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Clinical Information Systems

More than Hospital Administration Technology 

Staff Reporters

In contrast to hospital administration systems [HASs], according to Richard Mata MD MIS, clinical information systems [CISs] deal directly with patient care processes and results. Clinical system sophistication varies widely from hospital to hospital and has the strongest presence in tertiary care centers. And, some hospitals have become nearly “paperless” due to the installation of leading edge clinical information systems.

Leading Edge Hospitals

Several leaders have emerged in the field of clinical informatics, most of which are tertiary care centers and teaching hospitals. Whereas the typical hospital only has about 3 to 5% of its budget allocated toward information systems, these medical centers often have a much greater percentage earmarked for such systems.

Functions and Functions

Hospital clinical information systems [CISs] encompass a wide range of features and functions, and modules may include the following:

  • pharmacy information systems which may include bar coding and drug interaction checking;
  • computer physician order entry [CPOE] systems allowing clinicians to directly order tests and treatments on line. These systems can also check for selected appropriateness of care parameters;
  • other departmental systems such as laboratory information systems [LISs], radiology systems, and intensive care clinical computing; and
  • electronic medical record (eMR) systems, which allow physician orders, free text clinical notes, decision support, radiology images, and other areas to be nearly fully computerized, allowing a “paperless” medical institution.

High Start-Up Costs

Both budget outlays and implementation strategies for these systems are highly variable and require much deliberation and foresight. The start-up costs of these systems can vary from several hundred thousand dollars for a departmental system in a community hospital to tens of millions of dollars for EMR systems in large centers.

Assessment

In addition, ROI calculations become more subjective, as ROI is more dependent on cost avoidance (e.g., from fewer medical errors, more efficient work processes) rather than revenue generation. However, improvements in quality of care from well thought-out development and implementation can still provide significant financial returns.

More info: www.HealthcareFinancials.com

Conclusion

Please contribute your own thoughts, experiences, questions, knowledge and comments on this topic for the benefit of all our Executive-Post readers.

Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Exposing Medicare and Insurance Sales Commission Scams

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Some Agents and Brokers May Be Cashing-In

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

According to the Associated Press, on October 25, 2008, Medicare Advantage’s agents stand to make $500 to $550 this year. This happens by enrolling a beneficiary into one of their HMO type managed care type plans, while the agents could make another $500 for every year the beneficiary stays with the plan. It represents a financial reward that is raising concerns that agents and brokers will work too aggressively to enroll people into HMO plans that don’t meet their health needs; or where traditional Medicare may be a better personal fit.

CMS to Take Action

Representative Peter Stark (D-California) has urged the Centers for Medicare and Medicaid Services [CMS] to consider capping the commissions, while Kerry Weems, the acting administrator for CMS, said the agency plans to take action soon.

Insurance Policy “Twisting” and “Churning”

According to the Dictionary of Health Insurance and Managed Care, and others:www.HealthDictionarySeries.com:

  • Policy Twisting is the use of trickery to get someone to lapse an insurance policy and purchase a new one; usually in another company.

  • Policy Churning is a related fraudulent practice where an agent tricks a policy holder to fund a new one with the same insurer. Important information about the full consequences of their action is dishonestly withheld.

Both tactics are typically done to increase sales agent/broker commission income.

Scam Alerts

Although much more common with life insurance policies, each state has an insurance department that will help you if you think you’ve been scammed. Visit their website or office and you’ll get help on what to do. Many reputable insurance companies will quickly compensate you once it’s established that you were a victim of such fraud. Make sure you don’t waste you time by complaining to an insurer’s branch office. Contact the main office for swift response.

Assessment

America‘s Health Insurance Plans [AHIPs], the trade group representing insurers, encouraged CMS to develop clear and consistent standards, while two of the major players in the program, Humana Corporation and UnitedHealth Group both said that they welcomed regulation of insurance agent commissions. WellPoint and Cigna are the two other major health insurance companies in this country.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Paging Doctor Oogle

Patient Driven Referral Sites [PDRSs]

By Dr. Darrell K. Pruitt; DDS

By Staff Writers

It is clear to some practitioners that Internet-based consumerism is the future of medicine; as well as dentistry. 

