Medicare Pays Bonuses to 231 Hospitals With Lower Quality Because of Cheaper Costs

The federal government paid bonuses to 231 hospitals with subpar quality because their patients tend to be less expensive for Medicare, new research shows. The bonuses are small, generally a fraction of a percent of their Medicare payments. Nonetheless, rewarding hospitals of mediocre quality was hardly the stated goal when the Affordable Care Act created financial incentives to encourage better medical care from hospitals, doctors and other health care providers.

Spotlight

Alma

Alma is pioneering a new practice model for therapists to elevate the therapy experience and simplify access to care. We build co-practicing communities powered by shared technology and services.

OTHER ARTICLES
Health Technology

Blockchain in the Healthcare Industry

Article | September 12, 2023

Prioritizing health and managing it, has become highly important because our lifestyle is continuously evolving in ways that take a toll on us mentally, physically, and emotionally. However, the major issue for the patients lies in the inaccuracy of treatment due to the lack of complete health records in any hospital. With the recent changes in privacy legislation and data management, patients are even unable to retrieve their own health records. For example, someone had an accident and was taken to the emergency room. The first thing they will need to do in their condition is to fill the hospital’s form. Then, for the treatment, if the injured person is conscious enough, doctors ask questions like if they are allergic to some medicines or do they suffer from diabetes or any other disease. Besides, what if the individual denies having allergies or diabetes in their half-conscious state? And the previous hospitals where they have already had treatment before have denied sharing the medical details of the person either due to privacy issues or data corruption. Well, it can create a lot of fuzz. Solely, to improve the health industry without compromising the security of the individuals, blockchain has remained in the discussion. It has the potential to address the operability challenges present in the healthcare industry. But, what is blockchain, what are its underlying fundamentals, why blockchain, and what are its advantages? Today’s blog will help in understanding every aspect of blockchain and its impact on the healthcare industry. So let’s get started! What is Blockchain? Blockchain is a P2P or peer-to-peer distributed or decentralized ledger technology. It stores a chain of data called blocks of information. These blocks are chained together by cryptographic signatures. These signatures are called hash that is stored in the shared ledger and backed by a connected processes network - node. These nodes reserve a copy of the complete chain and get continually updated by synchronization. Though, to include blockchain in the process it’s necessary to hire a developer who has prior experience and knowledge about its architecture and can work with the components efficiently as blockchain is a designed pattern that consists of three major constituents - a distributed network, a shared ledger, and all the digital transactions. a. Distributed Network As discussed before, blockchain is built on peer-to-peer networks. While having no central point of storage, it makes the information on the network less vulnerable to being lost or exploited. Unlike the traditional client-server model that has a centralized storage point or controlling party, all the information in the blockchain network is constantly recorded and transferred to the participants of the network that are also known as nodes or peers. These peers also own several identical copies of the information. That’s why blockchain is seen as a huge improvement to centralized models and is considered the future of data storage and ownership. b. Shared Ledger Each authorized participant in the network records the transactions into the shared ledger. If they want to add any transaction, it is important to run algorithms that evaluate and verify the transactions. If the majority of members agree to the transaction’s validity, a new transaction gets added to the shared ledger. The changes done in the shared ledger is reflected in minutes or even seconds in the copies of the blockchain. Once the transaction is added, there’s no way to modify or delete it. Also, as the copy is shared in the form of a ledger to each member, no single member can alter data. c. Digital Transaction Transactions are information i.e. data transmission to one block. During the process of data transmission, each node acts as a central point to generate and digitally sign the transaction. As the nodes connect each other in the network, each of them has to verify the transaction independently for its conflicts, validity, and compliance. Only after the transaction passes the verification, the information is added into the shared ledger. The major element that makes digital transactions successful is cryptographic hashing that encrypts the data for security. Why Blockchain