ICD10 – Struck by a DUCK!

July 20th, 2014 by Nick Jacobs No comments »

For several years something called ICD-9s dominated the healthcare providers’ reimbursement landscape.  It’s how they get paid for treating their patients.  There were 13,000 different categories of ICD-9s that were always up for individual interpretation.   Well, as only they can do, the federal government has simplified the decision-making process by complicating things exponentially.  Now, instead of the traditional 13,000 choices, there will be something called ICD-10s with 68,000 billing codes.  Over five times more obscure, yet descriptive, billing selections for the already confused healthcare workers to decipher.

The implementation of these expansive diagnostic code changes will take place in October, 2015.  Katie Bo Williams of Healthcare DIVE News wrote a wonderful description of the  most absurd codes that will be a part of the ICD-10 list, and some of them were stupid enough to have some fun with here.

A few years ago, when the codes were beginning to appear in writing for the first time, I was working in Florida and was having lunch with a group of very Southern individuals.  I jokingly said, “You know there will be a billing code for getting hurt while riding on the back of a hog.”  One woman looked almost indigently at me and said, “You’re obviously not from the South.  Our hog races are very important to us.” To this day, I’ve never seen hog jockeys!  (Bucket list.)

W55.41XA:  Bitten by a pig, initial encounter.    Let me be perfectly clear.  This code absolutely is referring to a farm-related injury.   Because my farming experience has been pretty much limited to geese who bite and cows with limited denture capabilities for significant biting, I can’t personally respond as to how risky pigs can be if aggravated.  I think it’s interesting, however, that I already have two pig references and we still have several hundred more words to go.  Does this imply that, not unlike our schools, airports, and other public buildings, we’re going to have to have armed guards to protect us in our pig pens?

One of the fantastic code descriptions that Katie writes about is V9733XD:  Sucked into a jet engine, subsequent encounter.    It took a minute for this one to sink in because I read it as, “If you happened to have been sucked into a jet engine and lived and then were sucked in again, there was now a code for it.”  In the vernacular of the times, that would really suck.  She went on to explain, however, that it meant subsequent encounter with a physician, not a jet engine.

Z63.1: Problems in relationship with in-laws.   Truthfully, I can’t believe they didn’t have this one in the first 13,000 codes.  If you’re a fan of “Sons of Anarchy” it’s certainly clear why this needs to be a code.  Who hasn’t had this challenge?

Two or three years ago, one of my doctor buddies used this next one in a speech he was giving regarding reimbursements and what was coming our way.  Y93.D: V91.07XD:   Burn due to water-skis on fire, subsequent encounter.  A person has to ask, “What could you possibly have done to even get your water skis to catch on fire?  Did you soak them in a flammable liquid for two days?  Did you jump through a burning hoop on skis?”  In that case there should be a code for flaming Speedos.

12.Z99.89: Dependence on enabling machines and devices, not elsewhere classified.   This one obviously refers to a physician having to counsel us because of our addictions to electronic communication devices.   As Katie says, “There’s just no substitute for a Crackberry.”

Finally, my very favorite one is W61.62XD: Struck by a duck, subsequent encounter.    It’s my favorite for reasons that I can’t really write about here relating to a really old joke, but it is one of the only codes that rhymes.  He was struck by a duck!   Get him to the ER. STAT!

 

 

It’s NOT Business; It’s Personal

March 31st, 2014 by Nick Jacobs 3 comments »

Next Gen Sequencing, Pharmacogenomics, the Microbiome, and Integrative Medicine are leading us quickly into the next generation of personalized medicine where you will be treated individually based upon your specific genetic profile.  No more guessing; no more accidental dosages; no more unnecessary tests; the next generation of medical treatment is here, and it’s up to you to find the precise doctors and health systems to treat you appropriately.  Oh, yes, and Integrative Medicine gives you the tools to become the master of your own destiny by influencing your Epigenetics.  (Those genetic modifications which are influenced by personal health related decisions that do not change the DNA.)

