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October 21, 2009     Spotlight  Proactive approach to payment, error detection improves payment accuracy for payers and providers Organizations that pay for health care services face intense competitive pressures to control premiums. At the same time, they are focused on ensuring that their members receive the best possible care and that physicians receive fair, timely payments. Juggling these goals while managing costs has become even more difficult during the economic recession. In the past, payers focused cost control efforts on identifying and recovering overpayments or erroneous payments. However, Dean Farley, vice president of Ingenix Consulting, says a prospective or pre-payment approach to managing payments and controlling costs will facilitate better results throughout the system. "Everyone in health care has a vested interest in ensuring that those who need medical care receive it and that those delivering it are paid promptly," Farley stated. "When providers know in advance what they will be paid for treating specific conditions or patients, they have additional incentives to achieve better outcomes and deliver care as efficiently as possible." Click here to continue reading this article online.     Employers  American Heart Association: Wellness programs save money The American Heart Association issued a policy statement noting that employee wellness programs can help people reduce heart disease risk factors, including obesity, smoking and high blood pressure. "Research shows that companies can save anywhere from $3 to $15 for every $1 spent on health and wellness within 12 to 18 months of implementing a [workplace wellness] program," said the lead author of the statement. U.S. News & World Report/HealthDay News (9/30) Fresh idea leads to huge drop in workers' comp claim costs When managers at his company couldn't think of light-duty jobs for injured workers, Hal Beeler took a different tack and asked managers for a list of duties they'd like to have done around their offices but didn't have the resources for. Since those duties were often suitable for people who would otherwise be out on workers' compensation, the company was able to dramatically cut its workers' compensation claims. HRMorning.com (9/24) New study says paying attention to employee wellness is imperative A Families and Work Institute study points out that investing in employee wellness is imperative, not optional. "Employees' physical and mental health, stress levels, sleep quality and energy levels all significantly impact important work outcomes of interest to employers, such as engagement, turnover intent and job satisfaction," the report said. Fast Company (9/2009) Wellness programs help Texas companies drop health care expenses Dallas companies such as Hill & Wilkinson General Contractors use employee wellness programs, such as health screenings, to lower their health care bills. One expert says the first step should be focusing on the sickest employees, as a small percentage of workers drive most of an employers' medical expenses. The Dallas Morning News (9/22) Some companies ban multitasking on phones while driving To boost safety, some companies have stopped allowing their workers to make work-related phone calls and send texts and e-mails while driving. "There is an illusion of productivity. It's actually counterproductive," said a University of Michigan professor of psychology. The New York Times (9/30) Solutions: For Employers |  Health & Productivity Optimization |  Decision Support |  Health Benefits Consulting   Hospitals  Wireless is the new trend for hospitals Instead of the traditional no-cell phone rules, more hospitals are choosing to improve communications through wireless technology. "Our doctors and nurses need tools that are wireless so that they don't have to be tethered to a phone or a computer. If a nurse needs to reach a doctor with a question when she is administering some medication and that doctor is walking the halls of the hospital, wireless is the only way to reach him," said Methodist Healthcare's chief information officer. Telephony Online (9/23) Hospital group endorses electronic records, reaches out to physicians North Shore-Long Island Jewish Health System is offering its thousands of affiliated physicians sizable subsidies for adopting electronic medical records. The North Shore program "punctuates a trend of hospital groups trying to solidify and tighten relationships with physicians in their communities," said an expert in health technology. The New York Times (9/27) Children's Miracle Network competition will give hospitals games for kids More than 150 hospitals in the U.S. are competing for equipment from Microsoft that the facilities could use for game rooms for pediatric patients. The Children's Miracle Network is sponsoring the contest and will give three hospitals prizes such as Xbox 360 game systems, plasma TV screens and computers. The Plain Dealer (Cleveland) (9/29) West Virginia hospital launches Quick Kidz Pediatric ER A West Virginia hospital set aside space for a convenient, seven-days-a-week, child-friendly ER unit. "We talked with our pediatrics staff and did a lot of planning to come up with after-hours care that could address the need to see and treat children as quickly and efficiently as possible," said the hospital administrator. The Register-Herald (Beckley, W.Va.) (9/22) Solutions: For Hospitals |  Health Care EDI |  Coding & Reimbursement |  Performance Analysis |  Operational Improvement   Payers  Kaiser Permanente taps staff to design innovations for care improvement Kaiser Permanente used its own staff instead of hiring outside designers to come up with innovations that improved quality for its health care providers and patients. The staffers were taught the principles of design thinking and held collaborative workshops. BusinessWeek (9/24) Health insurers, AHIP