Two Way Radios in Primary and Acute Healthcare

Communication plays a crucial role in healthcare. Timely dissemination and sharing of information is critical for acute healthcare providers. Similarly, primary healthcare can be easily administered by using practical and handy communication channels. However, there are several factors that need to be taken into account before deciding upon an effective mode of communication in both primary and acute healthcare institutions. Reliability, coverage and confidentiality of transmitted information along with the institution’s capacity in handling the equipment, play an important role. Healthcare institutions can largely benefit from a mobile clinical staff and two way radios can provide prolific results if used effectively for sharing information.

Functionality and Build of Two Way Radios

Two way radios allow only one function at a time – either receiving or sending the signal. This helps the users efficiently communicate without interrupting the interlocutor. These devices are helpful in exchange of crisp information, rather than constant communication. Two way radios are also known as transceivers or walkie talkies.

Two way radios are simple devices made of primarily six components: power source, receiver, transmitter, microphone, speaker and the crystal. This implies that running and maintenance costs for these devices are not too high. Two or more communicating devices operate on the same radio frequency and a push-to-talk button switches the device between receiving and transmitting modes.

Primary Healthcare and its Challenges

There is a growing emphasis to offer primary healthcare to one and all. This requires creating an environment where equal emphasis is laid on healthcare for all individuals. However, shortage of trained medical practitioners poses a serious threat to achieving this objective. Medical planners have to focus on the use of technology to make the maximum use of the available resources.

Isolation of patients is a big problem that surfaces in primary healthcare. Patients who need medical attention are usually dispersed, especially in rural areas and may not have access to medical facilities. The supply of drugs and medical tests are difficult to conduct and this defeats the very objective of primary healthcare. Lack of communication is another major problem in administering primary healthcare.

A quick exchange of information offers a suitable solution to meet all these challenges. Two way radios enable exchanging of crucial medical information and gradation of current medical practices. The absence of advanced technologies in many locations also increases the importance of two way radio communication devices.

Using Two Way Radios in Primary Healthcare Settings

The most important use of two way radio in delivering primary healthcare is in connecting local medical practitioners with hospitals in cities and more advanced areas. This is critical to diagnosing a patient as well as for prescriptive purposes. A timely decision whether the patient must be referred to a hospital with advanced facilities can be crucial in saving lives. The hospital can also monitor the condition of a patient at another location through two way radios.

How well two way radio technology is implemented for primary healthcare will be dependent on medical and health protocols. Doctors in some countries contact health aides and monitor the situation of the patient by use of two way radios. The medical structure of a community and the country determines how effectively the two way radio can be used for primary healthcare.

Emergency situations can also be addressed by using two way radio. Lack of good transportation and communication facilities can jeopardize a community in case of a medical emergency. Two way radios can be used to send news of such medical exigencies to hospitals or district headquarters and help save many lives.

In some countries, two way radios are used to connect fieldworkers with doctors who are constantly on the move. Use of airplanes helps attend to critical patients in a very short time as soon as the news is delivered by way of two way radios.

Two way radios can also help in training field workers who play an important role in primary healthcare. It depends on the level of existing competence of the medical workers and the desired levels of training. Moreover, field workers can listen in to the conversation of co-workers with physicians and learn by observing the standard medical practices adopted in different cases.

Using Two Way Radios in Acute Healthcare Settings

Clinical information in a hospital can be shared with the help of two way radios. A mobile unit of clinical staff will be more efficient in dealing with day-to-day problems faced by patients and in specific cases where a patient requires immediate attention. A patient who undergoes a complicated heart surgery may require constant monitoring for a few hours after the operation. However, it may not be possible for the doctor who operated on the patient to stay by his side all the time. Two way radios can prove to be a handy solution for helping healthcare institutions, solve such critical operational issues. A nurse attending on the operated patient can inform the doctor about the patient’s progress or whether the patient needs immediate attention, using two way radios. This will not just update the doctor on the patient’s condition but also help him take immediate decisions based on the available inputs. The healthcare industry has successfully tested and used two way radios for acute healthcare. Hospitals make wide use of two way radios for exchange of information among healthcare workers.

Two Way Radios: Advantages

Two way radios provide for a cost effective medium of instant communication. Healthcare industry requires rapid and extensive sharing of information in the most cost effective and efficient manner. A large healthcare institution can be brought under the ambit of wireless radio communication without running up high costs. Moreover, radio signals are quite reliable as compared to mobile networks, where one must depend on the network strength and connectivity. Also, issues of interference do not surface often. Maintenance costs for these devices are also considerably low.

Two Way Radios: Standard Practices for Operation

Some of the standard practices followed for using two way radios in healthcare institutions are:

The devices are used in “receive only” mode in patient areas.
Medical staff is advised to leave the patient area if the device has to be used for outgoing communication.
Two way radios must be kept at a distance from highly energized medical devices.
Lowest possible setting must be used to avoid any interference if the device so permits.
In case of malfunctioning of any medical equipment, the use of radio devices must be stopped immediately.
Unnecessary use of two way radios may distract a medical practitioner during surgery. Therefore, such devices must be used only when required to avoid any delay in patient care.
Using Two Way Radio Systems: Interference and Other Issues

Two way radios do not generally interfere with other medical equipment. Research studies have proved that hospitals can safely use two way radios for communication purposes. These devices can be safely used at a distance of 0.5 meters from most medical equipment. The reason is that these devices operate at high frequencies and do not cause any interference. However, the use of two way radios is discouraged in highly sensitive medical environments like the ICU.

Some of the other issues with two way radio systems include problems, like poor maintenance, lack of power, non-availability of spare parts and poor training of the medical staff regarding the usage of these devices. Any compromise with the quality of the device can prove disastrous and defeat the entire purpose of setting up two way communication radios.

Conclusion

Two way communication systems have been in use for more than seventy years in the field of healthcare. Even today, with the advancements in technology, radio systems play a vital role in setting up communication in healthcare institutions. This is because no other technology can adequately address all the needs of healthcare communication – little interference with medical equipment and immediate and hassle free communication. This establishes the fact that two way radios will continue to play a major role for communication in primary and acute healthcare as well as improve the provision of healthcare services.

Hiring a Home Health Care Employee

Providing the primary care for an elder loved one can be difficult. When you cannot deliver all the elder care yourself and support from friends, family, and community organizations is not enough, it may be useful to hire a home health care worker. He or she can offer care from a few hours a week to 24 hours a day, and can provide many other helpful services. Types of in-home health care services include:

General Health Management like administration of medication or other medical treatments
Personal care such as bathing, oral hygiene, dressing, and shaving
Nutrition help like preparing meals, assisting eating, and grocery shopping
Homemaking services including laundry, dishwashing, and light housework
Companionship for example reading to the senior or taking them on walks

Recruiting and Interviewing Applicants

There are many avenues for hiring a home health care employee. Generally, home health care workers can be hired directly or through an agency. Home health care agencies often have a staff that includes social workers and nurses that will manage your care. However hiring an independent home health care worker is generally more cost effective, it will also give you more control over the type of care you receive.

Senior home care workers should be carefully screened for proper training, qualifications, and temperament. Fully discuss the needs of the elder care recipient during an interview with a prospective home health care employee. There should be a written copy the job description and the type of experience you are looking for.

References

Have applicants fill out an employment form that includes the following information:

Full name
Address
Phone number
Date of birth
Social Security number
Educational background
Work history

Before hiring, you should ask to see the senior home care worker’s licenses and certificates, if applicable, and personal identification including their social security card, driver’s license, or photo ID.

