So, what can we do to continue to expand health care coverage through health reform without breaking the U.S. bank? In an article titled “A Systemic Approach to Containing Health Care Spending” published in the August 2 New England Journal of Medicine, 23 health policy experts convened by the Center for American Progress set out nine major strategies to effectively contain health care costs both for public and private payers.
These experts insist that to effectively contain health care costs, strategies must target drivers of both the level and growth of costs and the role of medical prices and quantity of services; and eliminate administrative costs that do not improve health status and outcomes. The United States spends nearly $360 billion a year on administrative costs, accounting for 14 percent of excessive health spending.
“Although these solutions are not intended to be exhaustive, they have the greatest probability of both being implemented and successfully controlling health costs,” the report noted, emphasizing that it would be most effective to implement as a package the following recommended solutions.
• Negotiate uniform payment rates to apply to all payers and providers in a state; install an independent council to enforce a global spending target with growth per person limited to the average growth in wages. States will publicly report measured of quality, access, and costs with bonuses to be paid to high performing providers and payment rates adjusted for quality.
• Use payment alternatives to fee-for-service with fixed bundled payments for all the services and care a patient needs, including related rehabilitation and follow-up care for 90 days after discharge. Begin implementation as soon as possible using the bundles for 37 cardiac (heart) and orthopedic procedures used in the Medicare Acute Care Episode program.
• Implement competitive bidding for all medical equipment and devices, laboratory tests, radiological diagnostic services, beginning with Medicare and health insurance exchanges negotiating for private payers and state employee plans.
• Health insurance exchanges should offer tiered products based on high quality and low cost providers tied to reduced cost-share for insureds who use the high quality providers.
• Simplify administrative systems by electronic exchange of eligibility and claims information; use a single standard physician credentialing system; electronically provide monthly explanation of benefits statements; implement electronic health records integrating clinical (test orders, for example) and administrative tasks (billing, prior authorization, and payments).
• Require full transparency in medical provider pricing, including out-of-pocket costs, quality of care, and patient volume; prohibit “gag clauses” (which forbid contracted providers from disclosing to patients the discounts negotiated with insurers) on price information. Have state insurance department and health insurance exchanges collect, audit, and publicly report pricing and claims data.
• Expand use of non-physician providers such as advance practice nurses or nurse practitioners.
• Expand to private sector payers the Medicare ban on physician self-referral to facilities in which they or their families have a financial interest.
• Reduce costs of defensive medicine by providing a “safe harbor” for providers who use qualified health information technology and evidence-based clinical practice guidelines.
In conclusion, the NEJM article states, “These are the types of large-scale solutions that are necessary to contain health costs. Although many in the health industry perceive that it is not in their interest to contain national health spending, it is a fact that what cannot continue will not continue….Americans therefore face a choice. Payers could simply shift costs to individuals. As those costs become more and more unaffordable, people would severely restrict their consumption of health care and might forgo necessary care.
“We present alternative strategies to contain national health spending that allow Americans to access necessary care. Our approach addresses the system as a whole, not just Medicare and Medicaid. It is the path to rising wages, a sustainable federal budget, and the health system that all Americans deserve.”
Friday, August 31, 2012
Wednesday, August 29, 2012
New Standardized Identifiers For Health Care Providers Will Save Time, Money
Federal government efforts to reduce unnnecessary spending on health care administration continue with the backing of the Patient Protection and Affordable Care Act (ACA) and the Health Insurance Portability and Accountability Act (HIPAA).
Most recently, the Centers for Medicare and Medicaid Services (CMS) announced a final rule expected to save time and money for physicians and other health care providers by establishing a unique health plan identifier (HPID) and a data element that will serve as an “other entity” identifier (OEID) for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions. The rule also specifies the circumstances under which an organization-covered health care provider, such as a hospital, must require certain non-covered individual health care providers who are prescribers to obtain and disclose a National Provider Identifier (NPI). The final rule is scheduled to be published in the September 5 Federal Register.
The adoption of the HPID implements an administrative simplification provision of the ACA, and one of a series of changes required to cut red tape in the health care system. The measure is projected to save up to $6 billion over ten years. Currently, when a health care provider bills a health plan, that plan may use a wide range of different identifiers that do not have a standard format. As a result, health care providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility. The final rule will simplify these processes.
