Archive for the ‘News’ Category

Infographic: Big Data Tools Fight Medicare Fraud & Abuse

June 6th, 2016 by Melanie Matthews

Over the past five years, the Centers for Medicare & Medicaid Services has successfully implemented a Fraud Prevention System using “big data” and predictive analytics approaches to fight fraud, waste and abuse in the Medicare fee-for-service program.

Taking “big data” mainstream has given the CMS the ability to better connect with public and private predictive analytics experts and data scientists, as well as collaborate more closely with law enforcement.

A new infographic by CMS looks at how many claims have been analyzed, the return on investment of the program and the national savings growth.

2016 Healthcare Benchmarks: Data Analytics and IntegrationThe 2016 Healthcare Benchmarks: Data Analytics and Integration assembles hundreds of metrics on data analytics and integration from hospitals, health plans, physician practices and other responding organizations, charting the impact of data analytics on population health management, health outcomes, utilization and cost.

2016 Healthcare Benchmarks: Data Analytics and Integration examines the goals, data types, collection processes, program elements, challenges and successes shared by healthcare organizations responding to the January 2016 Data Analytics survey by the Healthcare Intelligence Network. Click here for more information.

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Infographic: is Fundamentally Flawed

November 22nd, 2013 by Jackie Lyons

The launch of the website was plagued with large-scale problems, and some of the issues have yet to be fixed.

Only .38 percent of visitors- or 36,000 people – were able to complete enrollment on the website, according to a new infographic from This infographic also outlines specific issues with the site, market efficiency, repercussions of centralizing health data and more. is Fundamentally Flawed

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

You may also be interested in this related resource: The Financial Professional’s Guide to Healthcare Reform.

Infographic: How the Sequester Will Impact Healthcare

July 16th, 2013 by Jackie Lyons

The government-wide spending cuts known as the sequester underway since March 1, 2013 are adding to the urgency to transform healthcare.

Cuts to domestic and military healthcare spending will increase from $85 billion in 2013 to $1.2 trillion in 2021, according to a new infographic from Blue Cottage Consulting. The infographic illustrates the services exempt from the cuts and the various impacts the cuts will have on healthcare, including the Medicare budget, community health centers, medical research and more.

How the Sequester Will Impact Healthcare

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

You may also be interested in this related resource: Futurescan 2013: Healthcare Trends and Implications 2013-2018.

Surviving Sandy: The Aftermath

November 5th, 2012 by Patricia Donovan

Remains of the Sea Girt boardwalk

Rumor has it the “Jersey Shore” cast will reunite for a fundraiser to benefit victims of Hurricane Sandy. Their efforts will certainly be appreciated. In the meantime, residents up and down the coast of the Garden State are coping heroically in the aftermath of the deadly storm. Our hearts go out to our staff, customers, friends and families that have been impacted by this devastating storm.

With our offices a mile from the beach, we are luckier than most. The building is without power but dry. In another of the random acts of kindness that have become commonplace over the last week, a business has lent us the use of a conference room until power is restored. In the blocks that surround us, residents’ belongings are strewn over the neighborhood — appliances and Christmas ornaments and Communion dresses blasted from homes by Sandy’s tsunami-like deadly forces of wind and water.

Many homes have been destroyed; thousands are homeless. Generators are humming in backyards. There is still so much to do. There have been and will continue to be amazing stories: of trees crashing through roofs or narrowly missing them; of boats lifted from marina cradles and deposited a half a mile from shore where they perch tipsily in driveways and on railroad tracks. Of dramatic rescues, and of volunteers cranking out thousands of dinners on hastily rigged generators and strings of borrowed gas grills. Of strangers showing up with offers to help.

A friend stopped by last night to inquire about the availability of an unoccupied home in our neighborhood. She and her daughter are homeless, great chunks of her waterfront home having been ripped from their moors sometime between last Monday night and Tuesday. Still in a self-described fog, she marveled at the water’s ingenuity: how it managed to fill refrigerator compartments and dresser drawers, even pocketbooks hung from door handles. She will have to saw open a waterlogged night table that Sandy has swollen shut to access the precious papers and letters she always kept close. In a one-story home, she did not have the luxury of moving things to an upper level for safekeeping.

There are signs of life: utility trucks with Ohio and Alabama license plates, pockets of power resuming a half a mile away; a “hurricane bride” on our own staff who relocated her reception in the space of three hours when Sandy shuttered the couple’s original site.

In the wake of such unimagined devastation, there are the usual blessings: the relatively few lives lost, neighbors opening hearts and homes to the displaced, the buoyancy of a seaside community determined to rebuild.

This is the real Jersey Shore, not Snookie’s version.