technology in healthcare? It has happened so often that the patient remains unable to gather all of their previous medical records in one format from one place swiftly or sometimes cannot even collect the required information at all. Unfortunately, in most cases, the information of critical patients remains scattered across several different institutions of healthcare that too in different formats. Besides, the data management systems along with the security regulations also vary in different institutions making it difficult to trace and fix mistakes. But, what can blockchain do? A blockchain is a system used for storing and sharing information with security and transparency. Every block in the chain is an independent unit of its own and a dependent link among the collective chain that creates a network controlled by participants rather than a third party. As blockchains are managed by network nodes instead of central authority, they are decentralized that prevents one entity from having complete control over the network. With the incorporation of blockchain, the need for a central administrator will be removed by cryptography. Healthcare providers will be able to promote data management processes beyond perception. It will help in collecting, analyzing, sharing, and securing medical records. It will provide the access to healthcare workers for retrieving health records with the cryptographic keys provided by patients from anywhere without creating any privacy or security problems. Advantages of Healthcare Blockchain Although applications of blockchain in the healthcare industry are inceptive, some early solutions have shown the possibility of reduced healthcare costs, improved access to information among different stakeholders, and streamlining the entire business process. So, keeping aside the buzz, let’s see the real advantages of blockchain in healthcare. 1. Master Patient Indexes The master patient index helps in the identification of patients across separate administrative systems. It is often created within the EHR or electronic health record system. As these EHRs have different vendors, there are several irregularities of MPIs. In many cases, the data of a patient between these healthcare systems become mismatched. However, with the nature of decentralization in Blockchain, it possesses the ability to solve the issue. In the blockchain-based MPIs, the data will be hashed to the ledger and content will remain unique as only the authorized nodes of the data can make changes to the hashes while all parties with access can only check the related information. 2. Single, elongated patient records Blockchain technology is potent to transform health care by placing patients at the center of the system while increasing the security and privacy of health records. It provides a new model for health information exchange by forming electronic elongated patient records secured and efficient. Additionally, the fact that the data is copied among all the nodes of the blockchain network creates an atmosphere of clarity and transparency that enables healthcare providers and patients to know how their data is handled by whom, how, and when. It can also help healthcare from potential frauds, data losses, or security attacks. 3. Supply Chain Management Supply chain management in healthcare is a challenging aspect. With scattered settings for ordering drugs, medical supplies, and critical resources, there’s an inherent risk of compromising the supply chain that might impact patient safety. Indulgence of blockchain technology in the transactions can tap into the complete process of medicine or drug products movement. As all the transactions will be recorded onto the shared ledger with every block recording and maintaining every transaction, it will become easy to verify the vendor, distributor, and origin of the drug within a matter of seconds. It will also enable healthcare physicians and officials to check the authenticity of the supplier’s credentials. 4. Claims Justification Currently, the insurance claim processes face difficulties like lack of transparency i.e. most customers don’t even know how insurance works; human errors and inefficiencies i.e. insurances are full of confusion along with human errors that create inefficiencies that lead to the increased cost to customers; higher frauds in claims. But, blockchain technology can simplify and enhance recordkeeping, payment processing, claims registration, contract management, and closure with its immutable ledger. 5. Interoperability Interoperability is the capability of distinct healthcare information technology to interpret, exchange, and use data. Due to the privacy issues, the alphanumeric code to identify a patient has been revoked that caused problems in gathering the required record of the patient. Enforcing measurement standards for industry-wide interoperability is also a challenge in interoperability. With blockchain in healthcare interoperability, data can be shared in real-time on the trusted network and provides access to the patient’s record in a secured manner. Moreover, with the pri

