Category Archives: Alise Healthcare

Healthcare Revenue Cycle Outsourcing

Historically, the drivers of change in healthcare have been focused on clinical advancements. Applying innovative strategies in healthcare finance and revenue cycle management have lagged significantly behind clinical progressiveness.

Unlike corporate America’s general financial sectors like credit card processing and accounts receivable collections, healthcare finance and business office operations have been slower to adopt the cost-effective improvements offered by the outsourcing of billing and collection accounts.

Recently, due to economic factors and the shifting of patient financial responsibility, healthcare executives have become more accepting of revenue cycle outsourcing initiatives. In spite of a looming paradox, which pits opposing goals against each other, maintaining fiscal health versus the political pressure of keeping jobs in the local community offers a continual balancing act for healthcare executives.

Gartner Research Inc. estimates healthcare executives spend about twenty percent of their budget on all categories of external sourcing options, compared to the general mainstream industries, which typically invest about a third of their budget on external sourcing.

Gartner also estimates that seventy percent of healthcare organizations who do choose to outsource meet or exceed their cost-savings expectations, and most see an improvement in services as they shift their non-core functions to outside experts.

Healthcare outsourcing in general has begun to see a significant rise in acceptance. During the next five to ten years, it is estimated healthcare will see an increase in the outsourcing of many financial, clinical and business processes.

The American Recovery and Reinvestment Act of 2009 (economic stimulus package for the U.S. economy), healthcare reform, and the Health Information Technology for Economic and Clinical Health Act (HITECH), will create significant opportunities for all outsourcing companies to aid healthcare organizations in meeting the requirements for the new set of regulations and requirements mandated by legislative action.

These industry changes will increase outsourcing demand because healthcare providers cannot efficiently implement these changes on their own and certainly not at the speed they want.

Historically, physicians, hospitals and insurance payers with larger footprints and decentralized organizations were the first to initiate outsourcing partnerships. Smaller organizations typically relied on internal resources or in limited cases, local outsourcers.

This trend is changing. All sized healthcare organizations are jumping on the outsourcing bandwagon and are moving toward leveraging IT, clinical and revenue cycle business processing outsourcing to improve the financial viability of their operations.

The motivators for the shift in strategy for smaller healthcare operations are due in part by the margin pressure they are under and the need to cut costs. The key ancillary benefits to an outsourcing strategy are operational efficiencies, cost reductions and delivering superior patient satisfaction.

Healthcare executives have numerous sourcing strategies from which to choose. Utilizing a US based local, regional or national outsourcing company has been the typical choice for healthcare executives who outsource.

With today’s technology, especially in the services’ sector, it is less important to contract with a local provider than to choose the best-in-class provider regardless where their business operation is located.

In the US, outsourcing, in general, has become a polarizing political issue driven by poor economic times and localized job losses. Even with local and national pressure to curtail outsourcing activities by consumer advocates, the return on investment (ROI) from cost reductions and improvements in quality have influenced healthcare executives to pursue offshore and onshore outsourcers as an alternative to maintaining an internal workforce.

Over the past ten years, the providers who have chosen their outsourcing partner wisely, and partnered with qualified process oriented firms, have experienced reduced operating costs and ultimately, higher patient satisfaction encounters.

Americans value the financial opportunities offered by our free-market economy. In every region of the country, community leaders attempt to support and protect local labor forces, which serve nearby businesses. The goal of this action is to keep jobs in the community and surrounding area.

Unfortunately, with budget cuts and margin pressure becoming greater than it’s ever been, healthcare executives cannot meet the demands of managing various clinical and revenue cycle functions, which typically demand a lower cost, more qualified and educated workforce.

The healthcare executives who have avoided non-localized outsourcing have succumbed to the local pressure of keeping jobs within their community regardless of the impact on the financial performance of the health system.

An interesting paradox exists as those same executives and community influencers do not think twice about purchasing clothes, food products, electronics, cars, toys, furniture, and household goods produced globally.