10 Ways Health IT Can Enhance Patient Care, Reduce Costs

July 16th, 2012 by Jackie Lyons

Caught between emerging advances in health information technology and the weight of the struggling economy, it is difficult to improve the provision of care and enhance the patient experience and outcome.

But what if there were a way to improve the quality of care without increasing costs? Verizon Connected Healthcare recently identified list 10 areas where it believes strategic use of technology will enhance patient care and reduce cost:

1. Telemedicine Removes the Geographic Barriers to Quality Care— Through telemedicine, hospitals can reduce preventable hospitalizations, which amount to $31 billion in annual costs. Telemedicine also brings the promise of providing remote care for the aging population, and patients with chronic conditions and difficulties in traveling. This technology can deliver new service to previously unserved markets, helping improve care for those markets, and bring in new revenue for providers.

2. Health Takes Flexibility to the Next Level in Caring for Patients— The rise in mobile health applications for smart phones has fostered more than 10,000 health applications in the iTunes store alone. According to Research2Guidance, the world market for mHealth apps will reach more than $1.2 billion in 2012. Healthcare providers now can leverage many applications to help patients better manage chronic disease, weight loss and other conditions, and medication reminders and heart rate monitors.

3. Chronic Disease is e-ManageableChronic disease accounts for 75 percent of every dollar spent on healthcare. At current growth rates, chronic disease spending, which is currently at $1.3 trillion, will more than double, to $2.2 trillion, by 2020. By leveraging health IT, providers can help patients better manage their conditions from anywhere at any time. For example, 95 percent of diabetes care is done by the patient at home, work or on the go, not by a clinic. Empowering the patient can be replicated in other areas of chronic care by harnessing telemedicine and mHealth applications to help provide patients with remote support and disease management.

4. Wellness and Preventative Care are Keystones of Health Education Encouraging health and well-being will help reduce the 70 percent of deaths in the United States stemming from preventable diseases. Many diseases can be prevented through education, and health IT is the new gateway to help modify unhealthy behaviors. For example, smart apps can help patients manage their health and well-being in real time, providing alerts to take medications, exercise or follow a recommended diet.

5. Fraud Solutions Shift from ‘Chasing’ to ‘Prevention’ — Healthcare fraud, waste and abuse are estimated to cost the United States $226 billion annually. Medicare fraud alone is estimated to cost the government $70 billion annually. Changing from a “pay-and-chase-model” to an “identify-and-intervene” approach is the first step in trying to stop fraud. Today’s technology-driven solutions, such as Verizon’s fraud management solution, monitor healthcare claims to identify fraudulent patterns before claims are paid — not after, when it is much more difficult to recoup dollars.

6. Data Breach Awareness Pays Off — According to the “Verizon 2012 Data Breach Investigations Report,” data breaches in the healthcare and social assistance industry groups represented more than 7 percent of the total breaches Verizon analyzed in 2011. The protection of patient information could help save billions yearly for the healthcare industry. Many healthcare breaches stem from simple mistakes such as lost or stolen laptops containing patient data. This can be prevented in several ways, including encrypting all devices carrying sensitive information and securing the network.

7. Cloud Computing Gives Patient Information a Shot in the Arm — Verizon believes the cloud will impact healthcare industry in many forms. Well-established cloud service providers can help healthcare businesses reduce operational costs and improve sharing of patient electronic health records. Cloud service providers are able to offer cloud-based services for the healthcare industry to help monitor, analyze and react to real-time patient information.

8. Electronic Health Records are the Building BlocksDigitized patient data can help reduce duplicate tests, administrative inefficiency and redundant paperwork, which equate to some $120 billion in annual spending. According to Verizon’s Tippett, “Because of regulations, the healthcare sector is 10 years behind the financial services industry when it comes to utilizing IT. To reduce costs and improve care, exchanging patient information digitally — from payors and providers to pharma and patients — must be embraced.”

9. Big Data Yields New Way to Look at Science— The widespread adoption of health IT will bring a new era of science in harnessing “big data” to improve quality of care. This will help doctors tap a new science of healthcare by aggregating and analyzing large amounts of patient data on treatments, conditions and more.

10. Data Pool Integration Makes for a Healthy System— Removing the silos of patient information will help enable better communications. Utilizing a common platform can unite the pharmaceutical, physician, patient, and provider for better information sharing. Creating a common data pool for these otherwise disenfranchised silos will transform the healthcare sector into a technology leader in storing, accessing and sharing critical information. This will ultimately help reduce redundant testing and paperwork, and reduce the chance of medical errors.

