Beginning next month, physicians, hospitals, and other healthcare providers in Ohio will have the opportunity to tackle the time and expense of "the paperwork monster" when health plans in the state introduce a new Web portal designed to streamline tasks such as billing, confirming eligibility, and referrals to other physicians or services.
America's Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association (BCBSA) are behind this pilot initiative that will examine how to offer physicians access to multiple insurers through a single information channel—a Web portal—in a given region of the country.
The initiative is initially designed to simplify information flow between health plans and physicians' offices, and later between health plans and hospitals.
The private insurers that have signed on to use the new portal are Aetna, Anthem, Cigna, Kaiser Permanente, Medical Mutual of Ohio, Humana, UnitedHealthcare, and WellCare Health Plans. At the current time, the Medicare and Medicaid programs are not involved in the Ohio initiative, although negotiations are still continuing. These plans represent about than 91% of state residents with private health insurance. Availity, LLC, is the project vendor. A similar initiative is planned for New Jersey.
Physician organizations who are supporting the effort are: the Ohio chapter of the American Academy of Pediatrics, the Ohio Academy of Family Physicians, the Ohio Medical Group Management Association, the Ohio Osteopathic Association, and the Ohio State Medical Association.
Streamlining the administrative process for providers "will result in tremendous savings, both in time and resources, and ultimately lead to improved consumer experience," said Scott Serota, BCBSA president and CEO.
The Ohio initiative is expected to simplify the work associated with patient visits and achieve savings by providing physicians with information in "real time" that:
Permits office staff to quickly determine patient eligibility and benefit information such as copayments, co insurance, and deductibles, and differences in coverage for services provided in network versus out of network.
Provides physicians access to current information on the status of claims submitted by physician offices for payment by insurers.
Tests real time referrals and preauthorization of services.
Provides for the online submission of healthcare claims.
Initiatives that streamline healthcare administration, such as this effort, have the potential to "slow the growth of the cost of care and contribute to savings nationally," said AHIP President and CEO Karen Ignagni.
Bradley Fluegel, executive vice president at WellPoint, the parent company of Anthem Blue Cross and Blue Shield, said that studies have shown the healthcare system could save up to $30 billion through automation of paperwork functions.
Cancelling elective surgeries, increasing respiratory beds, and ignoring patients' insurance status will do little to manage a moderate influenza outbreak, and much less to abate a severe one that may strike Los Angeles County.
A recently released report predicts that a moderate outbreak of influenza will increase emergency room visits by 201,800, or by 15%, in a 25-week scenario. In a more severe model of an influenza epidemic, ED visits will rise by nearly 500,000, or about 37%.
But what's far more worrisome is the projection that a moderate flu season will increase the total number of inpatient days for intensive care unit and med/surg beds by 138,900, and in a severe flu scenario, 332,000 inpatient days.
The onslaught of such scenarios will require care that Los Angeles County's 72 hospitals will not be able to provide.
Jim Lott, who represents the Hospital Association of Southern California, says he's not that concerned about the impact on emergency rooms. "We can expand our emergency department capacity on the fly by setting up tents," Lott says. "But the need to hospitalize these patients in acute care settings is where the danger lies."
Also of concern, Lott says, is the need for inpatient pediatric beds. "The demand on pediatric critical care beds will be the most severe problem," he says. "This is the population that both the CDC [Centers for Disease Control and Prevention] and state public health officials say could be the most severely impacted."
He adds that a major hospital for children in Los Angeles, Cedars Sinai Medical Center, is one of only 12 acute pediatric specialty centers in the county. "And they're concerned about being overwhelmed."
The scary scenarios were described in Los Angeles County Pandemic Flu Hospital Surge Planning Model, prepared by the National Health Foundation, a nonprofit health advocacy group in Los Angeles. The report sought to address what it called "a paucity of information" regarding supply and demand of hospital care during a flu epidemic and the consequences for LA County residents.
"Absent any intervention, hundreds of thousands of Los Angeles County residents will require hospital care during a flu pandemic when no hospital supply is available," the report warns.
While policy interventions might decrease unmet need by between 11% and 19% depending on the pandemic's severity, "the interventions modeled are not adequate to address the surge in demand."