Bringing Lean Healthcare to Life

Starting Blocks

Without a doubt, Lean is set to make a big impact on the Healthcare sector over the next few years and many Healthcare organisations in both the public and private sector are already exploring how they could apply it to their patient pathways and administrative processes.

Whilst many of the tools of Lean are familiar to the people in the Healthcare sector, particularly aspects of Process Analysis, the real difference that Lean will bring is a change in the way that improvements activities are implemented rather than the use of the tools themselves.

Many people in the Healthcare sector are looking to people with Lean skills gained in manufacturing to help guide them through the maze of implementing Lean, including helping the organisation to prepare for Lean as well as undertake the specific improvement activities, including Value Stream Events, Rapid Improvement Events etc. Running alongside this is the need to develop the internal capacity of organisations to lead improvements themselves, which is achieved by developing internal Lean facilitators (or Change Agents).

However, as we already know, not every problem in Healthcare can be related to a problem encountered in Manufacturing and there are some significant differences in approach required to make for a successful improvement programme for people more familiar with leading Lean improvements in Manufacturing.

In this article we review some of the key differences that we have found in pioneering Lean transformation in Healthcare and share the structure to Lean activities that we have been developing to ensure that the organisations make sustained improvements rather than isolated Lean ‘ram raids’.

Interestingly, our work to date is also providing some useful learning that can be applied in reverse – from Healthcare back into Manufacturing!

The Same, But Different

As we have already said, Lean will make a big difference to Healthcare and will help them achieve their operational and financial targets but it needs to be applied sensitively within organisations that have been ‘pummelled’ by initiatives and legislation and have a not unreasonable cynicism towards ‘this new initiative called Lean’.

Like in many manufacturing businesses first embarking on an improvement journey, Healthcare employees are concerned about Lean being a vehicle to cut jobs. This feeling has not been helped by the recent NHS guide issued about Lean Healthcare which has chosen to use a Chainsaw as their main logo and was referred to by a Service Improvement Lead within an SHA (Strategic Health Authority) as the ‘Slash & Burn’ guide to Healthcare.

Issues such as this, along with the use of manufacturing focused terminology, photos and case studies when working with employees in Healthcare, has the effect of building up internal resistance and leads to comments such as “My patients are not cars” made by a Renal Consultant we encountered recently.

Additional differences can be seen in the attitude towards risk in Healthcare. In Manufacturing, if you make a mistake with Lean you may increase the risk of accidents but it is more likely it will just reduce productivity or profits. In Healthcare, similar mistakes can impact on Patient Safety (including increasing Morbidity or even Mortality) and can attract significant media attention.

Making this scenario even more complex is the fact that the ‘care pathways’ that patients experience often interact and overlap in a way that Manufacturing value streams do not, with patients switching between pathways and specialities dependent on their specific needs and treatment plans.

Management of these processes and pathways is complicated by the need to balance clinical concerns (such as patient safety and medical best practice) with ‘business’ concerns (availability of resources and finance), and the often uneasy balance that has to be struck between senior clinicians and organisational managers on these issues.

Whilst this sort of complexity is not alien to manufacturing, where there is a constant need to balance cashflow against sales (for example), the fact that this balancing and the resulting management of risk in Healthcare is so prevalent leads to a very different style of management – being more consultative and inclusive than Manufacturing, which slows decision making and involves a lot more analysis than many Manufacturing decisions, and the need to prove things first to sceptical clinicians.

This constant need for balance between clinical and operational concerns leads to one of the biggest differences we encounter, namely the difficulty in engaging the right people for the right amount time to make the improvements sustainable. This is not a new problem in Healthcare with many improvement initiatives having fallen foul of changing priorities, the allocation of insufficient people to an improvement process or simply having failed to move from discussion into action quickly enough.

More Responsible Approach To Healthcare Reform

Signed into law on March 23, 2010, the Affordable Care Act (better known as Obamacare) was a large step towards a needed reform in healthcare. However, it was a large step in the wrong direction.

