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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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As compliance deadlines for the Health Insurance Portability and Accountability Act close in, the author details specific actions that must be taken to ensure that covered entities are indeed compliant with all of the Act's provisions.
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The market-driven managed competition concept has been successful in reducing increases in healthcare costs by controlling utilization and price, but has failed to date to produce an effective and efficient delivery of health services. The proposed health reform plan calls for universal access (excluding illegal aliens), a relatively broad range of clinically effective basic benefits, an option to purchase supplementary benefits, a ceiling placed on the nation's total health expenditures, local decisionmakers allocating available resources, existing insurers administering the plan and providing consumers with additional quality of care comparisons.
Occupational psychiatry services have become increasingly important since the passage of the Americans with Disabilities Act and the recent growth of workers' compensation mental health claims. Delivery of such services within the military is complicated by interagency financial relationships, recent implementation of a comprehensive managed care program, and military regulations governing medical services. In this article, we describe the provision of occupational psychiatry services in a large military medical system and present the results of a feasibility study of establishing a regular clinic to improve them. The results of the study highlighted the importance of having occupational psychiatry services available within the medical center, although it did not establish the necessity of a specific clinic to provide these services. Case material is presented that illustrates our approach and the range of services encompassed.
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Increasing demands for large-scale comparative analysis of health care costs has led to a similar demand for consistently classified data. Evidence-based medicine demands evidence that can be trusted. This study sought to assess managers' observed levels of agreement with physician code selections when classifying patient data. Using a non-sampled research design of both mailed and telephone surveys, we employ a nationwide cross-section of over 16,000 accredited US medical record managers. As a main outcome measure, we evaluate reported levels of agreement between physician and information manager code selections made when classifying patient data. Results indicate about 19 percent of respondents report that coder-physician classification disagreement occurred on more than 5 percent of all patient encounters. In some cases, disagreement occurred in 20 percent or more instances of code selection. This phenomenon shows significant variation across key demographic and market indicators. With the growing practice of measuring coded data quality as an outcome of health care financial performance, along with adoption of electronic classification and patient record systems, the accuracy of coded data is likely to remain uncertain in the absence of more consistent classification and coding practices.
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The increased role of consumers, along with increased healthcare costs, will compel health plans to use technology so everyone in the equation comes out a winner.
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Controlling administrative costs associated with managed care benefits has traditionally been considered a "mission impossible" in healthcare, with the unreasonably high cost of paperwork and administration pushing past the $420 billion mark. Why administrative costs remain a critical problem in healthcare while other industries have alleviated their administrative burdens must be carefully examined. This article looks at the key factors contributing to high administrative costs and how these costs can be controlled in the future with "mission possible" tools, including business process outsourcing, IT outsourcing, technology that helps to bring "consumerism" to managed care, and an IT infrastructure that improves quality and outcomes.
Not sure why your organization has problems turning receivables into cash? Administrators can use the tools described to perform a bill test and examine a statistically significant sample of accounts to identify revenue-cycle operations in need of improvement.
In the new health care marketplace dominated by managed care, patients expect more from their physicians and other providers. Because cost is not an issue for the managed care patient, physicians must find a way to distinguish their practices from others in the managed care plan directory. This article provides low-cost strategies that physicians may use to do so. These include: focusing on the customer; ensuring friendly, attentive, and trained staff using patient-friendly office policies; making the patient priority number one; listening to and communicating with patients; being a patient advocate; giving patients choices to increase their control over their care; respecting the time demands on the patient and his or her family, and others.
Online real-time patient scheduling presents a number of challenges. But a few advanced organizations are rolling out systems slowly, meeting those challenges as they go. And while this application is still too new to provide measurable benefits, anecdotal information seems to point to improvements in efficiency, patient satisfaction, and possibly quality of care.