Did you know that the Amish carry the “genetic indicators for obesity,” but they sure aren’t fat?  How can that be?  Well, if you walked an average of 20,000 steps per day, you would potentially alter your epigenetic profile as well.  Dr. Dean Ornish started working on this idea back in the late seventies with a revolutionary approach to health.  In fact, it was so revolutionary that the FDA literally questioned every aspect of his concept on many levels.  His aggressive, controversial approach to healthcare was a combination of diet, exercise, stress management and group support.  Can you imagine anything so contentious?

The truly amazing lesson learned from his work initially was that cardiac victims were able to regain their health and take control of those multiple morbidities that were leading them toward a premature grave.  As an early adaptor of the Ornish Program, we saw amazing transformational outcomes with our participants that were here-to-fore unexplainable.     Angina pain virtually disappeared a few weeks after starting the program.  Leg cramps went away.  The average person lost over 20 pounds but was a virtual eating machine, and people suffering from things like impotence, inflammatory disease, i.e., auto-immune diseases and general depression oftentimes experienced remission on some level.  Truthfully, the most fascinating outcome from this program was that those individuals who entered it saw a significantly improved psychological profile that remained positive long after completion of the actual hands on portion of the work.  They literally got their lives back.

By focusing on specific genetic panels, next generation genetic sequencing will help individuals pinpoint not only current, but also future problems nestled away in their DNA, and, like the Amish, through Integrative Medicine practices where we are literally treating the root causes of many of these afflictions, physicians and healthcare providers will not only be able to help you control these risk factors, in some cases, they could literally help to ameliorate the risks indicated in your genetic map.

Now, imagine having 300 of your genes tested to determine what medicines you can metabolize, and as a result of that test never getting the wrong medicine prescribed to you again.  It’s a onetime test with a life time of results.  If a certain number of human beings are destined to have a negative reaction to specific medicines, those medicines won’t be prescribed because the Pharmacogenomic tests will counter indicate its use.  The entire concept of trial and error medicine or “only one in one hundred thousand” risk factor exposures will eventually be virtually eliminated through Pharmacogenomics.    Have you heard the radio spots for Vanderbilt University Medical Center that claim protection from incorrect heart medications, or The Cancer Treatment Centers of America’s advertisements for genetic testing?

Finally, what about the microbiome?  We can finally analyze the millions of living organisms in our body’s’ digestive systems to determine their benefit or potential negative impact.  Only 1% of these organisms are harmful to us, but the other several million are literally believed to be contributing to everything from leaky gut syndrome to curing C-dif colitis.

So, let’s review: Integrative medicine, NextGen sequencing, Pharmacogenomics, the Microbiome and YOU?   Personalized medicine is knocking on our door on multiple levels.  Now it’s up to us to find the right practitioners, the well-schooled, open minded, and progressive medical centers that can combine these various approaches to keep us healthy.

Monopoly

February 16th, 2014 by Nick Jacobs 16 comments »

One definition of a monopoly is “the exclusive control of a commodity or service in a particular market, or a control that makes possible the manipulation of prices.”  Don’t get me wrong, if I had total control of a geography or industry, I’d love to own it.  Think about it, having the only lemonade stand in the middle of a desert would be a great business.  Even better would be to own the lemonade grove where the lemons are grown, and the sugar plantations where the sugar comes from, and finally, the water supply.  Now, that’s a monopoly. 

Someone told me years ago that the reason that Johnstown, Pennsylvania was never able to survive the loss of Bethlehem Steel was that Bethlehem controlled all of the water in that area.  Not having access to water for manufacturers is not any different than owning all of the lemon groves and sugar.

Recently, I read an article that a banker friend of mine gave me comparing hospitals and health systems to the banking industry.  This article, compared everything that is happening in the healthcare world in this country to what has been happening to banks.   It predicted that small and medium sized hospitals and health systems will continue to be forced into mergers and acquisitions in order to survive at any level.  The Affordable Care Act has set financial and information technology requirements and rules that make it almost impossible to maintain independent hospitals and health systems over the long-haul.