References should be checked out thoroughly. Prospective employees should provide the employer with names, dates of employment, and phone numbers of previous employers and how to contact them. It is best to talk directly to previous employers, rather than just to accept letters of recommendations. Also ask the applicant to provide or sign off on conducting a criminal background check

Special Points to Consider

Make sure the person you are considering hiring knows how to carry out the tasks the elder care recipient requires, such as transferring the senior to and from a wheelchair or bed. Training may be available, but make sure the worker completes the training successfully before hiring him or her.

No one should be hired on a seven-day-a-week basis. Even the most dedicated employee will soon burn out. All employees need some time to take care of their personal needs. No worker should be on call 24-hours a day. If the elder care recipient needs frequent supervision or care during the night, a family member or second home health care worker should be able to help out or fill in.

Live-in assistance may seem to be more convenient and economic than hourly or per-day employees but there can be drawbacks. Food and lodging costs must be calculated into the total cost of care, and it could be difficult to dismiss someone without immediate housing alternatives. If you decide to utilize a live-in arrangement, the employee should have his own living quarters, free time, and ample sleep.

Job Expectations and Considerations

Before hiring a senior home health care worker, you should go over the tasks you expect them to perform and other issues, such as promptness, benefits, pay scale, holidays, vacations, absences, and notification time needed for either employer or employee before employment is terminated. If you work and are heavily dependent on the home health care worker, emphasize the importance of being informed as soon as possible if he or she is going to be late or absent so that you can make alternative arrangements. Be clear about notification needed for time off, or what to do in the case the home health care worker experiences a personal emergency that requires them to abruptly leave work. It is important to have a backup list of friends, family, other home care workers, or a home health care agency you can call on.

Be clear about issues concerning salary, payment schedule, and reimbursement or petty cash funds for out of pocket expenses.

You should spend the day with the home health care worker on his first day to make sure you are both in agreement over how to carry out daily tasks. It would also be helpful to supply the home health care worker with a list of information on the elder care recipient such as: special diets, likes, dislikes, mobility problems, health issues, danger signs to monitor, possible behavior problems and accompanying coping strategies, medication schedule, therapeutic exercises, eye glasses, dentures, and any prosthetics.

You should also provide the following information to your home health care worker: your contact information, emergency contacts, security precautions and access to keys, clothing, and locations of washing/cleaning supplies, medical supplies, light bulbs, flashlights, fuse box, and other important household items.

Transportation

Another big consideration in hiring a senior home care worker is how he or she is going to get to work. If they do not have a reliable car or access to public transit, then you might want to consider hiring someone to drive him or her, which might be more economical than using taxis. Inform your insurance company if the home health care worker is going to drive your car when caring for the senior. Your insurance company will perform the necessary driving background checks. If the home health care worker is using his or her car to drive the elder care recipient, then discuss use of her or his car, and conduct a driving background check.

Insurance and Payroll

Check with an insurance company about the proper coverage for a worker in your home.

Make sure all the proper taxes are being drawn from the employee’s check by contacting the Internal Revenue Service, state treasury department, social security, and the labor department. If you do not want to deal with the complexities of the payroll withholdings yourself, than you can hire a payroll company for a fee.

Even if your home health care worker is working as a contractor, you are still obligated to report the earnings to the IRS. Talk to your accountant or financial adviser about making sure you are following IRS rules.

Ensuring Security

You should protect your private papers and valuables in a locked file cabinet, safe deposit box, or safe. If you are unable to pick up your mail on a daily basis, have someone you trust do it, or have it sent to a post box. You should check the phone bill for unusual items or unauthorized calls. You should put a block on your phone for 900 numbers, collect calls, and long-distance calls.

Keep checkbooks and credit cards locked up. Review credit card and bank statements on a monthly basis, and periodically request credit reports from credit reporting agencies. Lock up valuable possessions or keep an inventory of items accessible to people working in the house.

You can help to prevent elder abuse to your loved one by:

Make sure the home health care worker thoroughly understands his or her responsibilities, the elder care recipient’s medical problems and limitations, and how to cope with stressful situations.
Do not overburden the home health care worker.
Encourage openness over potential problems.

The following are possible signs of elder abuse or neglect:

Personality changes
Crying, whimpering, or refusing to talk
Sloppy appearance
Poor personal hygiene
Disorganized or dirty living conditions
Signs of inappropriate sedation, such as confusion, or excessive sleeping
Mysterious bruises, pressure sores, fractures, or burns
Weight loss

If you suspect abuse, act immediately. Do not wait until the situation turns tragic. Investigate the situation by talking to the elder care recipient in a safe situation, or install monitoring equipment. Examples of abusive behavior include yelling, threatening, or over controlling behavior that could involve isolating the senior from others. If the situation is serious, you should replace the home health care worker as quickly as possible. If you fear the elder care recipient is in danger, he or she should be separated from the home health care worker as soon as possible. Place the elder care recipient with a trusted relative or in a respite care facility. Make sure your loved one is safe before confronting the home health care worker, especially if there is concern about retaliation.

Report the situation to Adult Protective Services after ensuring the safety of the elder care recipient. The police should be contacted in the case of serious neglect, such as sexual abuse, physical injury, or misuse of funds.

Supervising a Home Health Care Worker

The most important thing to remember after hiring a home health care worker is to keep the lines of communication open. You should explain the job responsibilities clearly, and your responsibilities to the home health care worker. Do not forget that the home health care worker is there for the elder care recipient and not the rest of the family. For live-in arrangements, the maximum amount of privacy should be set up for the home health care worker’s living quarters. Meetings should be set up on a regular basis to assure that problems are nipped in the bud. If conflicts cannot be resolved after repeated attempts, than it is best to terminate the employee. In such a case, you may have to either place the elder care recipient in a nursing home temporarily or hire a home health care worker through an agency. Reserve funds should be kept on hand in the case of such an emergency.

General Eligibility Requirements for Home Care Benefits

Hiring a home health care worker directly is usually less expensive than hiring through a home health care agency; but if the elder care recipient is eligible and you wish to use assistance from Medicare, you must hire someone through a certified home health care agency. For the senior patient to be eligible, three or more services must be ordered by a physician. Other factors or eligibility are the required need for skilled nursing assistance, or one of the following therapies: physical, speech or occupational. The elder care recipient’s medical needs will determine asset and income requirements.

Hiring Home Health Care Workers through Home Health Care Agencies versus Independently

Different health professionals can assess the elder care recipient’s needs. A nurse or social worker can help with design and coordination of a home care plan. Your care manager, doctor, or discharge planner can help with services being covered by Medicare. They generally help make the arrangements with a home care agency.

You should ask the home health care agency how they supervise their employees, and what kind of training their employees receive. Find out the procedures for when an employee does not show up. Also ask about the fee schedule and what it covers, there may be a sliding fee schedule. Furthermore, find out if they have a policy for minimum or maximum hours. Ask the agency if there are any limitations on the types of tasks performed.

Especially if you have to pay for the care services yourself, find out if there are any hidden costs such as transportation. If all the costs for hiring a care worker through an agency become too much, you may want to consider hiring directly.

Hiring independent home health care workers is not only more economical than using an agency, but it also allows more direct control over the elder care.