Read More
Healthtech Security

What are the Key Types of Healthcare Supply Chain Management Solutions?

Article | August 31, 2023

Introduction Within the last two years, the healthcare industry saw an influx in patient care as COVID-19 swept through communities across the globe. The widespread shortage of patient care tools, personal protective equipment (PPE), and medical technology amid the pandemic led to an exponential rise in health expenditures and demand for essential supplies. In response to the medical demand-supply imbalance, the governments of numerous countries increased their medical care expenditures to counter the challenges of patient care equipment shortages. For instance, according to the National Healthcare Expenditure Data, federal government spending on healthcare and medical care grew by 36% in 2020 and is estimated to reach US$ 6.2 trillion by 2028 in the U.S. Despite the rise in medical budget allocations, medical facilities are still facing difficulties obtaining enough supplies with the growing prevalence of numerous chronic, infectious, and hereditary diseases. As a result, organizations are focusing on deploying innovative solutions, such as healthcare supply chain management software, to keep track of inventory, procurement, logistics, and others and strengthen their supply chain. Healthcare Supply Chain Management Solutions: Key Types Healthcare systems, hospitals, and other patient care sites require a broad array of supplies to perform diagnosis and treatment, from masks and gloves to catheters and implants. Inadequate supplies coupled with inflation is making supply chain management a crucial but complex component in providing optimal patient care across the healthcare industry. This has shed more light on the role of supply chain management in saving lives. Effective supply chains help various regulatory agencies, including medical goods manufacturers and insurance companies, deliver essential supplies, resources, technologies, and other patient care goods to healthcare establishments. Supply chain management solutions are thus garnering massive traction among healthcare organizations for simplifying and automating manual supply chain and logistics operations. Let’s have a look at the types of supply chain management software that assist healthcare organizations to optimize their supply chain processes Inventory Management Software Efficient medical inventory management is critical for the running of healthcare organizations. The software provides real-time inventory tracking, assisting organizations in closely monitoring inventory changes, avoiding shortages of both low-value and high-use patient care items, decreasing the wait time for access to medical supplies, and reducing the chances of late delivery. Order Management Software It is crucial for healthcare establishments to have an estimate of the demand and supply of goods to prevent shortages. Order management software enables these organizations to coordinate supply chain demand planning and forecasting. It also assists in streamlining warehouse operations, resulting in faster and more accurate order placement. Sourcing and Procurement Software By tapping into the power of sourcing and procurement solutions, healthcare organizations can develop robust sourcing processes and automate, streamline, and optimize their entire procurement processes. The software also assists establishments in improving their supply inventory levels, identifying the best supplier, and reducing their overall purchasing cost. Shipping and Tracking Software Shipping and tracking software assist in the planning and execution of the physical movement of goods. These solutions are primarily used by medical equipment manufacturers and suppliers during the delivery or relocation of patient care goods. The integration of these solutions enables organizations to track and manage numerous batches of goods in transit. The Bottom Line Growing competition, healthcare regulations, shipping costs, and increased logistics requirements from medical institutions have complicated the supply chain management processes. As a result, life-science companies are investing in cutting-edge supply chain management solutions to reduce numerous errors, improve logistics, and eliminate unnecessary costs spent to fix them. Thus, several companies are now emphasizing the incorporation of cutting-edge technologies, including artificial intelligence and data analytics, into healthcare supply chain management software to reap benefits such as process automation, streamlined inventory, reduced waste, improved decision-making, and lower labor, supply, and operational costs.

Read More
Digital Healthcare

AI Trends: AI and Medicine

Article | November 29, 2023

Artificial Intelligence is here to improve our lives, by not just making things more efficient, but also increasing our lifespan. Companies across industries are experiencing the advantages that come with AI innovation, especially the healthcare space. Throughout human history, we’ve been able to understand the parameters that determine health better, and we’ve developed accompanying technology. With vaccines in the late 1700s, anesthesia and medical imaging in the 1800s, to organ transplant and immunology in the 1900s, healthcare innovation has been on an upward slope.