Back in 1987 when managed care was penetrating our area, the prediction was that Pennsylvania would end up with three health systems representing the entire State.  That prediction seems to be coming true.  The banking article continued to put things in perspective as the “Too Big to FAIL” model grows in healthcare. 

Pittsburgh is going through an interesting “monopoly or no monopoly decision making time” where two nonprofit Titans are clashing, and the money being used to wage this war, not unlike the wars in Iraq and Afghanistan is coming from us, the citizens.   It’s interesting to calculate the costs of monopolies that, even in the nonprofit world, demonstrate a sort of capitalism run amuck.   How can anyone mess with organizations that employ tens of thousands of people?  Too big to fail. 

So, the Affordable Care Act will change this country forever.  Yes, there will be millions of people with insurance who lived before in fear of losing their homes, savings, and lives.  Yes, there will be hope where before there was nothing but fear.  The question becomes, however, will the health systems select the same model of mergers as the Defense, Airline, and the Banking Industries?  Will physicians be commoditized?  Will employees be placed on a long list where human beings can be moved and replaced like widgets and their value will be dictated by one source of power?  Last week 800 nurses walked off the job at a regional health system, the following day, 200 replacement nurses were brought in to take care of the patients.  This move represented the beginning of the end of an era.  Too big to fail or to negotiate?

I’ve been in leadership positions in large health systems and small hospitals.  I’ve started corporations, and run non-profits, but one thing I know for sure is that “Too Big to Fail” becomes a very dangerous place to live.  When an organization can place an economic strangle-hold on the everyday people who need that service the most, customer care and service always suffers.  I’m paying nearly a thousand dollars at 5:30AM tomorrow morning to fly one hour because of an airline monopoly.  Customer service doesn’t matter when you own the market.  Too big to fail allows corrupt investment bankers to walk free while for profit prisons continue to fill with people about which our system was too big to care.   It’s a jungle out there!

Heal with the PILL!

February 9th, 2014 by Nick Jacobs 2 comments »

 

A friend of mine showed me a paper that had been written by a brilliant, young physician.  In the paper she explained that, in her research, she had discovered that a fundamental piece of knowledge regarding the manner in which physicians in her specialty are expected to practice was seriously flawed.  She went on to prove that the science based on these two incredibly small original studies was also significantly outdated by new technologies.  In fact, it was clear that the knowledge garnered in the last decade alone through the use of new techniques and scientific advancements has proven this lack of accuracy in an unquestionable manner.

Here’s the worst part of this story; this flawed information has been printed in every textbook pertaining to this topic since about 1970, and change is slow.  Furthermore, every student of this specialty is expected to practice incorrectly in order to comply with the standards of their profession.

Okay, you say, what’s the big deal?  Well, the big deal is that the alternative practices that these flaws have resulted in suggest that the physicians prescribe certain types of drugs that, long term, may even be related to specific types of cancers in both men and women.  In other words, these mistakes which apply mostly to teenagers, could eventually lead to their premature death.  So, later in life when you say, “Why me?” there may indeed be an answer.

Far be it from me to reveal much more about this than to say that I’m NOT a doctor and I’m NOT a scientist, but I am a passionate individual who reads and learns a lot from the people with whom I am associated.  For example, we know that the chance that five prescription drugs will interact with each other in an unknown manner in our bodies is one hundred percent. Yet, many of us take more than that every day.

We know that nearly three quarters of the antibiotics used in this country are not used for human medicine. They are used on healthy livestock to prevent overwhelming infection.  Why?  To compensate for poor husbandry practices (severe overcrowding, filthy, excrement ridden environment, high degree of psychological stress, diet mismatched to their physiology and because antibiotics can act as growth promoters. They get sick, and when they get sick, Big Pharma is standing nearby to make their fortune by encouraging our farm factories to continue pumping antibiotics into our chickens, cattle and even farm raised fish.  The major health organizations in this country have called for a phase out to this practice.  We’re not really getting exposed to antibiotics in our food, but rather the antibiotic resistant strains of bacteria.

