With a new and possibly more receptive governor in the wings, a group of healthcare executives has resurrected a proposal to divert money from the charity hospital system to a free-market model in which patients could present insurance cards to the doctor of their choice.
More than 40 million people, or roughly one in five adults, have reported they do not have access to the healthcare they need, according to the annual report on the nation's health by the Centers for Disease Control and Prevention and compiled by the CDC's National Center for Health Statistics. The report, titled "Health, United States 2007," is a compilation of more than 150 health tables, and reveals that 20 percent of adults did not receive one or more of the following services, although they needed them because of cost: medical care, prescription medicines, mental health care, dental care or eyeglasses. Additional findings include:
Young adults between the ages of 18 and 24 were more likely to lack a primary source of care (30 percent) and to be without health coverage (30 percent).
One in 10 adults between the ages of 45 and 64 did not have a primary source of care, despite the fact that more than 5 percent suffered from high blood pressure, serious heart conditions, or diabetes.
One in 10 women between the ages of 45 and 64 with income below the poverty level had to delay medical care because of a lack of transportation.
Nearly 33 percent of children living below the poverty level did not have a recent dental visit in 2005, compared to less than one-fifth of their peers in high income families.
During his time as an oncologist in rural New Mexico, Masoud Khorsand, MD, witnessed firsthand how subspecialty practices struggled to manage operating costs associated with patient care. Frustrated with inefficiency and revenue leaks, Khorsand developed Akessa Oncology, an electronic medical record and practice workflow suite that helps bring financial stability to subspecialty physician practices. Akessa provides oncologists with a comprehensive EMR integrated with systems for pharmaceutical inventory management, practice management, and billing to improve workflows and ensure quality patient care. Akessa was developed by Argole Systems, a healthcare software and services company for which Khorsand is president, CEO, and founder.
HealthLeaders Media recently spoke with Khorsand about his foray into technology, what problems Akessa Oncology solves from smaller subspecialty practices, and the benefits of Akessa to practices trying to stay financially viable.
HealthLeaders Media: How did your experience as an oncologist in rural New Mexico make you want to develop a healthcare IT solution for smaller practices? Masoud Khorsand, MD: I established my independent practice in 1999, and by 2001 we got into trouble with financial issues due to the lack of adequately trained staff members in the office. We have had such a hard time training highly qualified staff in rural New Mexico--a lack of trained staff is, unfortunately, evident almost everywhere in any medical practice. The demand of Medicare and payers increasingly made it harder for us to survive financially. From a medical information standpoint, having adequate data is critical for practicing medicine. Right now I'm taking care of a patient with physicians in Albuquerque, Santa Fe and Houston. Communication and acquiring data from all of these sources requires a robust system. In a way, it is more difficult for us to practice medicine than a practice in Albuquerque because their patients are usually in the same town and the referring physicians all know each other very well, so communication is easier. In rural areas, a lot of doctors outside this area don't know us, or we don't know them. You need a really robust staff and robust system to be able to gather all of the data to be able to practice medicine.
HealthLeaders Media: What type of software challenges did you face that made you feel a system such as Akessa was necessary? Masoud Khorsand, MD: What we came across was that there are two or three major problems with the software that was currently available. Number one, they require a high level of expertise with computers--a level we usually do not see in rural areas. The second issue was that in order to be financially viable in a rural area, you have to have a very high efficiency. There is obviously a higher level of indigent patients, uninsured patients, Medicaid patients--and the fact remains that these types of patients and insurances are not highly profitable, and sometimes you lose money on them unless you really 100 percent collect what you are supposed to collect. Unfortunately, it is difficult to find software that makes sure you are collecting everything that you can. This is a problem found especially in oncology--we spend millions of dollars per year to purchase the drug, then we have to administer it, and we have to go after the patient or insurance company to pay for it.
HealthLeaders: How does Akessa Oncology help solve some of these problems? Khorsand There are many, many functions incorporated into this software that will ensure that every single service that is provided is followed through the system--from the time the patient receives the service to making sure insurance will pay for it, and ensuring the treatment is authorized. The system also ensures that codes used to pay the medical office match each other and are compliant with Medicare and non-Medicare rules. It also makes sure that all the charges are captured at the time of the service, then the charge is billed to the payer---there is a function in software that will assure that every single service that was provided for is actually billed. It makes sure charges are responded to or paid by the payer, and if they are not paid within 35 days, it issues an alert. The system follows up on that with a report that gives an idea of how much you collect on those charges, which patients are losing money, and what can be done to prevent that.
HealthLeaders: What is the cost of Akessa Oncology? Khorsand: We have three different levels of software. Number one has no purchase cost and has basically the basic elements of software-you just pay support per physician. The initial cost is zero in that model. The second model is if you purchase an inventory management portion of the system-a highly sophisticated part of the service. That costs about $10,000 per physician. And a third level is a much more sophisticated version of the software that comes at around $15,000.
A new public service campaign that coincides with World AIDS Day on December 1 aims to educate Hispanic teens on the link between non-injection drug use and HIV transmission. The campaign features includes a television spot in a blend of English and Spanish; a Webisode series that will launch soon on www.hiv.drugabuse.gov, outdoor, transit, and print placements and community events and partnerships.
According to the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), the new Hispanic spots build on an earlier English series, but continue the storyline from the point of view of a teen who used drugs and alcohol, engaged in risky behavior and now has HIV. In the new series, a young woman calls on her aunt for comfort and support.
Rather than simply translating the original spots that were launched in 2005, NIDA incorporated culturally relevant scenarios that would resonate with the Hispanic audience--in this case, turning to family in times of distress. There are two versions of the new series--one set for Spanish-language television stations and a bilingual set for English-language stations located in markets with large Hispanic populations.
Carteret General Hospital (CGH) expects supply savings to exceed more than $1 million in its first year after joining the Premier Hospital Alliance, saving $500,000 in just its first month as a new member.
The Healthcare Supply Chain Standards Coalition, a collaborative of organizations representing the healthcare supply chain, announced that Owens & Minor, Inc. (Richmond, Va.) and Cardinal Health (Dublin, Ohio) are the newest companies to join. The group seeks to enable the efficient delivery of quality patient care through the adoption of industry data standards. It has now has 28 members.
"The participation of these two leading companies is instrumental to the continued success of the standards movement in the healthcare supply chain," said Joseph Dudas, chair of the Standards Coalition and Mayo Clinic's director of accounting and supply chain informatics. "Success for this initiative is contingent upon all partners in the healthcare supply chain embracing and adopting a unified set of globally accepted standards."
The American Medical Group Association has been aggregating and analyzing comprehensive patient data from nearly 300 AMGA member organization who serve more than 50 million patients and represent about 75,000 physicians in 42 states. The goal is ultimately to retrieve and validate patient data stored in far-flung legacy systems using different technologies.