Future administrative simplification rules enacting HIPAA will address adoption of:
• a standard for claims attachments;
• operating rules for claims attachments; and
• requirements for certification of health plans’ compliance with all HIPAA standards and operating rules.
“These new standards are a part of our efforts to help providers and health plans spend less time filling out paperwork and more time seeing their patients,” said Health and Human Services Secretary Kathleen Sebelius.
The rule also makes final a one-year proposed delay—from Oct. 1, 2013, to Oct. 1, 2014—in the compliance date for use of new codes that classify diseases and health problems. These code sets, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10) will include codes for new procedures and diagnoses that improve the quality of information available for quality improvement and payment purposes.
This rule is the fourth administrative simplification regulation issued by HHS under the ACA, including the following with anticipated savings over ten years:
• On July 8, 2011—Operating rules for two electronic health care transactions to make it easier for health care providers to determine whether a patient is eligible for coverage and the status of a health care claim submitted to a health. Savings from this measure could be up to $12 billion.
• On Jan. 10, 2012—Standards for the health care electronic funds transfers (EFT) and remittance advice transaction between health plans and health care. Savings could be up to $4.6 billion.
• On Aug. 10, 2012—An IFC that adopted operating rules for the health care EFT and electronic remittance advice transaction. Savings are anticipated to be up to $4.5 billion.
The regulation is effective November 5. Health plans, excluding small health plans, are required to obtain HPIDs two years after the effective date, in 2014. Small health plans are required to obtain HPIDs three years after the effective date, in 2015. All covered entities are required to use HPIDs where they identify health plans that have HPIDs in standard transactions four years after the effective date, in 2016.
Covered entities have 180 days from the final regulation’s effective date to comply with the additional NPI requirement.
Most recently, the Centers for Medicare and Medicaid Services (CMS) announced a final rule expected to save time and money for physicians and other health care providers by establishing a unique health plan identifier (HPID) and a data element that will serve as an “other entity” identifier (OEID) for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions. The rule also specifies the circumstances under which an organization-covered health care provider, such as a hospital, must require certain non-covered individual health care providers who are prescribers to obtain and disclose a National Provider Identifier (NPI). The final rule is scheduled to be published in the September 5 Federal Register.
The adoption of the HPID implements an administrative simplification provision of the ACA, and one of a series of changes required to cut red tape in the health care system. The measure is projected to save up to $6 billion over ten years. Currently, when a health care provider bills a health plan, that plan may use a wide range of different identifiers that do not have a standard format. As a result, health care providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility. The final rule will simplify these processes.
Future administrative simplification rules enacting HIPAA will address adoption of:
• a standard for claims attachments;
• operating rules for claims attachments; and
• requirements for certification of health plans’ compliance with all HIPAA standards and operating rules.
“These new standards are a part of our efforts to help providers and health plans spend less time filling out paperwork and more time seeing their patients,” said Health and Human Services Secretary Kathleen Sebelius.
The rule also makes final a one-year proposed delay—from Oct. 1, 2013, to Oct. 1, 2014—in the compliance date for use of new codes that classify diseases and health problems. These code sets, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10) will include codes for new procedures and diagnoses that improve the quality of information available for quality improvement and payment purposes.
This rule is the fourth administrative simplification regulation issued by HHS under the ACA, including the following with anticipated savings over ten years:
• On July 8, 2011—Operating rules for two electronic health care transactions to make it easier for health care providers to determine whether a patient is eligible for coverage and the status of a health care claim submitted to a health. Savings from this measure could be up to $12 billion.
• On Jan. 10, 2012—Standards for the health care electronic funds transfers (EFT) and remittance advice transaction between health plans and health care. Savings could be up to $4.6 billion.
• On Aug. 10, 2012—An IFC that adopted operating rules for the health care EFT and electronic remittance advice transaction. Savings are anticipated to be up to $4.5 billion.
The regulation is effective November 5. Health plans, excluding small health plans, are required to obtain HPIDs two years after the effective date, in 2014. Small health plans are required to obtain HPIDs three years after the effective date, in 2015. All covered entities are required to use HPIDs where they identify health plans that have HPIDs in standard transactions four years after the effective date, in 2016.
Covered entities have 180 days from the final regulation’s effective date to comply with the additional NPI requirement.
Monday, August 27, 2012
10 Tips For Choosing the Perfect In-Home Health Care Agency
When caring for your aging parent or loved one becomes overwhelming and you need a break, or when extra help is needed with bathing, feeding, dressing, household duties or if caring for them yourself is just not possible anymore, selecting an in-home health care provider is a good alternative.