United States Rates Higher Than Most Nations in Diabetes-Related Deaths

May 7th, 2012 by Cheryl Miller

Obesity and diabetes continue to make headlines, and are the subjects of two of our stories this week. The first: the United States has among the highest rates of obesity and diabetes-related deaths than most nations, according to researchers contributing to a new Commonwealth Fund report. This, among other factors, accounts for the United States’ spending more on healthcare than most nations, but getting just fair marks when it comes to quality. More on this, including the nation with the lowest per capita healthcare costs, in this issue.

Kaiser Permanente, HBO, and four major organizations are hoping to raise the country’s rating with a new public health campaign aimed at obesity, excess weight and their effects on the nation’s health. Integral to the campaign is the launch of The Weight of the Nation, a four-part documentary series that will be available to all cable subscribers, not just HBO subscribers, on May 14th and 15th. There will also be an option to view the series with Spanish subtitles. Along with HBO, Kaiser is working with National Institutes of Health, the Institute of Medicine, the Michael & Susan Dell Foundation and the CDC on this month-long campaign.

A campaign of a different sort takes aim at underserved communities, with the government’s continued effort to ensure their access to primary healthcare services. HHS has dedicated nearly $730 million to build, expand or improve community health centers. Currently, more than 8,500 service delivery sites around the country deliver care to more than 20 million patients regardless of their ability to pay.

And there are no likely measures on tap to rein in specialty drug spending, which is expected to soar over the next decade, according to a new study from the Center for Studying Health System Change (HSC). Unlike conventional prescription drugs, whose spending has been limited by patent expiration, generic substitution and other factors, health insurers and employers have few tools to control rapidly rising spending on specialty drugs, which are typically high-cost biologic medications used to treat complex medical conditions. Studies show that specialty drug spending has increased by 14 to 20 percent annually in recent years.

Are you a follower, director or guide? Check out our story on these three types of communication styles within motivational interviewing to find out.

These stories and more in this week’s issue of Healthcare Business Weekly Update.

New HCAHPS Measure Would Evaluate Quality of Care Transitions

April 27th, 2012 by Patricia Donovan

Beginning in January, patients discharged from the hospital could be asked three key questions to assess the quality of their care transitions, as part of a proposed new measure in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey.

As part of a proposed rule issued April 24, CMS wants patients about to be discharged to respond to the following three statements about the care transition:

  • During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my healthcare needs would be when I left.

  • When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.

  • When I left the hospital, I clearly understood the purpose for taking each of my medications.

For the last question, patients would be able to indicate that they were not given any medication at discharge.

The proposed questions are based on the three-Item Care Transition Measure developed by the University of Colorado Health Sciences Center for the NQF Endorsement Project entitled “National Voluntary Consensus Standards for Quality of Cancer Care.” Detailed information on scoring methodology can be found on the Care Transition Measure Web site.

CMS also wants to add two “About You” items to the survey that would not be included in public reporting of the HCAHPS survey but would be employed in the patient-mix adjustment:

  • During this hospital stay, were you admitted to this hospital through the Emergency Room?

  • In general, how would you rate your overall mental or emotional health?

CMS said it has received numerous inquiries and requests from hospitals and researchers to add a survey item concerning patients’ overall mental health. Some researchers claim that mental health status is an important factor in how patients respond to HCAHPS survey items.

The HCAHPS Hospital Survey is a standardized survey instrument and data collection methodology for measuring patients’ perspectives on hospital care. In its current form, the HCAHPS survey contains 18 patient perspectives on care and patient rating items that encompass eight key topics: communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, and quietness of the hospital environment.

The survey also includes four screener questions and five demographic items, which are used for adjusting the mix of patients across hospitals and for analytical purposes. The current survey is 27 questions in length.

Stress Imaging Tests, Chest X-Rays Among 5 Tests That Might Be Unnecessary

April 9th, 2012 by Cheryl Miller

Maybe you should think twice before agreeing to that MRI, according to a new campaign underway to identify specific medical tests or procedures that are commonly used but not always necessary. As explained in ABIM Foundation’s Choosing Wisely campaign, brain imaging scans like CTs or MRIs aren’t always necessary for patients after fainting if no other seizures or neurologic symptoms are evident. Nine leading physician groups representing nearly 375,000 physicians have created lists of “Five Things Physicians and Patients Should Question” for areas including cardiology, radiology, oncology and gastroenterology, among others. Details in this issue.

The good news: 2011 saw the launch of a record-breaking number of disease treatment drug options, for everything from cancer to multiple sclerosis to CV disease. More orphan drugs, which treat rare diseases affecting less than 200,000 people, were also launched in the past 10 years.