Health Care Fraud – The Perfect Storm

Today, health care fraud is all over the news. There undoubtedly is fraud in health care. The same is true for every business or endeavor touched by human hands, e.g. banking, credit, insurance, politics, etc. There is no question that health care providers who abuse their position and our trust to steal are a problem. So are those from other professions who do the same.

Why does health care fraud appear to get the ‘lions-share’ of attention? Could it be that it is the perfect vehicle to drive agendas for divergent groups where taxpayers, health care consumers and health care providers are dupes in a health care fraud shell-game operated with ‘sleight-of-hand’ precision?

Take a closer look and one finds this is no game-of-chance. Taxpayers, consumers and providers always lose because the problem with health care fraud is not just the fraud, but it is that our government and insurers use the fraud problem to further agendas while at the same time fail to be accountable and take responsibility for a fraud problem they facilitate and allow to flourish.

1. Astronomical Cost Estimates

What better way to report on fraud then to tout fraud cost estimates, e.g.

- “Fraud perpetrated against both public and private health plans costs between $72 and $220 billion annually, increasing the cost of medical care and health insurance and undermining public trust in our health care system… It is no longer a secret that fraud represents one of the fastest growing and most costly forms of crime in America today… We pay these costs as taxpayers and through higher health insurance premiums… We must be proactive in combating health care fraud and abuse… We must also ensure that law enforcement has the tools that it needs to deter, detect, and punish health care fraud.” [Senator Ted Kaufman (D-DE), 10/28/09 press release]

- The General Accounting Office (GAO) estimates that fraud in healthcare ranges from $60 billion to $600 billion per year – or anywhere between 3% and 10% of the $2 trillion health care budget. [Health Care Finance News reports, 10/2/09] The GAO is the investigative arm of Congress.

- The National Health Care Anti-Fraud Association (NHCAA) reports over $54 billion is stolen every year in scams designed to stick us and our insurance companies with fraudulent and illegal medical charges. [NHCAA, web-site] NHCAA was created and is funded by health insurance companies.

Unfortunately, the reliability of the purported estimates is dubious at best. Insurers, state and federal agencies, and others may gather fraud data related to their own missions, where the kind, quality and volume of data compiled varies widely. David Hyman, professor of Law, University of Maryland, tells us that the widely-disseminated estimates of the incidence of health care fraud and abuse (assumed to be 10% of total spending) lacks any empirical foundation at all, the little we do know about health care fraud and abuse is dwarfed by what we don’t know and what we know that is not so. [The Cato Journal, 3/22/02]

2. Health Care Standards

The laws & rules governing health care – vary from state to state and from payor to payor – are extensive and very confusing for providers and others to understand as they are written in legalese and not plain speak.

Providers use specific codes to report conditions treated (ICD-9) and services rendered (CPT-4 and HCPCS). These codes are used when seeking compensation from payors for services rendered to patients. Although created to universally apply to facilitate accurate reporting to reflect providers’ services, many insurers instruct providers to report codes based on what the insurer’s computer editing programs recognize – not on what the provider rendered. Further, practice building consultants instruct providers on what codes to report to get paid – in some cases codes that do not accurately reflect the provider’s service.

Consumers know what services they receive from their doctor or other provider but may not have a clue as to what those billing codes or service descriptors mean on explanation of benefits received from insurers. This lack of understanding may result in consumers moving on without gaining clarification of what the codes mean, or may result in some believing they were improperly billed. The multitude of insurance plans available today, with varying levels of coverage, ad a wild card to the equation when services are denied for non-coverage – especially if it is Medicare that denotes non-covered services as not medically necessary.

3. Proactively addressing the health care fraud problem

The government and insurers do very little to proactively address the problem with tangible activities that will result in detecting inappropriate claims before they are paid. Indeed, payors of health care claims proclaim to operate a payment system based on trust that providers bill accurately for services rendered, as they can not review every claim before payment is made because the reimbursement system would shut down.

They claim to use sophisticated computer programs to look for errors and patterns in claims, have increased pre- and post-payment audits of selected providers to detect fraud, and have created consortiums and task forces consisting of law enforcers and insurance investigators to study the problem and share fraud information. However, this activity, for the most part, is dealing with activity after the claim is paid and has little bearing on the proactive detection of fraud.

4. Exorcise health care fraud with the creation of new laws

The government’s reports on the fraud problem are published in earnest in conjunction with efforts to reform our health care system, and our experience shows us that it ultimately results in the government introducing and enacting new laws – presuming new laws will result in more fraud detected, investigated and prosecuted – without establishing how new laws will accomplish this more effectively than existing laws that were not used to their full potential.

With such efforts in 1996, we got the Health Insurance Portability and Accountability Act (HIPAA). It was enacted by Congress to address insurance portability and accountability for patient privacy and health care fraud and abuse. HIPAA purportedly was to equip federal law enforcers and prosecutors with the tools to attack fraud, and resulted in the creation of a number of new health care fraud statutes, including: Health Care Fraud, Theft or Embezzlement in Health Care, Obstructing Criminal Investigation of Health Care, and False Statements Relating to Health Care Fraud Matters.

In 2009, the Health Care Fraud Enforcement Act appeared on the scene. This act has recently been introduced by Congress with promises that it will build on fraud prevention efforts and strengthen the governments’ capacity to investigate and prosecute waste, fraud and abuse in both government and private health insurance by sentencing increases; redefining health care fraud offense; improving whistleblower claims; creating common-sense mental state requirement for health care fraud offenses; and increasing funding in federal antifraud spending.

Undoubtedly, law enforcers and prosecutors MUST have the tools to effectively do their jobs. However, these actions alone, without inclusion of some tangible and significant before-the-claim-is-paid actions, will have little impact on reducing the occurrence of the problem.

What’s one person’s fraud (insurer alleging medically unnecessary services) is another person’s savior (provider administering tests to defend against potential lawsuits from legal sharks). Is tort reform a possibility from those pushing for health care reform? Unfortunately, it is not! Support for legislation placing new and onerous requirements on providers in the name of fighting fraud, however, does not appear to be a problem.

If Congress really wants to use its legislative powers to make a difference on the fraud problem they must think outside-the-box of what has already been done in some form or fashion. Focus on some front-end activity that deals with addressing the fraud before it happens. The following are illustrative of steps that could be taken in an effort to stem-the-tide on fraud and abuse:

- DEMAND all payors and providers, suppliers and others only use approved coding systems, where the codes are clearly defined for ALL to know and understand what the specific code means. Prohibit anyone from deviating from the defined meaning when reporting services rendered (providers, suppliers) and adjudicating claims for payment (payors and others). Make violations a strict liability issue.

- REQUIRE that all submitted claims to public and private insurers be signed or annotated in some fashion by the patient (or appropriate representative) affirming they received the reported and billed services. If such affirmation is not present claim isn’t paid. If the claim is later determined to be problematic investigators have the ability to talk with both the provider and the patient…

- REQUIRE that all claims-handlers (especially if they have authority to pay claims), consultants retained by insurers to assist on adjudicating claims, and fraud investigators be certified by a national accrediting company under the purview of the government to exhibit that they have the requisite understanding for recognizing health care fraud, and the knowledge to detect and investigate the fraud in health care claims. If such accreditation is not obtained, then neither the employee nor the consultant would be permitted to touch a health care claim or investigate suspected health care fraud.

- PROHIBIT public and private payors from asserting fraud on claims previously paid where it is established that the payor knew or should have known the claim was improper and should not have been paid. And, in those cases where fraud is established in paid claims any monies collected from providers and suppliers for overpayments be deposited into a national account to fund various fraud and abuse education programs for consumers, insurers, law enforcers, prosecutors, legislators and others; fund front-line investigators for state health care regulatory boards to investigate fraud in their respective jurisdictions; as well as funding other health care related activity.

