Aetna Inc. lowered its earnings forecast for 2009, partly blaming a continued trend of more expensive hospital claims that had worried investors when it was first disclosed in April. The reduced forecast also reflects Aetna's lowered projection of reimbursement it expects from the federal government for the company's Medicare health plan business.
As Texas seeks ways to trim Medicaid, an increasing number of doctors frustrated with reimbursements are opting not to see new Medicaid patients. As a result, Medicaid patients often grow sicker while hunting for a doctor. Dallas ranks last among 15 major cities in the percentage of physicians accepting Medicaid, according to a study by Merritt Hawkins & Associates.
Without healthcare reform, Minnesota's healthcare tab over the next nine years will nearly double to $78.5 billion, a new report projects,
and health spending will swell from 15 to 20% of the state's economy.
The report from the Health Care Economics Program at the state Health Department will be used to measure how well healthcare reforms slow the growth in healthcare spending in Minnesota. Starting next June, the Health Department will issue annual analyses comparing actual expenses with projected costs, with the difference pegged as the effect of reform.
The Family Van, Harvard Medical School's curbside clinic that has offered free tests and counseling in Boston's low-income neighborhoods for 17 years, saved the healthcare system roughly $20 million last year by getting hard-to-reach patients to stick with treatments and avoid costly care in hospital emergency rooms, according to a study.
As healthcare increase and lawmakers debate ways to overhaul the system, a team of Harvard-led researchers suggests that such alternative approaches are an overlooked but valuable return on investment.
Microsoft continued its push into healthcare through a deal with Merck to gain access to some genetic data-management software. Microsoft plans to incorporate the genetic and genomic data-management software into Microsoft Amalga Life Sciences. Amalga is part of a push by Microsoft, whose other offerings include patient health-records holder HealthVault, to become a bigger player in healthcare.
New York City Mayor Michael R. Bloomberg and city labor officials announced a tentative agreementto amend health benefits for more than 550,000 current and retired city employees, guaranteeing the city $400 million in savings over the next two fiscal years. The agreement imposes the $50 to $100 co-payments for about one-fifth of current and retired city employees, and eliminates coverage for preventive dental care at certain offices. For most other city employees, the plan would restrict certain hospital, ambulatory, and hemodialysis coverage to network providers and would implement several other administrative cost-saving measures.
The insurance industry says it wholeheartedly embraces a healthcare overhaul, promising Congress and the president that it will make it much easier for individuals to buy insurance on their own. The sweeping concessions would help legislators achieve their goal of providing coverage to many of the nearly 50 million individuals who currently have none. But so far, the industry has made no such promises to the market for small employers. By some estimates, about half of the nation's uninsured are people who are self-employed or work for a small business.
Editor's Note: This is the first of three contributed features submitted by members of the International Medical Travel Association's Board of Directors. The IMTA is a not-for-profit global organization of stakeholders in the international medical travel industry.
In 2008 our country witnessed the largest drop in home prices since the 1930s and The Great Depression—a decrease of about 8.2%—while a conservative estimate for medical inflation in America was 7% during 2008. This 15% swing and the seemingly unstoppable inflationary trend are causing many individuals and employers to pause long enough to at least consider the benefits of international medical travel.
Of course, they also contemplate the risks along with the benefits. An increasing number of employers are progressively getting more comfortable with surgery overseas—especially at JCI-accredited facilities. But employers thinking about amending their benefit plans to encourage employees to travel to JCI-accredited hospitals abroad are considering the possibility of unintended consequences—either as a result of the procedure or in making the international journey to receive medical care. Employers want to make sure they have a solid risk management plan to protect 1) their employees and 2) themselves.
Some employers and individuals may have concerns with the international legal process if they find it cumbersome to sue a provider in an overseas locale. Certainly, the naysayers of this trend are quick to point out its deficiencies, as a spokesperson for the American Hospital Association recently commented, ". . . medical tourism isn't without risks. Should something go wrong with your surgery you have no legal recourse as you do at home." We know, of course, that this is not entirely true, and that seeking damages for malpractice may vary from country to country. Additionally, employers want to be sure they and their directors and officers are protected if the employee decides to file a lawsuit.
After substantial research, many have learned that there does not seem to be a legal precedent to guide injured parties regarding who is responsible for unintended outcomes as a result of the employee’s decision to select an international care benefit option through an employer plan. Even though many facilitators include only JCI-accredited hospitals in their networks, the risk for unintended outcomes—as it does here in the United States—still exists. Overseas hospitals have worked hard to accommodate Western expectations and limits. However, overseas court systems may not be as rewarding as American juries, and access to them may not be as easy.
