Volume 5, Issue 1 - January 2012
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In this issue

Public Health Series 

Part I of IV

Over the past several years, access and community need have become increasing concerns. As such, issues of public health have become contentious topics leading to significant political debate. HC Topics' Public Health Series will include four articles address this changing areas of public health, including: healthcare nomenclature; health disparities; and, quality indicators.  The first article discusses the new language of healthcare that exemplifies the debate between medicine as a commercial good or regulated industry.

  Public Health Series: The New Language of Healthcare  

Some view healthcare as a normal commercial industry, subject to the same market forces that affect other fields (e.g., the auto industry). Others view healthcare as unique - resistant to normal market forces through regulation of costs, quality, and access. This dichotomy is leading to a unique shift in the language of healthcare, where patients are now referred to as "consumers" and doctors as "providers." This first article in HC Topics' Public Health Series examines how this shift in vernacular is unsettling to those supporting the mission centered provision of services regardless of cost and distorts the very essence of healthcare. (Read more...) 

  HIPAA Version 5010: What and When 

To correct inefficiencies and allow for the new ICD-10 coding expansion, HHS approved HIPAA Version 5010, a software upgrade, set of standard operating rules, and framework for supporting the new system. Although the final HIPAA rule originally mandated a January 1, 2012 compliance date, enforcement has been delayed till March 31, 2012, as providers struggle to comply with new regulations and systems. (Read more...) 

 Medical Loss Ratio Final Rule Divides Consumers and Insurers 

On December 2, 2011, HHS issued a final rule regarding the Medical Loss Ratio (MLR), which limits insurance company expenditures for activities that do not directly benefit beneficiaries. A significant change in industry oversight, the rule considers insurance broker and agent fees as administrative costs for purposes of a MLR calculation, which has received praise from consumer advocacy groups and criticism from the insurance industry(Read more...)   

  One Year of RAC Audits: MO is the "Big Winner" 

Recently, CMS issued the first annual report to Congress detailing the findings of the Recovery Audit Contractor (RAC) program. The report published the cumulative quality of overpayments and underpayments from October 2009 to September 2010 for each state and found that Missouri providers were owed more than $3 million in underpayments - the most of any state. (Read more...)   


New! Retrospective: Whistling Past the Graveyard - The Scenario 

"The only thing new in this world is the history that you don't know."

                                                                                      - President Harry S. Truman

The current push for widespread utilization of electronic health records (EHR) and measurement technology necessary for evidence-based medicine (EBM) to drive value-based reimbursement (VBR) models is similar to the scramble of physicians and medical groups in response to what was perceived as the threat of the insurance industry driven managed care organizations in the 1990s. while many believed that the gatekeeper model managed care failed to provide the cost reductions and physician success promised, there are lessons that may be drawn from the mistakes of the past searching in the healthcare delivery paradigm that may be instructive if the current push towards EHR, VBR, and EBM are not to fail again under the healthcare reform changes of the ACA. Whistling Past the Graveyard is a retrospective written by Robert James Cimasi relating to one particular engagement during the past 1990s era of healthcare reform, which was undertaken to define and develop an information and executive decision system that would facilitate physician integration perceived (and very often real) threat from the rapid incursion of managed care. This installment, Part I of IV of this series, The Scenario, describes the stakeholders and the problem to be solved. Part II will be entitled "The Software Solution", Part III will be entitled "The Healthcare Software Application Tango", and Part IV will be entitled "The Flim - Flam Man." (Read more...)   

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