2015 was a big year in medicine, with many technological advances and even a few big breakthroughs. The pace is certainly not slowing down when it comes to advancing technology and bringing healthcare into the digital age, so 2016 should see the advancements of 2015 go even further. There may also be other changes to healthcare as we know it, brought forth by the elections and other situations. Here are a few things to look for through the next year and beyond.
1. Improved Patient Engagement through Technology
With EMRs and EHRs being used more widely than ever and mHealth apps becoming available at an increased rate, patients can now view their own medical records and take control of their own wellness like never before. With wearable technologies also improving, 2016 may see wearables that help patients monitor health in new and inventive ways. With mobile alerts, monitors, and even therapies, patients may see improved outcomes aided by technology.
2. Drug Pricing Legislation
In September, the price of a crucial medication used to treat auto-immune disorders was increased from $13.50 to $750. While this was not the only example of massive price increases in medications in recent times, it was certainly one of the most dramatic. The incident resulted in a public outcry against medication price gouging. We may see legislation drawn up in 2016 to prevent increases like this.
3. Even More Mergers
Mergers and acquisitions among both healthcare providers and insurance companies have been on the rise. This trend is expected to continue through 2016 as medical providers attempt to stay profitable and increase their competitive advantage. Many physicians and specialists running private practices will likely see benefits in joining larger healthcare facilities as the landscape of insurance and health related technology continues to change and become more difficult to keep up with.
4. Politically Inspired Healthcare Changes
While the next president won’t actually be sworn in until January 20, 2017, we will likely see changes to some healthcare laws brought about as the elections unfold and candidates voice their opinions. The ACA will not be repealed in 2016, but key elements may be voted out or altered. As presidential candidates continue to propose changes to healthcare and speak about unfavorable aspects of care options and insurance offerings, many issues will come up and demand attention.
5. Home Care Increase
Home care has been increasing in recent years and will probably continue to do so into 2016 as the senior population continues to expand. The preference to stay in the home rather than seek institutional style care, the increasingly crowded conditions in nursing facilities, and the greater availability of home care providers may all work to continue the trend towards “aging in place.” Insurance changes may also come about as a result of this trend.
In the recent slew of United States Supreme Court cases, a decision was upheld involving the Affordable Care Act (ACA). Better known as “Obamacare,” the Supreme Court ruled on the wording and phrasing of the ACA. This case was a matter of a state’s obligation versus the federal government’s obligation.
Due to funding issues and technology deficiencies, states have been unable to keep up with enrollment demand and communication. The Affordable Care Act stated, “Established by the State,” with the most recent ruling interpreting that to mean, “State or Federal Government.” As a result, states are now allowed to piggy-back off of the federal government’s communication technologies, partially or completely. This helps create easier access to enrollment, speeding up the administrative process of providing healthcare insurance to Americans not covered.
The Ruling’s Immediate Impact
The Affordable Care Act allows for tax credits in all 50 states, where as before, the incentives were only extended to the 16 states with authorized online federal insurance exchanges. This allows for the current subsidies in place to continue providing healthcare access to the millions of uninsured. None of the current processes have changed as a result of this ruling, they have just been reaffirmed, and allow the IRS to continue providing a tax credit to those Americans that acquire health insurance.
What This Means at the State Level
Consumers can continue to receive, or gain access to, subsidies that help lower premiums regardless if they purchase their healthcare through federal or state exchanges. If this ruling would have gone the other way, over 6 million insured in 34 states would have lost their subsidy assistance, and their premiums would have rose any where from 300 to 600 percent.
Additional Benefits Reaffirmed Under This Ruling
In addition to the above results, the ruling also confirms the following:
Children stay insured under their parents until age 26
Seniors continue to receive discounts on medication
Americans with disability continue to receive discounts on prescriptions
Cost-equality; if you’re a woman you can’t be charged more than anyone else
The Outlook for Health Insurance
This court case was brought before The Supreme Court as a means to repeal the Affordable Care Act. Supreme Court Chief Justice Roberts knew the judicial implications within the healthcare insurance field if the Federal Government’s involvement was removed. There are currently over 17 million previously uninsured Americans that are now covered because of Obamacare.