- PROHIBIT insurers from raising premiums of policyholders based on estimates of the occurrence of fraud. Require insurers to establish a factual basis for purported losses attributed to fraud coupled with showing tangible proof of their efforts to detect and investigate fraud, as well as not paying fraudulent claims.

5. Insurers are victims of health care fraud

Insurers, as a regular course of business, offer reports on fraud to present themselves as victims of fraud by deviant providers and suppliers.

It is disingenuous for insurers to proclaim victim-status when they have the ability to review claims before they are paid, but choose not to because it would impact the flow of the reimbursement system that is under-staffed. Further, for years, insurers have operated within a culture where fraudulent claims were just a part of the cost of doing business. Then, because they were victims of the putative fraud, they pass these losses on to policyholders in the form of higher premiums (despite the duty and ability to review claims before they are paid). Do your premiums continue to rise?

Insurers make a ton of money, and under the cloak of fraud-fighting, are now keeping more of it by alleging fraud in claims to avoid paying legitimate claims, as well as going after monies paid on claims for services performed many years prior from providers too petrified to fight-back. Additionally, many insurers, believing a lack of responsiveness by law enforcers, file civil suits against providers and entities alleging fraud.

6. Increased investigations and prosecutions of health care fraud

Purportedly, the government (and insurers) have assigned more people to investigate fraud, are conducting more investigations, and are prosecuting more fraud offenders.

With the increase in the numbers of investigators, it is not uncommon for law enforcers assigned to work fraud cases to lack the knowledge and understanding for working these types of cases. It is also not uncommon that law enforcers from multiple agencies expend their investigative efforts and numerous man-hours by working on the same fraud case.

Law enforcers, especially at the federal level, may not actively investigate fraud cases unless they have the tacit approval of a prosecutor. Some law enforcers who do not want to work a case, no matter how good it may be, seek out a prosecutor for a declination on cases presented in the most negative light.

Health Care Regulatory Boards are often not seen as a viable member of the investigative team. Boards regularly investigate complaints of inappropriate conduct by licensees under their purview. The major consistency of these boards are licensed providers, typically in active practice, that have the pulse of what is going on in their state.

Insurers, at the insistence of state insurance regulators, created special investigative units to address suspicious claims to facilitate the payment of legitimate claims. Many insurers have recruited ex-law enforcers who have little or no experience on health care matters and/or nurses with no investigative experience to comprise these units.

Reliance is critical for establishing fraud, and often a major hindrance for law enforcers and prosecutors on moving fraud cases forward. Reliance refers to payors relying on information received from providers to be an accurate representation of what was provided in their determination to pay claims. Fraud issues arise when providers misrepresent material facts in submitted claims, e.g. services not rendered, misrepresenting the service provider, etc.

Increased fraud prosecutions and financial recoveries? In the various (federal) prosecutorial jurisdictions in the United States, there are differing loss- thresholds that must be exceeded before the (illegal) activity will be considered for prosecution, e.g. $200,000.00, $1 million. What does this tell fraudsters – steal up to a certain amount, stop and change jurisdictions?

In the end, the health care fraud shell-game is perfect for fringe care-givers and deviant providers and suppliers who jockey for unfettered-access to health care dollars from a payment system incapable or unwilling to employ necessary mechanisms to appropriately address fraud – on the front-end before the claims are paid! These deviant providers and suppliers know that every claim is not looked at before it is paid, and operate knowing that it is then impossible to detect, investigate and prosecute everyone who is committing fraud!

Lucky for us, there are countless experienced and dedicated professionals working in the trenches to combat fraud that persevere in the face of adversity, making a difference one claim/case at a time! These professionals include, but are not limited to: Providers of all disciplines; Regulatory Boards (Insurance and Health Care); Insurance Company Claims Handlers and Special Investigators; Local, State and Federal Law Enforcers; State and Federal Prosecutors; and others.

Funding Your Own Healthcare

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Expert Author David Crump

Introduction

More folks including both individual adults and families are on their own to provide funding for healthcare. There is a growing trend of being your own freelance business owner, being a contract employee or being employed by a business that does not offer a health insurance benefit. Many people make the mistake of buying price instead of value in a healthcare funding plan. This article provides an overview of options for funding healthcare with both advantages and disadvantages of each strategy.

How Much does Healthcare Cost?

Understanding what healthcare costs is important to deciding the best strategy for funding your own healthcare needs. Buying based only on price and not value (price vs. benefits) is a common and very grave mistake. Some examples of what healthcare can cost will help illuminate the importance of value and risk transfer (insurance) in funding your own healthcare.

Routine Care: Having an ongoing relationship with a medical doctor is important value and can help you avoid much more costly illness and improve your overall health outcome. I am an example of the benefits of routine medical care with the goals of avoiding cardiovascular disease, diabetes and managing my sinus allergies. My recent doctor visit including blood test = $248 Well Baby Check (price from local pediatrician) = $160 Annual Physical = $500? Cost depends on how elaborate a physical you get.

Rx Drug: Prescription drugs are approximately 10% of total healthcare spending [1]. Prescription drugs can be a large component of treating a major or chronic illness. These are drugs that I take with the list prices from my local drug store. OTC Claratin (equivalent house brand) = $10 / month Crestor = $137.99 / month Astelin = $115.99 / month An example of a more expensive medicine that my wife takes regularly for her chronic migraines: Topamax (generic equivalent) = $566.99 / month

Diagnostic Tests: Diagnostic tests are an important part of most disease identification, management and treatment and are a large component of healthcare costs. My recent blood test (three panels) = $152 X-Rays = $100+ Mammogram = $150+ MRI = $1000+; a complex MRI can cost several thousand dollars

Emergency Care: ER Visit = $1000+; this is based on my experience – I have never had an ER visit that was less than a $1000 in billed costs

Hospital Admission About 30% of healthcare costs are for in-patient hospitalization. The average length of a hospital stay is five days [2] with costs highly dependent on treatment. Heart Arrhythmia (irregular heartbeat) – Example from one of my clients = $45,000 including an ER admission and then three days in the hospital

Major Illness: Cancer (Lymphoma) – My brother over two years of treatment = $500,000+; It is hard to tell the actual total but when I called to see if my brother was close to exceeding his $1 million lifetime limit the expectation was at least $500,000 in paid benefits to complete his cancer treatment.

Chronic Illness: A chronic illness is defined by a medical condition lasting a year or more that requires ongoing treatment. Examples are Diabetes, Asthma, hypertension and Depression. Approximately half of all Americans have some kind of chronic aliment [2]. Type 2 Diabetes – Average Annual Cost = $5949 [3] Asthma – Average Annual Cost = $3192 [4]

Put all of this in a gigantic pile and the average cost of healthcare in Texas according to the Texas Department of Insurance in 2006 was $7110 per person. That is $593 per month per person. Admittedly that includes a lot of unhealthy and high healthcare uses but it provides some perspective on what healthcare costs. If you have not had a close relative, family or friend with a serious illness or injury, it is hard to imagine the high cost of healthcare. Value in funding healthcare is more than helping with the cost of routine care. Value to me means grappling with the risk of a major illness or injury.

