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Comprehensive Guide to Intensive Outpatient Program Billing Codes
Intensive outpatient programs (IOPs) play a crucial role in providing comprehensive treatment and support to individuals struggling with various behavioral health issues. Alongside the critical care they offer, it is equally important for IOP facilities to understand the complex world of billing codes. Proper utilization of billing codes ensures accurate reimbursement for services rendered and contributes to the financial stability of these facilities. In this article, we will explore into the intricacies of intensive outpatient program billing codes, exploring guidelines, regulations, and key considerations that every facility should know.
Understanding Intensive Outpatient Programs
Before we explore into the details of intensive outpatient program billing codes, let's briefly outline the nature and purpose of intensive outpatient programs. IOPs are designed to provide a structured treatment environment for individuals who require a higher level of care than traditional outpatient services but do not require 24-hour supervision. They typically involve a combination of individual therapy, group therapy, medication management, psycho-education, and support services.
Common Intensive Outpatient Program Billing Codes
Accurate billing is essential for IOP facilities to maintain their financial viability and continue providing high-quality care to their patients. By using proper intensive outpatient program billing codes, facilities can ensure that services are appropriately documented and billed, increasing the chances of obtaining reimbursement from insurance companies and other payers.
Evaluation and Management (E/M) Codes - CPT codes 99202-99499:��These codes are used for the evaluation and management of patients, including initial assessments, follow-up visits, and medical management.
Psychotherapy Codes - CPT codes 90832-90838: These codes cover individual psychotherapy sessions of varying durations, including initial assessments and subsequent sessions. CPT codes 90846-90853: These codes represent family psychotherapy sessions, providing therapeutic support and intervention for families involved in the treatment process.
Group Therapy Codes - CPT codes 90853-90857: These codes are used to bill for group therapy sessions, which are a common component of IOPs. They encompass various group sizes and durations.
Medication Management Codes - CPT codes 99212-99215: These codes are utilized for medication management services, including evaluation, prescribing, and monitoring of medications for patients in IOPs.
Overview of Other Intensive Outpatient Program Billing Codes
IOP billing codes depend on the classification of the services provided, specifically for mental health disorders or alcohol and substance abuse management.
For mental health disorders, the commonly used IOP billing code is S9480. This per diem outpatient code is used when billing for services related to depression, anxiety, bipolar disorder, and eating disorders. It should be paired with revenue code 0905, which is specific to intensive outpatient psychiatric services. This code combination, S9480/0905, is typically used for private payers, as Medicare may not recognize these specific codes.
On the other hand, for alcohol and substance abuse treatment in IOPs, the frequently used billing code is H0015. This per diem outpatient code is utilized when billing for services related to alcohol and other substance abuse. It is always paired with revenue code 0906, which is specific to intensive outpatient services for chemical dependency.
It is important to ensure proper documentation when billing for IOP services to meet payer guidelines. For substance abuse treatment, billers should ensure that the services billed last at least 3 hours a day for three days a week. The three-hour daily sessions, which may include assessments, individual and group counseling, and crisis intervention, should be treated as one unit of service to avoid duplication.
While the aforementioned codes are commonly used, it is essential to be aware that the application of billing codes may vary depending on carrier guidelines and state licensure laws. Some payers may accept universal billing codes for services related to mental health disorders or chemical dependency. However, others may require more specific billing codes.
Additional billing codes that may be used depending on payer requirements include H2019 for therapeutic behavioral services per 15 minutes, H2020 for therapeutic behavioral services per diem, H2035 for alcohol and other substance abuse treatment programs per hour, H2036 for alcohol and other substance dependence treatment program per diem, and S9475 for ambulatory setting substance abuse treatment or detoxification services per diem (typically used for Partial Hospitalization Programs).
It is important to note that both mental health and substance abuse billing codes may not be billed together for the same session. Depending on payer preferences, either the mental health code (S9480) or the substance abuse code (H0015) should be used, based on the primary diagnosis and services provided.
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#behavioral health billing services#medical billing and coding services#revenue cycle management#medical billing services#medical billing#intensive outpatient program billing codes
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Open Your Future in Healthcare: Top Benefits of Our Medical Coding and Billing Program
Unlock Yoru future in Healthcare: Top Benefits of Our Medical Coding and Billing Program
Are you seeking a rewarding career in the thriving healthcare industry? If so, enrolling in a extensive medical coding and billing program could be your key to a prosperous and fulfilling future. as healthcare continues to grow, the demand for skilled medical coders and billers is higher than ever.Our specialized program offers the training, certifications, and practical experience you need to excel in this dynamic field. In this article, we will explore the top benefits of our medical coding and billing program, how it can revolutionize your career, and why now is the perfect time to take this step toward your healthcare future.
Why Choose a Career in Medical Coding and Billing?
The healthcare industry relies heavily on accurate data management, making medical coding and billing essential roles. These positions are known for their stability, versatility, and the opportunity to make a meaningful impact in patients’ lives. With a solid understanding of medical terminology, insurance processes, and compliance regulations, you become a crucial part of the healthcare ecosystem.
Moreover, our medical coding and billing program prepares you for a variety of work environments, including hospitals, outpatient clinics, insurance companies, and even remote work options.
Top Benefits of Our Medical Coding and Billing Program
1. High Demand and Job Security
the growing complexity of healthcare billing and coding regulations ensures consistent employment opportunities. According to the U.S. Bureau of Labour Statistics, jobs for medical records and health details specialists are projected to grow faster than average over the next decade.
2. Lucrative Salary Potential
Medical coding and billing specialists enjoy competitive salaries, with the potential for increased earnings with experience and certification. Entry-level positions typically start around $40,000 per year, with seasoned professionals earning considerably more.
3. Flexibility and Remote Work Opportunities
Many medical coding and billing jobs offer flexible schedules and remote work options, allowing you to balance your personal and professional life effectively.
4. Fast and Cost-Effective Training
Compared to other healthcare careers, our program provides intensive training that can be completed in a shorter time frame, often within a few months, at a lower cost, making it accessible for many aspiring professionals.
5. Clear Career Progression
With certification and experience, you can advance to senior coding roles, management, consulting, or specialize in areas such as inpatient or outpatient coding.
6. Contribute to Healthcare Accuracy and Efficiency
Your work helps ensure accurate billing, compliance with legal standards, and timely reimbursement, directly influencing the quality of healthcare services.
practical Tips for Success in Medical Coding and Billing
Get Certified: Pursue industry-recognized certifications such as Certified Professional Coder (CPC) or Certified Coding Associate (CCA).
Stay Updated: Healthcare policies and coding standards evolve; continuous learning is key.
gain Hands-On Experience: Seek internships or externships offered through our program to build practical skills.
Network: join professional associations like the American Academy of Professional Coders (AAPC) for networking opportunities.
Leverage Online Resources: Utilize coding reference tools, online forums, and seminars to deepen your knowledge.
Success Stories: Real Experiences from Our Graduates
jane’s journey from Student to Certified Coder
After completing our medical coding and billing program in just four months,Jane obtained her CPC certification and secured a remote position within six weeks. She now enjoys flexible working hours and a salary increase,thanks to her certification and practical experience gained through our course.
Mike’s Transition into healthcare Management
Mike transitioned from a retail job to a rewarding healthcare career after our program. His knowledge of coding and billing opened doors to administrative roles, and he is now a department supervisor earning a competitive salary while making a difference in patient care.
What Our Medical Coding and Billing Program Includes
Feature
Description
Comprehensive Curriculum
Includes medical terminology, coding principles, insurance processes, and compliance regulations.
Certified Instructors
Learn from industry experts with years of healthcare experience.
Hands-On Training
Real-world practice with coding software and simulated billing scenarios.
Certification Planning
Guidance and resources to pass industry-standard exams such as CPC or CCA.
Flexible Learning Options
Online courses, weekend classes, and self-paced modules to suit your schedule.
Start Your healthcare Career Today!
Taking the frist step toward a lucrative career in healthcare is easier than ever. Our medical coding and billing program offers a clear pathway to employment, continuous growth, and job satisfaction. Whether you’re looking for a quick entry into the healthcare industry or seeking to develop a long-term career, this program is your gateway to success.
Enroll now? contact our admissions team today to learn more about enrollment options, course schedules, and financial aid opportunities.
Unlock Your Future in Healthcare with Confidence
Choosing a career in medical coding and billing can be a transformative decision, opening doors to stability, flexibility, and meaningful work. Our program provides you with the skills, certifications, and experience necessary to excel in this vital healthcare role. Embrace the opportunity to contribute to the healthcare industry while building a rewarding career that aligns with your goals. Start your journey today and unlock a future full of possibilities in healthcare!
https://medicalbillingcodingcourses.net/open-your-future-in-healthcare-top-benefits-of-our-medical-coding-and-billing-program/
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Leading Online Medical Billing and Coding Programs to Launch Your Healthcare Career in 2024
Top Online Medical Billing and Coding Programs to Launch Your Healthcare career in 2024
Embarking on a career in healthcare is a rewarding choice, and medical billing and coding are among the fastest-growing professions in the industry. With the rise of online education, aspiring professionals can now access top-quality training from the comfort of their homes. If you’re considering starting your journey in 2024, this complete guide highlights the best online medical billing and coding programs that can definitely help you achieve your career goals. Dive in to discover the ideal course for your needs and learn practical tips to succeed!
Why Choose Online Medical Billing and Coding Programs?
Online programs offer numerous advantages for aspiring healthcare professionals:
Adaptability: Learn at your own pace,fitting coursework around your schedule.
