13 Year Old McAllen
BY IAN MORRISON
As a Scot, obviously I am a whisky fan, and although I prefer the smoky malts of Islay (where my grandfather was from and where I visit my friends there frequently), I am also a huge fan of McCallan 18-year-old whisky, the sticky toffee pudding of single malts.
But as all policy wonks know, McAllen Texas is not famous for whisky but for Atul Gawande’s “Cost Conundrum” article in the New Yorker, in 2009 which is still required reading in medical school and MPH classes and was arguably the cornerstone of Obama health policy and the ACO movement.
Dr. Atul Gawande described overutilization and hi...
Source: The Health Care Blog - February 2, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: The Business of Health Care Affordable Care Act Atul Gawande Ian Morrison McAllen Texas Source Type: blogs
The Power of a Quality Review: Your Best Defense Against OIG Audits
The following is a guest article by Rebecca Darnall, Risk Adjustment Leader at Episource.
You don’t have to be a fortune teller to see the future of auditing at the Office of Inspector General (or OIG). It has given every indication that it intends to investigate fraud, waste, and abuse more robustly in the foreseeable future. To that end, the agency doubled its budget for audits in 2022. The clear message is to expect — and prepare for — more audits.
These actions are more than just saber-rattling. The risk of audits is a legitimate threat to all payer organizations. As proof, several health plans have been making h...
Source: EMR and HIPAA - February 2, 2023 Category: Information Technology Authors: Guest Author Tags: Administration Healthcare IT Regulations Revenue Cycle Management Audits Centers for Medicare & Medicaid Services CMS Coding Errors Demographic Error Encounter Error Episource Health Plans Insurance Missed Condition Mock RADV A Source Type: blogs
The Debt Limit and the High Costs of Debt
Romina Boccia and Dominik LettNews headlines are filled withspeculations about the U.S. debt limit. Most prevalently, whether Treasury could be forced to prioritize interest payments to bondholders while delaying other government obligations when the debt limit binds, potentially as early as June. If Congress failed to raise the debt limit in time, prioritization of interest on the debt, before other government payments, is one likely outcome.A more ominous speculation is whether the U.S. government would default on its debt. Treasury has the ability to prioritize interest payments and should be able to cover debt obligati...
Source: Cato-at-liberty - February 1, 2023 Category: American Health Authors: Romina Boccia, Dominik Lett Source Type: blogs
Matthew ’s health care tidbits: How do you tell the price of a drug?
Each time I send out the THCB Reader, our newsletter that summarizes the best of THCB (Sign up here!) I include a brief tidbits section. Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt
As the average THCB reader is probably all too well aware I live in Marin County, California and therefore my kids are on amphetamine-based medication for ADHD. This is annoying as all get out because, as a controlled substance, this medication needs to be re-prescribed every month (no automatic refills allowed). In addition no 90 day supplies are allowed, and the kids must have...
Source: The Health Care Blog - January 31, 2023 Category: Consumer Health News Authors: matthew holt Tags: Matthew Holt The Business of Health Care ADHD BCBS of Massachusetts Caremark Drugs primary care Source Type: blogs
Arrive Health Creates First-of-Its-Kind Medication Access Solution with Acquisition of Pharmacy Technology from UPMC Enterprises
Arrive Health, the leading provider of real-time benefit tools and integrated solutions that improve patient affordability, today announced the acquisition of a suite of innovative patient engagement and automation technologies developed by UPMC Enterprises and the UPMC Pharmacy Network.
Arrive Health will add AI-driven virtual assistant technology and a robust patient management system to its affordability offerings, expanding support for more than 200 million patients on their journey to fill and refill their medications. The combined assets will – for the first time – empower providers, care teams, and patients wi...
Source: EMR and HIPAA - January 30, 2023 Category: Information Technology Authors: Healthcare IT News Tags: Health IT Company Healthcare IT AI AI Virtual Assistant Arrive Health Artificial Intelligence Brenton Burns Health IT Acquisitions Healthcare M&A Kyle Kiser Medication Adherence Patient Affordability patient engagement Patient-Sp Source Type: blogs
Insurance company vs. doctor: How the defense and settlement provisions in malpractice contracts favor carriers
In a medical malpractice lawsuit, your defense is completely in the hands of the malpractice carrier, and, make no mistake of it, its interests come first. However, the medical malpractice insurance contract is more instrumental in the defense of a doctor than insurance companies realize. There are clauses in the contract that, at first glance,
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Insurance company vs. doctor: How the defense and settlement provisions in malpractice contracts favor carriers originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - January 26, 2023 Category: General Medicine Authors: Howard Smith, MD Tags: Physician Malpractice Source Type: blogs
Costco Wholesale: What Is Its Pharmacy Strategy? It's Complicated.
Conclusion: Costco Pharmacy Manages Hybrid Cash/Insurance Payments for Rx Drugs Better Than Most Other Big Pharmacy Chains. Still, Costco Won ' tALWAYS Be the Low-Price Leader Because of How the U.S. Prescription Drug Market Functions.Costco Pharmacy ' s cash prices for many prescriptions may be low enough for people to simply bypass their insurance and pay out-of-pocket, which Costco welcomes, similar to how Mark Cuban Cost Plus Drug Co. or a number of other rapidly-growing, cash-only pharmacies which are popping up nationwide operate because their cash prices may be potentially even cheaper than by using insurance. Howev...
Source: Scott's Web Log - January 21, 2023 Category: Endocrinology Tags: 2023 Big pharma bypass insurance cash pharmacy cash-only pharmacy Costco Costco Wholesale Corp. PBM ' Source Type: blogs
The “open data” movement runs aground on FOURIER
BY ANISH KOKA
Reanalysis of a trial used to approve a commonly used injectable cholesterol-lowering drug confirms the original analysis by accident.