From a risk management perspective, the entire continuum of services for international medical travel needs to be examined and attention paid to each opportunity to minimize exposure: 1) Provider selection and credentialing, 2) Care management processes, 3) Travel services, 4) Aftercare, 5) HIPAA privacy and security. Layer on top of this the need to monitor political events, currency, weather, and events like swine flu pandemics, and employers may quickly conclude that it makes sense to engage a trusted medical travel facilitator. With care and focus, each of these risk exposures can be addressed.
While there are no current "gold" standards for members and employers to consider for insurance coverage, there are a number of options to consider that are emerging for both. No-fault medical travel insurance policies can now be purchased by either the employer for the employee/dependent or directly by the medical traveler. These are low-cost policies that cover unintended medical consequences, damages due to travel accidents, and other significant mal-events that may occur in connection with this international medical care.
For employers sponsoring an international medical care option on their self-funded group plan, there are now liability insurance policies available. These products are a melding of professional liability and managed care liability policies intended to protect the employer if they are deemed liable in a medical travel accident. Limits are available readily to $5 million, and excess limits can be purchased in some instances. U.S. employers will have little trouble gaining access to the product, and Canadian employers will need some local representation to assist with the placement of this policy. In any event, select brokers can help guide employers through this process.
In conclusion, whether the accidental injury is a result of a medical procedure, an airplane, or another unforeseen accidental injury, reasonably priced insurance is now available to manage the risk for both employees and employers. Only time will tell if these insurance products are the catalyst that helps moves this trend to the mainstream of U.S employer benefit plans. However, both coverages have helped to eliminate perception barriers.
David Boucher currently serves as President and Chief Operating Officer of Companion Global Healthcare, Inc., which is a wholly-owned subsidiary of BlueCross BlueShield South Carolina.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
Editor's Note: This is the second in a two-part series about the partnership between Glen Cove Hospital and the National Health Service Elect.
A few weeks ago, in this column I wrote about a program where orthopedic surgeons and anesthesiologists from the United Kingdom observed hip and knee replacement surgeries performed by Eugene Krauss, MD, chairman of orthopedics at Glen Cove (NY) Hospital, part of the North Shore-LIJ Health System.
Both Krauss and Peter Kay, MD, president-elect of the British Orthopedic Association and one of the UK's representatives in the partnership, have high praise for the program, and say it could ultimately improve joint replacement efficiency and quality in the UK.
But they also say the joint replacement program is just the beginning of a partnership where the United Kingdom and the United States could realize the benefits of aspects of the other's health systems as the countries examine sweeping reforms.
Kay notes that since Barack Obama took office, one of the president's primary goals is to overhaul the nation's healthcare system. As a result, the U.S. system could have traits that are similar to the UK's National Health Service, the publicly funded healthcare system in England.
"You've got some massive changes in your healthcare system coming—you're probably going to move more towards a system like ours, and at the same time we'd be moving more to a system like yours," says Kay, who is also a practicing orthopedic surgeon at Wrightington Hospital in the UK.
"The key of working together is to find what is best—and what might be best might not be within our shores."
Krauss notes that the U.S. health system is driven by economics: in American hospitals efficiency and throughput is of utmost regard, he says. Good hospitals are seen as those that are efficient and with quality outcomes so they can make the most amount of money, Krauss says, and the United Kingdom is examining how to move closer to that model rather than its more socialistic orientation.
"I think the opposite is occurring here in the United States," Krauss says. "We've come out of a very economically-driven model—we are now going to have to look in terms of national healthcare programs."
Kay agrees that healthcare in systems in the U.S. are much more focused on making money, which he says is not necessarily a bad thing.
"Money doesn't have to become completely evil, I don't think," Kay says. "If you use money to drive efficiency and quality, as opposed to just profit and greed, I think money can be good. The focus just has to be right."
If the ultimate goal of the U.S. federal government is to provide coverage for every American, the U.S. will have to take some lessons from the United Kingdom as well. Krauss praised the UK's national standards for healthcare, as well as their tracking of these standards via a national registry, as something that the United States could learn from to ensure quality care across the country.
The Medicare patient that comes to a hospital such as Glen Cove, with its high-ranking orthopedics program, is not necessarily going to receive the same standard of care if they sought treatment in inner cities or rural areas, Krauss says.