Accessibility: Access top-tier programs regardless of your geographical location.
Affordability: Many online programs are cost-effective compared to customary classroom options.
Comprehensive Curriculum: Courses often include practical modules, practice exams, and real-world scenarios.
Top Features to Look for in�� an Online Medical Billing and Coding Program
Before choosing a program, consider the following criteria to ensure it aligns with your career ambitions:
Accreditation: Verify that the program is accredited by reputable agencies such as CAHIIM or AAPC.
Certification Preparation: Programs that prepare you for industry-recognized certifications, like CPC or CCS, are highly beneficial.
Curriculum Depth: Ensure the curriculum covers essential topics like medical terminology, anatomy, ICD-10, CPT coding, and insurance processes.
Support Services: Access to student support, mentors, internships, or job placement assistance.
Technology & Resources: Use of current coding software and engaging learning platforms.
top Online Medical Billing and Coding Programs for 2024
Program Name
Overview
Key Features
Penn Foster College
Aicaid-accredited program designed for flexible learning, preparing students for industry certifications.
Self-paced, career services, industry certification exam prep
AAPCS Medical Coding Certificate
Focuses on coding skills for outpatient and inpatient settings, aligned with AAPC certification requirements.
Online modules, practice exams, exam discounts
Coastline College
offering comprehensive medical billing and coding courses with a focus on practical submission.
State-of-the-art learning portal, instructor support, certification prep
Pennsylvania Institute of Health & technology
Intensive program combining coding, billing, and healthcare documentation.
Live instruction, certification exam assistance, internship opportunities
Coursera – Medical Billing and Coding Specialization
Partnered with top universities, offering a flexible online specialization in medical coding.
video lectures, quizzes, project-based learning
Benefits of Pursuing an Online Medical Billing and Coding Program
Investing in an online medical billing and coding program provides numerous advantages:
High Demand: the healthcare industry continues to expand, increasing job opportunities.
Good Salary Potential: Entry-level positions frequently enough start around $40,000 per year, with room for advancement.
Minimal Entry Barriers: Usually requires only a high school diploma or GED to enroll.
Job Flexibility: Many positions allow for remote work, providing flexibility and work-life balance.
Career Advancement: Certification and experience open doors to managerial roles or specialized coding positions.
Practical Tips for Success in Online Medical Billing and coding Programs
To maximize your learning experience,consider these expert tips:
Stay Organized: Keep track of deadlines,coursework,and certification exam dates.
Engage Actively: Participate in online forums, ask questions, and connect with instructors.
Practice Regularly: Use practice exams and coding simulations to hone your skills.
Network: Join professional associations like AAPC or AHIMA for networking and job opportunities.
Plan for Certification: Prepare thoroughly for industry-recognized credentials such as CPC or CCS.
Case Studies: Success Stories from Online Graduates
Maria’s Conversion into a Certified Coder
Maria enrolled in Penn Foster’s online medical billing and coding program while working part-time. She dedicated weekends to coursework, obtained her CPC ���certification, and now works remotely for a healthcare provider, earning a competitive salary. Her story exemplifies how flexible online programs can lead to a triumphant healthcare career.
John’s Journey into Healthcare Administration
After completing the Coursera specialization, John secured an internship and advanced into a managerial role. His proactive approach to online learning and networking helped him excel in the competitive healthcare industry.
Conclusion: Launch Your Healthcare Career in 2024 with the Right Program
Choosing the right online medical billing and coding program is a crucial step towards a fulfilling healthcare career. With numerous accredited and comprehensive options available, 2024 is the perfect year to invest in your education and professional growth. Whether you’re seeking a flexible learning schedule, certification preparation, or practical experience, the above-listed programs can definitely help you build a solid foundation in medical billing and coding. Start exploring your options today and take the first step toward a rewarding career in healthcare!
FAQs
1. How long does it typically take to complete an online medical billing and coding program?
Most online programs range from 6 months to a year, depending on the course intensity and your schedule.
2. Do I need prior healthcare experience to enroll?
No prior healthcare experience is usually required, though basic knowledge of medical terminology can be helpful.
3. Are online programs accredited and reputable?
Yes,always choose programs accredited by recognized agencies like CAHIIM or partnered with AAPC to ensure quality and industry recognition.
4.Can I get certified after completing an online program?
Absolutely! Many online programs prepare you specifically for industry certifications such as CPC, CCS, and others, which enhance employability and earning potential.
5. What is the job outlook for medical billing and coding professionals?
The employment of medical billing and coding specialists is projected to grow significantly, with strong demand due to healthcare industry expansion and increased reliance on electronic health records.
https://medicalcodingandbillingclasses.net/leading-online-medical-billing-and-coding-programs-to-launch-your-healthcare-career-in-2024/
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Explaining Inpatient Psychiatric Billing: A Comprehensive Guide For Patients And Providers
Welcome to our comprehensive guide on inpatient psychiatric billing! If you or a loved one has ever received treatment for mental health issues, you know that navigating the world of insurance and billing can be overwhelming. But fear not - we're here to demystify the process and provide all the information you need to understand inpatient psychiatric care billing. Whether you're a patient seeking clarity or a provider looking to ensure proper reimbursement, this article will shed light on common misconceptions and help pave the way toward smoother billing practices. So, let's dive in and unravel the complexities of inpatient psychiatric billing together!
Understanding Inpatient Psychiatric Care
Inpatient psychiatric care refers to treatment provided in a hospital or specialized facility for individuals experiencing severe mental health issues that require intensive intervention and supervision. This level of care is typically recommended when outpatient services are insufficient to address the complexity and severity of a person's mental health condition.
During inpatient psychiatric care, patients receive round-the-clock monitoring by a multidisciplinary team comprised of psychiatrists, psychologists, nurses, social workers, and other mental health professionals. The goal is to stabilize the individual's symptoms, provide therapeutic interventions, and develop an individualized treatment plan.
Depending on the patient's needs, various evidence-based treatments may be utilized in an inpatient setting. These can include medication management, individual therapy sessions, group therapy sessions, and therapy sessions focusing on skill-building or psychoeducation topics such as coping strategies or relapse prevention techniques.
Additionally, structured activities like art therapy or recreational programs may be included in the overall treatment approach. The length of stay in an inpatient psychiatric facility varies depending on factors such as response to treatment and insurance coverage.
It's important to note that inpatient psychiatric care is reserved for those who require intensive support due to acute symptoms or safety concerns. It provides individuals with a safe environment for comprehensive assessment, stabilization, and ongoing treatment tailored to their unique needs. By understanding what constitutes inpatient psychiatric care, patients and providers can better navigate the billing process associated with this crucial level of mental healthcare provision.
The Importance of Proper Billing for Inpatient Psychiatric Treatment
Proper billing for inpatient psychiatric treatment is crucial for both patients and providers. It ensures that the necessary services are accurately documented, billed, and reimbursed. Without proper billing practices, there can be significant financial implications for both parties involved.
Accurate and timely billing ensures patients receive the appropriate coverage from their insurance companies. Inpatient psychiatric care can be expensive, so patients need to have a clear understanding of what will be covered by insurance and what costs they may need to bear personally.
On the other hand, healthcare providers rely on proper billing to receive reimbursement for their services. This reimbursement helps cover the cost of providing high-quality care to patients with mental health needs. Providers may need accurate billing processes to avoid financial strain or even the potential closure of their facilities.
Furthermore, proper billing contributes to transparency within the healthcare system. By accurately documenting and coding procedures performed during inpatient psychiatric treatment, data is generated that can help inform research efforts aimed at improving mental health outcomes.
Proper billing for inpatient psychiatric treatment is vital in ensuring that patients are adequately covered by insurance and that healthcare providers receive fair reimbursement for their valuable services. It has financial implications and contributes to overall transparency within the healthcare system.
Common Misconceptions about Inpatient Psychiatric Billing
Inpatient psychiatric billing can be complex and confusing for patients and providers. However, you can navigate this process more effectively by understanding the basics of inpatient psychiatric care and the importance of proper billing.
One common misconception about inpatient psychiatric billing is that insurance always covers it. While many insurance plans provide coverage for mental health treatment, reviewing your policy to understand what services are included and any potential limitations or requirements is essential.
Another misconception is that inpatient psychiatric care is only necessary for severe mental health conditions. In reality, there are various reasons why someone may require this level of care, such as stabilization during a crisis or intensive therapy to address complex issues. It's essential not to dismiss the need for inpatient treatment based on assumptions about the severity of a person's condition.
There is also a need for clarification that all aspects of inpatient psychiatric care will be billed separately. While certain services or treatments may have separate charges, many facilities offer comprehensive packages that include room and board, therapy sessions, medication management, and other necessary treatment components.
Furthermore, some individuals believe that once they've paid their deductible or co-payments for outpatient mental health services, they won't have any additional costs if they require inpatient care. However, it's crucial to remember that different rules often apply when transitioning from outpatient to inpatient settings. Consult with your insurance provider and healthcare facility regarding any financial responsibilities associated with inpatient treatment.
By addressing these misconceptions head-on and better understanding how inpatient psychiatric billing works, patients and providers can work together more effectively toward successful outcomes. Remember: open communication between all parties involved—insurance companies, healthcare professionals, and patients—is critical when navigating billing complexities in a challenging situation like seeking mental health support.
Suppose you find yourself needing help with this process. In that case, seeking resources such as billing experts or patient advocacy organizations that can provide guidance and support may be helpful.
