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Insurers' listings of in-network doctors often out of date

Wed, 11/26/2014 - 07:30

Many insurers are offering smaller networks of doctors in their Medicare Advantage and commercial health plans this year. But those networks may be even narrower than they seem, physicians and regulators say, because the lists often include names and addresses that are erroneous or out-of-date. In some cases, the doctors shown as participating in plans have moved, retired or died, surveys show. Others are listed under the wrong specialty, work in hospitals full-time and don't see outpatients, or don't accept the plan being offered. In a study published in JAMA Dermatology last month, researchers at the University of California, San Francisco, tried contacting all 4,754 dermatologists listed in the three largest Medicare Advantage plans in 12 metro areas.

Categories: Healthcare News

More medicine goes off limits in US drug-price showdown

Wed, 11/26/2014 - 07:28

Steve Miller is waging war on high-priced medicine, guiding decisions to ban drugs from the health plans of millions of Americans and sending companies reeling in a $270 billion market. He and his colleagues at Express Scripts Holding Co. say they are just getting started. Miller is chief medical officer for the company, which oversees prescription benefits for health plans and employers covering 85 million patients. Unless more is done about a wave of new and expensive drugs, some priced at as much as $50,000 a month, Miller says that health plans are going to be swamped as costs double to half a trillion dollars as soon as 2020.

Categories: Healthcare News

Costs of responding to Ebola adding up

Wed, 11/26/2014 - 07:24

The American public's initial response to the spread of Ebola to the USA was fear. Their next reaction may be sticker shock, especially if taxpayers are asked to pick up much of the tab. Treating an Ebola patient at U.S. hospitals costs $25,000 to $50,000 a day. While some hospitals say they will absorb that cost themselves, others are looking to Washington to reimburse them for expenses not covered by insurance. Omaha's Nebraska Medical Center still hasn't been reimbursed for the $1.16 million cost of caring for its first two Ebola patients, Richard Sacra and Ashoka Mukpo, said Jeffrey Gold, chancellor at the University of Nebraska Medical Center.

Categories: Healthcare News

UPMC may have to tweak doctor contracts following Highmark terminations

Wed, 11/26/2014 - 07:22

UPMC faces having to review contracts for up to 700 of its doctors after Highmark terminated them from its network effective Jan. 1. How many contracts will have to be tweaked as the result of Highmark's Nov. 20 decision is unknown, but health lawyer Michael Cassidy, said the impact would be "significant." "It's going to be a significant issue," said Cassidy, who chairs the health law practice group at the downtown offices of Tucker Arensberg. "Some doctors will have protection, some won't." At issue is patient volume and other productivity standards that are baked into every doctor's contract when they work for a health system.

Categories: Healthcare News

Why are more and more hospitals partnering with each other?

Wed, 11/26/2014 - 07:20

Since I began working at the Puget Sound Business Journal about two months ago, I've noticed nearly every other week there's a new hospital affiliation — or partnership, or agreement, or some term indicating two organizations are joining forces — announced by a major health care company in the area. Just since I've been here, Monroe Valley General Hospital has become a part of EvergreenHealth, Group Health has moved some of its services to Swedish Medical Center and Yakima Valley Hospital joined Virginia Mason's network. In recent years, some of the biggest news in the hospital world was Swedish's new affiliation with Providence Health & Services.

Categories: Healthcare News

Can the design of hospitals help patients recover faster?

Wed, 11/26/2014 - 07:09

The design principles in typical healthcare environments inadvertently make patients and staff more stressed, Osborn says. "Ceilings are low, the lights are glaring, the floors are noisy, the privacy is non-existent," he says. "It all accumulates to push us towards hyperarousal? it's not soothing at all." For a building to be therapeutic, it should have spaces that flex to allow both sociability and privacy. Social spaces with comfortable, movable furniture encourage people to speak to other patients. Places that encourage family and friends to visit, like single-bed rooms or private areas which can be screened off, increase visiting, reduce patient stress and speed up recovery.

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Transforming Decision Support and Reporting

Tue, 11/25/2014 - 08:13

New technology is enabling easier access to information, creating collaborative care team interaction and improved clinical outcomes.

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Slideshow: Healthcare Executives Eye Efficiency

Tue, 11/25/2014 - 08:06

Four senior healthcare executives discuss some of the most effective cost-reduction efforts that their organizations have implemented.

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The next Ebola? Health officials try to prepare for future outbreaks

Tue, 11/25/2014 - 07:43

The next Ebola or the next SARS. Maybe even the next HIV. Even before the Ebola epidemic in West Africa is brought under control, public health officials are girding for the next health disaster. "It's really urgent that we address the weak links and blind spots around the world," Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, told The Associated Press. "Ebola is a powerful reminder that a health threat anywhere can affect us." Ebola sprang from one of those blind spots, in an area that lacks the health systems needed to detect an outbreak before it becomes a crisis.

Categories: Healthcare News

Some experts dispute claims of looming doctor shortage

Tue, 11/25/2014 - 07:41

You hear it so often it's almost a cliché: The nation is facing a serious shortage of doctors, particularly doctors who practice primary care, in the coming years. But is that really the case? Many medical groups, led by the Association of American Medical Colleges, say there's little doubt. "We think the shortage is going to be close to 130,000 in the next 10 to 12 years," says Atul Grover, the group's chief public policy officer. But others, particularly health care economists, are less convinced.

