Healthcare and 2013
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The document summarizes key healthcare topics and events from the 1st quarter of 2013. It discusses the expansion of HIPAA rules and enforcement starting in September 2013. It notes that 10% of new covered entities were selected for pre-payment meaningful use audits by Medicare and Medicaid audit agencies. It also discusses losses incurred by hospital-owned physician practices, increased RAC activity resulting in over $1.3 billion in claim denials in 2012, and the impact of sequestration cuts on healthcare spending. Finally, it provides updates on accountable care organizations and the growing trend of direct primary care and concierge medical practices.
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Privately owned physician practices have specialized in certain medical areas like heart disease, orthopedics, and spinal care. Over 30 years, their actions have led to operating outside the scope of quality patient care. Doctors were unhappy with low reimbursement rates from Medicare/Medicaid and felt entitled to higher fees. They sought to partner with private investors and operate as healthcare delivery businesses instead of under the hospital payment system to get around regulations. This resulted in the creation of sole proprietorships in medicine and led to the development of Stark Laws prohibiting physician self-referrals.
Acospin
The document provides questions and answers about the proposed Medicare Shared Savings Program and Accountable Care Organizations (ACOs). It addresses concerns about limiting beneficiary care, risk-bearing requirements for ACOs, data sharing with ACOs, and ensuring various types of providers can participate, including small physician practices and rural providers. Key points addressed include that beneficiary participation in ACOs is voluntary, strong protections and monitoring are in place to prevent limiting care, risk is intensified to better meet program goals, and options aim to facilitate diverse ACO models tailored to local needs.
Summary of Top Ten Health Industry Issues
The document summarizes the top 10 health industry issues for 2015 according to PwC's Health Research Institute. The issues include the rise of do-it-yourself healthcare using mobile apps and devices, balancing privacy and convenience with health data on mobile platforms, innovative ways to reduce costs for high-need patients, value-based payment models, expanding roles for physician assistants and nurses, and the need for partnerships and collaboration across the healthcare industry.
Accountable Care Organizations and The Medicare Shared Savings Program
Population Health Management, Enabled by Information Technology, Will Be Critical To Success. In 2012, the Centers for Medicare and Medicaid Services (CMS) will launch a shared-savings program with accountable care organizations (ACOs). ACOs that meet specified quality goals will be able to split with CMS any savings that surpass a minimum level. The challenge facing ACOs is choosing the right information technologies so they can track the health status of and the care provided to every one of their patients to produce significant savings or meet the quality benchmarks of CMS
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This document summarizes a presentation on developing patient engagement strategies to address four converging legislative initiatives in 2013: Meaningful Use, Accountable Care Organizations, hospital readmissions reduction, and hospital value-based purchasing. It discusses each initiative and their goals of improving care, health outcomes, and slowing cost growth. It emphasizes "output-oriented" Meaningful Use objectives focused on patient education and access to health information. Best practices are outlined for informed consent, pre-procedure instructions, discharge instructions, and viewing/downloading patient records.
Accountable care organizations lawrence 101211
The document discusses Accountable Care Organizations (ACOs) under Medicare. It summarizes a Medicare demonstration project that showed cost savings, which informed the development of ACOs in the Affordable Care Act. It then outlines requirements for ACOs, including structure, governance, quality measures, and a proposed rule from CMS regarding operations and reimbursement through Medicare shared savings programs.
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Chris Evert, the Chief Supply Chain Officer of Medical Technologies Corporation, must find major cost savings to offset taxes imposed by the Affordable Care Act. The U.S. medical device industry faces pricing pressures from group purchasing organizations that consolidate hospital purchases. Medical device manufacturers rely on distributors to supply products to hospitals, but distributors have narrow margins and cannot fully pass on tax increases. Large hospital systems are forming through consolidation to manage costs in a shifting reimbursement environment focused on patient outcomes rather than service volume.
WhitepaperBlockchainForClaims_V11
Blockchain technologies could be used to improve the healthcare claims process by creating a transparent, efficient system. Smart contracts encoded on a blockchain could automate agreements between providers, health plans, and patients. Patient and provider identifying data would be tokenized to protect privacy. Claims data stored on the blockchain would include a minimum of details to process claims, with links to more complete data on health plan APIs. This would allow near real-time claims processing while maintaining privacy through data tokenization and adding "salts" or fake claims to the blockchain. The system would be run through a healthcare industry consortium.
