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Monthly Archives: June 2011

Hospitalizations for Mental Health and Substance Abuse Disorders: Costs, Length of Stay, Patient Mix, and Payor Mix

New data from AHRQ highlight inpatient hospitalizations for mental health and substance abuse disorders, including costs, length of stay, and payor mix.  Overall, the AHRQ statistics show interesting differences between inpatient stays for mental health, substance abuse, and all other conditions, as well as significant utilization and cost differences among states. Community Hospitals: While treatment may occur in specialized psychiatric...

Medicare Payment Reform and Quality Improvement: MedPAC Recommendations to Congress on Medical Imaging and Poor Quality Providers

The Medicare Payment Advisory Commission (MedPAC) has made 10 new recommendations to Congress regarding Medicare payment accuracy and financial incentives for medical imaging and other diagnostic testing, and quality improvement, targeting the worse performing Medicare providers for intensive technical assistance. MedPAC – an advisory agency to Congress with a 17-member commission and an excellent staff headed by my former OMB...

Employer Sponsored Health Insurance: Changes in Health Premiums and Employee Contributions for Health Insurance

The Agency for Healthcare Research and Quality (AHRQ) has released interesting new data on increases in premiums and employee contributions for employer-sponsored health insurance coverage (ESI) from 2001 to 2009. Types of Employer-Sponsored Health Insurance Coverage: There are three types of employer-sponsored health insurance offered by employers in the U.S.: 1.  Single Coverage for the employee only. 2.  Employee-Plus-One Coverage for the...

Using Health Information Technology for Chronic Disease Management: AHRQ Webinar

The Agency for Healthcare Research and Quality (AHRQ) is hosting a free webinar on Using Health Information Technology for Chronic Disease Management.  Webinar is set for Tuesday, June 21, 2011, at 11:30 am EST. During the 90-minute conference, participants can watch and listen as presenters share their experiences, lessons learned, and insights into the potential of how various health information technology applications lend themselves to improving...

Medicare and Medicaid Compliance: OIG Advice for Operating an Effective Compliance Program

Comprehensive compliance programs are essential for all hospitals, health systems, physician practices, Medicare Advantage plans, Medicaid health plans, Medicare prescription drug plans, drug manufacturers, medical device makers, long-term care providers, and others doing business with Medicare, Medicaid, or other government health programs. To help prevent fraud, waste, and abuse in Medicare and Medicaid, the HHS Office of Inspector General (OIG) and joint...

Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation, by Marc Bard and Mike Nugent

Are you ready to be an Accountable Care Organization (ACO)? Significant new opportunities and challenges face health systems, hospitals, and physician practices as they decide whether to participate in the new Medicare Shared Savings Program and join together to form an Accountable Care Organization. Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation is an excellent new guidebook by Marc A. Bard, MD and...

Compliance Challenges of Health Reform: Questions Compliance Professionals Should Ask as They Prepare for Health Care Reform

With an array of payment reforms, quality and safety requirements, massive expansion of Medicaid, and creation of the new State Health Benefit Exchange marketplace, the Affordable Care Act (ACA) presents extraordinary new challenges for compliance, especially for health plans, physicians, hospitals and health systems, and drug and device manufacturers. In a recent keynote address at Health Care Compliance Association’s Annual...

Hospital Readmissions: Data on Hospital Readmission Rates for Medicare, Medicaid, Privately Insured, and Uninsured Patients

Hospital readmission rates are receiving increasing attention by Medicare, Medicaid, and private health plans.  Research shows that a high proportion of hospital readmissions are preventable.  Most hospital payment methods, most notably the Medicare Part A inpatient prospective payment system (IPPS), create strong financial incentives for hospitals to discharge patients quickly. Therefore, Medicare and other payors are looking at ways to...

Direct-to-Consumer Advertising of Prescription Drugs: Legal, Policy, Market, and Public Health Issues for Potential Bans on DTC Advertising of New Brand Drugs

Direct-to-Consumer (DTC) advertising of prescription drugs, especially new brand-named drugs, remains controversial.  Some in Congress remain eager to prohibit advertising of brand-name prescription drugs to consumers in the first two years following a drug’s approval by the Food and Drug Administration (FDA).  Is this a good idea or is it a flawed policy rife with legal, policy, public health, and...

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