Proper screening is essential to ensure that the person you choose has, not only the skills to provide excellent care, but also the right personality for the job. Consider these tips and hints and you will find that hiring an in-home heath care provider does not have to be stressful.
1. Evaluate Your Loved One's Needs
While some older adults just need assistance with basic living skills, others have additional health care needs that require a special skill set. Therefore, it is necessary to make a list of all of the duties that an in-home health care professional will need to provide so you can narrow down the list of candidates early on. If you are hiring through an agency, give them as much information from the start so they can match you up with someone who possesses all of knowledge and capabilities to give the best care possible to your loved one.
If your home health care worker will be assisting with bathing or dressing, it is important to discuss this with your loved one to make sure that they are comfortable with the gender of the companion. Women or men may become embarrassed when opposite gendered health care workers assist them with personal care and this may cause bath time to become stressful.
2. Speak With Local Experts
Before you go to the yellow pages or check out the classifieds for home heath aids, speak with neighbors, doctors, and elder care providers locally who can give you some recommendations and advice. Find out where other families have found in-home help and have them tell you about their experience. An administrator at a local nursing home may also have some suggestions for you on where to locate the best care giver. Support groups are a wealth of information, as well.
3. Create a Job Description
When you are ready to begin speaking with applicants and conducting interviews, start by writing a job description. The job duties can serve as talking points for your interview and also give the applicants a clear picture of what will be required of them.
4. Prepare Interview Questions
If you are not experienced at conducting formal interviews, you will benefit greatly by having a prepared list of questions. It will help you stay in control of the interview, not miss any key points, and make the best use of your time. Write it all down.
5. Outline an Employment Contract
Even if the person you select comes highly recommended and you and your family really hit it off with them, make sure to remain professional. This includes having them sign a contract that outlines your expectations, their duties, as well as boundaries. You can then refer back to the contract should a situation arise in the future. Often Home Health Agencies prepare the contracts themselves. Be sure to read them carefully and add anything that you wish to be included.
6. Personally Screen Candidates
Since the person you hire will be spending time alone with your parent or loved one, it is essential that you approve them yourself. Having an agency just send someone over is not acceptable in this situation. Even if they can paint a picture of a candidate's qualifications, because the job of health care provider is so intimate, personality is equally as important. If your loved one is able to participate in the interview, that is ideal. Regardless, they should spend some time together to make sure that they click.
7. Conduct a Background Check
Do not trust your intuition. When you think that you have found the person you want to hire, do conduct a background check to make sure that the person you hire does not have a questionable past.
8. Check References
Even if this is their first job in the field of health care, every applicant should be able to provide references. Ideally, these should come from past employers. Otherwise, professors, internship supervisors, and personal references can also be used.
9. Protect Your Home and Family
Since the health care provider you hire will most likely have free access to your home, possessions, and family members, find out if they are bonded. It they are not bonded themselves, find out if the agency that you hired them from is. Remember not to leave credit cards, checkbooks and personal papers in unsecured areas.
10. Stay Involved
Your job is not over once the contract is signed and employment has begun. The more of a presence you have in your loved one's life the better. Even if you can not be there in person, scheduling telephone meetings can let the health care provider know that you are involved and on top of things. Ask for progress reports and find out if there are any difficulties. Since the health care provider is around your loved one the most, they can give you the best information about their physical health as well as their state of mind.
One way to stay involved is to use a caregiver's organizer (which we just happen to offer on our website). The Caregiver's Companion is an organizational tool that has sections for personal information, family history, medications and side effects, medical appointments, and home health care workers notes. I hate selling, but this IS a very good tool in my opinion.
Shelley Webb has been a registered nurse for almost 30 years, with experience in the fields of neonatal intensive care, dialysis, case management and elder care. When her father came to live with her in 2005, the advantages of her medical experience became clear. Due to his dementia and congestive heart failure, her father was not able to care for himself alone any longer and so she took over these duties.
Having experienced the helplessness, frustration, overwhelm and even loneliness that care giving for an aging parent brings, Shelley is well aware of the emotional and educational support that caregivers need and so she began The Intentional Caregiver web site. With its weekly newsletter, daily news updates and monthly audio interviews of experts in elder care and supporting services, Shelley strives to encourage and educate caregivers so that they can be empowered to provide the best possible care for themselves while caring for their aging loved one(s).