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Discussing Transformative Changes in Medicare Policies for Behavioural Health Billing in 2024
Dealing with the constantly evolving world of behavioral health billing requires a clear understanding of recent policy updates. In 2024, significant reforms are happening to address long-standing issues with mental health reimbursements. This blog explains these policy changes, emphasizing their practical benefits for psychiatry billing service providers and patients. Let's explore how these modifications can enhance Behavioral health billing services in terms of accessibility, cost, and quality. Expanding Access to Mental Health Professionals In a big shift from the past, these policies create a special benefit category for Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs). Recognizing their unique skills opens doors for patients to get therapy from qualified professionals, focusing on targeted medical billing and coding practices for specialized services. Revolutionizing Access to Intensive Outpatient Services Expanding access to intensive outpatient services (IOPs) is a crucial change in Behavioral Health Billing. This shift breaks down old limitations tied to specific diagnoses. By broadening coverage, more individuals with moderate to severe mental health conditions can now receive intensive care outside of traditional inpatient settings, offering a substantial improvement in overall patient well-being. Innovations in Crisis Intervention Acknowledging the critical need for immediate intervention during mental health crises, the policies explore the coverage of mobile crisis services. This forward-thinking approach aims to go beyond physical location limitations, meeting patients at their moments of greatest need. At the same time, it streamlines crisis-related billing and coding procedures, ensuring a swift response to urgent situations. Optimizing Reimbursement Rates The proposed increases in reimbursement rates for crucial behavioral health services demonstrate a dedication to excellence. These higher reimbursement rates not only encourage providers to deliver treatment within primary care settings but also pave the way for early intervention and improved accessibility. Remaining informed about rule changes and cultivating collaborative relationships with behavioral health specialists are integral components of successfully navigating these changes. Shifting Focus: From Illness to Wellness Going beyond a reactive approach, these policies signal a paradigm shift towards preventative and well-being initiatives. This holistic strategy encompasses the integration of technology, wellness incentives through Medicare Advantage plans, and cooperative efforts with community organizations, faith-based groups, and social service agencies. Addressing broader social and economic factors impacting mental health becomes an essential part of this comprehensive strategy. Addressing Workforce Shortages While the transformative policies hold immense promise, overcoming the critical barrier of a shortage of behavioral health care professionals is essential. Innovative solutions, including programs offering loan repayment and expanded telehealth opportunities, become vital steps. Fostering collaboration among healthcare professionals not only optimizes treatment outcomes but also streamlines communication in billing and coding processes within the healthcare system. Uncovering New Challenges The evolution of Behavioral Health Billing introduces its own set of challenges varying from technological adaptations, some privacy concerns and changes in compliance requirements. Let's delve into these challenges to assist providers in navigating the changing landscape: Technological Adaptation Providers must stay up-to-date with technological advancements and adapt to new systems to ensure a smooth transition without compromising patient care. Addressing issues related to integrating Electronic Health Records (EHRs) and ensuring data security becomes crucial. Privacy Concerns in Telehealth While telehealth enhances accessibility, new challenges emerge concerning patient privacy. Providers face hurdles in safeguarding privacy in virtual settings, including potential issues related to illegal access or data breaches. Regulatory Compliance Dealing with the intricate web of rules surrounding behavioral health billing requires attention to detail. Providers must stay abreast of the latest changes in compliance requirements to ensure their procedures align with the new legal frameworks. Conclusion The landscape of Behavioral Health Billing is undergoing a transformative shift in 2024. These policy changes go beyond mere administrative adjustments. They signify a pivotal turning point, promising enhanced access, affordability, and a redefined approach to psychiatry billing services. As providers adapt to this evolving landscape, the realization of accessible and high-quality behavioral health care becomes a tangible reality. Stay ahead of the curve by partnering with Medcare MSO is a trusted name in medical billing companies in USA, your ally in navigating the complexities of behavioral health billing and coding. Explore the future of behavioral health billing with Medcare MSO and optimize your practice for a new era of psychiatry billing services. Photo by Marek Levák on Unsplash Read the full article
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Braking Bad
The Ohio Supreme Court has imposed an interim suspension of an attorney convicted in a health care fraud scheme.
The United States Attorney for the Northern District of Ohio had this release
Six people from Ohio pleaded guilty in federal court to crimes related to a health care fraud conspiracy in which Medicaid was billed $48 million for drug and alcohol recovery services, many of which were not provided, not medically necessary, lacked proper documentation, or had other issues that made them ineligible for reimbursement.
Ryan P. Sheridan, 39, of Leetonia; Jennifer M. Sheridan, 41, of Austintown; Kortney L. Gherardi, 30, of Girard; Lisa M. Pertee, 51, of Sunbury; Thomas Bailey, 45, of Poland, and Arthur H. Smith, 55, of Austintown, are expected to be sentenced in January 2020. All six pleaded guilty to crimes related to their work at Braking Point Recovery Center, which operated drug and alcohol rehabilitation facilities in Austintown and Whitehall, Ohio.
According to the court documents:
Ryan Sheridan was the sole owner of Braking Point Recovery Center, which operated drug and alcohol rehabilitation centers in Austintown and Whitehall, Ohio, that provided detox, intensive outpatient treatment, day treatment and residential living rehabilitation.
Sheridan also owned and operated numerous other businesses, including Breaking Point Health and Fitness LLC and Braking Point Recovery Housing LLC, which owned recovery houses (or “sober houses”) for individuals attempting to maintain abstinence from drugs and alcohol.
As part of being a certified provider, Sheridan agreed to follow the rules and regulations of the Ohio Medicaid Program and the Ohio Department of Mental Health and Addiction Services.
Between January 2015 and October 18, 2017, various defendants submitted or caused to be submitted billings to Medicaid for drug and alcohol services that were: coded to reflect a service more costly than was actually provided; without proper documentation; without proper assessment documents containing valid diagnosis; billings for patients whose records did not contain diagnosis by a physician; related to treatment at unlicensed inpatient beds; billings related to Bailey dispensing of Suboxone even though Bailey did not have the authority to do so; for case management services when, in fact, the clients were working out at Sheridan’s gym; billings based on quotas provided to the nurses by the defendants to bill four to five hours of treatment daily, even if the services were not medically necessary; billing for in-patient detox and drug treatment services that were, in fact, provided in an out-patient setting, among other violations.
Braking Point submitted approximately 134,744 claims to Medicaid for more than $48.5 million in services it claimed to provide between May 2015 and October 2017. The claims caused Medicaid to pay Braking Point more than $31 million. Medicaid suspended payments to Braking Point on October 18, 2017.
The Sheridans, Gherardi, Pertee, Bailey and Smith developed a standard protocol of distributing the same amount of Suboxone to every patient seeking drug treatment immediately upon entering Braking Point’s detox program without being evaluated by a properly licensed physician to determine the medical necessity for the use of Suboxone.
The Sheridans, Gherardi and Bailey used Smith’s DEA data waiver license to dispense more than 3,000 doses of Suboxone in 2017 alone without Smith having seen the patients. Smith held himself out to be Braking Point’s medical director but only went to Braking Point approximately twice a month.
Ryan Sheridan made numerous financial transactions involving money derived from unlawful activities, including health care fraud and conspiracy to commit health care fraud.
Prosecutors are also seeking for forfeit property and proceeds obtained as a result of these crimes, including nearly $3 million, property in Columbiana, Mahoning and Trumbull counties, and eight automobiles, including replicas of vehicles used in the movies “Back to the Future,” “Ghostbusters” and “Batman.”
“These defendants stole tens of millions of dollars from taxpayers through fraudulent billing and other crimes,” U.S. Attorney Justin Herdman said. “They used the drug epidemic plaguing Ohio as a way to line their pockets and profited off the suffering of others.”
“Patients trust that providers of medical services are putting their best interests at heart and are not using them as pawns for profit” said Lamont Pugh III, Special Agent in Charge, U.S. Department of Health & Human Services, Office of Inspector General – Chicago Region. “That trust was cast aside by these defendants as exhibited by their guilty pleas. The OIG will continue to work with our federal, state and local partners to ensure that those who commit criminal acts to unjustly enrich themselves at patient and taxpayer expense are held accountable”.
“These guilty pleas clearly indicate these individuals intended to fraudulently bill and deceive taxpayers out of millions of dollars,” said FBI Special Agent in Charge Eric B. Smith. “This should send a strong message to anyone who intends to cheat the system for their own benefit. The FBI and our law enforcement partners are focused on stopping those that commit healthcare fraud.”
“Ryan Sheridan and his co-defendants wreaked havoc on the integrity of our health care system for their own personal gain,” said Bryant Jackson, Special Agent in Charge, IRS Criminal Investigation, Cincinnati Field Office. “Health care fraud affects every American and today’s announcement illustrates that the IRS and our law enforcement partners are steadfast in our commitment to detecting and dismantling health care fraud schemes and holding perpetrators of these crimes accountable.”
“Health care fraud and the diversion of prescription medications are an increasing threat to our community,” said DEA Special Agent in Charge Keith Martin. “Dishonest and greedy healthcare providers who abuse the system for their own personal gain will not be tolerated and remain a priority for the DEA.”
“The victim here isn’t just the health care system, it’s the people struggling with addiction who needed a beacon of hope but instead found themselves at the center of a shady scheme,” Ohio Attorney General Dave Yost said. “I’m grateful for U.S. Attorney Herdman’s work to secure justice for these victims and their loved ones.”