Read More
AI

Getting cancer screening programmes back on track with AI and digitisation

Article | December 21, 2021

COVID-19 has been a catalyst for change, with the diagnostics industry taking centre stage and rising to the challenge of a global pandemic. One of the silver linings of this mammoth task has been the unprecedented time and focus dedicated to finding new technologies and solutions within the sector. The lessons learned from the pandemic now need to be taken forward to improve breast and cervical cancer detection, prevention and treatment across the UK over the coming years. In the more immediate term, the diagnostics industry, alongside public health leaders, faces a daunting backlog as screening programmes for breast and cervical cancer were put on pause for months. These two life-saving tests have been some of the most overlooked during the pandemic and getting back on track with screening is critical as we start to turn the corner. We believe innovation in diagnostics, particularly artificial intelligence guided imaging, is a key tool to tackle delays in breast and cervical cancer diagnosis. The scale of the backlog in missed appointments is vast. In the UK, an estimated 600,000 cervical screening appointments were missed in April and May 2020. And an estimated 986,000 women missed their mammograms, of which an estimated 10,700 could be living with undiagnosed breast cancer. It is clear that hundreds of thousands of women have been affected as COVID-19 resulted in the reprioritisation of healthcare systems and resource allocation. Both cervical and breast cancer screening are well suited for digital technologies and the application of AI, given both require highly trained medical professionals to identify rare, subtle changes visually –a process that can be tedious, time-consuming and error prone. Artificial intelligence and computer vision are technologies which could help to significantly improve this. What does AI mean in this context? Before examining the three specific areas where digitisation and AI can help, it is important to define what we mean by AI. It is the application of AI to medical imaging to help accelerate detection and diagnosis. Digitisation is the vital first step in implementing an AI-driven solution – high quality images demand advanced cloud storage solutions and high resolution. The better the quality of the input, the more effectively trained an AI system will be. The first area where AI-guided imaging can play a role is workflow prioritisation. AI, along with increased screening units and mammographers, has the potential to increase breast cancer screening capacity, by removing the need for review by two radiologists. When used as part of a screening programme, AI could effectively and efficiently highlight the areas that are of particular interest for the reader, in the case of breast screening, or cytotechnologist when considering cervical screening. Based on a comparison with the average time taken to read a breast screening image, with AI 13% less time is needed to read mammogram images, improving the efficiency with which images are reviewed. This time saving could mean that radiologists could read more cases a day and potentially clear the backlog more quickly. For digital cytology for cervical cancer screening, the system is able to evaluate tens of thousands of cells from a single patient in a matter of seconds and present the most relevant diagnostic material to a trained medical professional for the final diagnosis. The job of a cytotechnologist is to build a case based on the cells they see. Utilising these tools, we are finding that cytotechnologists and pathologists are significantly increasing their efficiency without sacrificing accuracy to help alleviate the backlog of cervical screening we are seeing in many countries. Prioritising the most vulnerable patients Another key opportunity is applying AI to risk stratification, as it could help to identify women who are particularly at risk and push them further up the queue for regular screening. Conversely, it would also allow the screening interval for those women at lower risk to be extended, creating a more efficient and targeted breast screening programme. For example, women with dense breast tissue have a greater risk factor than having two immediate family members who have suffered from breast cancer. What’s more, dense breasts make it more difficult to identify cancerous cells in standard mammograms. This means that in some cases cancers will be missed, and in others, women will be unnecessarily recalled for further investigation. A simple way to ensure that those most at risk of developing breast cancer are prioritised for screening and seen more regularly would be to analyse all women on the waiting list with AI-guided breast density software. This would allow clinicians to retrospectively identify those women most at risk and move them to the top of the waiting list for mammograms. In the short term, to help tackle the screening backlog, prior mammograms of women on the waiting list could be analysed using the breast density software, so that women at highest risk could be seen first. Finding new workforce models Being able to pool resources will allow resource to be matched to demand beyond borders. Globally, more than half a million women are diagnosed with cervical cancer each year and the majority of these occur where there is a lack of guidance to conduct the screening programme. The digital transformation of cervical screening can connect populations that desperately need screening to resources where that expertise exists. For example, developing countries in Africa could collect samples from patients and image these locally, but rely on resources in the UK to support the interpretation of the images and diagnoses. Digital diagnostics brings the promise of a ‘taxi-hailing’ type model to cervical cancer screening – connecting groups with resources (drivers with cars) to those who are in need (passengers): this is an efficient way of connecting laboratory professionals to doctors and patients around the world. It’s going to take many months to get cancer screening programmes up and running at normal levels again, with continued social distancing measures and additional infection control impacting turnaround times. But diagnostic innovation is on a trajectory that we cannot ignore. It will be key to getting cancer screening programmes get back on track. AI is a fundamental piece of the innovation puzzle and we are proud to be at the forefront of AI solutions for our customers and partners.

Read More

Spotlight

Alma

Alma is pioneering a new practice model for therapists to elevate the therapy experience and simplify access to care. We build co-practicing communities powered by shared technology and services.

Related News

Digital Healthcare

TRC Healthcare Teams Up with Pharmacy Quality Solutions on Pharmacy Continuing Education Podcasts