Proper screening is essential to ensure that the person you choose has, not only the skills to provide excellent care, but also the right personality for the job. Consider these tips and hints and you will find that hiring an in-home heath care provider does not have to be stressful.
1. Evaluate Your Loved One's Needs
While some older adults just need assistance with basic living skills, others have additional health care needs that require a special skill set. Therefore, it is necessary to make a list of all of the duties that an in-home health care professional will need to provide so you can narrow down the list of candidates early on. If you are hiring through an agency, give them as much information from the start so they can match you up with someone who possesses all of knowledge and capabilities to give the best care possible to your loved one.
If your home health care worker will be assisting with bathing or dressing, it is important to discuss this with your loved one to make sure that they are comfortable with the gender of the companion. Women or men may become embarrassed when opposite gendered health care workers assist them with personal care and this may cause bath time to become stressful.
2. Speak With Local Experts
Before you go to the yellow pages or check out the classifieds for home heath aids, speak with neighbors, doctors, and elder care providers locally who can give you some recommendations and advice. Find out where other families have found in-home help and have them tell you about their experience. An administrator at a local nursing home may also have some suggestions for you on where to locate the best care giver. Support groups are a wealth of information, as well.
3. Create a Job Description
When you are ready to begin speaking with applicants and conducting interviews, start by writing a job description. The job duties can serve as talking points for your interview and also give the applicants a clear picture of what will be required of them.
4. Prepare Interview Questions
If you are not experienced at conducting formal interviews, you will benefit greatly by having a prepared list of questions. It will help you stay in control of the interview, not miss any key points, and make the best use of your time. Write it all down.
5. Outline an Employment Contract
Even if the person you select comes highly recommended and you and your family really hit it off with them, make sure to remain professional. This includes having them sign a contract that outlines your expectations, their duties, as well as boundaries. You can then refer back to the contract should a situation arise in the future. Often Home Health Agencies prepare the contracts themselves. Be sure to read them carefully and add anything that you wish to be included.
6. Personally Screen Candidates
Since the person you hire will be spending time alone with your parent or loved one, it is essential that you approve them yourself. Having an agency just send someone over is not acceptable in this situation. Even if they can paint a picture of a candidate's qualifications, because the job of health care provider is so intimate, personality is equally as important. If your loved one is able to participate in the interview, that is ideal. Regardless, they should spend some time together to make sure that they click.
7. Conduct a Background Check
Do not trust your intuition. When you think that you have found the person you want to hire, do conduct a background check to make sure that the person you hire does not have a questionable past.
8. Check References
Even if this is their first job in the field of health care, every applicant should be able to provide references. Ideally, these should come from past employers. Otherwise, professors, internship supervisors, and personal references can also be used.
9. Protect Your Home and Family
Since the health care provider you hire will most likely have free access to your home, possessions, and family members, find out if they are bonded. It they are not bonded themselves, find out if the agency that you hired them from is. Remember not to leave credit cards, checkbooks and personal papers in unsecured areas.
10. Stay Involved
Your job is not over once the contract is signed and employment has begun. The more of a presence you have in your loved one's life the better. Even if you can not be there in person, scheduling telephone meetings can let the health care provider know that you are involved and on top of things. Ask for progress reports and find out if there are any difficulties. Since the health care provider is around your loved one the most, they can give you the best information about their physical health as well as their state of mind.
One way to stay involved is to use a caregiver's organizer (which we just happen to offer on our website). The Caregiver's Companion is an organizational tool that has sections for personal information, family history, medications and side effects, medical appointments, and home health care workers notes. I hate selling, but this IS a very good tool in my opinion.
Shelley Webb has been a registered nurse for almost 30 years, with experience in the fields of neonatal intensive care, dialysis, case management and elder care. When her father came to live with her in 2005, the advantages of her medical experience became clear. Due to his dementia and congestive heart failure, her father was not able to care for himself alone any longer and so she took over these duties.
Having experienced the helplessness, frustration, overwhelm and even loneliness that care giving for an aging parent brings, Shelley is well aware of the emotional and educational support that caregivers need and so she began The Intentional Caregiver web site. With its weekly newsletter, daily news updates and monthly audio interviews of experts in elder care and supporting services, Shelley strives to encourage and educate caregivers so that they can be empowered to provide the best possible care for themselves while caring for their aging loved one(s).