(Mike Frisch)
https://lawprofessors.typepad.com/legal_profession/2020/03/braking-bad.html
https://lawprofessors.typepad.com/legal_profession/2020/03/braking-bad.html
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Redefining Values in American Health Care
By RICHARD HOEHN, MD
Experts claim we could have been better prepared when the COVID-19 pandemic struck in early 2020. With an annual budget of $400-700 million, the Strategic National Stockpile (SNS) is designed to respond to chemical, biological, and other disasters. Its $8 billion inventory included 13,000 ventilators and a limited supply of personal protective equipment, N95 masks, and medical supplies. This left state and local governments scrambling as the COVID-19 pandemic accelerated and the capacity of many hospitals was overwhelmed.
Faced with immediate and visible death and suffering, leaders took drastic steps to contain the virus, “flatten the curve,” and mitigate economic consequences. Trillions of dollars were allocated to recovery and stimulus packages.
This scenario mirrors our general approach to health care: chronic underfunding of public health followed by high costs and loss of life.
While not as shocking as a sudden pandemic, millions of Americans struggle daily with medical and socioeconomic challenges. Our health care system is designed to care for these patients when they have a problem, not to keep them well. This creates a dichotomy where a minority of the population spends most of the health care dollars and little is invested in the remaining majority
National spending on health care was $3.6 trillion in 2018, or $11,000 per person. Half of spending goes to 5% of people, at $53,000 each; the costliest 1% averaged $116,000. This leaves just $300 per person for the other half of Americans. Millions spend nothing.
How much should we spend? Historically, $50,000 per quality-adjusted life-year (QALY) has been the accepted threshold, but this number is higher today. We cannot assign a cost per patient, but understanding costs is important. This highlights the aspects of health care that we currently value – and others we should perhaps value more.
What we pay for
Surgical hospital stays cost $18,500 in 2014 (versus $7,900 for non-surgical admissions), totaling $187 billion. Many common surgeries are generally accepted as necessary, such as cesarean sections, cardiac procedures, cancer resections, and fracture repairs. However, controversies exist around procedures with more nuanced indications.
Back pain affects 80% of Americans and is associated with obesity, depression, and inactivity. Costs are estimated at $100 billion per year, mostly due to lost wages and productivity. The most common surgical treatment is spinal fusion surgery, which costs $12 billion per year, or $29,000 per person. For patients who meet specific criteria, surgery offers hope of improving their symptoms.
The Spine Patient Outcomes Research Trial (SPORT) compared surgery and other nonoperative treatments among highly-selected patients. Surgery cost $34,000-$69,000 per QALY, depending on the procedure, and led to long-term symptom improvement. Successful outcomes were less likely in patients with obesity, diabetes, and other comorbidities.
However, many fusion procedures may be unindicated. A spine multidisciplinary conference reported that 58% of patients offered spinal fusion may be better managed nonoperatively. In fact, when orthopedic surgeons at a 2009 conference were asked what they would choose for themselves, 61% said nonoperative treatment, 38% said no treatment, and only 1% was willing to undergo surgery.
Our fee-for-service system creates a conflict of interest. Spine surgery is five times more common in the United States than other developed countries, and directly related to the supply of spine surgeons. Over a 10 year period, while rates of back pain were unchanged, there was a twofold increase in opioid prescriptions and a fourfold increase in MRIs, epidural steroid injections, and lumbar spinal fusions. Providers are incentivized to deliver treatments aimed at diagnoses, beyond back pain.
Another example of high cost care is chronic kidney disease. Medical and lifestyle interventions can slow disease progression, but many patients eventually reach end stage renal disease (ESRD) and become dependent on hemodialysis. In 2018, Medicare spent $12.7 billion on outpatient dialysis services for nearly 400,000 ESRD patients, or $32,000 per patient.
The lifetime costs of hemodialysis are such that payors have determined kidney transplantation is relatively cost-effective. While long-term hemodialysis costs $72,000 per QALY gained, transplantation costs $40,000-$80,000. ESRD and other chronic medical conditions make up the majority of health care spending.
Another factor that drives health care costs is end-of-life spending. Nearly one-third of Medicare spending is on the last year of life, estimated at $40,000-$50,000 (compared to $7,000 for other years). This is often due to unexpected declines in health that require high-intensity care meant to be lifesaving. But not always. Many patients with terminal conditions receive similar interventions in their final months with less consideration of the expected benefit.
End-stage or end-of-life care is expensive, and the outcomes are often foregone. Earlier investments can have greater impact with lower cost.
What we should value more
It has been said that a person’s life expectancy is more accurately predicted by their zip code than their genetic code. Decades of research have shown that up to 80% of health outcomes are due to non-medical characteristics such as income, education, employment, and housing. These are the social determinants of health, and insurers are beginning to recognize their importance.
The North Carolina Department of Health and Human Services is investigating new ways to buy health, rather than health care. The state’s Medicaid program will invest $650 million over five years in the Healthy Opportunities Pilot program, testing the use of health care dollars to pay for social interventions. Investments will focus on four important social domains: food, housing, transportation, and interpersonal violence/toxic stress.
In preparation, the Department spent a year developing a comprehensive fee schedule. Housing investments are the most expensive, such as $1,300 for moving support or $10,000 for safety/accessibility modifications. Most fees are considerably lower. Domestic violence intervention, monthly medical transportation, and weekly meal assistance all cost less than $200. This fee schedule is a valuable starting point for insurers interested in launching similar programs.
But there are barriers to investing in social determinants of health. North Carolina created their fee schedule to accommodate a special waiver from the federal government that allowed reimbursement for non-medical interventions. This infrastructure is unique and not available in most of the country. Without new policies, it never will be.
Some private organizations are taking similar steps to improve care and reduce costs for various high-risk populations. Commonwealth Care Alliance, a community-based health care organization in Massachusetts, has special programs for elderly and disabled patients. These programs increased utilization of outpatient services and reduced hospitalizations by half. Average monthly savings per patient were $1,600.
HealthCare Partners in California created its Comprehensive Care Centers to manage its high-risk patients. Physicians are salaried and may earn bonuses for meeting quality goals. Hospitalizations have decreased and the program has saved $2 million per year for every 1,000 members.
“You are what you do,” said Carl Jung, “not what you say you’ll do.” Similarly, what we pay for defines what we value. We spend thousands of dollars per patient on high-intensity, episodic health care, while failing to invest in programs that improve health. We spend more money and have worse health than most developed nations.
Payers and policy makers must create universal billing and reimbursement structures that support comprehensive care, social determinants of health, and other proactive programs. We must also reconsider how we incentivize costly and less beneficial interventions.
A growing segment of our population will face economic challenges due to the deepest recession since World War II. These Americans will fall behind. Their health will suffer, and their delayed care will be expensive.
By taking a pragmatic approach and re-aligning incentives it is possible to both improve health and save money. While the public debate is often consumed with the cacophony of “Medicare for All” and “Repeal and Replace,” our reality is somewhere in the middle. The conversation must shift to identifying values we share and applying evidence-based solutions. The COVID-19 pandemic is amplifying the flaws in our health care system; going forward, we should find ways to be better prepared.
Richard Hoehn is a surgical oncology fellow at the University of Pittsburgh Medical Center.
Redefining Values in American Health Care published first on https://venabeahan.tumblr.com
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Redefining Values in American Health Care
By RICHARD HOEN, MD
Experts claim we could have been better prepared when the COVID-19 pandemic struck in early 2020. With an annual budget of $400-700 million, the Strategic National Stockpile (SNS) is designed to respond to chemical, biological, and other disasters. Its $8 billion inventory included 13,000 ventilators and a limited supply of personal protective equipment, N95 masks, and medical supplies. This left state and local governments scrambling as the COVID-19 pandemic accelerated and the capacity of many hospitals was overwhelmed.
Faced with immediate and visible death and suffering, leaders took drastic steps to contain the virus, “flatten the curve,” and mitigate economic consequences. Trillions of dollars were allocated to recovery and stimulus packages.
This scenario mirrors our general approach to health care: chronic underfunding of public health followed by high costs and loss of life.
While not as shocking as a sudden pandemic, millions of Americans struggle daily with medical and socioeconomic challenges. Our health care system is designed to care for these patients when they have a problem, not to keep them well. This creates a dichotomy where a minority of the population spends most of the health care dollars and little is invested in the remaining majority
National spending on health care was $3.6 trillion in 2018, or $11,000 per person. Half of spending goes to 5% of people, at $53,000 each; the costliest 1% averaged $116,000. This leaves just $300 per person for the other half of Americans. Millions spend nothing.
How much should we spend? Historically, $50,000 per quality-adjusted life-year (QALY) has been the accepted threshold, but this number is higher today. We cannot assign a cost per patient, but understanding costs is important. This highlights the aspects of health care that we currently value – and others we should perhaps value more.
What we pay for
Surgical hospital stays cost $18,500 in 2014 (versus $7,900 for non-surgical admissions), totaling $187 billion. Many common surgeries are generally accepted as necessary, such as cesarean sections, cardiac procedures, cancer resections, and fracture repairs. However, controversies exist around procedures with more nuanced indications.
Back pain affects 80% of Americans and is associated with obesity, depression, and inactivity. Costs are estimated at $100 billion per year, mostly due to lost wages and productivity. The most common surgical treatment is spinal fusion surgery, which costs $12 billion per year, or $29,000 per person. For patients who meet specific criteria, surgery offers hope of improving their symptoms.
The Spine Patient Outcomes Research Trial (SPORT) compared surgery and other nonoperative treatments among highly-selected patients. Surgery cost $34,000-$69,000 per QALY, depending on the procedure, and led to long-term symptom improvement. Successful outcomes were less likely in patients with obesity, diabetes, and other comorbidities.