Research is currently being pursued in regard to certain antibiotics which, taken long term are suspected to be contributing to at least two types of cancer.  What are the risks long term for entire generations that are being exposed to the ramifications caused by these antibiotics in our food supply?

When we were doing breast cancer research, we saw that about 75 percent of the cancers presented were caused by our environment.  So, when it comes time to side against the environment, against naturally produced food products, and to walk away from obvious flaws in the literature that is the basis for the education  of certain physician specialties, just know that it may be your kids or grandkids that are going to pay the price.

Let me end this rendition of “Nick-a-pedia” by suggesting that Integrative Medicine considers food as your medicine. Seriously, diet, exercise, stress management, and socialization are the fundamental principles of functional medicine.  How can these things hurt anyone?

I’ll never forget when one of my research scientists told me years ago that hydrogenated fats were the worst human experiment ever perpetrated on man-kind without his knowledge, and here we are decades later, after tens of thousands of unnecessary heart attack deaths, finally banning them.  This is NOT BRAIN SURGERY!

Starting with a CLEAN SLATE

December 27th, 2013 by Nick Jacobs 4 comments »

In the book “Change or DIE” there is a reference to the fact that, when confronted with life altering decisions, about 90% of us make the choice not to change, not because we are suicidal or obtuse, but because resisting change seems to be built into our DNA.

Immediately before my son went to college, he appeared in the kitchen and asked us if he could “get some things off his chest.”   He wanted to start this next part of his life with a clean slate.   The first thing that came out of his mouth was, “Dad, your car does go 140mph,” and that was the beginning of about thirty very uncomfortable minutes of reconciliation.

As we enter the New Year, there is at least one thing that I’d like to “get off my chest,” because it has become increasingly apparent to me that I’m conflicted.  I’ve always embraced the underdog in both my life and my career.  As a teacher, my personal mission was usually wrapped around helping some kid who could have easily gone to the dark side.  This typically was accomplished by motivating him or her into attaining a goal that was perceived to be unattainable.  It was a “Climb every mountain“ scenario where their own self-worth became evident to them, and they realized that all of life does not have to be bad.   Many of those students are still my friends decades later.

My reconciliation to you today is that I was a rabid believer in finding a way to provide healthcare to all of the citizens of the United States.  Like millions of others in this country, my own job experiences sometimes took me to the brink of being uninsured and there was no family trust for us to dig into to cover our health insurance costs.

As a hospital CEO, I had also seen those very tragic cases where the young mom had underestimated the speed with which infant illness can progress, and due to her lack of understanding of the healthcare system, waited a day too long to bring her baby to the Emergency Room where it died in her arms.

My position also allowed me to understand the Charge Master and cost shifting so that the poor could be taken care of regardless of their ability to pay.  It was the uninsured or underinsured, working poor who typically were hurt the most by this system because they not only were billed full charges (which never happened to those of us who had insurance), but they were also turned over to bill-collectors.  These under-insured could literally have their homes taken from them for the unpaid balance of some catastrophic event and the resulting charges.

Consequently, when the Affordable Care Act looked as if it was going to pass, my defending the poor mentality kicked into high gear; that was until I realized that the first such healthcare bill to pass since 1948 was the definitive reconciliation package.  It looked like a duck but smelled like fertilizer.  Hospitals lost $500B in Medicare fees while pharmaceutical and insurance companies maintained all but a small percentage of their previous profits.  (They are huge employers in our country.)

Fee for service was still the primary driver while wellness and prevention took a typical back seat in the program and family practice and internal medicine physicians were still financially undervalued.   Worst of all, the government clearly displayed its inconceivable ineptness by creating a catastrophic misfire during the computerized enrollment roll-out.