Many experts assert that withdrawing those benefits would throw the healthcare industry into disarray, negatively impacting general practitioners. This most recent ruling helps provide easier access to healthcare for the remaining 35 million uninsured individuals. A nice caveat to take away from this: many health insurance entities have benefitted from the ruling. Providers like Humana and United Health Group saw their stock prices increase as a result this decision.
Medical billing is the process of filling out and submitting necessary forms in order to claim funds owed by insurance companies for services provided to patients. Medical billing is extremely important for all types of medical practices, but may be the single most mundane task performed in the office. For many medical offices, outsourcing can provide a barrage of benefits over performing medical billing tasks in-house.
1. Reduces Strain on Staff
Outsourcing medical billing can benefit both large and small medical practices in many different specialty areas. Depending on how billing is handled, less staff may be needed or staff members that currently work on medical billing may be free to perform other tasks. Removing this cumbersome task from the shoulders of staff members may improve the company culture and help to create a friendlier office that is more appealing to patients.
2. Allows Greater Customer Focus
With billing tasks being handled by professionals, receptionists, doctors, and other staff members can increase their focus on the most important part of the job-the patients. Doctors may have more time for each patient, which may help to improve the overall service provided. Staff members may also breathe easier and have more time to focus on patient needs.
3. Decreases Potential for Errors
Medical billing may be mundane, but it is not easy. CPT codes are updated and deleted annually, requirements and rules change frequently, fees change, and carrier rules change. It can be exceedingly difficult for over-worked staff members or physicians to keep up with these changes. Medical billing specialists are experts, however. By outsourcing medical billing to a third party that focuses solely on this area, medical offices greatly reduce the potential for errors that may affect revenues and even incur penalties.
4. Speeds Time to Payment
Medical billing services can submit claims quickly and will thoroughly review the claim to prevent errors that may result in denials. This means a faster turnaround time, with money going into the banks instead of just onto the books. If denials do occur, medical billing service specialists will quickly correct the errors and back their work to recover payment as quickly as possible.
5. Increases Transparency
While some offices are afraid to relinquish control of medical billing for fear of losing transparency in their operations, the opposite is generally true. Allowing professionals to handle time consuming medical billing tasks and headaches can free physicians and staff up to have more time to review monthly reports and get a better feel for the overall health of the practice. This can give medical offices greater control over operations than they generally have when they are stretched thin trying to handle all tasks in-house.
Companies are increasingly using technology to change the landscape of the healthcare industry. Physicians and other healthcare providers have recently begun to adopt new technologies en masse to increase their efficacy in treating patients and improve the quality of care. A company in Australia has created a new electronic medical records (EMR) software platform known as Clinic to Cloud (C2C).
It is unique in that it is entirely cloud hosted meaning EMRs can be accessed and edited from anywhere and is not kept in a physical office. This is a huge advantage for healthcare providers as it allows them to access patient records from their tablet or smartphone and hosts a ton of other features designed to increase the quality of care the healthcare provider delivers to each patient.
Cloud-Based EMRs
Almost overnight, it seemed that everyone started talking about the “Cloud” which refers to storing data on a third-party server to allow access from anywhere in the world. This technological development breaks down huge barriers to efficiency by removing the need for doctors and other healthcare specialists to retrieve physical copies of EMRs or have physical access to the database that houses the EMRs. C2C allows doctors to access their patients’ inf0rmation via their smartphones and tablets from anywhere. This is extremely useful and reduces the barriers of inconvenience for doctors who might wish to review a case while not in the office or the hospital.
Prescription Drugs
C2C also allows doctors and healthcare providers to track pharmaceutical drug use by patients. This reduces the potential for error and accidental complications from combining inappropriate pharmaceuticals. The program has a page for the prescription drugs that the doctor has prescribed and even allows the doctor to create a page of “favorite” drugs for quick reference and comparison. C2C can also be integrated with Medicare, MIMS, and other databases to identify potentially harmful drug interactions.
