Hospitals Overcharging Consumers at 10X Cost

The problem with hospitals being owned by for-profit entities is that pricing can be arbitrary. IF you can get away with overcharging it doesn’t matter where you are, so long as people pay. Some hospitals gouge even further than the usual song and dance between healthcare provider and insurance. The largest offenders seem to be in Florida.

The researchers said other consumers who could face those high charges are patients whose hospitals are not in their insurance company’s preferred network of providers, patients using workers’ compensation and those covered by automobile insurance policies.

Generally, hospitals know they won’t be collecting on the money they invoice as only a fraction is covered by insurance, and even then some patients are not insured yet are provided services. That explains astronomical invoices for apparently mundane procedures. Profit maximizing hospitals don’t have any checks or balances for their pricing, so they’ll go as high as they can.

For more:

http://www.washingtonpost.com/national/health-science/why-some-hospitals-can-get-away-with-price-gouging-patients-study-finds/2015/06/08/b7f5118c-0aeb-11e5-9e39-0db921c47b93_story.html

New Joint Commission Medical Imaging Standards

The Joint Commission has issued new standards around protocols, documentation and education that are designed to reduce unnecessary medical imaging and improve quality and safety.

The Joint Commission standards for diagnostic imaging are designed to help prevent duplicate and unnecessary medical imaging of patients, and reduce potentially harmful exposure to radiation when patients need CT scans, MRI or a combination of these and other diagnostic tests. The new protocols raise the bar for quality and safety at ambulatory imaging sites, critical access hospitals and accredited hospitals. The changes also impact the uncertainties around dosage radiation for patients.

Many have questioned whether the changes are enough.

The Joint Commission’s imaging standards were initially intended for release last year, but they were postponed due to lack of detail and clarity. Compliance to new protocols becomes difficult when a patient is seen by multiple healthcare providers – especially in different geographic regions – and when the patient’s journey spans different facilities, specialists and time zones as they strive to get well.

Healthcare provider education on the imaging equipment and diagnostic materials will be the main element to improve imaging standards and ultimate improve healthcare provision.

TPP Critics Fear Higher Drug Prices

The Trans-Pacific Partnership (TPP) is a proposed free-trade treaty between 12 countries throughout the Asia Pacific including the US and Canada. Respective governments have worked hard to push through legislation approving the new treaty. As deadlines approach more and more criticism and opposition has emerged over the proposed regulations.

Critics fear that the new agreement would provide unbalanced benefits to corporations. For example, a recent draft appears to give U.S. pharmaceutical firms unprecedented protections against competition from cheaper generic drugs, possibly transcending the patent protections in U.S. law.

This has many organizations concern including Doctors Without Borders.

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FBI Arrest 243 Healthcare Professional and workers with Medicare Fraud

243 individuals —- including medical professional such as doctors, nurses, and others–were arrested for their alleged involvement in Medicare fraud schemes totalling approximately $712 million in false billings.

The arrests were a coordinated operation in 17 cities by Medicare Fraud Strike Force teams, which include personnel from the FBI, the Department of Health and Human Services (HHS), the Department of Justice (DOJ), and local law enforcement.

The arrests are the largest-ever health care fraud takedown in terms of both loss amount and arrests.

Continue reading FBI Arrest 243 Healthcare Professional and workers with Medicare Fraud

House GOP Aim to Balance Budget in 10 years with Medicare Reforms

House Republicans are proposing major changes to Medicare and Medicaid as a part of a blueprint to balance the budget within 10 years. The proposal depends on repealing the Obamacare, including financial assistance for low- and middle-income individuals, and the taxes implemented to help pay for coverage expansion programs.

The budget calls for shifting to a premium support model for Medicare, in which beneficiaries would receive subsidies to shop for coverage on the open market. But that change—which Democrats denigrate as vouchers—wouldn’t be implemented until 2024 to limit the impact on current beneficiaries.

House Republicans also want to overhaul Medicaid to give states greater flexibility on how they spend those dollars and merge it with the Children’s Health Insurance Program. Referred to as “State Flexibility Funds,” the approach would resemble block grants to states that they could use to provide healthcare coverage to low-income households.

Nurses Week 2014 – Backbone of Healthcare

If you want to use the term ‘backbone’ then nurses would be the backbone of the healthcare system. Generally, in most hospitals the primary caregivers are nurses, and they also are a part of correctly diagnosing patients. Not only that, they spend their days serving patients, improving their health. But many nurses also go above and beyond, and their holistic approach to healthcare provision contributes to us in significant ways when we find ourselves at our physical (or mental) worse.

Hug a nurse this week for the annual Nurses Week! Healthcare wouldn’t be healthcare without them.

Joint Commission Change Standards for diagnostic imaging services

The Joint Commission announced changes to its standards for accredited hospitals, critical access hospitals, and ambulatory health care organizations that provide diagnostic imaging services, including ambulatory organizations that have achieved Advanced Diagnostic Imaging certification. The changes will be effective July 1, 2014 with additional requirements to be phased in by 2015.

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Classic Surgeon, Leaving a Sponge Behind

The Joint Commission issued a Sentinel Event Alert urging health centers to re-assess policy and practice to avoid mistakenly leaving items in a patient’s body after surgery.

Yes, it happens more often than you’d expect, even with the high level of proficiency and # of eyes on the patient, unintended retention of foreign objects (URFOs) or retained surgical items (RSIs), happens. The impact on patient safety is obviously massive with the possibility of physical and emotional issues.

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ELI5 – Why Is Obamacare Good or Bad?

A good topic to discuss, unfortunately, no simple way to explain the nuances of the Obamacare package. Although most economists would agree the best solution would be a form of universal healthcare, what we have in front of us now is Obamacare.

Read for some thoughts and explanations like you were five and needed an answer now.

http://www.reddit.com/r/explainlikeimfive/comments/1nhv9o/eli5_for_a_nonamerican_why_is_obamacare_such_an/