partner on Web site to help eliminate paperwork America's Insurance Health Plans, the Blue Cross Blue Shield Association and eight payers are collaborating on a Web portal that should reduce administrative costs by eliminating paperwork. The Web site will provide a central location where doctors can check patient coverage and eligibility and file claims, among other tasks. American City Business Journals/Columbus, Ohio (10/5) Expert: Money is better spent on kidney transplants than dialysis Experts say the cost of kidney transplantation may initially be higher compared with dialysis, but within months that cost is worth it. An OptumHealth executive noted that dialysis can run more than $13,000 monthly. "There is no doubt, based on an economic analysis, giving someone a kidney within about three years is a tremendously cost-effective thing to do," said the head of the National Kidney Foundation. Pittsburgh Tribune-Review (9/28) AHIP to lobby for stronger legislation on requiring coverage Health insurers will lobby for stiffer penalties in health reform legislation for individuals who choose not to buy coverage. "People will drop coverage and those who stay in would see rate shock" under current proposals, said the head of America's Health Insurance Plans. Google/The Associated Press (10/5) Movement grows to combine some behavioral health care with doctor visits A trend in settings that provide medical care as well as health insurance, such as Kaiser Permanente in Northern California and Veterans Affairs facilities, is to include simple mental health interventions with other doctor visits in order to treat behavioral or mental health problems that would otherwise go unaddressed. The Philadelphia Inquirer (9/28) Solutions: For Payers |  Care & Health Management |  Network & Credentialing |  Payment Integrity |  Consumer Tools |  Underwriting & Actuarial |  Health Care EDI |  Decision Support |  Claims Reimbursement   Pharma  Novartis tracks patient compliance through microchips in pills Microchips in Novartis' Diovan, a blood pressure drug, keep track of whether patients taking the medication are getting all the doses they need. If they skip any doses, reminders are text-messaged to them. A Novartis official said the technology proved successful in a small patient group. The Wall Street Journal/Health Blog (9/22) Bayer ranks at the top in climate protection The Carbon Disclosure Project named Bayer as the best company in the world with regard to protecting the climate. "Companies which control their risks today, manage their emissions and seize the opportunities to produce low-carbon goods and services will be the best placed to prosper in a low-carbon economy of the future," said the chief executive of the CDP. The FINANCIAL (9/22) Executives tout benefits of large company size Cash to pay for clinical trials and cover bases when studies aren't successful is one of several advantages big pharma companies have over smaller ones, company executives say. "In order to be really successful and realize the value of your assets in a reasonable period of time, you need to have critical mass globally and in key markets," said a Wyeth official. Reuters (9/22) Huge market for obesity drugs is inviting to many drugmakers Vivus leads the pack in the pharmaceutical industry's race to come up with a successful obesity drug that does not have overwhelming side effects; also in the race are drugmakers Arena Pharmaceuticals and Orexigen Therapeutics. Vast potential sales leave enough room for a number of obesity drugs to do well, according to an analyst. The Wall Street Journal (9/21) PhRMA board unanimously approves guidelines on clinical trials Drugmaker trade group PhRMA implemented new voluntary guidelines on conducting clinical trials, which include a ban on ghostwriting and a recommendation to post "summary results" of all studies, even those that lead to dropping a drug from the pipeline. The Wall Street Journal/Health Blog (9/30) Solutions: For Pharma |  Therapeutically-Specialized Research |  Drug Safety |  Research Staffing |  Health Economics & Outcomes |  Clinical Data Services   Physicians  Alliance addresses solutions for obesity epidemic in U.S. Physician organizations and others in the Strategies to Overcome and Prevent Obesity Alliance recommend that doctors talk to their patients about weight loss and use better clinical approaches to obesity. "Our hope is by putting these recommendations forward, members of Congress and private-sector businesses can understand that they are raised by a bipartisan group of people who represent every sector of the American economy," said the alliance director. American Medical News (subscription required) (9/24) Poll: Doctors think tort reform is key to controlling health care costs When doctors were asked in a recent poll, "If it is true health care is growing too expensive, what key thing do you think should be done to slow increasing medical costs?" their predominant answer was tort reform. Investors Business Daily (9/23) Surgeons to benefit from 3-D cancer imaging system The Department of Defense awarded an $849,000 grant to Thomas Jefferson University and University of Delaware researchers to create 3-D cancer images. "This system will combine the 3-D visual image with the sense of touch and permit surgeons to view, palpate and manipulate selected organs and tissues," said the study leader. American City Business Journals/Philadelphia (9/25) Physician group recommends protections against new drugs The American College of Physicians recommends the Food and Drug Administration take more actions to protect consumers from newer drugs, including limiting public advertising of these products and placing a special symbol on them to alert consumers. Los Angeles Times (9/24) Meditation, mindful communication can alleviate physician burnout Physicians, many of whom experience burnout and stress, could benefit from meditation and