Healthcare’s Dangerous Fee-For-Service Addiction

Healthcare's Dangerous Fee-Fo

For its many users, healthcare’s fee-for-service reimbursement methodology is like an addiction, similar to gambling, cigarette smoking and pain pill abuse. Doctors and hospitals in the clutches of this flawed payment model have grown dependent on providing more and more healthcare services, regardless of whether the additional care adds value.

I don’t use this metaphor lightly, nor wish to trivialize our nation’s growing problem with addiction. Rather, as a physician and former healthcare CEO, I am increasingly concerned with the impact this payment structure is having on American health. And I worry about whether providers are willing to “kick the habit” before it’s too late.

Addictive Qualities

The Affordable Care Act, signed into law March 2010, included several provisions encouraging doctors to focus on increasing value (instead of simply maximizing the volume) of healthcare services. And yet, seven years later, between 86% and 95% of U.S. healthcare providers are still paid for each individual test, procedure and treatment they provide, an arrangement that continues to drive up healthcare costs with little to show for it. According to the latest Commonwealth Fund report, the United States spends more on healthcare than any other industrialized country but ranks at or near the bottom in almost every measure of comparative quality.

As with any addiction, America’s dependence on fee-for-service has dire financial and health consequences. This year, the estimated cost of care for an insured family of four will reach nearly $27,000, paid for through a combination of employer health insurance ($15,259), payroll deductions ($7,151) and out-of-pocket expenses at the point of care ($4,534). Year over year, patients are on the hook for a higher percentage of their total healthcare costs, which rose 4.3% compared to just a 1.9% increase in the U.S. GDP last year. This is a major warning sign. If medical costs continue to surge 2% to 3% higher than our nation’s ability to pay, the healthcare system will soon reach a breaking point. Businesses, the government and insurers will have no choice but to ration care or slowly eliminate coverage for the nation’s poor, middle-class and elderly populations.

As with all addictions, the fee-for-service model has mind-altering effects, distorting the perceptions of its users in ways that make them unaware of their growing dependence. When providers are paid for doing more, that’s what they do: They increase utilization of services and ratchet up the cost of care without even realizing they’re part of the problem. According to one study, just 36% of practicing physicians were willing to accept “major” responsibility for reducing healthcare costs. Of course, the first step, as with other habits, is to recognize the problem. Only then can we explore treatment options.

 

Read More: http://snip.ly/hlh5h#https://www.forbes.com/forbes/welcome/?toURL=https://www.forbes.com/sites/robertpearl/2017/09/25/fee-for-service-addiction/&refURL=&referrer=

Are You Obese but Healthy? You May Still Be 96% More Susceptible to Heart Failure

 

Are You Obese but HealthyObesity is one of the biggest causes of non-communicable, lifestyle diseases today. According to the World Health Organisation, close to 1.9 billion adults were obese in the year 2014. Around 2.8 million people die due to some complications associated with obesity every year. A recent study published in the Journal of the American College of Cardiology notes that obese people who may otherwise be healthy and free from ailments like diabetes, hypertension, et cetera may still run at a high risk of heart failure. Such individuals are 96% more likely to be at a risk of heart failure over people with normal weight who are also metabolically healthy.

“Obese individuals with no metabolic risk factors are still at a higher risk of coronary heart disease, cerebrovascular disease and heart failure than normal weight metabolically healthy individuals,” noted lead author Rishi Caleyachetty, from the University of Birmingham. “Obese patients, irrespective of their metabolic status, should be encouraged to lose weight and that early detection and management of normal weight individuals with metabolic abnormalities will be beneficial in the prevention of CVD events,” suggested Krish Nirantharakumar, senior lecturer from the varsity.

Experts studied electronic health records of close to 3.5 million British adults to assess cardiovascular diseases.

 

Read more: http://snip.ly/qtuw9#http://www.ndtv.com/food/are-you-obese-but-healthy-you-may-still-be-96-more-susceptible-to-heart-failure-1749667

How Americans get their health insurance

With Obamacare firmly in the crosshairs of Republican lawmakers, the debate around U.S. healthcare is at a fever pitch.

While there is no shortage of opinions on the best route forward, the timeliness of the debate also gives us an interesting chance to dive into some of the numbers around healthcare – namely how people even get coverage in the first place.

How Americans get healthcare

The following infographic shows a breakdown of how Americans get healthcare coverage, based on information from Census Bureau’s surveys.

Put together by Axios, it shows the proportion of Americans getting coverage from employers, Medicaid, Medicare, non-group policies, and other public sources. The graphic also includes the 9% of the population that is uninsured, as well.

visual 1Axios via Visual Capitalist

The following definitions for each category above come from the Kaiser Family Foundation, a non-profit that uses the Census Bureau’s data to put together comprehensive estimates on healthcare in the country:

Employer-Based: Includes those covered by employer-sponsored coverage either through their own job or as a dependent in the same household.