Healthcare IT Solutions – A Must Have For Today’s Healthcare Industry

IT solutions have found its root in each and every field and healthcare sector is not an exception to the rule. Till date, the healthcare industry was going very slow in the implementation of healthcare it solutions for the very reason that the industry depends more on individual knowledge and judgment. It is true that information technology can not be a substitute for human brains; however, it can prove to be a very useful tool or aid in performing various tasks.

Healthcare it solutions can prove to be of great help all across the entire healthcare industry:

Healthcare Diagnostics – Proper and timely diagnosis plays a very important role in the treatment and recovery of the patient. If a diagnostic tool is available to the healthcare professional that is equipped with advanced healthcare software, the task of diagnosing a disease would become much easier. Healthcare it solutions are playing a very crucial role in the field of healthcare diagnostics, the trend is catching up and there is lot to come.

Healthcare Treatment – Once the disease is diagnosed it has to be treated in the right manner. Availability of advanced new age tools can make the task of treating a patient much easier. Advanced radiation, surgical and other medical equipments that are equipped with cutting-edge software is providing a new route to the over all treatment process. Use of healthcare it solutions has made possible the treatment of a no. of diseases till date that was not available to the mankind.

Healthcare Billing – Healthcare it solutions not only plays a crucial role in the diagnosis and treatment of the patient. However, it also plays an important role in the healthcare billing sector. Once the services are provided the patient needs to be billed by the healthcare professional / hospital. The process may seem to be very easy, however, in real practice it involves a step ladder process to be followed including providing codes and various formalities. The task is tedious and time consuming, the manual process often results into a no. errors, here comes the role of healthcare it solutions in the billing process.

A fully-functional billing system especially designed for the healthcare industry, taking into consideration the industry requirements, can prove to be of great help and support to the medical professionals as well as hospital setups. The billing system makes the overall process of entering data as per the guidelines, data processing and bill generation an easily manageable task.

Healthcare Claims Processing – Healthcare costs are rising and so is the need for health insurance. Entering data, forwarding claims and getting them processed is a time consuming process… it is believed that healthcare professionals spend maximum time on this issue, which otherwise could be utilized for providing quality service to the patients. Healthcare it solutions like an advanced claims processing system could come handy in this situation. It ensures to speed up the over all process and helps to make it an easily manageable task.

Healthcare Record Maintenance – Once the healthcare services are delivered including billing and claims processing, it is not an end to the road. The most important task starts from here – patient record maintenance is a very important activity that every healthcare professional has to take care of. Patient records are maintained for future use by healthcare professionals. In case of any ailment in the future, the patient records are referred by doctors that help them to diagnose the disease. In case patient records are not maintained in the right manner or they can not be accessed under circumstances of emergency; it could be a life threatening condition for the patient.

Healthcare it solutions by way of an advanced emr system is making life easy for both healthcare professionals as well as patients. The system helps to store the patient data in a systematic manner, which can be accessed at any point of time by any registered healthcare professional. The availability of detailed patient data at the right time ensures better diagnosis and timely treatment.

It wouldn’t be wrong to say that the specialized field of healthcare it solutions is all set to transform the healthcare industry and has become a must have!

The author is a healthcare IT solutions consultant with years of experience in the industry. At present, the author is engaged in providing technical advice to a no. of health IT cos., medical practices and hospitals. Aamy also takes great interest in writing on various topics related to healthcare it solutions, claims processing systems, electronic medical records, practice management and more.

The New Approach to Healthcare Enterprise Information Management – EHR, EMR, EIM

The lack of a healthcare specific, compliant, cost-effective approach to Enterprise Information Management (aka EIM) is the #1 reason integration, data quality, reporting and performance management initiatives fail in healthcare organizations. How can you build a house without plumbing? Conversely, the organizations that successfully deploy the same initiatives point to full Healthcare centric EIM as the Top reason they were successful (February, 2009 – AHA). The cost of EIM can be staggering – preventing many healthcare organizations from leveraging enterprise information when strategically planning for the entire system. If this is prohibitive for large and medium organizations, how are smaller organizations going to be able to leverage technology that can access vital information inside of their own company if cost prevents consideration?

The Basics -

What is Enterprise Information Management?

Enterprise Information Management means the organization has access to 100% of its data, the data can be exchanged between groups/applications/databases, information is verified and cleansed, and a master data management method is applied. Outliers to EIM are data warehouses, such as an EHR data warehouse, Business Intelligence and Performance Management. Here is a roadmap, in layman terminology, that healthcare organizations follow to determine their EIM requirements.

Fact #1: Every healthcare entity, agency, campus or non-profit knows what software it utilizes for its business operations. The applications may be in silos, not accessible by other groups or departments, sometimes within the team that is responsible for it. If information were needed from groups across the enterprise, it has to be requested, in business terminology, of the host group, who would then go to the source of information (the aforementioned software and/or database), retrieve what is needed and submit it to the requestor – hopefully, in a format the requestor can work with (i.e., excel for further analysis as opposed to a document or PDF).

Fact #2: Because business terminology can be different WITHIN an organization, there will be further “translating” required when incorporating information that is gathered from the different software packages. This can be a nightmare. The gathering of information, converting it into a different format, translating it into common business terminology and then preparing it for consumption is a lengthy, expensive process – which takes us to Fact #3.

Fact #3: Consumers of the gathered information (management, analysts, etc) have to change the type of information required – one-off report requests that are continuously revised so they can change their dimensional view (like rotating the rows of a Rubik’s cube to only get one color grouped, then deciding instead of lining up red, they would really like green to be grouped first). In many cases, this will start the gathering process all over again because the original set of information is missing needed data. It also requires the attention of those that understand this information – typically a highly valued Subject Matter Expert from each silo – time-consuming and costly distractions that impact the requestor as well as the information owner’s group.

Fact#4: While large organizations can cope with this costly method in order to gather enough information to make effective and strategic business decisions, the amount of time and money is a barrier for smaller or cash strapped institutions, freezing needed data in its silo.

Fact #5: If information were accessible (with security and access controls, preventing unauthorized and inappropriate access), time frames for analysis improve, results are timely, strategic planning is effective and costs in time and money are significantly reduced.

Integration (with cleansing the data, aka Data Quality) should not be a foreign concept to the mid and smaller organizations. Price has been the overriding factor that prevents these tiers from leveraging enterprise information. A “glass ceiling”, solely based on being limited from technology because of price tag, bars the consideration of EIM. This is the fault of technology vendors. Business Intelligence, Performance Management and Data Integration providers have unknowingly created class warfare between the Large and SMB healthcare organizations. Data Integration is the biggest culprit in this situation. The cost of integration in the typical BI deployment is usually four times the cost of the BI portion. It is easy for the BI providers to tantalize their prospects with functionality and reasonable cost. But, when integration comes into play, reluctance on price introduces itself into the scenario. No action has become the norm at this point.

What are the Financial Implications for a Healthcare Organization by maintaining the status quo?

Fraud detection is the focal point for CMS in their EHR requirements of healthcare organizations, Let’s take a deeper, more meaningful look at the impact of EHR. Integration, a prominent component of Enterprise Information Management in the New Approach, brings data from all silos of the organization, allowing a Data Quality component to verify and cleanse it. The next step would be to either send it back to its originating source in an accurate state and/or put it into a repository where it will be accessible to auditing (think CMS Sanctions Auditors), Business Intelligence solutions, and Electronic Health Records applications. With instantly accessible EHRs, hospitals and their outlying practices can verify patients with payors, retrieve medical histories for diagnosis and treatment decisions, and update/add patient related information. What impact to treatment does a review of a new patient’s history have for both patient and practice? Here are some elements to consider:

1. Diagnosis and treatments that are based on previous patient dispositions – reducing recovery time, eliminating Medicare/Medicaid/Payor denials (based on their interpretation as to fault of the practitioner in original treatment or error incurring additional treatment).