Categories: Healthcare News

Upfront costs of going digital overwhelm some doctors

Tue, 11/25/2014 - 07:40

Dr. Oliver Korshin practices ophthalmology three days a week in the same small office in east Anchorage, Alaska, he's had for three decades. Many of his patients have aged into their Medicare years right along with him. For his tiny practice, which employs just one part-time nurse, putting all his patients' medical records in an online database just doesn't make sense, Korshin says. It would cost too much to install and maintain — especially considering that he expects to retire in just a few years. But starting next year the federal government will penalize Korshin and other doctors for not using electronic health records; Medicare will withhold 1 percent of his payments.

Categories: Healthcare News

For rural veterans with PTSD, telemedicine may help

Tue, 11/25/2014 - 07:38

For the many veterans with post-traumatic stress disorder (PTSD) who don't have access to a trained mental health care team, connecting with such a team remotely by phone and video chats may help, a new study suggests. At least 500,000 veterans in the Veterans Health Administration (VHA) system, or nearly 10 percent of the VHA population, were diagnosed with PTSD in 2012, the researchers write in JAMA Psychiatry. Previous studies have found that PTSD treatments delivered by interactive video are equivalent to therapy given in person, according to lead author John Fortney of the VA Puget Sound Health Care System in Seattle, Washington.

Categories: Healthcare News

Radiologists are reducing the pain of uncertainty

Tue, 11/25/2014 - 07:37

When Dr. Jennifer Kemp's husband got advanced rectal cancer, she got an unexpected patient's-eye view of her profession. Her husband was having scans every three months, terrified each time that they might reveal bad news. Dr. Kemp, a Denver radiologist, would sit down with her husband's radiologist afterward. Even so, it could be an hour before a scan was ready to be viewed. "I couldn't believe how anxiety-provoking it was to wait even an hour," she said. "Sometimes he would get a scan I didn't feel comfortable interpreting and he had to spend 24 hours waiting — and I had connections," she added. "That was absolute torture."

Categories: Healthcare News

CMS Mulls Income-Adjusting MA Stars

Mon, 11/24/2014 - 08:04

The Medicare Advantage star ratings program is already risk-adjusted for clinical factors such as comorbidities. Now federal officials are considering adjusting the quality rating program based on beneficiary income levels.

Categories: Healthcare News

Aligning Executive Compensation with Provider Mission

Mon, 11/24/2014 - 08:01

The latest HealthLeaders Media research report looks at structures and strategies for executive compensation as the industry shifts from volume- to value-based models.

Categories: Healthcare News

Healthcare M&A leads global deal surge

Mon, 11/24/2014 - 07:47

In a big year for deal making, the health care industry is a standout. Large drugmakers are buying and selling businesses to control costs and deploy surplus cash. A rising stock market, tax strategies and low interest rates are also fueling the mergers and acquisitions. It's all combining to make 2014 the most active year for health care deals in at least two decades. The industry has announced about $438 billion worth of mergers and acquisitions worldwide so far, about 14 percent of the $3.2 trillion total for all industries, according to data provider Dealogic. Overall, M&A is on track for its best year since 2007, the year before the financial crisis intensified.

Categories: Healthcare News

Bay Area nurses, hospitals clash over Ebola training

Mon, 11/24/2014 - 07:40

When the Ebola virus hit home in the United States in September, Sandra Ward, an emergency room nurse at Kaiser Permanente Medical Center in Walnut Creek, was eager to get the latest training to protect herself. But during a session in which nurses practiced putting on protective gear, she noticed the hood was missing, leaving her exposed. "We see this picture of a hood that the CDC (Centers for Disease Control) has started recommending a couple of weeks ago, but we haven't gotten it yet," Ward said last week. "It scares me." That fear has sparked a vigorous debate over how much preparation and training is enough for health care workers to deal with the Ebola virus, after two Texas nurses contracted the disease from an infected patient.

Categories: Healthcare News

Teamwork: TX program benefits hospitals, patients and students

Mon, 11/24/2014 - 07:39

Karen Rogers, a 53-year-old who suffers from a number of chronic ailments, welcomes Allen, an Angelo State University pre-med student, into her small, north-side San Angelo home. She doesn't mind divulging her personal life and struggles with depression to him. She values the advice he offers and above everything appreciates his presence with an open ear. "There's someone out there who's listening to me. I'm not crazy. Sometimes that's all you need," Rogers said. Rogers is part of a care coordination program recently launched by Shannon Medical Center. The program aims to reduce the recidivism of chronic emergency room visits by assigning a health coach, nurse and social worker to oversee patients weekly.

Categories: Healthcare News

Wheaton (IL) doctors work to spread positive message about house calls

Mon, 11/24/2014 - 07:37

On a recent Tuesday morning, Bernard and Margaret Sloan got flu shots, had their blood drawn and discussed medications with their doctor. The couple -- married 67 years -- had their procedures done by a nurse and Dr. Paul Chiang, home health care provider extraordinaire, while they sat on a red, floral sofa in the comfort of their Wheaton home. "There's just something unique being in the home that you can't get in the hospital, ER or doctor's office," Chiang said. "I'm going into your world. I'm stepping into your life."

Categories: Healthcare News

Opinion: Teaching hospitals are the best place to test health innovation

Mon, 11/24/2014 - 07:34

Digital technologies such as electronic medical records, mobile devices, and analytics offer the potential to transform health care. Whether it's a patient using her smartphone to better manage her diabetes, a provider monitoring a patient for arrhythmia remotely, or an electronic health-record system alerting a clinician of a potential drug allergy, digital technologies can create meaningful value for patients and practitioners alike. Yet there are significant barriers to the development and adoption of such technologies that academic medical centers are uniquely positioned to overcome. One of the primary barriers we see in digital health is the difficulty that start-ups face in accessing real-world hospital settings during the technology-development phase.

Categories: Healthcare News