#1 Preparing for Health Care Reform
The document provides an overview of healthcare reform under the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA). It discusses key provisions including the expansion of Medicaid eligibility, establishment of health insurance exchanges, essential health benefits, and various delivery system reforms aimed at improving quality of care and reducing costs.
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The document discusses disruptive changes underway in the medical devices industry that will transform it over the next 5 years. It identifies 5 major disruptors: 1) a power shift to payers and providers who are focusing more on cost and value-based evidence, 2) heightened regulatory scrutiny that is increasing compliance costs, 3) unclear sources of innovation as R&D spending yields diminishing returns, 4) new healthcare delivery models that are shifting care settings out of hospitals, and 5) a need to serve lower socioeconomic classes in developing markets. The disruptors threaten $34 billion in industry profits by 2020 but taking appropriate measures could help maintain revenue growth and offset margin declines, preserving significant value for medical device companies.
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Historically, the medical device industry has been highly attractive and relatively stable. As a consequence, established players have been able to compete successfully across the device spectrum, applying common business models and processes without much need for differentiation.
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Advertising AssignmentPick a global product brand and co.docx
Advertising Assignment
Pick a global product / brand and country of interest to you (Do not choose South
Korea). In a 2-page report (double space), compare and contrast how that offering is
advertised in the USA and the foreign market. Please provide your thoughts pro and
con and any questions you have about the differences in marketing practice, as well as
any suggestions / recommendations for potentially doing things better. Source material
for this assignment can be obtained from an internet search and published journal
articles. Please provide a bibliographic list of your references at the back of your paper.
MLA Format.
Please reply to
William Polanco- Rowland–
Please note minimum of 200 words. Please cite one scholarly source. In-text citation should be included.
The cost of healthcare and the associated dollar signs connected to it has kept a certain number of patients away from seeing a doctor when needed. The creation of Managed Care Organizations exists to deal with the exorbitant prices associated with seeing a healthcare provider and actually decreasing costs while increasing the level of care (Nikitas et al, 2020). The common thread is the network of providers that exists within each network that agrees to provide care for the policy holders for an agreed price. Among the Managed Care Organizations are three plans known as Health Maintenance Organization (HMO’s), Preferred Provider Organization(PPO’s), and Point-Of-Service Plan (POS). The structure of HMO’s exists as a network of hospitals, doctors and providers that usually only pay for care in the network visits. These have lower premiums the insured must use a provider within the network that is their Primary Care Physician (PCP). In addition, referrals must be obtained from the PCPs for visits to specialists within the network (healthy.kaiserpermanente.org, 2022) Membership is generally required in the form of employment or one who lives in the area of coverage. With an associated higher cost is the PPO’s. They will allow for visits to in or out of network providers as well as cost of fee coverage for visiting those out of network providers, generally covered by the increased monthly premiums and out of pocket costs (healthy.kaiserpermanente.org, 2022). The third plan being mentioned here is the Point-Of-Service Plan (POS). This is considered a hybrid of plans which allows for the insured to make decisions to see who they want as a provider without first obtaining prior approval. With regard to a plan that works best for the consumer, the HMO plan is one where the nurse within the system is most connected to the providers and the case files allowing for a seamless connection with provider to facility. The other two plans have steps between each provider and information can be lost in the shuffle. The position of nurses working within the healthcare system allows them an opportunity to help keep health costs down via means of self aud.
Pwc top health industry issues for 2014
The document discusses several major trends in the US healthcare industry in 2014 as the Affordable Care Act continues implementation. Key points include:
1) Companies are reinventing themselves and blurring traditional lines as insurers seek to directly manage healthcare delivery to control costs, providers enter the insurance business, and retailers expand healthcare services.
2) With traditional venture capital pulling back from healthcare, corporate venture arms are investing more heavily in startups, bringing cash as well as expertise, connections, and other resources.
3) Employers are increasingly interested in private health insurance exchanges as a way to define their contribution while giving employees more choice and potentially reducing administrative costs and budget unpredictability.