TRC Healthcare | October 12, 2021

TRC Healthcare, a top provider of evidence-based medication advisory resources for clinicians announced a partnership with Pharmacy Quality Solutions (PQS), a leading technology provider of pharmacy performance management services. Along with PQS, TRC Healthcare will offer a pilot program for pharmacy continuing education (CE) through the PQS podcast, the PQS Quality Corner Show. The first podcast episode available for CE debuted August 2021 in TRC Healthcare's Pharmacist's Letter. With the pilot program, TRC Healthcare is exploring expansion of its CE channels with the inclusion of audio podcasts. Listeners of the PQS Quality Corner Show have the ease of podcast learning with the ability to earn CE credits through the Pharmacist's Letter website. "Our research has shown that many pharmacists are eager to explore different ways to digest CE content, and podcasts were at the top of the list. PQS is a leader in pharmacy quality and education and has developed a solid podcast listenership. We are very much aligned to make it more convenient for our pharmacy audience to access content on the go. We are excited to work with PQS in this endeavor." Wes Crews, CEO of TRC Healthcare The first set of episodes available for CE credit covers the topic of immunizations and can be downloaded on all major streaming services. "In our efforts to make each one of our episodes better than the last, we are pleased to evolve our content in 2021 and work with TRC Healthcare to provide continuing education for pharmacists. As our show has always been about education and improvement on quality, we have purposefully structured our show to follow a CE seminar format where we ask key questions and help our audience learn essential details." Quality Corner Show Host and PQS Senior Manager of Pharmacy Accounts, Nick Dorich, PharmD The second set of episodes covers geriatric care and is available on the Pharmacist's Letter and the Quality Corner Show. About TRC Healthcare TRC Healthcare (TRC) is a premier source of lifelong learning solutions for healthcare professionals. TRC is most recognized for their education and CE offerings within the highly-regarded Pharmacist's Letter, Prescriber's Letter, and Pharmacy Technician's Letter. TRC also offers Pharmacy Technicians University, the leading online training program for pharmacy technicians. The Natural Medicines database makes it easy for subscribers to find unbiased, evidenced-based research about alternative drug therapies. Through the acquisition of CriticalPoint and NetCE, TRC Healthcare recently expanded its offerings. CriticalPoint increases patient safety through a variety of educational compounding offerings concentrating on USP 797, 800, and 795. NetCE is an industry-leading, continuing-education platform, specializing in continuing education across multiple professions including nurses, physicians, and mental health. These additions give TRC Healthcare the industry's largest catalog of continuing education and advisory services, with thousands of courses trusted by healthcare professionals to provide accredited training that meets continuing education and licensing requirements. About Pharmacy Quality Solutions, Inc. (PQS) PQS is a healthcare quality technology company, connecting healthcare payers and providers who value measurement as the pathway to better patient outcomes. Partners of PQS represent nearly 90% of all Medicare Part D lives and 95% of community pharmacies. PQS delivers quality insights and guidance to support their customers' efforts to optimize the quality of medication management and use for their Medicare, Medicaid and commercial populations. PQS' industry-leading platform, EQUIPP®, provides standardized measurement and reporting on key medication use quality measures and value-based reimbursement programs focused on medication adherence, treatment outcomes and patient safety.

Read More

Aetna and Oak Street Health want to help Medicare patients

Oak Street Health | August 03, 2017

Primary care for Medicare patients shouldn’t be so difficult right? That’s what Aetna and Oak Street Health think. The two are teaming up to improve care for said patient population in Illinois. Through their partnership, Chicago-based Oak Street will be able to see Aetna Medicare Advantage PPO and HMO patients. Currently, the agreement only applies to those living in Illinois. Founded in 2012 by three former members of the healthcare practice at The Boston Consulting Group, Oak Street operates 24 primary care clinics throughout Illinois, Indiana and Michigan. Thirteen of them are in Illinois.

Read More

Whistleblowers: United Healthcare Hid Complaints About Medicare Advantage

United Healthcare | July 28, 2017

United Healthcare Services Inc., which runs the nation’s largest private Medicare Advantage insurance plan, concealed hundreds of complaints of enrollment fraud and other misconduct from federal officials as part of a scheme to collect bonus payments it didn’t deserve, a newly unsealed whistleblower lawsuit alleges. The suit, filed by United Healthcare sales agents in Wisconsin, accuses the giant insurer of keeping a dual set of books to hide serious complaints about its services and of being intentionally ineffective at investigating misconduct by its sales staff.