However, many fusion procedures may be unindicated. A spine multidisciplinary conference reported that 58% of patients offered spinal fusion may be better managed nonoperatively. In fact, when orthopedic surgeons at a 2009 conference were asked what they would choose for themselves, 61% said nonoperative treatment, 38% said no treatment, and only 1% was willing to undergo surgery.
Our fee-for-service system creates a conflict of interest. Spine surgery is five times more common in the United States than other developed countries, and directly related to the supply of spine surgeons. Over a 10 year period, while rates of back pain were unchanged, there was a twofold increase in opioid prescriptions and a fourfold increase in MRIs, epidural steroid injections, and lumbar spinal fusions. Providers are incentivized to deliver treatments aimed at diagnoses, beyond back pain.
Another example of high cost care is chronic kidney disease. Medical and lifestyle interventions can slow disease progression, but many patients eventually reach end stage renal disease (ESRD) and become dependent on hemodialysis. In 2018, Medicare spent $12.7 billion on outpatient dialysis services for nearly 400,000 ESRD patients, or $32,000 per patient.
The lifetime costs of hemodialysis are such that payors have determined kidney transplantation is relatively cost-effective. While long-term hemodialysis costs $72,000 per QALY gained, transplantation costs $40,000-$80,000. ESRD and other chronic medical conditions make up the majority of health care spending.
Another factor that drives health care costs is end-of-life spending. Nearly one-third of Medicare spending is on the last year of life, estimated at $40,000-$50,000 (compared to $7,000 for other years). This is often due to unexpected declines in health that require high-intensity care meant to be lifesaving. But not always. Many patients with terminal conditions receive similar interventions in their final months with less consideration of the expected benefit.
End-stage or end-of-life care is expensive, and the outcomes are often foregone. Earlier investments can have greater impact with lower cost.
What we should value more
It has been said that a person’s life expectancy is more accurately predicted by their zip code than their genetic code. Decades of research have shown that up to 80% of health outcomes are due to non-medical characteristics such as income, education, employment, and housing. These are the social determinants of health, and insurers are beginning to recognize their importance.
The North Carolina Department of Health and Human Services is investigating new ways to buy health, rather than health care. The state’s Medicaid program will invest $650 million over five years in the Healthy Opportunities Pilot program, testing the use of health care dollars to pay for social interventions. Investments will focus on four important social domains: food, housing, transportation, and interpersonal violence/toxic stress.
In preparation, the Department spent a year developing a comprehensive fee schedule. Housing investments are the most expensive, such as $1,300 for moving support or $10,000 for safety/accessibility modifications. Most fees are considerably lower. Domestic violence intervention, monthly medical transportation, and weekly meal assistance all cost less than $200. This fee schedule is a valuable starting point for insurers interested in launching similar programs.
But there are barriers to investing in social determinants of health. North Carolina created their fee schedule to accommodate a special waiver from the federal government that allowed reimbursement for non-medical interventions. This infrastructure is unique and not available in most of the country. Without new policies, it never will be.
Some private organizations are taking similar steps to improve care and reduce costs for various high-risk populations. Commonwealth Care Alliance, a community-based health care organization in Massachusetts, has special programs for elderly and disabled patients. These programs increased utilization of outpatient services and reduced hospitalizations by half. Average monthly savings per patient were $1,600.
HealthCare Partners in California created its Comprehensive Care Centers to manage its high-risk patients. Physicians are salaried and may earn bonuses for meeting quality goals. Hospitalizations have decreased and the program has saved $2 million per year for every 1,000 members.
“You are what you do,” said Carl Jung, “not what you say you’ll do.” Similarly, what we pay for defines what we value. We spend thousands of dollars per patient on high-intensity, episodic health care, while failing to invest in programs that improve health. We spend more money and have worse health than most developed nations.
Payers and policy makers must create universal billing and reimbursement structures that support comprehensive care, social determinants of health, and other proactive programs. We must also reconsider how we incentivize costly and less beneficial interventions.
A growing segment of our population will face economic challenges due to the deepest recession since World War II. These Americans will fall behind. Their health will suffer, and their delayed care will be expensive.
By taking a pragmatic approach and re-aligning incentives it is possible to both improve health and save money. While the public debate is often consumed with the cacophony of “Medicare for All” and “Repeal and Replace,” our reality is somewhere in the middle. The conversation must shift to identifying values we share and applying evidence-based solutions. The COVID-19 pandemic is amplifying the flaws in our health care system; going forward, we should find ways to be better prepared.
Richard Hoehn is a surgical oncology fellow at the University of Pittsburgh Medical Center.
Redefining Values in American Health Care published first on https://wittooth.tumblr.com/
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Open Your Future in Healthcare with Top-Rated Medical Coding Training Programs
**Title: Unlock Your Future in Healthcare with Top-Rated Medical Coding Training Programs**
**Meta Title: Discover the Best Medical Coding Training Programs to Jumpstart Your Career in Healthcare**
**Meta Description: Looking to break into the healthcare industry? Explore top-rated medical coding training programs that will equip you with the skills and knowledge needed to succeed in this in-demand field.**
**Introduction:** Are you looking to carve out a rewarding career in the healthcare industry? Medical coding is a critical aspect of healthcare administration that plays a vital role in maintaining accurate healthcare records, billing, and insurance reimbursement processes. By mastering medical coding, you can unlock a world of opportunities in hospitals, clinics, insurance companies, and other healthcare settings. To help you kickstart your career in medical coding, we have compiled a list of top-rated training programs that will provide you with the necessary skills and knowledge to excel in this dynamic field.
**Benefits of Pursuing Medical Coding Training Programs:** 1. **In-Demand Career**: Medical coding is a rapidly growing field, with a high demand for skilled professionals in healthcare settings. 2. **Competitive Salaries**: Certified medical coders command competitive salaries and enjoy lucrative career prospects. 3. **Flexible Work Options**: Medical coding offers flexible work arrangements, including remote work opportunities and part-time positions. 4. **Career Growth**: With experience and additional certifications, medical coders can advance into managerial or specialized roles. 5. **Job Security**: The healthcare industry is resilient to economic downturns, providing stable employment prospects for medical coders.
**Top-Rated Medical Coding Training Programs:**
| Training Program | Description | Duration | Accreditation | |——————|————-|———-|————–| | AAPC Medical Coding Training | Comprehensive training program covering ICD-10-CM, CPT, and HCPCS coding systems. | 6 months | AAPC accredited | | AHIMA Certified Coding Specialist (CCS) Program | Intensive program focusing on inpatient and outpatient coding practices. | 12 months | AHIMA accredited | | Online Medical Coding Academy | Flexible online program with self-paced learning modules and interactive exercises. | Varies | Online academy accreditation | | Local Community College Coding Course | In-person training at a local community college with hands-on coding practice. | 9 months | Community college accreditation |
**Practical Tips for Choosing a Medical Coding Training Program:** 1. **Accreditation**: Ensure that the training program is accredited by a recognized organization such as AAPC or AHIMA. 2. **Curriculum**: Review the curriculum to ensure that it covers essential coding systems and practices. 3. **Job Placement Assistance**: Look for programs that offer job placement assistance and internship opportunities. 4. **Cost**: Consider the cost of the program and explore financial aid options if needed. 5. **Reviews and Testimonials**: Read reviews and testimonials from past students to gauge the program’s quality and effectiveness.
**Case Study: Emily’s Success Story** Emily, a recent graduate of the AAPC Medical Coding Training Program, landed a job as a medical coder at a prestigious hospital. With the knowledge and skills acquired during her training, Emily quickly adapted to her role and excelled in accurately coding medical records. She credits the comprehensive training program for preparing her for a successful career in healthcare.
**Conclusion:** Embark on a fulfilling career in healthcare by enrolling in a top-rated medical coding training program. With the right skills and knowledge, you can unlock countless opportunities in this in-demand field and make a positive impact on the healthcare industry. Choose a reputable training program, stay committed to your education, and watch your career soar to new heights in the world of medical coding.
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https://medicalcodingandbillingclasses.net/open-your-future-in-healthcare-with-top-rated-medical-coding-training-programs/
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Redefining Values in American Health Care
By RICHARD HOEN, MD
Experts claim we could have been better prepared when the COVID-19 pandemic struck in early 2020. With an annual budget of $400-700 million, the Strategic National Stockpile (SNS) is designed to respond to chemical, biological, and other disasters. Its $8 billion inventory included 13,000 ventilators and a limited supply of personal protective equipment, N95 masks, and medical supplies. This left state and local governments scrambling as the COVID-19 pandemic accelerated and the capacity of many hospitals was overwhelmed.
Faced with immediate and visible death and suffering, leaders took drastic steps to contain the virus, “flatten the curve,” and mitigate economic consequences. Trillions of dollars were allocated to recovery and stimulus packages.
This scenario mirrors our general approach to health care: chronic underfunding of public health followed by high costs and loss of life.
While not as shocking as a sudden pandemic, millions of Americans struggle daily with medical and socioeconomic challenges. Our health care system is designed to care for these patients when they have a problem, not to keep them well. This creates a dichotomy where a minority of the population spends most of the health care dollars and little is invested in the remaining majority
National spending on health care was $3.6 trillion in 2018, or $11,000 per person. Half of spending goes to 5% of people, at $53,000 each; the costliest 1% averaged $116,000. This leaves just $300 per person for the other half of Americans. Millions spend nothing.
How much should we spend? Historically, $50,000 per quality-adjusted life-year (QALY) has been the accepted threshold, but this number is higher today. We cannot assign a cost per patient, but understanding costs is important. This highlights the aspects of health care that we currently value – and others we should perhaps value more.
