color deficiency. According to the plea agreement, the patients named in the original indictment were not the only patients for whom Card falsely billed health insurance companies.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Gov. Brown Calls Special Session On Health Care Reform – CBS San Francisco
Gov. Jerry Brown is telling California lawmakers that he will call a special legislative session on health care at the end of the year.
See on sanfrancisco.cbslocal.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Virginia moving on implementing health reform
Virginia has made progress in updating its computer system for verifying eligibility for Medicaid and has passed insurance regulations in preparation for implementing federal health care reform, according to a report by a nonprofit organization tracking states’ efforts.
But Virginia is behind in some key areas — it hasn’t created health insurance exchanges or marketplaces where people could buy affordable health insurance plans, and it may not be producing enough doctors to care for hundreds of thousands of newly insured people expected to be covered when reform is fully implemented.
The report, paid for by the Robert Wood Johnson Foundation, a health care philanthropy, was done by researchers at the Urban Institute, a nonprofit policy research organization, “Virginia has made significant progress in health reform implementation, despite significant political opposition in and out of the state government,” conclude the report’s authors, Linda J. Blumberg, John Holahan and Vicki Chen, of the Urban Institute.
See on www2.timesdispatch.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
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