Medicaid: Includes those covered by Medicaid, the Children’s Health Insurance Program (CHIP), and those who have both Medicaid and another type of coverage, such as dual eligibles who are also covered by Medicare.

Medicare: Includes those covered by Medicare, Medicare Advantage, and those who have Medicare and another type of non-Medicaid coverage where Medicare is the primary payer. Excludes those with Medicare Part A coverage only and those covered by Medicare and Medicaid (dual eligibles).

Other Public: Includes those covered under the military or Veterans Administration.

Non-Group: Includes individuals and families that purchased or are covered as a dependent by non-group insurance.

Uninsured: Includes those without health insurance and those who have coverage under the Indian Health Service only.

Healthcare mix by state

Here’s another look at how Americans get healthcare coverage on a state-by-state basis.

This time the graphic comes from Overflow Data and it simply shows the percent of buyers in each state that receive health coverage from public sources:

Oddly, the state that gets the highest proportion of public health coverage (New Mexico, 46.6%) is kitty-corner to the state with the lowest proportion of public health coverage (Utah, 21.3%).

Why the debate is paramount

If you ask some people what is going on with U.S. healthcare, they will tell you that things are going “sideways” – that costs are going up, but care is not improving anywhere near the same pace.

Here’s a graphic we published last year from Max Roser that puts this sentiment in perspective:

us healthcare systemVisual Capitalist via Our World in Data

It’s fair to say that care has been going sideways in the U.S. for some time, and the stakes couldn’t be higher.

So, what needs to be done to fix the problem?

Read the original article on Visual Capitalist. Get rich, visual content on business and investing for free at the Visual Capitalist website, or follow Visual Capitalist on TwitterFacebook, or LinkedIn for the latest. Copyright 2017. Follow Visual Capitalist on Twitter.

HIPAA compliance expectations from Small Healthcare Providers

For The Health Information Portability and Accountability Act (HIPAA), the Business Associate is a major component. According to HIPAA, a Business Associate (BA) is an organization or a person who works with or provides service to a Covered Entity. A CE is one who handles or discloses Protected Health Information (PHI). This makes a Business Associate any person or entity that is involved in creating, receiving, maintaining or transmitting PHI to a CE for a purpose or activity or function as mandated and regulated by the HIPAA Privacy Rule.

Small businesses struggle with meeting HIPAA requirements

There are specific requirements that small healthcare practices need to put in place and to show that their program is current and meets the regulatory requirements set out in HIPAA. They need to conceive and implement a HIPAA compliance program that meets the requirements set out in this legislation. The compliance program should not only be adequate; it should be robust and resilient enough to withstand HIPAA’s strict scrutiny at various levels.

Helping small healthcare providers with the knowledge and skill needed for meeting HIPAA requirements is the purpose of a two-day seminar that is being organized by GlobalCompliancePanel, a leading provider of professional trainings for all the areas of regulatory compliance. At this seminar, Jay Hodes, who is a leading expert in HIPAA compliance and President of Colington Consulting, which provides HIPAA consulting services for healthcare providers and Business Associates, will be the Director.

Want to get a complete understanding of the requirements that small healthcare providers need to meet to comply with HIPAA requirements? Just register for this learning session by visiting HIPAA compliance expectations from Small Healthcare Providers.

Full explanation of what all a small business provider needs to do

This seminar is particularly created for small healthcare providers who have a difficulty in understanding the HIPAA compliance requirements and meeting them. It will be useful for those of various business sizes, but is primarily focused on the small healthcare provider. Jay will impart the kind of teaching with which organizations will be able to meet all of the HIPAA, HITECH, and Omnibus Rules.

The basis to implementing the requirements of compliance program is to first fully understand them. This is the learning that this seminar will offer. At the end of two days of intense learning that will be interspersed with lively presentations; participants will have inculcated a full grasp of all of the requirements for a comprehensive HIPAA compliance program. They will also have got a clear understanding of the kind of steps that they need to take to mitigate risk.

Steps needed to develop, review and amend HIPAA

The Director will include practical exercises over these two days that will help participants know all that is needed for developing, reviewing, and amending HIPAA policy and procedure. He will equip the participants with a clear roadmap for what needs to be place when it comes to all of the HIPAA regulations.

Over the two days, Jay will cover the following areas:

o  Why was HIPAA created?

o  Who Must Comply with HIPAA Requirements?

o  What are the HIPAA Security and Privacy Rules?

o  What are the Consequences of being a Business Associate

o  What is a HIPAA Compliance Program for a Business Associate?

o  What is a HIPAA Risk Management Plan?

o  What is a HIPAA Risk Assessment?

o  What is the Role of the HIPAA Security Official?

o  What are HIPAA training requirements?

o  What is a HIPAA data breach and what happens if it occurs?

o  What are the penalties and fines for non-compliance and how to avoid them

o  Case Examples of HIPAA Data Breaches

o  Creating a Culture of Compliance

o  Q&A.