What we pay for
Surgical hospital stays cost $18,500 in 2014 (versus $7,900 for non-surgical admissions), totaling $187 billion. Many common surgeries are generally accepted as necessary, such as cesarean sections, cardiac procedures, cancer resections, and fracture repairs. However, controversies exist around procedures with more nuanced indications.
Back pain affects 80% of Americans and is associated with obesity, depression, and inactivity. Costs are estimated at $100 billion per year, mostly due to lost wages and productivity. The most common surgical treatment is spinal fusion surgery, which costs $12 billion per year, or $29,000 per person. For patients who meet specific criteria, surgery offers hope of improving their symptoms.
The Spine Patient Outcomes Research Trial (SPORT) compared surgery and other nonoperative treatments among highly-selected patients. Surgery cost $34,000-$69,000 per QALY, depending on the procedure, and led to long-term symptom improvement. Successful outcomes were less likely in patients with obesity, diabetes, and other comorbidities.
However, many fusion procedures may be unindicated. A spine multidisciplinary conference reported that 58% of patients offered spinal fusion may be better managed nonoperatively. In fact, when orthopedic surgeons at a 2009 conference were asked what they would choose for themselves, 61% said nonoperative treatment, 38% said no treatment, and only 1% was willing to undergo surgery.
Our fee-for-service system creates a conflict of interest. Spine surgery is five times more common in the United States than other developed countries, and directly related to the supply of spine surgeons. Over a 10 year period, while rates of back pain were unchanged, there was a twofold increase in opioid prescriptions and a fourfold increase in MRIs, epidural steroid injections, and lumbar spinal fusions. Providers are incentivized to deliver treatments aimed at diagnoses, beyond back pain.
Another example of high cost care is chronic kidney disease. Medical and lifestyle interventions can slow disease progression, but many patients eventually reach end stage renal disease (ESRD) and become dependent on hemodialysis. In 2018, Medicare spent $12.7 billion on outpatient dialysis services for nearly 400,000 ESRD patients, or $32,000 per patient.
The lifetime costs of hemodialysis are such that payors have determined kidney transplantation is relatively cost-effective. While long-term hemodialysis costs $72,000 per QALY gained, transplantation costs $40,000-$80,000. ESRD and other chronic medical conditions make up the majority of health care spending.
Another factor that drives health care costs is end-of-life spending. Nearly one-third of Medicare spending is on the last year of life, estimated at $40,000-$50,000 (compared to $7,000 for other years). This is often due to unexpected declines in health that require high-intensity care meant to be lifesaving. But not always. Many patients with terminal conditions receive similar interventions in their final months with less consideration of the expected benefit.
End-stage or end-of-life care is expensive, and the outcomes are often foregone. Earlier investments can have greater impact with lower cost.
What we should value more
It has been said that a person’s life expectancy is more accurately predicted by their zip code than their genetic code. Decades of research have shown that up to 80% of health outcomes are due to non-medical characteristics such as income, education, employment, and housing. These are the social determinants of health, and insurers are beginning to recognize their importance.
The North Carolina Department of Health and Human Services is investigating new ways to buy health, rather than health care. The state’s Medicaid program will invest $650 million over five years in the Healthy Opportunities Pilot program, testing the use of health care dollars to pay for social interventions. Investments will focus on four important social domains: food, housing, transportation, and interpersonal violence/toxic stress.
In preparation, the Department spent a year developing a comprehensive fee schedule. Housing investments are the most expensive, such as $1,300 for moving support or $10,000 for safety/accessibility modifications. Most fees are considerably lower. Domestic violence intervention, monthly medical transportation, and weekly meal assistance all cost less than $200. This fee schedule is a valuable starting point for insurers interested in launching similar programs.
But there are barriers to investing in social determinants of health. North Carolina created their fee schedule to accommodate a special waiver from the federal government that allowed reimbursement for non-medical interventions. This infrastructure is unique and not available in most of the country. Without new policies, it never will be.
Some private organizations are taking similar steps to improve care and reduce costs for various high-risk populations. Commonwealth Care Alliance, a community-based health care organization in Massachusetts, has special programs for elderly and disabled patients. These programs increased utilization of outpatient services and reduced hospitalizations by half. Average monthly savings per patient were $1,600.
HealthCare Partners in California created its Comprehensive Care Centers to manage its high-risk patients. Physicians are salaried and may earn bonuses for meeting quality goals. Hospitalizations have decreased and the program has saved $2 million per year for every 1,000 members.
“You are what you do,” said Carl Jung, “not what you say you’ll do.” Similarly, what we pay for defines what we value. We spend thousands of dollars per patient on high-intensity, episodic health care, while failing to invest in programs that improve health. We spend more money and have worse health than most developed nations.
Payers and policy makers must create universal billing and reimbursement structures that support comprehensive care, social determinants of health, and other proactive programs. We must also reconsider how we incentivize costly and less beneficial interventions.
A growing segment of our population will face economic challenges due to the deepest recession since World War II. These Americans will fall behind. Their health will suffer, and their delayed care will be expensive.
By taking a pragmatic approach and re-aligning incentives it is possible to both improve health and save money. While the public debate is often consumed with the cacophony of “Medicare for All” and “Repeal and Replace,” our reality is somewhere in the middle. The conversation must shift to identifying values we share and applying evidence-based solutions. The COVID-19 pandemic is amplifying the flaws in our health care system; going forward, we should find ways to be better prepared.
Richard Hoehn is a surgical oncology fellow at the University of Pittsburgh Medical Center.
Redefining Values in American Health Care published first on https://venabeahan.tumblr.com
0 notes
Text
Redefining Values in American Health Care
By RICHARD HOEN, MD
Experts claim we could have been better prepared when the COVID-19 pandemic struck in early 2020. With an annual budget of $400-700 million, the Strategic National Stockpile (SNS) is designed to respond to chemical, biological, and other disasters. Its $8 billion inventory included 13,000 ventilators and a limited supply of personal protective equipment, N95 masks, and medical supplies. This left state and local governments scrambling as the COVID-19 pandemic accelerated and the capacity of many hospitals was overwhelmed.
Faced with immediate and visible death and suffering, leaders took drastic steps to contain the virus, “flatten the curve,” and mitigate economic consequences. Trillions of dollars were allocated to recovery and stimulus packages.
This scenario mirrors our general approach to health care: chronic underfunding of public health followed by high costs and loss of life.
While not as shocking as a sudden pandemic, millions of Americans struggle daily with medical and socioeconomic challenges. Our health care system is designed to care for these patients when they have a problem, not to keep them well. This creates a dichotomy where a minority of the population spends most of the health care dollars and little is invested in the remaining majority
National spending on health care was $3.6 trillion in 2018, or $11,000 per person. Half of spending goes to 5% of people, at $53,000 each; the costliest 1% averaged $116,000. This leaves just $300 per person for the other half of Americans. Millions spend nothing.
How much should we spend? Historically, $50,000 per quality-adjusted life-year (QALY) has been the accepted threshold, but this number is higher today. We cannot assign a cost per patient, but understanding costs is important. This highlights the aspects of health care that we currently value – and others we should perhaps value more.
What we pay for
Surgical hospital stays cost $18,500 in 2014 (versus $7,900 for non-surgical admissions), totaling $187 billion. Many common surgeries are generally accepted as necessary, such as cesarean sections, cardiac procedures, cancer resections, and fracture repairs. However, controversies exist around procedures with more nuanced indications.
Back pain affects 80% of Americans and is associated with obesity, depression, and inactivity. Costs are estimated at $100 billion per year, mostly due to lost wages and productivity. The most common surgical treatment is spinal fusion surgery, which costs $12 billion per year, or $29,000 per person. For patients who meet specific criteria, surgery offers hope of improving their symptoms.
The Spine Patient Outcomes Research Trial (SPORT) compared surgery and other nonoperative treatments among highly-selected patients. Surgery cost $34,000-$69,000 per QALY, depending on the procedure, and led to long-term symptom improvement. Successful outcomes were less likely in patients with obesity, diabetes, and other comorbidities.
However, many fusion procedures may be unindicated. A spine multidisciplinary conference reported that 58% of patients offered spinal fusion may be better managed nonoperatively. In fact, when orthopedic surgeons at a 2009 conference were asked what they would choose for themselves, 61% said nonoperative treatment, 38% said no treatment, and only 1% was willing to undergo surgery.
Our fee-for-service system creates a conflict of interest. Spine surgery is five times more common in the United States than other developed countries, and directly related to the supply of spine surgeons. Over a 10 year period, while rates of back pain were unchanged, there was a twofold increase in opioid prescriptions and a fourfold increase in MRIs, epidural steroid injections, and lumbar spinal fusions. Providers are incentivized to deliver treatments aimed at diagnoses, beyond back pain.
Another example of high cost care is chronic kidney disease. Medical and lifestyle interventions can slow disease progression, but many patients eventually reach end stage renal disease (ESRD) and become dependent on hemodialysis. In 2018, Medicare spent $12.7 billion on outpatient dialysis services for nearly 400,000 ESRD patients, or $32,000 per patient.
The lifetime costs of hemodialysis are such that payors have determined kidney transplantation is relatively cost-effective. While long-term hemodialysis costs $72,000 per QALY gained, transplantation costs $40,000-$80,000. ESRD and other chronic medical conditions make up the majority of health care spending.
Another factor that drives health care costs is end-of-life spending. Nearly one-third of Medicare spending is on the last year of life, estimated at $40,000-$50,000 (compared to $7,000 for other years). This is often due to unexpected declines in health that require high-intensity care meant to be lifesaving. But not always. Many patients with terminal conditions receive similar interventions in their final months with less consideration of the expected benefit.