mindful communication, according to a study. "From the practitioner's perspective, the opportunity for deeper connection is all too often missed in the stressful, complex and chaotic reality of medical practice," said the study leader. United Press International (9/23) Solutions: For Physicians  |  Health Care EDI |  Revenue Cycle Optimization |  Coding & Reimbursement |  Operational Improvement   Public Sector  U.S. government gears up to quickly detect any flu vaccine side effects The U.S. government plans to track flu vaccination side effects to quickly detect any problems. Under one tracking program, the CDC will give all vaccine recipients cards detailing how to use the nation's Vaccine Adverse Event Reporting system. The Washington Post/The Associated Press (9/28) CDC-funded centers of excellence will help detect health threats The Centers for Disease Control and Prevention is helping fund four centers of excellence that will contribute to public health threat detection. The university-based centers "will advance the study and practice of public health informatics through collaborative efforts," said a CDC official. Government Health IT (9/28) Medical research to receive $5 billion in stimulus money The White House has decided to dedicate $5 billion from the stimulus package to "cutting-edge medical research in every state across America." Speaking at the National Institutes of Health, President Barack Obama said the investment "will also lead to new jobs: tens of thousands of jobs conducting research, manufacturing and supplying medical equipment, and building and modernizing laboratories and research facilities." Yahoo!/Reuters (9/30) Studies find public smoking bans lead to reduction in heart attacks Banning smoking in public places can lead to a reduction in heart attacks, according to two groups of researchers, one reporting its findings in Circulation and another in the Journal of the American College of Cardiology. "Public smoking bans seem to be tremendously effective in reducing heart attack and, theoretically, might also help to prevent lung cancer and emphysema," said one of the study leaders. Yahoo!/Reuters (9/21) Community prevention programs are successful, study finds A study from the New York Academy of Medicine and Trust for America's Health counters a recent Congressional Budget Office report by stating that community-based programs for illness prevention do indeed reduce costs and improve health. "There is clear, strong evidence that community prevention works," said the executive director of Trust for America's Health. Modern Healthcare (free registration) (9/21) Solutions: For Public Sector |  Claims Overpayment Prevention |  Care & Health Management |  Coding & Reimbursement   Workers' Compensation & Auto Liability  Insurance companies do well in underwriting, claims handling, poll shows A poll of insurance agents showed that respondents think companies are successful at underwriting and claims handling but could improve communications and technology. "It's reassuring to find that insurance companies are doing so well where it matters most to independent agents. Companies are demonstrating sound, consistent underwriting and paying client claims promptly and fairly," said the executive director of the Professional Insurance Agents of Connecticut, New Hampshire, New Jersey and New York State, which administered the survey. National Underwriter (free registration) (10/2) Mintel Comperemedia report finds auto insurers are keeping customers happy Mintel Comperemedia reports that auto insurance customers are pleased with their providers and do not frequently switch carriers. "Auto insurers are clearly doing something right, because the overwhelming majority of customers feel satisfied by their current provider," a Mintel executive said. Insurance Networking News (10/1) IIABA study notes successes of large insurers despite economy A study of best practices issued by the Independent Insurance Agents & Brokers of America finds that the best big insurers are growing their workforces despite the economy's problems. "This year's study indicates that the Best Practices Agencies, overall, continue to perform well despite facing some challenges in soft market conditions," said an IIABA executive. National Underwriter (free registration) (10/1) North Carolina workers' comp rate reductions could save employers millions North Carolina plans a forum on the state rate bureau's request for an average of almost 10% lower workers' compensation rates beginning in April. Employers could save almost $120 million if the requested rates are approved, according to the insurance commissioner. RiskandInsurance.com (10/1) Proposed legislation would create Federal Insurance Office A proposed bill would add to the Treasury Department a new unit called the Federal Insurance Office, which would be authorized to monitor the industry and create policy "on prudential aspects of international insurance matters." Business Insurance (10/1) Solutions: For Workers Comp & Auto Liability |  Claims Cost Management |  Data Benchmarking & Pricing |  Health Care EDI   SmartQuote  Education is not a preparation for life; education is life itself." --John Dewey, philosopher, psychologist Subscriber Tools       Web version |  Search past news |  Archive |  Privacy policy   About Ingenix Ingenix unites the brightest minds to transform organizations and improve health care through information and technology. We partner with more than 250,000 clients worldwide to solve the most important problems in health care. Learn more at ingenix.com.       Recent Ingenix Innovations Issues: Tuesday, September 29, 2009 Thursday, September 17, 2009 Tuesday, September 01, 2009 Tuesday, August 25, 2009 Thursday, August 06, 2009     Lead Editor:  Elizabeth Collins       Distributed by: SmartBrief, Inc.®, 1100 H ST NW, Suite 1000, Washington, DC 20005     © 1999-2009 SmartBrief, Inc.® Legal Information