I’m sure that my desire to support the underdog will never fully vanish, but the fight to support this camel shaped bill has created quite a quandary for me.  Yes, I’d still rather spend a trillion dollars on healthcare than on war, but people are getting hurt in both scenarios, and it appears to be, like so many other government decisions, all about the lobbyists.

Things to Expect from Obamacare in 2014 or Not?

November 1st, 2013 by Nick Jacobs 4 comments »

It used to be that we watched NBC, CBS, and ABC for all of our news.  Newsman, Walter Cronkite, was the most trusted human being in the United States.  Then, during the Clinton Administration, our media began to change as MSNBC and Fox came on line with a very different brand of edutainment.    Sergeant Joe Friday’s “The Facts, Ma’am, nothing but the facts,” became a myth.  Instead of the news, we could select which slant of the news we would prefer, and for many people, feeding at the trough of the one that most represented their views became a regular daily activity.

In college we learned about semantics and were taught the destructive force of improperly slanted communications.  We were also given examples of how these slanted interpretations influenced the masses.  Joseph Goebbels, Hitler’s PR man, did an astounding job of reaching the lower middle classes of Germany.  He used terror and hatred to influence their opinions on everything from literature, to war, to Jews.  He positioned his boss, Adolf, that smarmy little dude, as the leader of the “not so free world.”

A friend of mine was in the home of a prominent millionaire at the end of October in 1989 soliciting support for a not for profit organization.  During their meeting the phone rang, and the host excused himself to answer it.  The conversation went something like this, “No . . . absolutely not.  No, not this week;  not until next week.”  After the call he returned to my friend and said, “Do you believe it?  Those guys wanted to tear down the Berlin Wall this week.”

The following week, 28 years after it was constructed, the Berlin Wall came down – November 9th, 1989.

Influence comes in many forms, and it was obvious to my friend that a few very wealthy people had a great deal of influence in the way our world operates.  Many of those individuals or their offspring now control the media oligopoly, a group of people that went from thousands to less than a dozen major owners internationally, a reality that can create a lack of competition and diversity while providing completely biased political views reflective of what will benefit them directly.

With these New Rules in mind, I’ve decided to give you two different views of Obamacare for 2014:

Right:   Obamacare will result in Death Squads that will determine the fate of our loved one.

Left:      Obamacare will result in the saving of thousands of babies who would have perished due to         previously unavailable pre-natal care.

Right:    Obamacare will result in the complete loss of ownership of our medical records due to EMR’s (Electronic medical records) being available to the government.

Left:      Your Medical Records will soon be available to you no matter where you are in the country and will contribute to a higher quality of care.

There you have it.  Pick which side of the road you want to live on as you watch the cars go by, but then understand that you really don’t have much control of the direction in which they are moving.  Big media can keep us immersed in the deep concerns of the Kardashian family, feed us genetically modified white bread and send us to the Coliseum while Rome burns or we can VOTE.  The problem with voting is that we really should have enough objective information to allow us to make an informed decision, and, unless it’s a Tweet, that’s very unlikely.

Keep in mind, too, that our vote will be influenced by the lobbyists whose clients will benefit the most from the election.  As one talking head said, “I just wish they’d dress like NASCAR drivers so that we could determine who owns them.”   I, for one, am fed up with this polarity.

Let’s find some middle ground and try to save ourselves and our country.

What I’m Doing In New Jersey

October 3rd, 2013 by Nick Jacobs 15 comments »

I have been working to create and grow integrative holistic medicine centers, satellites and programs in New Jersey health systems.  (Integrative refers to evidence-based, world medicine practices and holistic refers to body, mind and spirit.)  My work helps to fund, recruit and place individuals and physicians trained in integrative modalities like functional medicine, acupuncture, massage, bio-identicals  into those systems so that habit change processes in life planning can be implemented.