Patient Services
Another useful aspect of C2C is its patient portal and patient services. It allows for patients to communicate points of concern with the doctor as well as schedule appointments. The CEO of the software claims that this is a feature unique to C2C and should revolutionize the doctor/patient relationship.
Other Features
C2C also delivers a host of other unique and exciting features. These include voice recognition and text-to-speech as well as a clean, minimal interface designed to minimize clicks to save time and increase efficiency. With many of these new medical technology companies on the rise, it remains to be seen how these developments will change the landscape of EMR, medical billing, and the doctor/patient relationship.
In an in age of increasingly complex technology, the doctor-patient relationship has evolved in certain ways. Electronic health records (EHRs) also known as electronic medical records (EMRs) have become instrumental by increasing efficiency through saving doctors time while increasing the quality of care that each patient receives.
Not only do EMRs streamline the management and accuracy of patient health information (PHI) but they also provide doctors access to a patient’s PHI from anywhere in the world. By connecting doctors more quickly than with telephones and paper, doctors are able to save time and resources while simultaneously increasing the likelihood of successfully treating a patient.
EMR Software
EMR software has made it easier to store large amounts of PHI. When it is stored and transmitted electronically, it is referred to as ePHI. It has also changed the way that doctors are able to access ePHI. EMR software allows doctors to search by specified criteria and cross reference other doctors’ notes from one place.
Allowing doctors access from anywhere is vital to the increase in efficiency not only because doctors across the world have access to the ePHI, but primary doctors are also able to access the ePHI from home. In recent polls, as many as half of the doctors surveyed reported accessing patients’ ePHI from home. . In this way, EMR software facilitates the ways in which doctors can approach treatments and diagnoses.
Smartphone and Tablet Apps
EMR software has other implications. Many doctors are now reporting accessing ePHI through their smartphones and tablets. A new market has emerged for apps related to management of EMR. Recent software developments have made it possible to create a doctor-patient portal in which the doctors and patient can engage in a virtual dialogue and share information without needing to be face to face. This provides care and attention in addition to the scheduled appointments.
Transitioning to Virtual Platforms
Some may argue that this could lead to a dependence on technology and a reduction in actual face-to-face time between the doctor and the patient. While it is always important for patients to maintain regularly scheduled appointments with doctors, these developments in EMR software and applications allow doctors to provide care and effort without the constraint of physically being with the patient.
This could lead to doctors being more productive and successful in their treatment. EMR software companies like Quest National Services reduce the burden on doctors and allow them to focus more on patients.
In a recent case in Georgia, the Grady Health System reached a settlement in a case for approximately 3 million dollars. Grady was sued by the state for allegedly using inaccurate medical coding to turn more of a profit. The Grady Health System and the State of Georgia have since reached a settlement for 2.95 million dollars and no admission of wrongdoing.
Cases like this are only becoming more common as tougher laws are being enacted to stop healthcare fraud. Under the Affordable Care Act (ACA) and the Health Insurance Portability and Accessibility Act (HIPAA), strict standards for medical coding and billing must be adopted to ensure that proper methods are being followed and patients are being protected.
Healthcare Fraud
One of the main goals of both the ACA and HIPAA is to help safeguard patients from healthcare and insurance fraud. This is accomplished through ensuring that all patients have access to affordable healthcare and through the implementation of stringent medical billing and coding standards. In the case of the Grady Health System, it was suggested that Grady did not follow proper coding standards, allegedly by inflating costs or inaccurately coding.
HIPAA, ACA, and Medical Billing
HIPAA and the ACA also set standards for the medical billing process. They mandate the use of a standard codex to be used by any healthcare provider taking any part in a public health program. The codex used for the purpose of standardizing the medical billing process is known as the Current Procedural Terminology (CPT).
The CPT is a list created and maintained by the American Medical Association (AMA) and refers to procedures and services rendered, rather than diagnoses, in order to standardize the way insurance companies are billed. Failure to adhere to these standards can lead to issues with how or if the healthcare provider is fully reimbursed for services and how much the services will cost the patient.