2. Instant fraud detection of patients seeking treatment for the same malady across the practices within the organization. Prescription abuse and Medicare fraud saves money not only for the payors, but the healthcare organization as well.

3. The Association of Fraud Examiners states that 9% of a Hospital’s revenue each year is actually lost to fraud.

One overlooked but common impact is in the cost of managing patient records. Thousands of file folders in storage with new instances being added each time a new patient enters into the system. Millions of pieces of paper capturing patient information, payer data, charts, billing statements, and various items such as photo copies of patient IDs, are all stored in those folders. The folders are then stored in vast filing cabinets – constantly being accessed by filing clerks, nurses, practitioners and assorted staff. Contents of the files being misplaced or filed incorrectly. Hundreds, if not thousands, of square feet being consumed for storage. The AHA projects that an enterprise leveraging Electronic Health Records will recover no less than 15,000 square feet of usable space. That space can be used for additional services, opening up new channels of revenue. The justification is easy: how much would it cost the hospital to build out 15,000 square feet for a new service? The average cost to build space utilized for Health Services is $65 per square foot, or $975,000 total. An EIM solution through the New Approach would be less than 20% of that. Not only has the EIM solution reduced dollars lost to fraud, lowered the days for payor encounters to be paid, increased cash on hand, but it will also open up new services for the patient community and revenue back to the healthcare organization.

Electronic data is costly in its own way. Bad aka “Dirty” data has enormous impact. Data can be corrupted by error in data entry, systems maintenance, database platform changes or upgrades, feeds or exchanges of data in an incompatible format, changes in front end applications and fraud, such as identity theft. The impact of bad data has a cause and effect relationship that is pervasive in the financial landscape:

1. Bad data can result in payor denials. Mismatched member identification, missing DRG codes, empty fields where data is expected are examples of immediate denials of claims. The delay lowers the amount of Cash on Hand as well as extends the cycle of submitted claim to remittance by at least 30 days.

2. Bad data masks fraud. A reversal of digits in a social security number, a claim filed as one person for the treatment of another family member, medical histories that do not reflect all diagnosis and treatments because the patient could not be identified. Fraud has the greatest impact on cost of delivering healthcare in the United States. Ultimately, the health system has to absorb this cost – reducing profitability and limiting growth.

3. Bad data results in non-compliance. CMS has already begun the architecture and deployment of Sanctions Data Exchanges. These exchanges are a network of data repositories that are used to connect to health healthcare system, retrieve CMS related data, and store it for auditing. The retrieval will only be limited to the patient encounters that show a potential for denial or fraud, so the repository will not be a store of all Medicare and Medicaid patient encounters. But, the exchange has to be able to read the data in its provider data source in order for CMS to apply certain conditions against the information it is reading. What happens when the information is incomplete or wrong? The healthcare system is held accountable for the encounters it cannot read. That means automatic and unrecoverable denials of claims PRIOR to an audit, regardless of claim legitimacy.

The Price Fix by Big Box Healthcare Technology Firms

Are the major healthcare software and technology vendors (Big Box) price gouging? Probably not. They are a victim of their own solution strategies. Through acquired and some organic growth (McKesson, Eclipsys, Cerner, etc), they find their EIM solutions lose their agnostic approach. This is bad…very bad for health systems of all sizes. With very few exceptions, the vast majority of healthcare organizations DO NOT BUY all applications and modules from a single stack player. How could they? Healthcare systems grow similarly – some organic, some through acquisition. When a hospital organization finds over the course of time, an application that is reliable, such as a billing system, there is tremendous reluctance to remove a proven solution that everyone knows how to use. Because the major technology providers in the healthcare space act as a “One Stop Shop”, they spend most of their time working on integrating in their own product suite with little to no regard to other applications. Subsequently, they find themselves trapped: they have to position all products/modules to maintain the accessibility and integrity of their data. This is problematic for the hospital that is trying to solve one problem but then must purchase additional solutions to apply to areas that are not broken, just to be able to integrate information. That is like going to the hardware store for a screwdriver and coming back with a 112 piece tool set with a rolling, 4 foot cart built for NASCAR. You will probably never use 90+% of those tools and will no longer be able to park in your own garage because the new tool box takes up too much space!

IT resources – including people – must be utilized. In today’s economy, leveraging internal IT staff to administer a solution post-deployment is a given. If those IT resources do not feel comfortable in supporting the integration plan, then status quo will be justified. This is the “anti” approach to providing solutions in the healthcare industry: the sales leaders from Big Box technology firms want their sales people in front of the business side of the organization and to stop selling to IT. While this is a common sense approach, the economy in 2010 mandates that IT has to at least validate their ability to administer new technology solutions. The prospect of long-term professional consulting engagements to follow post installation has been shrinking at the same rate as healthcare organizations profit margins.

Empowering the healthcare organization to utilize its existing IT staff to administer and develop with the new products is not part of the business plan when Big Box players market to the industry. It is the exact opposite – recurring revenue from lengthy, and sometimes permanent, professional services consulting engagements is part of the overall target. The initial price quote for a Big Box solution is scary enough, but the fact remains that it is still not representative of what the ongoing cost to maintain through consulting arrangements. This is a variable cost, which is difficult to predict, and drives finance managers and executives crazy.

Solving the Dilemma – A Better Solution through a New Approach at a Fraction of the Cost

When Healthcare Business Experts combine talents with Technology Architects, EIM Solutions cost drop dramatically. This is the New Approach to Healthcare EIM, providing the way health organizations will be able to provide successful solutions at significantly reduced costs – opening the door for health systems of all sizes.

The EIM Firm (using the New Approach) versus Big Box Healthcare Technology Providers:

Smaller, more agile firms bring many benefits to Healthcare Organizations of any size. The benefits:

1. They are focused on specific verticals – just like the Big Box Health Technology providers. Subject Matter Experts (SME) in the smaller firms typically are industry veterans with years of experience and success in their approach who see their resume as a service offering better utilized when they are able to apply their methods for successful strategy planning as opposed to learning the methods of a Big Box player. Their income is better since their revenue is applied into a smaller operating cost, extending lower pricing for solutions that are MORE EFFECTIVE and offering stronger client/vendor relationships as the SME limits themselves to a certain number of clients.

2. Solutions built on proven approaches and strategies. Again, the firm’s SMEs are able to define a methodology that can be re-used or re-configured in each client instance. This saves time and money for the client as delivery is accelerated and the cost of architecting is eliminated.

3. The firms themselves develop solutions and methodologies agnostically. Their understanding of the diversity of systems that exist in the technology of a healthcare organization allows them to not only develop adaptable solutions but also add a Business Process Management Plan (BPM). The BPM will define for the organization EXACTLY how information is received, processed, cleansed, stored, shared and accessed. It also will define an action plan for training IT for administration and support as well as end users at all levels on how they will leverage it going forward. BPM planning in a healthcare organization is a low six figure investment with an outside consulting group. The EIM firms will include it in the cost of the solution. Basically, it is the difference in being told what is wrong and here are the recommendations to fix it versus here is what is wrong and this is how it will be fixed with the new solution.

