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Separating the Affordable Care Act exchange hype from reality

May 12th, 2016

by Leslie Small

In the news business, there's truth in the time-worn axiom, "if it bleeds, it leads." Or, as is more accurate for business reporting, "if it fails, it prevails."

There is something about human nature--the Germans call it schadenfreude--that cultivates an intense fascination with failure. And nowhere is this more apparent than the ever-polarizing Affordable Care Act.

Combine a drama-hungry news cycle with what one recent study termed a "toxic political atmosphere" surrounding the healthcare reform law, and you get headlines predicting certain doom every time there's even a hint of trouble on the ACA's public exchanges.

But with a law as complex as the ACA, concerns about the stability of its signature marketplace often run the risk of oversimplifying the myriad factors keeping it afloat.

So with that in mind, this special report takes a look at some of the main "risk factors" influencing the exchanges in order to parse out what's actually worth worrying about.

>>Read the full analysis at FierceHealthPayer

From the battlefield to the medical field: Growing physician leaders

May 5th, 2016

by Mark Hertling

Physicians, hospitals and a variety of healthcare organizations are concerned with how we as a nation will address the Triple Aim: improved patient care, access to medical treatment and reduced healthcare costs. America is facing a healthcare challenge, so it would seem an absolute requirement for physicians--those most involved--to be at the forefront, leading the way.

Physicians are the foot soldiers of healthcare; they must shepherd the medical profession, and they have the primary responsibility of improving our nation’s health. But unfortunately, doctors are often disconnected from policymaking roles. By necessity, physicians are primarily focused on medical solutions to the critical problems their patients face. But while doctors are on the front line of the tactical battle finding ways to improve care and access for the patient, they are often disconnected from the development of the policies and procedures that result in the strategic decision-making process aimed at improving the healthcare system.

=> Read more!

Healthcare improvement starts with putting the patient at the center

May 5th, 2016

by Thomas Dahlborg

“She was shocked. ‘How could it be?’”

As I sipped my iced green tea the other morning, an incredible woman who has now become a good friend shared with me the following story:

“To say that Dr. Jankowski [name changed] was absolutely floored when the findings were shared would be an understatement. She was also disheartened and hurt and asked me, ‘how could this be?’”

My good friend continued:

“Dr. J had been charged with instilling a patient-centered care culture within the large healthcare system. She had been working day and night with her team to manifest the needed change and the new focus. She felt good about the effort, and yet the progress was not what she had hoped for or expected. Yes, the healthcare system’s marketing and communications highlighted patient-centered care, and yet she knew if you pulled back the curtain the reality was not congruent with the branding.”

=> Read more!

CMS' hands off approach to MU and HIE in Medicaid managed care rule may backfire

May 5th, 2016

by Marla Durben Hirsch

Many people have been focused on what the Centers for Medicare & Medicaid Services' new sweeping Medicaid and CHIP managed care rule does. The long-awaited rule overhauls and modernizes how Medicare managed care works, bringing much of it into the 21st century.

But I'm more focused on what the rule does not do. It fails to modernize and update Meaningful Use and health information exchange, despite pleas from commenters for CMS to do so.

Commenters asked CMS to provide guidance to states choosing to create incentive programs for providers not part of the Meaningful Use program. They asked that such programs leverage ONC certification criteria so that the same standards and methods of data would be used for both the state program and the Meaningful Use program.

>>Read the full commentary at FierceEMR

A hospital exec’s perspective from the other side of the bed

April 28th, 2016

by Raymond Hino

High-quality patient experience is always a concern for me, as I believe we must make our patients’ time with us as pleasant as possible. Until recently, though, I haven’t had much experience as a patient myself. The most serious procedure I have ever had done in a hospital is an inguinal hernia repair, and my experience was very good. That couldn’t have anything to do with the fact that I was also the CEO of that facility, right?

But a more recent hospital experience in a facility, where I was not known, has given me a different perspective. A little more than a year ago, I was visiting my mother-in-law and brother-in-law, who were both inpatients at a local community hospital on the same day. This hospital has a great reputation. I was looking forward to seeing how they were doing and to get a closer look “under the hood.” Little did I know that before the day was done, I myself, would be joining them as a patient at that hospital.

=> Read more!

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