Regardless of the increasing number of complaints about managed care’s malevolent business model, managed care medical and dental plans are already wilting under the heat of transparency as well as the stifling economy. Market share continues to fall because of Adam Smith-like competition. 

These days, consumers are talking like a small town. Dentistry is no exception in the healthcare space. 

Enter Doctor Oogle

Doctor Oogle is a web 2.0 platform, built on a social architecture of national participation where patients post comments and opine about participating providers; nice or nasty. According to the site, it also offers a public database of dentists with patient feedback about dental practitioners. One can also read reviews, ratings, and recommendations; select a practitioner or schedule an appointment.

Ad-Driven Contrast of PDRSs

In contrast to WebMD, Servicegrades.com or other Patient-Driven Referral Sites (PDRS), which sell dentists ad space, DR. Oogle is completely uninfluenced by paid advertisements because there are none.  Participating dentists pay a flat monthly fee.

Defining Dental Quality 

If we can agree that in dentistry [perhaps more than medicine] patient satisfaction is an important measurement of quality care, DR. Oogle is a natural measuring tool just begging to be used by patients holding preferred provider lists.  In addition, DR. Oogle has the largest database of patient ratings of any other PDRS.

Dollar-Based Dental Benefits 

As businesses pull-back from expensive dental and medical insurance, some providers encourage owners to replace it with a fair and simple dollar-based benefit system; like Direct Reimbursement [DR] instead of intentionally confusing procedure-based benefits. This is akin to a concierge medical practice.

And, dentistry may be more susceptible to consumer influences, than whole-body medicine for a variety of reasons; for example:

  • costs of dental treatment are a small fraction of hospitalization,
  • emergencies are not generally life threatening, even if painful, and,
  • patients readily recognize bad dentistry [sometimes even as it is being performed].

Welcomed Transparency

Some dentists – and doctors – opine that managed care dentistry [medicine] is simply dentistry [medicine] provided by the lowest bidder – with little to no quality control – an unethical/specious business foundation that ultimately leads to the abandonment of patients’ interests.  Of course, this is not a new hue and cry against managed care precepts. 

DIY Studies

And so, in a recently received, and anonymous, do-it-yourself DR. Oogle study; one researcher was shocked at how much the listed dentists were disliked by their customers [patients]. Of course, there are statistical wrinkles: 

  • Maybe these lower rated dentists are not as bad as the reviews describe.
  • Is it possible that a few vocal people who expect discounts are impossible to satisfy?
  • How fair is that to a young dentist – just trying to scrape by anyway possible?
  • What dentist can maintain professionalism indefinitely in the financially thank-less environment of managed care? 
  • What about the future? 

Even if a preferred provider goes bankrupt trying to maintain professional standards, he or she remains sadly unappreciated.  Discount dentistry [medicine] comes at a tremendous price.

Assessment:

Collaborative healthcare 2.0 is the philosophy where patients, providers, and payers interact collaboratively and competitively in order to enhance quality medical services at value-driven prices in the most appropriate venue and time.

Dr. Oogle is an imperfect tool that in many respects seeks to further this goal.

Nevertheless, although metering tools will undoubtedly improve going forward, caring and competent dental professionals need not fear them. All others beware of patient empowerment and transparency.  

Conclusion:

You thoughts and opinions are appreciated. Please comment on Dr. Oogle and/or related doctor evaluation methods. [PDRSs].  Or, discourse on the increasingly transparent healthcare ecosystem in general.

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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SEC Rule 151-A and Insurance Agents

NAFA Criticizes the SEC

Staff Reportersinsurance-book

Insurance agents without securities licenses won’t be able to sell index annuities under this new proposed rule.