With about $115B a year being spent on Integrative Medicine related services and products internationally at a 10% annual growth rate, these transformational avenues to wellness and prevention are making huge differences in healthcare costs and treatments.  By doing Integrative medicine assessments, education, coaching and life planning, these centers for well-being are changing the health of their region’s population.  This is being done through evidence based diet, exercise and stress management programs where healthy behavior habit practices and holistic diagnostics focusing on root-cause issues are first identified and then addressed.   The other good news is that these programs are being reimbursed through the Accountable Care Act at $100+ dollars per visit up to 72 visits a year.

Thirty million U.S. citizens will have health insurance in January of 2014.   In the new world order of American healthcare,  we will be providing population health for people, tens, even hundreds of thousands of people who have typically only ever seen physicians in an Emergency Room setting after the illness has become acute.  These urgent practitioners have served as their family physicians since they were small children, and prevention and wellness have been distant realities in their world.

We also live in a country that inundates us with advertisements, billboards, and jingles about manufactured food that has been specifically engineered and designed to be addictive through its sodium and sugar content and its man-made scientifically analyzed texture.  We have fallen into a style and standard of living that has produced sedentary and obese citizens; 26 million diabetics and 70 million pre–diabetics.  It is a system that is costing us $35B in diabetic treatments, and has a bottom line price tag of $2.4T a year.  Why not reach out to medical practice techniques that are thousands of years old?

Integrative Medicine approaches your health in a common sense manner, teaches you how to break bad habits, immerses you in nurturing activities that address your whole being, and allows you to become introspective about your own health so that root cause affects can be addressed and ameliorated.

Finally, medically directed nutraceuticals, herbs, vitamins and healthy foods along with other  modalities such as acupuncture, massage, music, art, aroma and humor therapies are proven methods of treatment that are being embraced at places like Duke University , The Cleveland Clinic, Scripps, Atlantic Health, the VA, the DoD and over three dozen major medical and academic centers in the United States.  The due diligence has been done.  It’s time to shift your personal paradigm and embrace this opportunity to make yourself healthy.

Population Health – Now or NEVER

August 3rd, 2013 by Nick Jacobs 12 comments »

 

It’s easy to be a remote dashboard video driver at a NASCAR race when someone else is assuming all of the pressure and risks behind the wheel.  Oftentimes that’s what my job feels like.  From my perspective I can observe the healthcare world and not personally be directly impacted by the fallout that others face on a daily basis.  The good news for both of us, however, is that this neutral and objective viewpoint gives me valuable knowledge that is both significant and in many cases critical to those of you who are still doing the driving.

For example:  Last week I heard about a hospital that had chosen to drop a clinical program that has been part of their service menu for years.  The incredibly interesting aspect of this decision to lay off several highly skilled individuals was that over a year ago the Affordable Care Act had changed the reimbursement for this program in a manner that produces exponentially better financial benefits to the organization.  Consequently, that decision would appear to be an uninformed or at least a minimally informed decision;  a potentially lucrative, multi-million dollar program is being eliminated while other health systems are currently initiating that very same program due to its value proposition in wellness, prevention and economic benefit.

Even the least informed of us have determined that the only way to survive the onslaught of change that the industry is now facing is through a serious and concentrated effort in dealing with population health.  Along with supply chain, consolidation, and attention to HCHAPS, hospital acquired infections, readmission rates and transparency;  population health is a critical pathway to address the balancing of the teeter totter of healthcare finance.

With 45% of the newly insured falling into the Medicaid ranks and somewhere between 7000 and 10,000 Baby Boomers moving onto the Medicare ranks on a daily basis, our hospitals will be inundated with medical vs. surgical cases that would have or should have either been prevented or at least ameliorated to some degree through public health efforts, education, and outreach.