The Importance of Accurate Medical Billing
With the increasing amount of laws pertaining to healthcare and specifically medical billing, it is critical that healthcare providers are knowledgeable and up-to-date regarding coding standards. Failure to adequately adhere to the standards or properly code for services rendered has the potential to cost a firm millions of dollars.
For this reason, it is often helpful to turn to companies like Quest National Services that specialize in medical coding and billing. They will help ensure that businesses are compliant and educated when it comes to new laws and policies.
The Affordable Care Act (ACA aka “Obamacare”) calls for every citizen of the United States to be covered by some form of health insurance by the end of the Open Enrollment Period (OEP) in February 2015. Because of the nature of the mandate, a Special Enrollment Period (SEP) was opened to add a grace period for those who did not realize that failure to comply by the end of the OEP would result in a fine.
While the federally-funded web portal healthcare.gov only signed up a small amount of would-be violators, the states of California and Washington recently blew past that number when they opted to allow SEPs for their insurance marketplaces. These states dedicated much effort to spreading the word through advertising and social media about the SEP and the fact that non-covered persons would be responsible for a fee taken from their tax refunds. The coverage provided under these two SEPs outstripped by far the coverage provided by the federal marketplace and healthcare.gov.
What Is a Marketplace?
A marketplace is defined under the ACA as an organization that facilitates the purchase of health insurance policies that comply with the regulations and guidelines under the ACA. In order to be considered covered, and thus avoid a fee, eligible persons must purchase a plan for coverage by the end of the Open Enrollment Period for each year. In this case, the marketplaces provided by the states of California and Washington performed much more productively than the virtual federal marketplace, healthcare.gov.
Open Enrollment Period
In order to incentivize coverage, there is a deadline each year by which individuals and families would need to be covered in order to avoid a fee. This is known as an Open Enrollment Period and the most recent one ended in February 2015. The fee is to incentivize people to seek coverage earlier rather than later. However, because of the complexity and novelty of these provisions, a grace period was allowed to those who missed the original OEP.
Special Enrollment Period
Since so many people remained uninsured despite the closing of this year’s OEP, a Special Enrollment Period was made available through healthcare.gov and most recently, through the marketplaces of California and Washington. This SEP was opened in order to allow those who were unaware or unable to purchase a policy by the OEP to seek coverage and avoid paying the fee. When California and Washington opened their SEPs, they signed up record numbers of people and far and away performed better than the healthcare.gov system in terms of number of policies sold.
As healthcare evolves and improves with technology, both patients and care providers look for better ways to prevent and diagnose illness, and to identify and reduce health risks. Maintaining and reviewing health records is the way to accomplish this, but paper records are the method of the past. Electronic records have a foot planted firmly in the present and are becoming the future.
Which Offers Better Patient Value, EMR or EHR?
Electronic record software comes in two main types, Electronic Medical Record (EMR) and Electronic Health Record (EHR). The American Recovery and Reinvestment Act of 2009 (ARRA) provided incentive funds to stimulate the adoption of these software systems by hospitals and physicians. The acronyms EMR and EHR are often used interchangeably, but there are distinct differences between the two software services. According to the National Alliance for Health Information Technology (NAHIT), EMR and EHR are defined as follows:
EMR: The electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care.
EHR: The aggregate electronic record of health-related information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care.
The key functional difference between the two is the EHR provides a more comprehensive scope of a patient’s medical history, by pulling data from additional electronic health systems, creating long-term and aggregate health information. This allows doctors, hospitals, and clinical decision makers to anticipate health maintenance requirements. On the other hand, EMR software keeps records of a single diagnosis or treatment, essentially a replacement for paper charts and records, and is more likely to be used by a specialist.
Why Haven’t I Heard of EHR?
With most EHR software, the patient can log onto their record and review their personal health information, which is a cultural change for most patients. EHR is the industry standard, but the market term for the electronic record industry is EMR. Analyzing Google Trends data shows far more searches for “electronic medical record” are performed than “electronic health record”, but the gap is slowly closing.