End-stage or end-of-life care is expensive, and the outcomes are often foregone. Earlier investments can have greater impact with lower cost.
What we should value more
It has been said that a person’s life expectancy is more accurately predicted by their zip code than their genetic code. Decades of research have shown that up to 80% of health outcomes are due to non-medical characteristics such as income, education, employment, and housing. These are the social determinants of health, and insurers are beginning to recognize their importance.
The North Carolina Department of Health and Human Services is investigating new ways to buy health, rather than health care. The state’s Medicaid program will invest $650 million over five years in the Healthy Opportunities Pilot program, testing the use of health care dollars to pay for social interventions. Investments will focus on four important social domains: food, housing, transportation, and interpersonal violence/toxic stress.
In preparation, the Department spent a year developing a comprehensive fee schedule. Housing investments are the most expensive, such as $1,300 for moving support or $10,000 for safety/accessibility modifications. Most fees are considerably lower. Domestic violence intervention, monthly medical transportation, and weekly meal assistance all cost less than $200. This fee schedule is a valuable starting point for insurers interested in launching similar programs.
But there are barriers to investing in social determinants of health. North Carolina created their fee schedule to accommodate a special waiver from the federal government that allowed reimbursement for non-medical interventions. This infrastructure is unique and not available in most of the country. Without new policies, it never will be.
Some private organizations are taking similar steps to improve care and reduce costs for various high-risk populations. Commonwealth Care Alliance, a community-based health care organization in Massachusetts, has special programs for elderly and disabled patients. These programs increased utilization of outpatient services and reduced hospitalizations by half. Average monthly savings per patient were $1,600.
HealthCare Partners in California created its Comprehensive Care Centers to manage its high-risk patients. Physicians are salaried and may earn bonuses for meeting quality goals. Hospitalizations have decreased and the program has saved $2 million per year for every 1,000 members.
“You are what you do,” said Carl Jung, “not what you say you’ll do.” Similarly, what we pay for defines what we value. We spend thousands of dollars per patient on high-intensity, episodic health care, while failing to invest in programs that improve health. We spend more money and have worse health than most developed nations.
Payers and policy makers must create universal billing and reimbursement structures that support comprehensive care, social determinants of health, and other proactive programs. We must also reconsider how we incentivize costly and less beneficial interventions.
A growing segment of our population will face economic challenges due to the deepest recession since World War II. These Americans will fall behind. Their health will suffer, and their delayed care will be expensive.
By taking a pragmatic approach and re-aligning incentives it is possible to both improve health and save money. While the public debate is often consumed with the cacophony of “Medicare for All” and “Repeal and Replace,” our reality is somewhere in the middle. The conversation must shift to identifying values we share and applying evidence-based solutions. The COVID-19 pandemic is amplifying the flaws in our health care system; going forward, we should find ways to be better prepared.
Richard Hoehn is a surgical oncology fellow at the University of Pittsburgh Medical Center.
Redefining Values in American Health Care published first on https://wittooth.tumblr.com/
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Text
The Myth That Refuses to Die: All Health Care is Local
By PAUL KECKLEY
In 1980, industry healthcare planners imagined a system where the centerpiece was a hospital in every community and a complement of physicians. Demand forecasting was fairly straightforward: based on the population’s growth and age, the need was 4 beds per thousand and 140 docs per 100,000, give or take a few.
In 1996, the Dartmouth Center for the Evaluative Clinical Sciences published the Dartmouth Atlas on Health Care quantifying variability in the intensity of services provided Medicare enrollees in each U.S. zip code. They defined 306 hospital referral regions (HRRs) that remain today as the basis for regulation of our healthcare system.
In the same timeframe (1980-2000), the ratio of doctors per 100,000 doubled as the number of medical schools increased from 75 to 126 leading health planners (Graduate Medical Education National Advisory Council) to predict a surplus of 70,000. Meanwhile, demand for hospital beds edged down slightly to 3.5/1000—the result of managed care efforts in certain parts of the country.
Today, we operate 2.4 beds per thousand and have 265 physicians per 100,000. But the bigger story is the widespread variability in the volume, costs and quality of care across our communities. Across the 306 HRRs, bed supply ranges almost 250%; physician supply even more and costs as much as 400%.
For almost 40 years, we’ve operated the U.S. health system based on an underlying assumption that all healthcare is local. We’ve presumed that except in rare circumstances, patients stayed home for the care they need. But that’s changing.
Three trends are converging that are changing how we think of the markets we serve:
Virtual care: Goldman Sachs forecasts virtual care will be a $20 billion industry by 2020 as employers and insurers adopt lower cost options to local medicine. Investor-funded companies (American Well, Teladoc, 2nd.MD, Carena, Health Integrated, MD Live, et al) offer distance medicine that is convenient and less costly. 78% of consumers say they would be receptive to receiving care virtually (Carenet Healthcare Services) though only 14% of hospitals offer digital tools and only 23% offer telemedicine (Kaufman Hall). And funding for digital health is robust: per RockHealth, start-ups have attracted $18 billion in the last four years, with most applications targeting mechanisms whereby consumers can make better choices about the care they receive, where, from whom and at what cost.
Destination Hubs: Historically, individuals left their community when facing a complex diagnosis based on a referral from a trusted local clinician. For cancer, Hutchinson, Dana Farber, Memorial Sloan Kettering, Mayo, MD Anderson, Moffit and others were prominent. For hearts, Cleveland Clinic, New York Presbyterian, Mayo, Mass General, Duke, Northwestern, Brigham and Women’s and others attracted referrals. Most of these set-up referral management programs to accommodate out of town patients, offering lodging and other forms of assistance. But destination hubs have expanded beyond those that cater to physician referrals. Each of these is a business model that makes a big bet that consumers will leave their community for care elsewhere:
Founded in 1988, Cancer Treatment Centers of America (CTSA) operates inpatient and outpatient facilities in 5 markets. Its national ads promote its integrative clinical model and patient-friendly approach to diagnosing and treating the full continuum of cancers. On its website, patient satisfaction scores for each patient cohort are reported with scores averaging above 95%.
Founded in 2005, Laser Spine Institute operates surgery centers in 7 markets and advertises nationally. It offers a free MRI and requires candidates for their minimally invasive procedures to stay within 15 miles of their surgery center one day after the procedure for post-op follow-up. Per its website, the company has performed 75,000 procedures: 60% for patients who live outside its markets.
Large employers like Boeing, Wal-Mart, Lowe’s, Whole Foods are contracting directly with hospitals out of their local markets. Though only 3% of employers contract directly today, the National Business Group on Health estimates activity will increase as health costs escalate in coming years.
And medical tourism remains a factor: According to Patients beyond Borders, 1.4 million U.S. adults traveled outside the U.S. for medical care last year. The Joint Commission International accredits 458 hospitals off-shore that perform elective surgical procedures as 30% of the
So, destination hubs are no longer limited to tertiary care providers in urban settings.
Affordability: One in five Americans under the age of 65 say they are having problems paying their medical bills and 2 million will declare bankruptcy due to medical debt this year (Nerd Wallet). As prices charged by U.S. providers. Reported by the Federal Reserve last November, household debt hit an all-time high last year increasing 16% since the summer of 2013. Student loan, medical and mortgage debt are the culprits. As households face higher deductibles, affordable options will be on their radar. Out-of-market healthcare services offered at a lower price by a reputable provider will be attractive. And the entry of Amazon-JPMorgan-Berkshire Hathaway into the fray of employer benefits and health cost containment promises to spark increased consideration of new models and strategies.
The bottom line is this: healthcare is no longer about competition between insurers, physicians and hospitals operating in a relatively confined hospital referral region. It’s about health facilities and services offered by parties that bet local consumers will respond favorably to their pitches.
The reality is that consumers are finding alternatives to local care: some to obtain services they can’t get at home and many for care they think better, cheaper or easier to access elsewhere.
For the least fortunate in our communities, staying at home for care is reality. For others, out of town options are expanding.
Strategies that presume all healthcare is local are bound to the same fate as Borders, Blockbuster and 10,000 other retailers who’ve ceased operations in the past decade as their markets changed (National Retail Federation). They recognized the retail apocalypse too late to respond.
So, at best, some healthcare is local, but not all.
Paul
The Myth That Refuses to Die: All Health Care is Local published first on https://wittooth.tumblr.com/
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Text
The Myth That Refuses to Die: All Health Care is Local
By PAUL KECKLEY
In 1980, industry healthcare planners imagined a system where the centerpiece was a hospital in every community and a complement of physicians. Demand forecasting was fairly straightforward: based on the population’s growth and age, the need was 4 beds per thousand and 140 docs per 100,000, give or take a few.
In 1996, the Dartmouth Center for the Evaluative Clinical Sciences published the Dartmouth Atlas on Health Care quantifying variability in the intensity of services provided Medicare enrollees in each U.S. zip code. They defined 306 hospital referral regions (HRRs) that remain today as the basis for regulation of our healthcare system.
In the same timeframe (1980-2000), the ratio of doctors per 100,000 doubled as the number of medical schools increased from 75 to 126 leading health planners (Graduate Medical Education National Advisory Council) to predict a surplus of 70,000. Meanwhile, demand for hospital beds edged down slightly to 3.5/1000—the result of managed care efforts in certain parts of the country.
Today, we operate 2.4 beds per thousand and have 265 physicians per 100,000. But the bigger story is the widespread variability in the volume, costs and quality of care across our communities. Across the 306 HRRs, bed supply ranges almost 250%; physician supply even more and costs as much as 400%.