"We are going to have to be able to move towards a national system that reimburses doctors and hospitals based on outcomes—to do that you have to be able to measure the outcomes, and they already have those standards in place," Krauss says. "You are really aligning our government's incentives, the hospitals' incentives, the doctors, and the patients."
Both Kay and Krauss say that while the partnership between Glen Cove and the NHS is currently focused on orthopedics, they hope it can expand to include lessons that can benefit the country's entire health system. By learning about the benefits and pitfalls of each other's systems, the countries can incorporate best practices they learn from each other.
And as both countries struggle to provide quality care (and make money) during the worldwide recession, they need all the help they can get.
"We are all in the same boat when it comes to funding healthcare, finding cost effective and efficient solutions to keep going," Kay says. "We think that other areas of healthcare may benefit from this sort of engagement."
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There are two camps of technology leaders in healthcare. Chief information officers who are focused on more than technology (such as operations, construction, and strategic planning) versus IT directors who are exclusively focused on technology.
The CIOs who focus beyond technology are often the IT leaders who are part of the CEOs inner circle and a valuable member of the senior leadership team. They have demonstrated that they bring knowledge and a skill set to help the organization realize its overall business and clinical goals. The recession combined with the government's focus on health information technology has created a great opportunity for IT directors who are ready for more responsibility and an expanded role in the organization. Healthcare facilities are searching for ways to be more efficient and improve clinical outcomes and technology can play a huge role in improving hospital operations, which is the goal right now for many senior leaders. Surviving this recession in a manner that they can be successful on the other side.
Understand how the economy affects your job. It is essential to demonstrate that you understand the big picture—how the recession is impacting the organization and that you are willing to help and contribute, even if that means putting a favorite IT project on hold. It's also the perfect opportunity to showcase what skills you have as a leader by driving efficiency and staying current on IT innovations that can help the organization save money or improve care. During the past several months, many hospitals have been forced to lay off staff members, a large portion of whom were from the administrative offices. Organizations are cutting back on the number of executives they have so it is essential for IT leaders to demonstrate that they can take on more than technology projects.
Emulate C-suite executives. IT leaders should ensure that their staff members know the organization's strategic goals by keeping them updated about its milestones and future projects. Portraying the role you wish to have is an important step in gaining the trust of and being viewed as a senior leader. For instance, CIOs should demonstrate skills in strategic thinking and planning, listening, communication and even empathy. How can IT leaders demonstrate these skills? By helping keep staff members calm in troubled times, fulfilling the role of a business enabler, operational driver, service leader, visionary and people motivator. Empowering people is how you can get the long term results the organization needs to be successful.
Focus on the whole organization. Identify ways that IT can help the organization run more efficiently. Are you deeply involved in strategic planning, so that you can help ensure goals and objectives are being adequately evaluated and met? CIOs also need to be able to empathize with the clinical and business processes of the organization. Put yourself in the shoes of the people who do the work and imagine you are running the business, the report advises.
Choose a CMIO who knows the physicians well. Chief medical information officers need to understand clinicians and be viewed as a trusted advocate on their behalf. They also need to be candid with clinicians and able to communicate what is and isn't possible when it comes to technology.
Optimize workflow in an electronic environment. Organizations need to make the transition to a paperless environment as soon as possible. The funding for HIT in the American Recovery and Reinvestment Act of 2009 has made this transition even more urgent if organizations want to claim their share of stimulus funds. Having both paper and electronic systems does not work. It is the CIOs responsibility to transition to and leverage electronic medical records as quickly as possible. That means CIOs need to be able to articulate how technology can enable business and improve patient safety and quality by improving care delivery processes. CIOs need to relate to stakeholders that have varied levels of technological experience. It is important for them to avoid terminology and nuances of technology that staff members won't understand.
Embrace the seriousness of clinical IT implementation. CIOs should recognize the enormous changes that they are asking clinicians to make by switching from a paper-based system to a paperless environment. It is a fundamental change in care delivery and physicians need to completely alter the way they practice medicine. IT leaders should acknowledge what a huge undertaking this is and involve various stakeholders to make the transition as seamless as possible.
Look ahead. CIOs should be able to articulate a vision of the future and how technology fits into that vision, so senior executives and staff members want to help achieve that vision of the future. To accomplish that goal in the current economy means that CIOs will need to excel at doing more with less and prioritizing the projects that are the most important to the organizations overall strategy and performance.
IT leaders who can master these skills and make themselves an invaluable member of the team will not only have job security during this difficult time, but they can also become a valuable member of the senior leadership team.
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