The bad news: Americans continued to ration their healthcare, using less prescription drugs and visiting the doctor less frequently, a trend researchers say has been in effect since 2009, with the onset of the recession. The only group to increase its prescription drug use were those ages 19 to 25 who were able to remain on their parents’ healthcare plans.

Some of those young adults were also responsible for a surprising statistic: an increase in ED use. The surge in newly insured adults has led to a surge in visits to the ER.

According to data from University of Colorado School of Medicine, many are using the ER as a default option when their primary care office is closed, or co-payments are too high. And with an estimated 32 million adults, the majority of them Medicaid patients, expected to receive insurance with healthcare reform, this could cause problems for the effectiveness of EDs overall.

These stories and more in this week’s issue of the the Healthcare Business Weekly Update.

The Supreme Court and the Buzz on Healthcare Reform

April 2nd, 2012 by Cheryl Miller

Forget Hunger Games; healthcare reform was the main draw this past week as the Supreme Court presided over three days’ worth of hearings on the Affordable Care Act.

According to news reports, two of the top issues addressed by the justices were whether the rest of the law could stand if the individual mandate requirement that most Americans get insurance or face a penalty was struck down; and the validity of expanding the state-federal Medicaid healthcare program for the poor. The judges will release their final rulings in June.

One thing many people could have used last week was a new vocabulary and glossary report just published by Thomson Reuters. Confused about what a mandate is, or the difference between EHR and EMR, or ED and ER? The report will clear it up for you, and even provide informational statistics and charts on key healthcare issues like state by state insurance status and annual fraud, and waste and abuse costs.

Interest was so high in CMS’ Health Care Innovation Challenge initiative that the agency announced it will need several additional weeks to process the applications and announce winners. CMS received approximately 3,000 applications, representing tens of thousands of clinicians, information technology entrepreneurs, medical suppliers, health centers, hospitals, community-based organizations and individual citizens from every corner of the nation. CMS first announced the challenge in December; it plans to award up to $1 billion in grants to applicants with the most compelling new ideas to deliver better health, improved care and lower costs to people enrolled in Medicare, Medicaid and CHIP, particularly those with the highest healthcare needs.

In another innovation challenge, hearts were thumping when HHS announced the winners of its contest seeking innovative technology applications to help solve tough health IT problems. The first place winners created THUMPr, an app whose simple, user-friendly interface enables users to create personal heart health profiles.

And lastly, a sad statistic: CDC announced that 1 in 88 children have been diagnosed with autism by the time they are eight, and costs for this disease have tripled to $126 billion in the United States since 2006. The majority of those costs aren’t spent on healthcare, but on educational and care issues, but it’s a disorder that keeps on increasing, and could use our undivided attention.

These stories and much more in this week’s issue of the Healthcare Business Weekly Update.

Survey Finds Many Healthcare Organizations Use Physician Alignment Criteria in Incentive Plans

March 26th, 2012 by Cheryl Miller

Almost half of all healthcare organizations are using physician alignment criteria in their incentive plans, according to a new survey from Integrated Healthcare Strategies. The survey, which monitors trends in healthcare salary increases, incentive practices, and benefit changes, was expanded to include the prevalence of physician alignment goals, given the market’s increasing interest in it. The most popular goal is meeting CMS’s quality standards, followed by physician use of electronic patient records and readmission rates.

What incentives are you providing your physicians? Describe the physician reimbursement models in place at your organization by taking our Physician Reimbursement Models survey by April 15th and you will receive a free summary of survey results once it is compiled.

Nurses play a key role in a new initiative from CMS. The agency is seeking up to five hospitals working with nursing schools to train advanced practice registered nurses (APRN). Recognizing that nurses are crucial to a strong primary care work force, but that the cost of training APRNs has limited many hospitals and other healthcare providers from doing so, CMS will provide up to $200 million in funds for clinical training to those hospitals selected to participate in the program, which is expected to run for four years. Applications must be submitted by May 21, 2012.

Nurses could play a key role in another story we cover on the use of anesthesia providers to monitor sedation during colonoscopies and other gastro-intestinal-related procedures. The practice has more than doubled from 2003 to 2009, and is costing the United States more than $1 billion a year, says a new study from the RAND Corporation. Of particular concern is that most of the increase is coming from low-risk patients, who may not need the service. Instead, researchers point to current treatment guidelines that show that these procedures can be safely administered by physicians and assisting nurses if the patients are not at risk for anesthesia-related complications.

And, where is Gloria Steinem when we need her? A new report shows that women are paying more for the same healthcare coverage as men; inequities include policies that charge female non-smokers more than male smokers, and that provide no maternity coverage to women of child-bearing age. Variations exist in each state and across the country, researchers state.

These stories and more in this week’s issue of Healthcare Business Weekly Update.