What is a typical EIM Firm solution?

1. Solution Assessment, noting the current systems, data sources and methods of sharing information as well as business processes, key personnel identification that are gate keepers if information, timeliness of providing information and overall effectiveness in leveraging enterprise information for strategic business planning. See figures 1 for an example of the information process flow visual component of an actual assessment.

2. EIM solution that contains an integration engine that accesses all data sources – reading and writing back to the database or application, providing data quality services and maintaining HIPAA as well as HL7 requirements. See Figure 2 for a diagram.

3. EHR Data Warehouse. A repository to build Electronic Health Records through the integrated data flow.

4. EHR Portal for patient entry (when additional information needs to be added) via a browser.

5. Business Intelligence Dashboards for metrics, AD Hoc analysis and Performance Management Scorecards on organizational goals and objectives.

6. Onsite implementation and integration of the EIM solution.

7. Onsite training during installation for IT and end users. Ongoing training provided via webinars, documentation and technical support staff.

8. Relationships maintained by the Subject Matter Experts for the life of the solution.

9. Stimulus “HITECH” Act pays $44,000 per physician for an EHR solution implemented. The SME creates the grant request to be submitted so the healthcare organization receives Stimulus funds to pay for the total EIM solution

Key Element of the Solution

Onsite Delivery and full time support are key. But, the most important element is training. Why? As noted earlier, it is paramount that existing IT investments, namely personnel, be able to not only administer but also conduct development as the need arises. In Healthcare, CMS managed Medicare/Medicaid is already margins that are in the negative. As private payers follow suit, the number of uncollectable encounters will increase, impacting current profitability models and increasing future cost for treatment. By mitigating IT costs, the Total Cost of Ownership (TCO) qualifier should actually evolve to a Return on Investment (ROI). ROI is immediate for this solution approach, but it is sustained year over year by leveraging internal IT to support and develop. Now, the Healthcare Organization has eliminated costly professional service consulting engagements and re-investments into new feature licensing. This takes a variable cost every year and makes it a fixed, yet smaller amount – a sensible financial approach to accomplish a proven strategy.

Summary -

Why EIM? Whether it is Omnibus, “Obama”-care or an edit (not overhaul) of the Healthcare industry, Healthcare Organizations know these truths:

1. Electronic Health Records are necessary for the Fraud detection unit of CMS. Each organization must comply with accessibility, HIPAA and format. Fraud reduces overall revenues for a hospital by 9% (ACFE)

2. EHR/EHR have proven to be highly effective in eliminating internal waste, patient fraud, practice fraud and paper overhead. Vast amount of space within the facilities that had been used to store patient records in hard copy can now be utilized to provide additional services and open new revenue streams.

3. Bad or “dirty” data in electronic or hard copy format is costly. According to the AHA (September, 2008), the average cost of a patient record with good or accurate information is $343 annually. The annual cost of a patient record with bad information is $2,054 annually. On average, 18% of patient information within a healthcare organization is bad.

4. Strategies developed by healthcare organizations without 100% of the information they own that is also timely and relevant are ineffective. Objectives cannot be defined, successful processes cannot be identified and improvement plans have little to no metrics in which to determine success.

5. Stimulus/HITECH Act pays $44,000 per physician when EHR is part of the EIM solution. With the smaller EIM firms, Stimulus pays for the entire solution.

Why a New Approach EIM Firm?

1. Subject Matter Expertise from consultants that have proven methodologies.

2. Agility to adapt to the client need instead of the Big Box approach of the client adapting to their product limitations.

3. A Better Solution at a Fraction of the Cost. Their solutions are based on needs and not features.

4. Relationships with the vendor, resulting in improved services, maximum values from vendor solutions and a focused approach to the client needs and goals.

5. A Return on Investment as opposed to a Total Cost of Ownership. Clients need to see solutions that immediately pay for itself and then recover lost revenue while offering channels to new profit centers.

Scott Schledwitz is a Subject Matter Expert in Healthcare Strategic Planning, Information Integration, Data Quality, and Balanced Scorecard Methodologies. He has developed solution products and practices for compliance measures, reporting and planning utilized by various agencies within the United States on the Federal and State levels. Within healthcare, he has consulted with hospital systems ranging from 1 to 100 campuses, providing them assessments and solutions to improve information efficiencies, extend information across the enterprise, develop organizational strategies that start at the top and cascade to the individual contributor. Through a Balance Scorecard Methodology, he has advised these organizations on how to identify their objectives, successful processes, define projects to overcome deficiencies and view the results in an easy to understand dashboard.

Tips on Healthcare Consulting

Getting healthcare consulting for the IT department can prove to be beneficial, as it will assist to improve efficiency, productivity, monetary efficiency, patient and clinical satisfaction, and quality. Some issues which are typically provided by a healthcare consultation services contain strategies to improve revenue, cut back on expenses, accomplish regulatory compliance, enhance company and clinical processes, and optimize the safety of patients.

These sorts of consulting services can be especially useful for IT departments that may be searching into alternatives for new wellness details systems, assessing the readiness of the infrastructure for wellness records, or implementing a lot more advanced clinical applications. So if you are in charge of a healthcare organization which is going to be making modifications and you want it to go smoothly, contemplate it.

Those which are in charge of running healthcare organizations comprehend how hard it could be to implement alterations within the data technology department. Since so much relies on the electronic infrastructure operating smoothly, it is not genuinely an option to have down time. These kinds of challenges can be met and overcome with appropriate Healthcare Consulting.

Getting consulting for the IT staff will give them the training and info they have to deal with any compliance implementations that your organization is faced with. They’ll also discover ways to enhance the system, permitting them to boost revenue and lower high-priced. They’ll be able to assist streamline clinical processes and even enhance the general safety and well being of patients.

Have you ever regarded as whether or not or not your organization could benefit from Healthcare Consulting? Even though you might have a especially talented information technology staff, it may be hard to remain on top of compliance laws and regulations although managing to streamline enterprise and boost revenue. Nonetheless, a consultation can help with those things.

Healthcare organizations that invest in consultations for their IT staff make a wise investment. They’ll probably recognize gains in revenue while simultaneously studying how to cut expenses. Surprisingly, with the correct details this is achievable while increasing the safety of patients. Consider investing in consultation services for the staff today.

Anybody inside the healthcare industry is conscious of how tough it could be to generally stay compliant while still generating revenue and keeping the safety and satisfaction of patients. Naturally, there are likely methods that every single organization could improve in, but finding those weak points is difficult, especially when they are in the information technology sector.

Even so, it’s achievable and suggested that organizations invest in Healthcare Consulting, which helps IT staffs to simply remain compliant although advancing care via the adoption of EMR/EHR. Quite a few organizations that have been looking into selections for various healthcare info systems have discovered these sorts of consultation services to be specifically helpful. Since the services will also aid the IT staff to increase revenue, it really is a great return on investment.

SharePoint Consulting for Healthcare – Improve Collaboration and Real Time Decision Making

Healthcare providers have a lot to deal with besides providing a quality care. The onus of the health care providers also lies on the overall development of a community at large. Healthcare organizations have to make sure they attend all incoming patients, reduce their waiting time, reduce infections acquired per thousands, thus providing a quality service in line with the prerequisites of a business for survival. SharePoint consulting on these areas can go a long way in streamlining your workflows and business intelligence system.