For almost 40 years, we’ve operated the U.S. health system based on an underlying assumption that all healthcare is local. We’ve presumed that except in rare circumstances, patients stayed home for the care they need. But that’s changing.
Three trends are converging that are changing how we think of the markets we serve:
Virtual care: Goldman Sachs forecasts virtual care will be a $20 billion industry by 2020 as employers and insurers adopt lower cost options to local medicine. Investor-funded companies (American Well, Teladoc, 2nd.MD, Carena, Health Integrated, MD Live, et al) offer distance medicine that is convenient and less costly. 78% of consumers say they would be receptive to receiving care virtually (Carenet Healthcare Services) though only 14% of hospitals offer digital tools and only 23% offer telemedicine (Kaufman Hall). And funding for digital health is robust: per RockHealth, start-ups have attracted $18 billion in the last four years, with most applications targeting mechanisms whereby consumers can make better choices about the care they receive, where, from whom and at what cost.
Destination Hubs: Historically, individuals left their community when facing a complex diagnosis based on a referral from a trusted local clinician. For cancer, Hutchinson, Dana Farber, Memorial Sloan Kettering, Mayo, MD Anderson, Moffit and others were prominent. For hearts, Cleveland Clinic, New York Presbyterian, Mayo, Mass General, Duke, Northwestern, Brigham and Women’s and others attracted referrals. Most of these set-up referral management programs to accommodate out of town patients, offering lodging and other forms of assistance. But destination hubs have expanded beyond those that cater to physician referrals. Each of these is a business model that makes a big bet that consumers will leave their community for care elsewhere:
Founded in 1988, Cancer Treatment Centers of America (CTSA) operates inpatient and outpatient facilities in 5 markets. Its national ads promote its integrative clinical model and patient-friendly approach to diagnosing and treating the full continuum of cancers. On its website, patient satisfaction scores for each patient cohort are reported with scores averaging above 95%.
Founded in 2005, Laser Spine Institute operates surgery centers in 7 markets and advertises nationally. It offers a free MRI and requires candidates for their minimally invasive procedures to stay within 15 miles of their surgery center one day after the procedure for post-op follow-up. Per its website, the company has performed 75,000 procedures: 60% for patients who live outside its markets.
Large employers like Boeing, Wal-Mart, Lowe’s, Whole Foods are contracting directly with hospitals out of their local markets. Though only 3% of employers contract directly today, the National Business Group on Health estimates activity will increase as health costs escalate in coming years.
And medical tourism remains a factor: According to Patients beyond Borders, 1.4 million U.S. adults traveled outside the U.S. for medical care last year. The Joint Commission International accredits 458 hospitals off-shore that perform elective surgical procedures as 30% of the
So, destination hubs are no longer limited to tertiary care providers in urban settings.
Affordability: One in five Americans under the age of 65 say they are having problems paying their medical bills and 2 million will declare bankruptcy due to medical debt this year (Nerd Wallet). As prices charged by U.S. providers. Reported by the Federal Reserve last November, household debt hit an all-time high last year increasing 16% since the summer of 2013. Student loan, medical and mortgage debt are the culprits. As households face higher deductibles, affordable options will be on their radar. Out-of-market healthcare services offered at a lower price by a reputable provider will be attractive. And the entry of Amazon-JPMorgan-Berkshire Hathaway into the fray of employer benefits and health cost containment promises to spark increased consideration of new models and strategies.
The bottom line is this: healthcare is no longer about competition between insurers, physicians and hospitals operating in a relatively confined hospital referral region. It’s about health facilities and services offered by parties that bet local consumers will respond favorably to their pitches.
The reality is that consumers are finding alternatives to local care: some to obtain services they can’t get at home and many for care they think better, cheaper or easier to access elsewhere.
For the least fortunate in our communities, staying at home for care is reality. For others, out of town options are expanding.
Strategies that presume all healthcare is local are bound to the same fate as Borders, Blockbuster and 10,000 other retailers who’ve ceased operations in the past decade as their markets changed (National Retail Federation). They recognized the retail apocalypse too late to respond.
So, at best, some healthcare is local, but not all.
Paul
The Myth That Refuses to Die: All Health Care is Local published first on https://wittooth.tumblr.com/
0 notes
Text
The Myth That Refuses to Die: All Health Care is Local
By PAUL KECKLEY
In 1980, industry healthcare planners imagined a system where the centerpiece was a hospital in every community and a complement of physicians. Demand forecasting was fairly straightforward: based on the population’s growth and age, the need was 4 beds per thousand and 140 docs per 100,000, give or take a few.
In 1996, the Dartmouth Center for the Evaluative Clinical Sciences published the Dartmouth Atlas on Health Care quantifying variability in the intensity of services provided Medicare enrollees in each U.S. zip code. They defined 306 hospital referral regions (HRRs) that remain today as the basis for regulation of our healthcare system.
In the same timeframe (1980-2000), the ratio of doctors per 100,000 doubled as the number of medical schools increased from 75 to 126 leading health planners (Graduate Medical Education National Advisory Council) to predict a surplus of 70,000. Meanwhile, demand for hospital beds edged down slightly to 3.5/1000—the result of managed care efforts in certain parts of the country.
Today, we operate 2.4 beds per thousand and have 265 physicians per 100,000. But the bigger story is the widespread variability in the volume, costs and quality of care across our communities. Across the 306 HRRs, bed supply ranges almost 250%; physician supply even more and costs as much as 400%.
For almost 40 years, we’ve operated the U.S. health system based on an underlying assumption that all healthcare is local. We’ve presumed that except in rare circumstances, patients stayed home for the care they need. But that’s changing.
Three trends are converging that are changing how we think of the markets we serve:
Virtual care: Goldman Sachs forecasts virtual care will be a $20 billion industry by 2020 as employers and insurers adopt lower cost options to local medicine. Investor-funded companies (American Well, Teladoc, 2nd.MD, Carena, Health Integrated, MD Live, et al) offer distance medicine that is convenient and less costly. 78% of consumers say they would be receptive to receiving care virtually (Carenet Healthcare Services) though only 14% of hospitals offer digital tools and only 23% offer telemedicine (Kaufman Hall). And funding for digital health is robust: per RockHealth, start-ups have attracted $18 billion in the last four years, with most applications targeting mechanisms whereby consumers can make better choices about the care they receive, where, from whom and at what cost.
Destination Hubs: Historically, individuals left their community when facing a complex diagnosis based on a referral from a trusted local clinician. For cancer, Hutchinson, Dana Farber, Memorial Sloan Kettering, Mayo, MD Anderson, Moffit and others were prominent. For hearts, Cleveland Clinic, New York Presbyterian, Mayo, Mass General, Duke, Northwestern, Brigham and Women’s and others attracted referrals. Most of these set-up referral management programs to accommodate out of town patients, offering lodging and other forms of assistance. But destination hubs have expanded beyond those that cater to physician referrals. Each of these is a business model that makes a big bet that consumers will leave their community for care elsewhere:
Founded in 1988, Cancer Treatment Centers of America (CTSA) operates inpatient and outpatient facilities in 5 markets. Its national ads promote its integrative clinical model and patient-friendly approach to diagnosing and treating the full continuum of cancers. On its website, patient satisfaction scores for each patient cohort are reported with scores averaging above 95%.
Founded in 2005, Laser Spine Institute operates surgery centers in 7 markets and advertises nationally. It offers a free MRI and requires candidates for their minimally invasive procedures to stay within 15 miles of their surgery center one day after the procedure for post-op follow-up. Per its website, the company has performed 75,000 procedures: 60% for patients who live outside its markets.
Large employers like Boeing, Wal-Mart, Lowe’s, Whole Foods are contracting directly with hospitals out of their local markets. Though only 3% of employers contract directly today, the National Business Group on Health estimates activity will increase as health costs escalate in coming years.
And medical tourism remains a factor: According to Patients beyond Borders, 1.4 million U.S. adults traveled outside the U.S. for medical care last year. The Joint Commission International accredits 458 hospitals off-shore that perform elective surgical procedures as 30% of the
So, destination hubs are no longer limited to tertiary care providers in urban settings.
Affordability: One in five Americans under the age of 65 say they are having problems paying their medical bills and 2 million will declare bankruptcy due to medical debt this year (Nerd Wallet). As prices charged by U.S. providers. Reported by the Federal Reserve last November, household debt hit an all-time high last year increasing 16% since the summer of 2013. Student loan, medical and mortgage debt are the culprits. As households face higher deductibles, affordable options will be on their radar. Out-of-market healthcare services offered at a lower price by a reputable provider will be attractive. And the entry of Amazon-JPMorgan-Berkshire Hathaway into the fray of employer benefits and health cost containment promises to spark increased consideration of new models and strategies.
The bottom line is this: healthcare is no longer about competition between insurers, physicians and hospitals operating in a relatively confined hospital referral region. It’s about health facilities and services offered by parties that bet local consumers will respond favorably to their pitches.
The reality is that consumers are finding alternatives to local care: some to obtain services they can’t get at home and many for care they think better, cheaper or easier to access elsewhere.
For the least fortunate in our communities, staying at home for care is reality. For others, out of town options are expanding.
Strategies that presume all healthcare is local are bound to the same fate as Borders, Blockbuster and 10,000 other retailers who’ve ceased operations in the past decade as their markets changed (National Retail Federation). They recognized the retail apocalypse too late to respond.
So, at best, some healthcare is local, but not all.
Paul
The Myth That Refuses to Die: All Health Care is Local published first on https://wittooth.tumblr.com/
0 notes