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29Jun, 2015

Mega Health Insurance Mergers – Good Or Bad?

By: Charity Darby | Tags: ACA, Aetna, AMA, Anthem, Cigna, hospitals, Humana, MAP, NYSE, payers, PPM, providers, Sherman Trust Anti-Trust Act

The media recently announced at least two proposed mega-mergers by large insurance companies however, no offer has been accepted at this time. Cigna Corporation had received an offer from Anthem, Inc. for, at the last count, $47.5 billion (USD). Aetna, Inc. is also reportedly close to tendering an offer to buy Humana, Inc. Additionally, there is talk on the Street that UnitedHealth Group, Inc. made a takeover approach to Aetna. If completed, I believe the first two deal deals would have a direct impact on patients, providers and maybe even […]
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22Jun, 2015

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What industry today produces more paper check transactions than it did in 2000?

By: Charity Darby | Tags: clearinghouse, healthcare, medical records, ObamaCare, transactions

Trivia Question: What industry today produces more paper check transactions than it did in 2000? I know this because it’s coming from me however, most, if not everyone will know that the answer to the question is healthcare. Yes, healthcare in the United States of America! The country that invented the personal computer, credit card, cellular phone, telephone, internet and automatic clearing house payment (ACH) is creating more paper than ever.. let me repeat, than ever! Recently, BloombergBusiness published a story with the headline: Why America’s $2.9 Trillion Medical Industry Still […]
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15Jun, 2015

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Final Rules for ACOs-Act 2

By: Charity Darby | Tags: ACO, benchmarking, CMS, EHR, EMR, HHS, U.S Department of Health and Human Services

Today the U.S. Department of Health and Human Services (HHS) released the Final Rule for The Centers for Medicare & Medicaid (CMS) on the Medicare Shared Savings Program (MSSP) in an effort to encourage more participation of accountable care organizations (ACOs) in risk-based models. The CMS press release noted: The final rule issued today improves the program over the proposed rule in a number of areas, including but not limited to: • Creates a new Track 3, based on some of the successful features of the Pioneer ACO Model, which […]
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5Jun, 2015

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Back to the Future on ICD-10?

By: Charity Darby | Tags: CMS, HHS, ICD-10, ICD-11, ICD-9, Medicaid, Medicare, WHO

A year ago, we were all on ICD-10 watch at this time. Odd makers were all taking sides as to what would happen with the deadline of October 1, 2014 to submit on ICD-10 billing codes to Medicare and Medicaid (the largest single payer of medical care in the United States). Insurance companies and hospitals were all rushing to meet the deadline to have Congress intervene and push off a full year. Today the watch is the same, and maybe with the Medicare Sustainable Growth Rate (SGR) issue resolved, (see […]
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29May, 2015

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“EMR 1.0” ?

By: Charity Darby | Tags: EHR, EMR, EMR 1.0, HIT, mobile devices, tablets

Part One Recently USA Today published an article on electronic health records & electronic medical records (EHRs/EMRs ). The article mentioned that the U.S. government is relaxing some of the tougher rules and requirements for hospitals using EHRs/EMRs. What grabbed my attention first was the mention of “The problem is we’re in the EHR 1.0 stage. They’re not good yet.” I will add more comments later however, their admission that EHR 1.0 was at a very, very early stage in the overall development. Let’s take a few steps back to […]
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22May, 2015

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Surescripts’s State of Digital Health Information

By: Charity Darby | Tags: controlled substances, E-prescriptions, health data transaction, National Progress Report, Surescripts, U.S. Healthcare

Surescripts (www.surescripts.com) recently released their 2014 National Progress Report and it was very impressive! Surescripts processed 6.5 billion health data transactions in 2014 – a feat that the company’s officials say marks a major digital transformation of U.S. healthcare. I don’t think that is an exaggeration. We are past the tipping point in the use of technology in healthcare. Based on the report, the company handled more transactions over the past year than American Express (6 billion) or PayPal (4.2 billion). In a press release dated May 19, 2015 Surescripts […]
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15May, 2015

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U.S. Electronic Health Records Industry To Continue Growing To End Of The Decade And Beyond

By: Charity Darby | Tags: EHR, EMR, Market Share, PQRS, Telehealth

Kolomara Information, a leading publisher of market research in medical markets, recently published a report entitled EMR 2015: The Market for Electronic Medical Records . In the public information released, the researchers expect that the Electronic Health Record (EHR) market will continue to grow past Meaningful Use (MU) with the incentive funding running out over the next few years. The report projects annual market growth of seven to eight percent during the next five years, with good competition and stable growth despite the absence of incentives boosting the market. From […]
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15May, 2015

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Is Expanding Telehealth Next On The Horizon?

By: Charity Darby | Tags: communications, EHR, EMR, Integration, Meaninful Use, MU-2, Telehealth, telemedicine

Just a few weeks ago the U.S. Senate Subcommittee on Communications, Technology, Innovation, and the Internet, held a 2 hour hearing on “Advancing Telehealth Through Connectivity.” Stakeholders testified to lawmakers that telehealth is helping to achieve financial and care-related benefits, but still many barriers remain to widespread appeal and use. In summary, industry experts from the U.S. Federal Communications Commission (FCC), informed the Senators that the use of telemedicine has both increased the quality of care by improving outcomes and, has reduced the cost of healthcare. This will provide a […]
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24Apr, 2015

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EHR Information Blocking Warning from the ONC

By: Charity Darby | Tags: information blocking

Recently the Office of the National Coordinator for Health IT (ONC) published a blog noting that they are “becoming increasingly concerned about these practices, which devalue taxpayer investments in health IT and are fundamentally incompatible with efforts to transform the nation’s health system.” Those words were from National Coordinator Keren DeSalvo, MD, and Jodi G. Daniel, ONC’s director of the Office of Policy Planning. They effectively call out “persons or entities (who) knowingly and unreasonably interfere with the exchange or use of electronic health information.” The problem is going to […]
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17Apr, 2015

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The SGR Is Dead!

By: Charity Darby | Tags: fee-for-service, Medicaid, Medicare, medigap, operating costs

We are now at the beginning of real healthcare payment reform in the United States. The President of the United States signed in to law the “Medicare Access and CHIP Reauthorization Act of 2015.” The new law represents 2 years of bipartisan hard work at the Capitol, and resolves a dilemma created by the Balanced Budget Act of 1997. Prior to today, legislative action has been required 17 times since 2003 to prevent catastrophic reimbursement cuts to Medicare service providers; this always creates huge political maneuvering not to mention, a […]
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