The report continued, "The hospital system alone cannot meet the increase in demand expected during a flu pandemic . . . Policymakers need to pursue early, aggressive, targeted, and layered community interventions."
Eugene Grigsby, president and CEO of the NHF, says he doesn't think the challenges in meeting demand stop at the Los Angeles County line.
"We think it will be a problem throughout the whole state," he says.
"Without a really good disaster plan, the rollout period could be very confusing and messy, and so the inability to really be effective in dealing with the demand could be exacerbated," he adds.
Additionally, Grigsby says, most hospitals in the Los Angeles area "have no good count on how many respirators they really have." Even the state stockpile, which was purchased several years ago, may be in question. "If there is a stockpile and these respirators haven't been used, no one knows whether they will work or not," he says.
"The real story coming out of our report," Grigsby says, "is who's in charge. Is there a plan? Who knows about it? And is it well articulated. How all this is coordinated is a really critical aspect."
With the Senate Finance Committee poised to vote on a broad healthcare reform bill, President Obama and his top aides have reached out to current and retired Republican leaders in the hopes of countering the charge that Democrats are using their congressional majorities to push through partisan legislation. In the past two days, former Senate Republican leader Bill Frist; George W. Bush health and human services secretary Tommy G. Thompson and Medicare chief Mark McClellan; and California Gov. Arnold Schwarzenegger have all spoken favorably of overhauling the nation's healthcare system, although with plenty of caveats regarding the details.
The Securities and Exchange Commission has opened a probe into whether Hospital Corporation of America violated securities law by manipulating its books and records, according to documents and people familiar with the investigation. The investigation has been focusing in part on HCA's London subsidiary and whether the company fabricated tens of thousands of payments for phantom nursing shifts. HCA runs more than 160 facilities across the United States and in London.
Some influential centrist Democrats in the Senate are warming to a compromise that envisions health insurance plans run by state governments. A new proposal by Sen. Tom Carper would spell out how to boost competition in the private insurance market by enacting government-run plans at the state level. States could act alone or in concert with others to gain more leverage in the marketplace, and would be bound by the same rules established for private companies using the national insurance exchange envisioned by the Senate Finance bill. Another option would entail states opening their workers' employee-benefit plans to the general public, the Wall Street Journal reports.
Taken together, the views of four senators—Senator John D. Rockefeller IV of West Virginia, Senator Olympia J. Snowe of Maine, Senator Blanche Lincoln of Arkansas, and Senator Ron Wyden of Oregon—represent the spectrum of concerns Democrats will face in trying to assemble the 60 votes they need to get a bill through the full Senate using regular procedure. Satisfying each of them, without alienating the others, is the challenge facing Democratic leaders, reports the New York Times.
As children received swine flu vaccine for the first time, federal health officials attacked popular myths about the pandemic and the vaccine designed to stop it. Thomas R. Frieden, MD, director of the Centers for Disease Control and Prevention, said in a news conference that the most common misperceptions are that this flu should ever be called a "mild disease," that the vaccine is untested and that it has arrived too late. Flu is widespread across the country and some hospitals are getting so many emergency room visits that they have set up triage tents, but Frieden said no intensive care units have had more patients than ventilators—something that did happen in one Canadian province last spring.
Fearing for his life, Anthem Blue Cross of California client Ephram Nehme paid for his own surgery in Indiana, where wait times for organ transplants are far shorter than in California. But Anthem Blue Cross said it would not pay for a transplant in Indiana. Nehme, a Lebanese immigrant, could afford the surgery himself and went to Indiana for the liver transplant. But he remains angry with Anthem and sued the company, accusing it of putting its bottom line ahead of his medical needs.
Instead of pens, scribes at the University of Virginia Medical Center use laptops as they trail doctors from bed to bed, taking detailed notes that will form part of each patient's electronic medical record. Experts say the scribes' role illustrates hospitals' often bumpy transition from clipboards and closets of paper charts to digital records.
An interactive Web site may help patients decide if swine flu's bad enough to require a doctor's attention, using the same type of triage calculations that doctors at Atlanta-based Emory University use. Microsoft Corp. unveiled the site, where users type in their age—it's only for people over 12—and answer questions about fever, other symptoms, and their underlying health.