Read More

Digital Healthcare

TRC Healthcare Teams Up with Pharmacy Quality Solutions on Pharmacy Continuing Education Podcasts

TRC Healthcare | October 12, 2021

TRC Healthcare, a top provider of evidence-based medication advisory resources for clinicians announced a partnership with Pharmacy Quality Solutions (PQS), a leading technology provider of pharmacy performance management services. Along with PQS, TRC Healthcare will offer a pilot program for pharmacy continuing education (CE) through the PQS podcast, the PQS Quality Corner Show. The first podcast episode available for CE debuted August 2021 in TRC Healthcare's Pharmacist's Letter. With the pilot program, TRC Healthcare is exploring expansion of its CE channels with the inclusion of audio podcasts. Listeners of the PQS Quality Corner Show have the ease of podcast learning with the ability to earn CE credits through the Pharmacist's Letter website. "Our research has shown that many pharmacists are eager to explore different ways to digest CE content, and podcasts were at the top of the list. PQS is a leader in pharmacy quality and education and has developed a solid podcast listenership. We are very much aligned to make it more convenient for our pharmacy audience to access content on the go. We are excited to work with PQS in this endeavor." Wes Crews, CEO of TRC Healthcare The first set of episodes available for CE credit covers the topic of immunizations and can be downloaded on all major streaming services. "In our efforts to make each one of our episodes better than the last, we are pleased to evolve our content in 2021 and work with TRC Healthcare to provide continuing education for pharmacists. As our show has always been about education and improvement on quality, we have purposefully structured our show to follow a CE seminar format where we ask key questions and help our audience learn essential details." Quality Corner Show Host and PQS Senior Manager of Pharmacy Accounts, Nick Dorich, PharmD The second set of episodes covers geriatric care and is available on the Pharmacist's Letter and the Quality Corner Show. About TRC Healthcare TRC Healthcare (TRC) is a premier source of lifelong learning solutions for healthcare professionals. TRC is most recognized for their education and CE offerings within the highly-regarded Pharmacist's Letter, Prescriber's Letter, and Pharmacy Technician's Letter. TRC also offers Pharmacy Technicians University, the leading online training program for pharmacy technicians. The Natural Medicines database makes it easy for subscribers to find unbiased, evidenced-based research about alternative drug therapies. Through the acquisition of CriticalPoint and NetCE, TRC Healthcare recently expanded its offerings. CriticalPoint increases patient safety through a variety of educational compounding offerings concentrating on USP 797, 800, and 795. NetCE is an industry-leading, continuing-education platform, specializing in continuing education across multiple professions including nurses, physicians, and mental health. These additions give TRC Healthcare the industry's largest catalog of continuing education and advisory services, with thousands of courses trusted by healthcare professionals to provide accredited training that meets continuing education and licensing requirements. About Pharmacy Quality Solutions, Inc. (PQS) PQS is a healthcare quality technology company, connecting healthcare payers and providers who value measurement as the pathway to better patient outcomes. Partners of PQS represent nearly 90% of all Medicare Part D lives and 95% of community pharmacies. PQS delivers quality insights and guidance to support their customers' efforts to optimize the quality of medication management and use for their Medicare, Medicaid and commercial populations. PQS' industry-leading platform, EQUIPP®, provides standardized measurement and reporting on key medication use quality measures and value-based reimbursement programs focused on medication adherence, treatment outcomes and patient safety.

Read More

Aetna and Oak Street Health want to help Medicare patients

Oak Street Health | August 03, 2017

Primary care for Medicare patients shouldn’t be so difficult right? That’s what Aetna and Oak Street Health think. The two are teaming up to improve care for said patient population in Illinois. Through their partnership, Chicago-based Oak Street will be able to see Aetna Medicare Advantage PPO and HMO patients. Currently, the agreement only applies to those living in Illinois. Founded in 2012 by three former members of the healthcare practice at The Boston Consulting Group, Oak Street operates 24 primary care clinics throughout Illinois, Indiana and Michigan. Thirteen of them are in Illinois.

Read More

Whistleblowers: United Healthcare Hid Complaints About Medicare Advantage

United Healthcare | July 28, 2017

United Healthcare Services Inc., which runs the nation’s largest private Medicare Advantage insurance plan, concealed hundreds of complaints of enrollment fraud and other misconduct from federal officials as part of a scheme to collect bonus payments it didn’t deserve, a newly unsealed whistleblower lawsuit alleges. The suit, filed by United Healthcare sales agents in Wisconsin, accuses the giant insurer of keeping a dual set of books to hide serious complaints about its services and of being intentionally ineffective at investigating misconduct by its sales staff.

Read More

Events