NAFA Opines

The National Association of Fixed Annuities (NAFA) recently took a firm stand against the Security & Exchange Commission’s (SEC) proposed Rule 151A, which would regulate index annuities as securities rather than as insurance products.

Insurance-Securities Hybrid Product

NAFA said in a statement issued in July that it “strongly disagrees with the SEC proposal and will pursue all available avenues of recourse,” including taking legal recourse, if required.

Assessment

NAFA Says Nix SEC Rule 151A.

Conclusion

In other words, if Rule 151A is adopted, insurance agents without securities licenses would not be able to sell Index Annuities [IAs].  IAs are investment products that combine both fixed income investments and equity index options so as to be able to leverage opportunities in both.

Please comment and opine; especially insurance agents, investment advisors and financial planners.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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IT Start-Up QWAQ

Introducing QWAQ Forums

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

QWAQ Forums, yes that name is spelled correctly, is a new start-up company in Palo Alto, California. Founded in 2006 by CEO Gregory Nuyens and CTO David Smith, it just raised $7 million in venture capital funding. Early customers include industry giants Intel and BP.

What It Is?

QWAQ is a [Software-as-a-Service [SaaS] provider that combines enterprise-wide collaboration with a three-dimensional interface environment, akin to Second Life, etc. It provides virtual workspaces for program management, virtual offices and virtual operations centers. Most interestingly, its users create virtual avatars, and meet with co-workers in a 3-D environment to share and edit documents and use other business applications.

For example, QWAQ users upload, share and edits documents like MSFT® WORD files, MSFT-PowerPoint® slides, Open Office® and MSFT-Office® documents. Users can launch FireFox® in a forum to browse the web. There are also VOIP and text chat capabilities 

The Healthcare Connection

QWAQ, it seems, is already popular with some doctors like radiologists in different locations who use medical imaging applications inside its forums. And, applications can be co-located and employed behind hospital or health enterprise firewalls, for added security protection.

Assessment

This new-wave application currently lacks granular permissions as all documents can be copied by anyone in the Forums; which are self-invited and self-hosted. Yet, it does seem to possess, next-generational “fly.”

Link: www.QWAQ.com

Conclusion

Current cloud computing competitors include Central Desktop, Basecamp and PBwiki; while MSFT-SharePoint dominates the collaboration space.

But, since no one else offers the 3-D experience of QWAQ, your opinions and comments are appreciated; especially from radiologists and all those HIT experts “out there.”  

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

Subscribe Now: Did you like this Executive-Post, or find it helpful, interesting and informative? Want to get the latest E-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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Patients Challenging Medical Invoices and Bills

Root Cause is Money, Failure-to-Disclose and Frustration

[By Staff Reporters]

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Patients are challenging their medical bills with lawyers and lawsuits, out of frustration about the lack of up-front disclosure over costs by doctors and hospitals.

Involve More than a Few Cases

For example, after being charged $82,282 for a 23-hour stay in doctor-owned Westfield Hospital for two operations on her abdomen, a 56-year-old West Penn Township woman called the hospital and her insurer for an explanation.

Not satisfied with the response, she hired a lawyer and notified a reporter, after which Westfield officials said she was overcharged due to human error.

In another 2006 class-action Seattle lawsuit that was expected to have a ripple effect on consumers and hospitals, two patients of the Virginia Mason Medical Center filed suit against the center and won, after which Virginia Mason agreed to pay back an estimated $60 million to more than 3,200 patients who over six years had been charged ”overhead” for procedures performed in hospital-owned clinics – in some cases adding 60 percent to the price patients would have been charged for the same procedure performed by the same doctors in their offices.

Assessment

Although private legal action over medical bills is hard to track, the number of billing and coverage complaints filed with the Pennsylvania Attorney General’s health care unit has risen steadily, with the 2,000 or more complaints so far this year representing a five or six percent increase over last year; according to Morning Call, July 13, 2008.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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