For example, one medical issue that we don’t regularly hear about in the nonmedical-civilian world is the epidemic of inflammatory disease that is impacting our country.   Unless or until we move into our at-risk populations and address the urban food deserts, analyze the human impact created by the paragraphs of chemical additives to even our most basic foods, and deal with the endless consumption of sugar and salt in our manufactured diets;  heart disease, cancer, and dozens of other inflammatory related afflictions will fill the hospital beds and lead to the $2,000,000 work-ups that take us down one diagnostic rabbit hole after another and into Detroit City-type deficits.

Coupons for fruits and vegetables, green pathways for walking, bike paths, other forms of diet, exercise, stress management and socializing activities, and integrative medicine education would have a significant impact on the general health of our population.  So too would anti-bullying campaigns, anger management programs, and job creation.  Obviously, healthcare can’t be the panacea for all 316,000,000 or so people in this country, but, by immersing ourselves into areas of population health we will contribute significantly to our collective future.

The old adage of “common sense being uncommon” hits heavily on this topic because we all know that even Superman had his vulnerabilities.  Our kryptonite has become our addiction to all of those things that common sense would tell us are absolutely not logical in terms of lifestyle, consumption, work-schedules, video-addictions, nutrition starved diets, sodium and sugar consumption.  Oh, and while we’re at it, let’s find a corner of a couch and plant ourselves firmly into that spot for eight or so hours at a time.

We must embrace ways to reach our populations and care about them before we end up spending every healthcare dollar ineffectively caring for them while never addressing the root cause of their problems.

Mastering the CHARGE DESCRIPTION MASTER

July 22nd, 2013 by Nick Jacobs 22 comments »

Hospital prices have come under seemingly ever increasing scrutiny recently in various forms.  The TIME magazine article by Steven Brill, “The Bitter Pill,” which was a comprehensive outsider’s analysis of The Charge Description Master (CDM), has certainly generated some interesting discussions at not only social events, but also in most C-suites and hospital board meetings.

Almost simultaneously, the Medicare program’s recent release of hospital charge data has generated significant national media attention to this issue.  The dialogue regarding the growing influence of consumer-driven utilization of health care services and pricing transparency has taken on a life of its own as we enter this new era of healthcare delivery.

Everyone familiar with the inner workings of the health care industry knows that the CDM’s patient prices represent a very complicated issue.  And while a few healthcare consulting firms have been on the leading edge regarding this matter, fewer still have taken the steps to recommend that hospitals and health systems implement the wide range of policies and procedures needed to begin to appropriately address it.   These steps can include initiating suitable charity policies and installing processes that allow you to estimate patient liability , but even these do not produce a solution that will help to ameliorate the challenges raised by this new national transparency.

One crucial task that a hospital should perform is the development and implementation of a thoughtfully considered and carefully structured CDM patient pricing methodology, but delivering that solution has been consistently elusive.   

One firm however, SunStone Consulting, LLC, has incorporated its years of experience into the development of Pretium, a new web-based CDM pricing solution.

In their work as financial consultants to over 250 hospitals and health systems in the United States over the past 30 years, SunStone’s consultants have performed literally hundreds of pricing analyses and rate setting engagements. These engagements have been for hospitals ranging in size from 35 to 1,250 beds and including academic medical centers, major teaching hospitals, for and not-for-profit health systems, community and small rural hospitals.

Developed with SunStone’s expertise, and based on each user hospital’s customized structured charging methodology, Pretium offers a high degree of confidence in CDM pricing.   Other pricing software tools most frequently provide the user with plenty of information, but ultimately leave the identification of the actual CDM price to someone’s judgment.  This is not so with Pretium which calculates a CDM price and provides comprehensive documentation relating to exactly how each and every price was determined.

As most professionals in the healthcare finance business know, CDMs contain complex algorithms with large amounts of internal relational logic.  Pretium allows a user to incorporate all of these unique pricing considerations present in many patient services with individualized, specific, detailed pricing issues.

