Healthcare Economy

Minute Clinics are now called the "Disruptive Innovation" in the Health care Industry. This term refers to a product (or service) that enters a market as a simpler, lower-cost alternative to an existing product that is "overbuilt" for the needs of the market. Using lower-cost technology or workers, the innovation improves until it establishes a dominant market share. (Source: Bohmer, "The Rise of In-Store Clinics.")

Studies have shown that minute clinics have impacted the cost health care, though not significantly. These studies are also not comprehensive and does not include large geographies or multiple retail clinics. However, given the "disruptively innovative" idea that are the retail clinics, I wonder if there is a creative way of mixing the retail clinics or the minute clinics into the Health care system that will help us cut down costs. There are several ideas and concepts and business models that are floating around in the market like Accountable Care Organizations (ACO's) , Patient Centered Medical Homes(PCMH)  to begin with. Let me take the example of the PCMH. A thought that comes to my mind about PCMH is : What are we going to do about the patients who do not have any chronic diseases but who we want to keep healthy so that they don't slip into the Chronic disease category?

My suggestion is that the Health Plans allow such members to use the Retail clinics for preventive services, while the PCP takes charge of the chronically ill patients. This calls for an integration between the retail clinics and physician offices. EMR can be electronically transferred and shared between the Retail Clinics and the Physician offices. This will also keep the American Medical Association (AMA) happy because the minute clinics are no longer in battle with the Physicians but are in cahoots. Can this be a win-win-win-win situation for the Health Plans, Physicians, Patients and the Minute Clinics? Thoughts?

Posted by Vidya Rajagopalan at 2:31 PM | Permalink | Comments (0) | TrackBacks (0)

Acute ambiguity exists in the market right now in the ares of product readiness, analysis readiness, and people readiness; There is precious little time remaining to evaluate, decide, and act in these areas to prepare your facility for ICD10.  The product firms are still very much in the mode of making important decisions about their products' readiness for ICD10, including mapping, conversions, use of irreversible effective dates, exposing APIs to undefined 3rd party tools, and so on.  Understanding your products firms' direction and decisions on these and many other issues is ciritcal for 2012, while you still have the ability to influence or establish contingency plans.
 
Preserving existing ICD9-based analytics models could disappear and ICD10 based analytics models are new and untested.  How will your facility determine if the proper use of ICD10 codes will preserve, degrade, or improve reimbursements?  Waiting until December 31, 2013 to find out is probably not the wisest course. 
 
Some hospitals seems to treat ICD10 as little more than a coding retraining exercise and seem to be ignorant of the challenges others have faced during simpler and less critical changeovers.  Chief among the overlooked people readiness issues is with Clinical Documentation.  ICD10 requires far more clinical infomation for accurate coding so how should physicians be prepared in 2012?  The increased complexity of ICD10 coding combined with the need for additional clinical information could greatly reduce the net productivity of the coding function.  How is your facility preparing itself in 2012 to prepare for acquiring, housing, and training additional coders?  The volume and complexity of interactions between the billers, payers, and A/R specialists will also see a sharp increase, thus reducing new productivity in these functions as well. 
 
How you prepare in 2012 for these personnel issues could determine your ability to address these and other challenges when they arrive on your doorstep in 2013!  Use this year to take a hard at ICD10 and all of its impact areas, while you can.

Posted by Mark Brownlee at 2:22 PM | Permalink | Comments (0) | TrackBacks (0)