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Hospital readmission reduction's impact on assisted living feb 2013
This document discusses how hospital readmission reduction programs under the Affordable Care Act are impacting assisted living facilities. Hospitals now face penalties for excessive readmissions within 30 days of discharge, prompting them to form Accountable Care Organizations and shift patients to lower-cost post-acute care settings like assisted living. As hospitals feel the financial pressures, assisted living facilities need to demonstrate their ability to provide quality care and minimize readmissions in order to maintain partnerships with hospitals and referral sources. The document provides strategies for assisted living facilities to enhance their services, collect data, and implement best practices to adapt to these healthcare industry changes.
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In today's rapidly advancing technological landscape, the intersection of privacy and innovation has become a paramount concern. One area that has sparked considerable debate and regulatory scrutiny is the use of tracking technologies in the healthcare sector. As healthcare providers strive to improve patient care and streamline operations, they have turned to various tracking technologies to enhance efficiency and data collection. However, the implementation of these technologies raises significant questions about patient privacy and compliance with the Health Insurance Portability and Accountability Act (HIPAA).
HIPAA, enacted in 1996, was designed to safeguard the privacy and security of individuals' medical information. It sets strict guidelines and standards for the handling, storage, and transmission of protected health information (PHI). The law not only applies to healthcare providers but also to their business associates, such as technology vendors and service providers. HIPAA's primary objective is to strike a balance between the need for healthcare organizations to collect and share patient data for treatment and administrative purposes while ensuring the confidentiality and privacy of individuals' sensitive medical information.
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While these tracking technologies offer undeniable benefits, they also raise concerns about patient privacy. The vast amount of data generated by these technologies, ranging from personal identifiers to sensitive medical records, demands robust safeguards and strict adherence to HIPAA regulations. Unauthorized access, data breaches, and misuse of patient information can result in severe consequences, including legal repercussions, reputational damage, and loss of patient trust.
In this context, it becomes crucial for healthcare organizations to strike a delicate balance between leveraging tracking technologies to improve patient care and compliance with HIPAA regulations. Robust security measures, such as encryption, access controls, and regular audits, must be implemented to protect patient information from unauthorized access or breaches. Additionally, transparent communication and patient consent are vital to ensure individuals are aware of how their data is being collected, stored, and used.
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These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
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Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
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Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
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Healthcare and 2013
- 1. Healthcare and 2013 1st Quarter Highlights Dr. Jose I. Delgado Taino Consultants Inc. www.tainoconsultants.com
- 2. Omnibus Rule Effective Date Mar 26, 2013 Expands HIPAA Privacy and Security Rule Liability for Covered Entities and Business Associates expanded Enforcement date Sep 23, 2013
- 3. Meaningful Use Audits Pre-payment audits started 10% of new Covered Entities selected for audit Audit Agencies Medicare - Figliozzi and Company Medicaid - States and designated contractors Failure to produce proof may be prosecuted as fraud
- 4. Hospital Owned Practices Loses of $100k per year per doctor The longer the hospital owned the higher the probability of losses Direct correlation with number of practices owned and operating losses
- 5. Recovery Audit Contractor (RAC) 90% of Hospitals participating experience some RAC activity Medical Records Requests up by 10% Cumulative claim denials reached 1.3 billion for 2012 63% of participating hospitals spent at least $10k per quarter to manage RAC activity Note: Participating refers to participation with the American Hospital’s Association RACTRAC survey
- 6. Sequestration Sequestration is $1.2 trillion in automatic spending cuts due to go into effect over the next 10 years, with roughly $85 billion slated for this year. Mar 1st was the first day of sequestration Mar 22, new legislation funded government for 6 more months
- 7. Accountable Care Organizations Networks of providers that assume risk for the quality and total cost of the care they deliver. Pioneer ACOs threatening to drop out of program More than 400 ACOs up and running ACOs success in question
- 8. Concierge Hybrids and graying line between concierge and direct primary care muddy the water Nearly 10 percent of doctor practice owners will embrace direct pay or "concierge" practices in the next three years Increases in health insurance premiums pushing patients to catastrophic coverage and pay for service/hybrid concierge models
- 9. Other topics to follow Healthcare Reform Medicaid Incentives ICD-10 HIPAA Audits