The open-data movement seeks to liberate the massive amount of data generated in running clinical trials from the grasp of the academic medical-pharmaceutical industrial complex that mostly runs the most important trials responsible for bringing novel therapeutics to market.
There are only a few elite academic trialist groups capable of running large trials and there’s ample reason to be suspicious about the nexus that has developed between academia and the pharmace...
Source: The Health Care Blog - January 19, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Uncategorized Source Type: blogs
The Open Data Movement Runs Aground on FOURIER
BY ANISH KOKA
Reanalysis of a trial used to approve a commonly used injectable cholesterol-lowering drug confirms the original analysis by accident.
The open-data movement seeks to liberate the massive amount of data generated in running clinical trials from the grasp of the academic medical-pharmaceutical industrial complex that mostly runs the most important trials responsible for bringing novel therapeutics to market.
There are only a few elite academic trialist groups capable of running large trials and there’s ample reason to be suspicious about the nexus that has developed between academia and the pharmace...
Source: The Health Care Blog - January 19, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Medical Practice Anish Koka FDA regulations Fourier open data Source Type: blogs
At CES, A Tractor And A Patient Stethoscope Point To Digital Health Future
By MICHAEL MILLENSON
A Deere tractor developed in Moline, Illinois and a stethoscope-for-patients from Singapore pointed to the future of digital health at CES 2023, the Consumer Technology Association gathering that’s become a global innovation hub.
The tractor appeared on a large video screen during the opening keynote by Deere & Company chief executive officer John May. The industrial company exec clearly relished the chance to trumpet the way Deere had turned tractors into high-tech tools to optimize farmers’ outcomes – an accomplishment inspiring envy among medical information mav...
Source: The Health Care Blog - January 18, 2023 Category: Consumer Health News Authors: matthew holt Tags: Health Tech CES Michael Millenson Wearable stethoscope Source Type: blogs
Senior Gynaecologist fined for doing Anomaly Scan as it missed the Anomaly, Important Judgment
According to https://advrohiterande.blogspot.com/2023/01/a-senior-gynaecologist-fined-for-doing.html it appears to be a case of medical malpractice where Dr. Usha Mukhi, a gynaecologist, is being held liable for not detecting a congenital abdominal wall defect during an ultrasound examination of a patient ' s pregnancy. The patient, Seema Deswal, argues that the Dr. Mukhi should have referred her to a qualified radiologist and that the anomaly could have been detected earlier and the baby could have been aborted within 20 weeks of pregnancy. The case was initially dismissed by the District Forum, but was later allowed...
Source: Sumer's Radiology Site - January 15, 2023 Category: Radiology Authors: Sumer Sethi Source Type: blogs
Activating Transparency in Health Care Pricing
The Centers for Medicare & Medicaid Services (CMS) have taken up the campaign for price transparency over the past few years. The need for this is obvious and pressing. Unlike any other industry, health care institutions have historically been totally free to charge what they want and not even tell you in advance. Most of us have had lived the horror movie that follows a hospital stay, receiving a bill in the mail…and then another bill…and another…
Hospitals have trouble predicting how much a procedure will cost for many reasons. They have a welter of agreements with different insurance companies and ...
Source: EMR and HIPAA - January 13, 2023 Category: Information Technology Authors: Andy Oram Tags: Administration Analytics/Big Data Health IT Company Healthcare IT Revenue Cycle Management CMS Costs Healthcare Cost Transparency Healthcare Price Transparency Healthcare Prices Healthcare Pricing Marcus Dorstel Turquoise Health Source Type: blogs
Caught in the middle: How health insurance companies influence cancer drug selection
Patients may find themselves caught in the middle between their health insurance company and their oncologist when it comes to selecting the drugs used to treat their cancer. Why is this? The American Cancer Society explains biologic drugs (derived from living organisms such as yeast, bacteria, or animal cells) and biosimilar drugs, which behave similarly
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Caught in the middle: How health insurance companies influence cancer drug selection originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - January 12, 2023 Category: General Medicine Authors: Paul Pender, MD Tags: Meds Oncology/Hematology Source Type: blogs
The CHIPHIT complex and the future of health care: Can we create a low-cost, high-quality system?
The high cost, low quality, and systemic inequities of the U.S. health care system have prompted its redesign. The current health care system is now controlled by consolidated health care institutions, insurance companies, pharmaceutical companies, and health information technology companies (CHIPHIT complex). The CHIPHIT complex, along with the federal government, will shape the future health
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The CHIPHIT complex and the future of health care: Can we create a low-cost, high-quality system? originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - January 11, 2023 Category: General Medicine Authors: Hayward Zwerling, MD Tags: Policy Health IT Public Health & Policy Source Type: blogs
Blockchain Could Save Healthcare Billions Every Year
The following is a guest article by Michael Kim, Senior Vice President/CIO at MultiPlan.
In recent years, blockchain has been one of the most-hyped technologies: A public ledger that lives on a network of computers, each validating any changes in real-time. Unlike traditional distributed databases with centralized management, blockchain offers a shared database, providing security, transparency, traceability, and speed. While the shared ledger idea can be traced back to the 80s, blockchain technology emerged in 2008 as the foundation for decentralized currency, namely Bitcoin.
While it is true the cryptocurrency mark...
Source: EMR and HIPAA - January 10, 2023 Category: Information Technology Authors: Guest Author Tags: Health IT Company Healthcare IT Interoperability IT Infrastructure and Dev Ops Revenue Cycle Management Blockchain Blockchain Technology Data Sharing Database Errors Health IT Interoperability Humana Improve Patient Outcomes Improv Source Type: blogs