Collaboration in Healthcare Organizations

Healthcare operations involve a lot of communication, collaboration and workflows to make the organization more efficient. Besides, collaboration amid workflows plays a major role in dealing with critical contingencies. For instance, delay in a patient’s discharge process due to time lapsed in getting approvals from several administrative staff owing to enormous amount of paperwork, may increase waiting time of a patient who might need immediate medical attention. Further, due to the absence of doctors availability at odd hours, it would become hard to connect with critical cases that require immediate help. These are just a few examples of the caveat that lies in the collaboration eco-system in a typical healthcare organisation. It would be wise for an organisation to seek SharePoint consulting services from reputed service providers who have experiences in implementing SharePoint across healthcare organisations.

Metrics important for successful functioning of Health Care Providers

Efficiency, productivity, low cost and proper care together build the foundation of a successful healthcare organization. It is important to keep tabs on these metrics to set the organization in the right direction. While the current HIS and EPR systems facilitate information gathering, they lag in providing real-time data visualization of key metrics to make quick decisions. For a healthcare organization it is important to watch metrics like patient’s re-admissions, bed availability, infection acquired per thousands etc.

SharePoint Consulting for Healthcare

SharePoint consulting can help healthcare organizations become more efficient, productive and save time by providing a collaborative platform that leverages employees’ efficiency, mobility and bridges the gap that resides in the system. For instance, SharePoint dashboards can help keep real time tabs on metrics which are critical to the healthcare like bed availability, patients’ waiting time etc. They can also provide analytical data which can display the trends prevalent in the organization. It can provide alerts for an action. Rather than working on multiple excel sheets, it provides a one shot view of trends and drill down, presenting information in a more granular form to facilitate accurate decision making. Thus we see SharePoint works as a wonderful Business intelligence (BI) tool for critical decision making.

Besides, SharePoint renders a collaborative platform that allows healthcare staff to effectively communicate among themselves, work in synergy and manage time even at non-working hours. SharePoint enables healthcare employees like doctor, nurses and administrative staff access to relevant information to expedite clinical processes. It also enables people who are located at dispersed location access to the network, thus making collaboration easy even at odd hours. SharePoint features like document management and co-authoring make it easy for employees to manage documents and allows multiple users to work on a single document. These features can also be operated offline and are synchronized automatically once connected to the network.

Consumer Directed Healthcare – A New Trend

Gone are the days when the maxim that ruled the healthcare industry was “Build it and they will come”, under the impression that that if people knew where services were located they would find their way to the clinics.

In post liberalisation India the healthcare industry is waking up to the fact that the consumer has to be pursued and enticed into visiting healthcare facilities of a particular brand and to buy healthcare products of a particular brand. With the government permitting 100 per cent foreign direct investment (FDI) in the health care industry, there is a deluge of private players in the Indian Healthcare market today. And this has dramatically changed the facade of healthcare marketing and communications in India.

Taking the case of hospitals, there is a wide variety of services (that are not just medical) on offer for the patient. From in-house multi cuisine restaurants, swimming pools, walking tracks, indoor games facilities, libraries and play areas to travel desks that arrange sightseeing tours and shopping for patients, you name it and they have it, all in a bid to woo more and more patients. Hospital promotions take on the form of Public Relations, VIP and visitor hospital tours and walk in exhibitions, loyalty and outreach programmes, support groups etc.

Similarly the pharmaceutical industry is going overboard in its attempts to appease the two routes that they have to reach out to the end consumers- doctors and pharmacists. For retailers it is boom time as they get free supplies of medicines, expensive gifts, holiday trips and also huge margins for promoting and selling particular brands at their outlets. With doctors the gifts, incentives and schemes are getting wilder by the day. The trend is to customise the gift to the doctor so that the pharmaceutical company actually meets a relevant need of the doctor rather than flooding him with things that he throws away or hands over to others. Taking examples of customised gifts it could be admission of a doctor’s child to a reputed school or even the reimbursement of shopping bills. All in an attempt to get a better hold on this indirect consumer. For over the counter drugs there are advertisements in all shapes and sizes visible just anywhere. With sponsoring TV programmes to conducting mass consumer contact programmes to free sampling, pharmaceutical companies are trying innovative marketing ideas to get a share of the consumer’s wallet.

One look at the statistics and the reason behind this intense competition gets clear. According to a Confederation of Indian Industry – McKinsey study on India’s health industry, the country’s spending on health care is expected to increase from Rs 86,000 crore at present to Rs 200,000 crore in the next decade. Health care’s contribution to India’s GDP will increase from the current 5.2 per cent to 8.5 per cent by 2012. The players in the healthcare industry fully realise that these predictions will come true with harnessing the burgeoning purchasing power of the Indian consumer.

How to Choose a Healthcare Consulting Company

If you’re a healthcare professional, or involved with running a hospital or doctor’s surgery, then perhaps you’re looking for ways to improve the service you offer to your patients, or want to make your staff and other resources more efficient. Why not see how healthcare consulting could help?

Here’s what you need to know when choosing a Healthcare consulting company.

1. You might have already identified the symptoms that are preventing you from offering a better level of patient care, or your staff being as effective as possible. Perhaps you have too many staff on, or there are not enough appointments available, or people are waiting too long to be seen in Accident and Emergency

2. Healthcare consultants will help to identify the cause of the problems, so that you can begin to think about solving them. Some problems might be simple to resolve, whilst others might involve a complete change of working practice, and introducing new technology. Are what they suggesting practical and will they work in your environment?

3. The healthcare consultants you use will need to be as devoted to patient care as you are. If they don’t seem to understand your requirements, or how you operate, or what your problems are and how they affect patients, then how can they hope to resolve them?

4. It’s essential that you choose healthcare experts, who know that streamlining healthcare isn’t the same as in other industries, and who understand what’s involved and the implications of getting it wrong. If they’re accountants more used to streamlining factories, then they’re more likely to be interested in saving money, rather than having your patients’ best interests at heart.

5. Consultants that have worked with other Healthcare services or hospitals will be able to use their experience to help identify what you need, and how to implement it. If they only have the theory, and not the the practice, you won’t want to be their first healthcare client.

6. You’ll want to make sure that the healthcare consulting company have actual clinical expertise of working in a hospital, GP or dental surgery so that they can suggest ideas that will actually work in a real healthcare environment, such as a ward, or busy waiting room not just on paper.

7. As there might be a lot involved, everybody involved will need to be kept informed of the changes, and so communication will be hugely important. What sort of help will you get from the healthcare consulting company? Will you be expected to manage everything, and run a hospital?

8. You’ll want to ensure that the solutions will solve your problems and make things better for your patients and staff, and not just a one size fits all approach that’s used for every company in all industries.

9. You’ll want to know that the solutions use proven methods, and industry best practice. Why not find out where else they have been used? Which other hospitals or surgeries had the same sort of problem, and are now using the suggested solution?

10. You’ll want to make sure that the healthcare consultants will help you to operate a better and more efficient working environment, so that you spend less time on administration, or trying to work around problems, and more time actually treating patients.

Now you know how they can help, and the benefits they bring, how will healthcare consulting improve your patient experience?

If you need a Healthcare Consulting company to help you improve the service you offer to patients, then why not see how SystemC.com can help? With consultancy, Clinical Information Systems [http://www.systemc.com/health-and-social-care-solutions/healthcare-products/medway-clinicals/medway-business-intelligenc-%28bi%29.aspx] Electronic medical record software, patient administrative systems and much more, you’re sure to find exactly what your patients need. If you’re in healthcare, then you need SystemC.