Value-Based Reimbursement: Be Careful What You Wish For - Number of Quality Programs Expands Post-ACA (Part Two of a Three-Part Series)
In the years following the 2010 passage of the Patient Protection and Affordable Care Act (ACA), payors in the United States have aggressively pursued value-based reimbursement models, led by the Centers for Medicare and Medicaid Services (CMS). To date, the Center for Medicare and Medicaid Innovation within CMS has proposed or implemented over 60 programs to "test innovative payment and service delivery models to reduce program expenditures...while preserving or enhancing the quality of care furnished to individuals." The second installment of this Health Capital Topics three-part series on value-based reimbursement will examine the impact of the ACA and CMS activities on value-based reimbursement in the United States. (Read more...)

Telemedicine: Professional Practice Standards (Part Three of a Four-Part Series)
As highlighted in Part Two of this four-part series on telemedicine, the growth in reimbursable telemedicine services has been widely varied across payor types, as well as across the United States. Much of this variance can be attributed to the current state of medical licensure rules for each state. While many state legislatures have debated increasing reimbursement for telemedicine services, state medical boards continue to impose restrictive regulations on telemedicine. The third installment in this Health Capital Topics four-part series on telemedicine will examine today's shifting telemedicine licensure environment in light of the legislative trends and professional practice standards impacting healthcare delivery. (Read more...)

Disruptive Innovation in Healthcare
ADisruptive innovation refers to the process wherein smaller players in a particular market meet the demands of consumers that established incumbents have overlooked in their quest to provide for the most profitable customers. In the healthcare industry, disruptive innovation allows the provision of healthcare to be done in more cost-effective and convenient ways compared to traditional methods. Although disruptive innovations may threaten the economic viability of established institutions, professionals, and investments, these forces could improve the quality and accessibility of healthcare. This Health Capital Topics article will discuss the current environment for disruptive innovation in the healthcare industry, and will examine the potential effects that disruptive innovation may have for patients and providers. (Read more...)

An Ounce of Prevention is Worth a Pound of Cure: Distribution of Medical Malpractice Claims - Implications for Healthcare Organizations
In today's emphasis on reducing healthcare costs and spending, many commentators have noted that reforms to the U.S. system of medical malpractice, such as noneconomic damages caps, could reduce overall healthcare spending. While the effectiveness of "tort reform" measures on reducing healthcare spending has been challenged, new data regarding the concentration of paid medical malpractice claims among physicians may offer new insight into future medical malpractice reform efforts. A January 2016 study published in the New England Journal of Medicine (NEJM) found that "1% of all physicians accounted for 32% of paid claims," and positively correlated the risk level of a physician for a malpractice claim with the number of previous paid malpractice claims against the physician. Identifying physicians with increased risk levels for a malpractice claim, as well as designing protocols and training regimens to decrease this risk, prior to the onset of legal implications, could serve as a proactive means by which health systems can reduce the burden of medical malpractice while reducing unnecessary healthcare expenditures. This Health Capital Topics article will discuss the results of the NEJM study on medical malpractice claim distribution, and detail how health systems can utilize claims data to take proactive measures to reduce the burden of medical malpractice and associated costs. (Read more...)