Pretium also provides a state-of-the-art Pricing Review screen that equips the user with powerful analytics that ensures that calculated proposed prices make sense in the context of the hospital’s pricing philosophy. This Pricing Review screen permits the user to quickly and easily make pricing changes and to determine immediately the estimated impact on gross and net patient revenue.  This feature then makes it possible to identify CDM prices that will protect the hospital’s net revenue stream while being sensitive to the local market, individual hospital’s cost and other internal and external benchmarks.

Finally, Pretium facilitates the user’s ability to explain detailed patient prices while keeping the organization in compliance with specific pricing regulations and guidelines.  These features, combined with SunStone’s expert pricing consultants’ advice, provide a powerful tool that can be used to accurately recommend pricing for the entire CDM.

Pretium is profoundly different from typical software pricing tools, and with the availability of continuous software upgrades in this heavily scrutinized environment, this CDM program can make these complex decisions and changes more accurate and dependable on an ongoing basis.

For more information or to schedule a demonstration, please contact Leonard Brauner at 212-622-9393 or via email at leonardbrauner@sunstoneconsulting.com

 

Healthy Apps

July 19th, 2013 by Nick Jacobs 22 comments »

I recently saw a rather robust list of apps that apply to your health.  If you don’t know what apps are, you might want to consider reading a different blog, but if, like me, you’re old but still curious, you’ll keep on reading.  So, these apps can be used on I phones, Androids, and tablets.  Some of them are relatively incredible, some aren’t; and some are just fun, but, no matter, they are the future.  App Health.  

The first app is called Brush DJ.  One of the less impressive genes that my grandkids seem to have inherited from me is teeth related.  You see, my teeth were always referred to by my mom as “soft teeth.”   As a kid, growing up without fluoride and having an aunt with a penny candy counter in her store, I just thought soft meant rotten teeth.  Cavities happened a lot to me.  Don’t get me wrong, I brushed ‘em, but, probably not often enough.  Then, after the dentist would fill my teeth with all of that wonderful mercury, he’d give me a lollipop.   

So Brush DJ goes into your telephone or tablet’s music collection, randomly selects a song and plays it for two full minutes while showing you where you should be brushing and at what time.  Cool, huh? 

I have mixed feeling about this one.  It’s called Depression Screening.  This app helps to identify depression issues; it assesses and tracks feelings of possible depression.  I haven’t tried it yet because it seems somewhat depressing.  ( Okay, I know, not PC.)   

Gene screen is described as a fun way to learn how recessive genetic traits and diseases are inherited and how certain diseases are more prevalent in different populations.  It also provides information on some recessive genetic diseases and screening programs.   

Let me be fully transparent here because, once again, I haven’t tried this one.  I don’t think that I  really want to know why my mid-section is now about a foot and a half shorter than my overall height or maybe, just maybe, I don’t care which one of my grandfathers or potentially grandmothers contributed to my excessive bodily hair which is everywhere but on my head.   

The next one is called, I prevent running injuries. It’s supposed to protect you from injuries.  I wasn’t even going to download it because the last time that I ran was to the dinner table. On the other hand, I have had friends who, while running and not paying attention to their surroundings, ran into street signs and had to have stitches.  Oh, and another friend fell into a sewer, but was very lucky and swam to safety.   

So, if you’re a runner or a swimmer you might consider that app.   

Finally, the Nottingham Hip Fracture Score Calculator wins it all.  This nifty little app will predict mortality in patients over 65 with a fractured neck or femur, and the app allows for rapid calculation of the score.  

Even though all of my old relatives are dead, I may just download this one for the fun of it.  So, Aunt Amy fell out of the tub?  Should I bother to cover her with a sheet and call the ambulance, or . . . what the heck?   This sounds like an app that was either created by a cold hearted actuarial, a surgeon who is calculating the maximum surgical time or possibly, an ambulance chasing attorney?   

First of all, why do you need to calculate this situation so quickly?  Is it part of the Death Panels of the Affordable Care Act?  (For you NSA guys with those little bomb filled drones, that was a joke.)  

Finally, this is America!  We are entitled to spend as much as we want on healthcare; no matter how stupid the outcome.