Healthcare

CMS has used the opportunity brought in by the increased specificity of ICD-10 codes to increase the granularity of DRG codes. This will help CMS streamline Medicare payments. Since significant number of Medicare and commercial claims is paid based on DRG codes, the added granularity is bound to cause uncertainty around provider reimbursements. This uncertainty combined with the payment reductions under SGR (Sustainable Growth Rate) has the potential to significantly impact providers’ bottom-line. Payers are not immune to the impact either. It’s crucial that payers and providers simulate claim payments, compare the payouts between I9 and I10, and be better prepared for the change.

Continue reading "ICD 10 – uncertainty around provider reimbursement" »

Posted by Vijay Kumar B at 04:51 AM | Permalink | Comments (0) | TrackBacks (0)

Physicians, nurses and case managers spend time with patients to educate them on self-health management; however, technology is increasingly playing an important role in enabling patients lead a better quality of life. Two key dimensions of patient enablement are:
• Access to care at the right level and the right time
• Access to information that helps them manage their health
Technology is addressing both the dimensions of patient enablement. E-Consultation is enabled via internet, IP TV, kiosks and mobile devices which gives patients anytime, anywhere access to care for certain conditions that do not require physician office visit.  E-Consultation can happen in synchronous mode over video/web chat or in an asynchronous mode over email. Some payors are reimbursing for eConsultation making this form of care a viable option for their members.

Continue reading "Patient enablement via technology" »

Posted by Seema Pandey at 08:09 AM | Permalink | Comments (1) | TrackBacks (0)

To begin diving deeper into interoperability within healthcare, let’s talk about interoperability within the healthcare provider sector.  The healthcare provider industry is suffering from, what a colleague has very eloquently described as, ‘extreme heterogeneity’ of IT systems even within a single provider.

Continue reading "Interoperability Trends within the Healthcare Provider Sector" »

Posted by Dr. R Balaji at 08:45 AM | Permalink | Comments (0) | TrackBacks (0)

Observation

As we enter the next decade, it is interesting to reflect on where the leading healthcare provider and payer organizations were in 2000 and what has been accomplished to solve the evasive dilemma of creating a truly integrated Electronic Medical Record (EMR) that can provide a complete picture of an individual’s health available on demand.

Continue reading " “The Complete Electronic Medical Record” - What will “Complete Integration” require from a Service Provider?" »

Posted by Gary O. Claytor at 06:51 AM | Permalink | Comments (2) | TrackBacks (0)

Yes, I believe so. Earlier patients were not well informed about their conditions, disease progression, medications, their side effects and the onus was entirely on the physicians to extract necessary information from patient and care-givers for treatment related decision-making. Extracting clinically significant information was a challenge in with language/cultural barriers coming into play or a patient who is inarticulate or unobservant about relevant signs and symptoms. With information explosion in the wake of internet wave, now a large number of patients visit physicians with prior research on their signs and symptoms as well as treatment options.

Continue reading "Can informed and enabled patients contribute to better outcomes?" »

Posted by Seema Pandey at 09:48 AM | Permalink | Comments (0) | TrackBacks (0)

As the global healthcare industry grapples with tremendous challenges on both cost and quality fronts; the healthcare consumer is simultaneously undergoing an equally dramatic change in behavior, attitude and awareness.  This new-age healthcare consumer will soon demand a significantly more active role in managing his/her own health needs as well as filtering and monitoring the relevant services that would be provided by the health industry.

Continue reading "Interoperability requirements will underpin key health industry and health consumer trends" »

Posted by Dr. R Balaji at 09:19 AM | Permalink | Comments (0) | TrackBacks (0)

The necessity for dual processing with ICD-10 is not just a result of interoperability between entities on disparate code-sets. Even if we assume that all the payers and providers are migrating to ICD-10 (desirable, but hardly a pragmatic situation) on Oct 1st, 2013 (compliance date), dual processing is going to be required for some adjusted claims and inpatient claims.

Continue reading "ICD 10 – processing adjusted claims" »

Posted by Vijay Kumar B at 12:08 PM | Permalink | Comments (1) | TrackBacks (0)

Few weeks ago, in one of my blogs, I had attempted to set some basic tenets for the tactical option (downgrade-store-and-forward) for complying with the 5010 mandate. They primarily covered,
• A dynamic rules based bidirectional converter
• A comprehensive store-and-forward mechanism for storing and retrieving reduced data
• A clear performance management strategy to manage data reduction (for down conversion) and data addition (for up conversion)
• A robust API to provide access to reduced data for the downstream applications, and
• A comprehensive test bed and associated test strategy
I promised in that blog that I would not ignore the strategic approach (remediating downstream applications to make full use of the mandate) and would tackle that in a future blog. So here we are. Lets see what are the basic tenets for the strategic approach.

Continue reading "5010 – Are you really ready? – Part 2" »

Posted by Rajiv Sabharwal at 07:52 AM | Permalink | Comments (0) | TrackBacks (0)

Supply and demand is perhaps one of the most fundamental concepts of economics and it is the backbone of a market economy. Demand refers to how much (quantity) of a product or service is desired by buyers. The quantity demanded is the amount of a product people are willing to buy at a certain price; the relationship between price and quantity demanded is known as the demand relationship. Supply represents how much the market can offer. The quantity supplied refers to the amount of a certain good producers are willing to supply when receiving a certain price. The correlation between price and how much of a good or service is supplied to the market is known as the supply relationship. Price, therefore, is a reflection of supply and demand, according to Investopedia.com, a Forbes company.

Continue reading "The Law of Supply and Demand - "Healthcare Rationing for our Future”" »

Posted by Gary O. Claytor at 12:37 PM | Permalink | Comments (4) | TrackBacks (0)