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With the rising healthcare costs in America, and specifically prescription drugs, many seek relief by purchasing prescription drugs online. People have turned to cheaper online alternatives for clothes, books, hotel reservations, and more; online prescription drug purchases are quickly becoming a solution for pharmacy needs. Some health insurance programs even offer buying prescription drugs online through national pharmacy chains.
Online Prescription Safety
Several safety precautions should be taken before purchasing prescriptions online.
Talk to your doctor. You should only take medications prescribed to you by your doctor. They will determine if a specific drug is safe for you, or if a better treatment option is available. Only use websites that require prescriptions.
Use a licensed pharmacy. The National Association of Boards of Pharmacy authorizes licensing for online pharmacies. Some websites also carry the seal of approval from Verified Internet Pharmacy Practice Sites, gained by maintaining state licenses and allowing inspections by the National Association of Boards of Pharmacy. Using a licensed pharmacy will also help guard against receiving a counterfeit drug with no active ingredients.
Compare Prices. Check the prices at your local pharmacy or drug store for perspective when shopping online. If the price sounds too good to be true, it probably is.
Require access to a registered pharmacist.
While some online pharmacies have conventional physical locations, any chosen online pharmacy should provide access to registered pharmacists to answer any questions or concerns you may have.
Canada’s Cheap Drugs
Canada has long been known for cheaper prescription drugs, compared to the US, and is at the forefront of the online pharmaceutical industry. Canada’s ability to sell cheap drugs, compared to the US, is in part to the Canadian government implementing price controls, capping the amount drug companies can charge drug distributers and pharmacies. The chances are high that your recent online prescription purchase will come from Canada.
The Future of Drugs in America
The increase of online prescription purchases has forced a legislative discussion within the federal government. The U.S. is the only industrialized nation without caps on the price pharmaceutical companies can charge. Proponents of this capitalistic practice hold that it promotes innovation, and encourages the development of best, safest, and most effective drugs. Some argue that introducing price controls on pharmaceuticals would limit the supply for consumers and ultimately decrease the average life span in America. Time will tell, as change is already here and sure to impact prices. Patient and consumer education is critical for purchasing prescriptions online, just as it was for online dating and online shopping during that shift in culture to a cheaper and convenient alternative.
A new study has found that diagnostic errors are the single largest source of successful malpractice claims. Furthermore, the study concludes that diagnostic errors have the unfortunate distinction of being the most dangerous, costly and common type of medical mistake.
Study Finds High Costs
The study encompassed malpractice reports from a 25 year period, between 1986 and 2010. Researchers made use of data from the National Practitioner Data Bank. They analyzed 350,706 paid malpractice claims in order to ascertain the specific cause of patient allegations.
According to the study’s findings, diagnostic errors were the cause of 28.6 percent of all malpractice claims between 1986 and 2010. Furthermore, paid claims resulting from diagnostic errors represented the largest portion of malpractice claims from a financial standpoint. Diagnostic errors accounted for $38.8 billion in malpractice payments between 1986 and 2010, representing 35.2 percent of all medical malpractice compensation over this period.
Diagnostic Errors and Mortality Rate
A second worrisome finding from this study concerned the link between diagnostic errors and accidental death. As a whole, malpractice allegations were linked with patient mortality in 23.9 percent of cases. However, in the specific instance of malpractice allegations stemming from diagnostic errors, death as a result of malpractice was linked in 40.9 percent of cases.
The Difficulties of Diagnostic Errors
Although this study serves as a reminder of the dangers that can accompany a diagnostic error, it also shines light on the difficulty that accompanies addressing diagnostic errors. Within the scope of this study, both surgical errors and treatment errors also represented a large portion of malpractice claims. However, the study’s authors posited that these types of malpractice issues were more easily addressed due to the greater degree of immediacy accompanying an error. While the results of an unsuccessful surgery may be quickly apparent, incorrectly diagnosing a serious condition as something relatively innocuous is often slower to cause harm.
Due to the significant burden that diagnostic errors place on both the health of patients and the livelihood of health professionals, the authors of this study call for an increased focus on diagnostic errors as a critical health policy issue.
