AllMed Healthcare Management Blog: 04/21/06
Friday, April 21, 2006
British Hospital Deals With Hospital Bed Management Issues
http://www.borehamwoodtimes.co.uk/
Simon Weldon, director of operations for emergency care for Barnet and Chase Farm NHS Trust, admitted that the hospital's bed management system needed to be improved to avoid patients waiting more than four hours for a bed.
"Making efficiencies is our biggest challenge and I will be doing everything I can to improve the service," he said.
Questions were raised about the shortage of hospital beds this week after an Elstree pensioner who had suffered a heart attack was kept on a trolley for a day and a half.
posted by Dr. Skip
Medical Utilization Review For Prisoners
http://www.commercialappeal.com/
Representatives of Correctional Health Plan Network, which has nine Mississippi counties as clients, indicated they may be able to reduce costs 27 percent or more.
County government is responsible for medical, dental and psychiatric care of prisoners in Sheriff's Department custody. The prisoners aren't part of the health plan that covers county employees.
"It's a self-funded plan for inmates, that's what it is," said John Hill, a company official.
The escalating cost of prisoner health care has drawn increasing attention across the state and nation. County officials suspect some prisoners may get thrown in jail as a way of obtaining free medical attention.
posted by Dr. Skip
More New York Medical Patients Winning Appeals
http://www.insurancejournal.com
A new report shows that more New Yorkers are challenging and winning reversals of decisions that deny them insurance coverage for certain medical conditions.
A new report chronicles the increased utilization of New York State's external appeal law, which allows New Yorkers to potentially overturn their insurer or health maintenance organization's denial of coverage.
The process allows consumers to challenge denials of coverage on the grounds that a procedure, treatment or piece of medical equipment is deemed experimental, investigational, or not medically necessary.
"More New Yorkers are learning about the state's External Appeal mechanism and about 45 percent of the cases are being resolved in the consumer's favor, giving more residents access to health care services that they might not have otherwise received," said Superintendent of Insurance Howard Mills.
posted by Dr. Skip
Medical Technology & Utilization Review
Medical management programs have undergone a significant transformation over the past three decades. Utilization review came into vogue, case management entered the scene, disease management established a foothold, and now predictive management is knocking at the door. Today, these services are being integrated into a seamless platform.
"Technology has enabled predictive modeling, evidence-based medicine, enhanced clinical interventions, financial outcomes and consumer-directed care services to thrive," noted conference co-chair, Joel V. Brill, MD. "This new approach will transform how medical management decisions are made -- by getting the correct information to the right person at the appropriate time and guiding the patient through the system," observed Dr. Brill.
posted by Dr. Skip
New Guidelines Help Clinicians Assess Risk Of Post-surgical Pulmonary Complications
http://www.medicalnewstoday.com/
Pulmonary complications, including pneumonia and respiratory failure, are a common - and dangerous - problem for patients following major surgery. To address this issue, a comprehensive systematic review and meta-analysis in the April 2006 issue of The Annals of Internal Medicine provides clinicians with new guidelines to use prior to surgery in assessing a patient's risk of developing pulmonary problems postoperatively.
"Independent of surgical complications, such as infections and bleeding, there are three major types of medical risks that accompany major surgery," explains the study's lead author Gerald W. Smetana, MD, an internist in the division of general medicine and primary care at Beth Israel Deaconess Medical Center (BIDMC) and Associate Professor of Medicine at Harvard Medical School. "These include cardiac risks such as a heart attack, the risk of blood clot formation, and pulmonary risks."
posted by Dr. Skip
URAC CEO Says Credibility and Trust are Essential to Gain Consumer Confidence (Press Release)
Hospitals and health organizations host many of the 2 billion-plus health information sites on the World Wide Web, but they battle a lack of consumer confidence in the privacy and security practices of online health portals.
In this give-and-take environment where consumers want more Web-based
health information but don't know whether they can trust the source, Web
portals need to offer tangible evidence of solid privacy and quality
practices. Alan Spielman, president and chief executive officer of URAC,
will make the business case for Web site privacy, security and accuracy
when he addresses the 18th Annual National Managed Health Care Conference
during sessions April 25 and 26 at the Washington, D.C. Convention Center.
A March 23, 2006 report released by Forrester Research revealed that
consumers visiting health Web sites tie their confidence in privacy and
security to their trust of the organization hosting the site. The report
specifically examined government health Web sites, often touted as one of
the better sources for reliable health information. But in February, a
widely circulated report from the Government Accountability Office (GAO)
documented significant weaknesses in controls designed to protect privacy
and security on Department of Health and Human Services and Centers for
Medicare and Medicaid Services sites. With so much doubt circulating about
the security of even government-sponsored health Web sites, consumers need
even more assurance about security from hospital and health plan portals.
"As hospitals and other health organizations become more engaged in
providing Web resources to aid in health outreach and care coordination,
they need to be aware that credibility and trust are essential to this mix
of high- touch and high-tech health care," Spielman said. "Organizations
need to address what it takes to create portals that serve as trusted,
reliable resources for consumers seeking health-related information."
URAC, an independent, nonprofit organization, is well known as a leader
in promoting health care quality through its accreditation and
certification programs. URAC pioneered Health Web Site accreditation in
2001 to assess the quality and privacy practices of accredited sites. The
accrediting organization also offers HIPAA Privacy and HIPAA Security
accreditation. URAC, the nation's only organization that accredits health
Web sites, updated those accreditation standards in January 2006, including
additional protection of consumer information and more rigorous standards
for editorial content review.
"Accreditation is a valuable tool for the industry, because it offers a
seal of approval from a neutral third party that consumers can trust,"
Spielman said. "As consumer-directed health plans become more popular, more
and more consumers will use the Internet to research health plans,
hospitals and other providers, and to seek health information.
Accreditation is a credible way for organizations to demonstrate to
consumers that they meet URAC's high standards."
posted by Dr. Skip