Democrats and President Barack Obama resorted to a flawed system of government-subsidized healthcare accompanied by a mandate (now regarded as a tax) forcing every American to purchase healthcare if they are not offered coverage by their employer.

Critics have highlighted many issues and possible problems with Obamacare ranging from underfunded “high-risk pools” to a growing government deficit due to a lack of revenue to provide for those who will be receiving healthcare for very cheap prices. Surrounding the law are several myths that Barack Obama and his allies in Congress like to parade around Capitol Hill and through the media.

Republicans and Democrats agree that the American healthcare system is not perfect. It is flawed, and there are many Americans who are not receiving coverage simply because they cannot afford it. However, despite these worries, Barack Obama’s healthcare law is not the solution to an ever-growing problem. In fact, the Affordable Care Act could likely cause many more issues separate from the issue of how many Americans are covered by health insurance.

It is for these reasons that I bring forth a new idea for healthcare reform. I feel that this plan is one that both parties can rally behind because of its simplicity and ease of institution. The Affordable Care Act was highly criticized because the Speaker of the House herself did not even know what exactly was in the law. Nancy Pelosi admitted this when she uttered her now famous phrase, “We will just have to pass it to see what is in it.” If a law is so complex and large that those voting on the law do not even entirely understand the principles of it, then it is not a good idea to blindly accept the law so that America can “see what is in it.”

Here is my proposed healthcare reform plan:

Political ideology and world viewpoints aside, economists and politicians generally agree on the fact that the laws of supply and demand and the dynamics of price action are constantly at work in the market. Furthermore, all Americans generally agree that incentives are very strong things. Consider taxes for example. If a business owner will be taxed higher for every dollar that he makes over a certain point, what incentive does he have to work harder in order to earn more money above this tax threshold? If this threshold were not present, then he would be much more inclined to work, therefore, earn more money.

The reason I bring up this tax incentive, or lack thereof, is because of the role that taxable income can play in a smarter route to healthcare reform.

Consider this scenario: A physician runs his own practice in downtown Charlotte. Every day, he treats people that have health insurance; he receives his payment from the insurance company, and he pays his taxes. His costs remain high because of his need to make a profit, therefore stay in business. He must take into account how much of a percentage he will be taxed on the revenue that he is generating.

What if this physician did not have to worry about how much of a percentage the government would take in taxes, however?

In my plan, when a doctor or physician treats someone without health insurance, every cent’s worth of that treatment will be non-taxable income that the doctor has generated. For instance, if Mary, an uninsured single mother, gets treated for an illness at Doctor Smith’s office for $100, Dr. Smith would not have to pay taxes on any of that $100. However, taxes would still be taken out on income generated from payments originating from insurance companies.

Obviously, in this situation, Dr. Smith would not set the same price for Mary that he would for an insured person. In an effort to attract more uninsured patients, Dr. Smith would lower his prices for the uninsured so that he could generate more income that would not be taxed. Dr. Roberts, another physician down the street would see that Dr. Smith has lowered his prices for the uninsured, and he would attempt to undercut his prices to be more attractive. Barack Obama has flaunted the idea of “shopping around” for the most affordable coverage. This plan causes a healthcare market that promoted exactly that.

Think of how gas station owners determine prices. There is a general accepted price for a gallon of gas in each state based on the cost of a barrel of oil, the state taxes on gasoline, and other factors. After determining the accepted price in the state, gas station owners attempt to attract more customers by setting their prices a little lower than their competitors. Why would doctors not do the same provided with an incentive to generate more income for themselves?

Furthermore, this plan has an effect on the already existing insurance companies. To prevent their customers from dropping their healthcare plan and choosing to become uninsured due to lower costs, premiums would decrease. The insurance companies would also want to remain attractive to customers, and the only way of doing this would be to lower the cost of their own healthcare coverage. Premiums would especially decrease if these insurance companies were also extended tax breaks.

I understand that the issue of high-risk patients and those with pre-existing conditions would still need to be met. No matter to what extent doctors lower their costs, those considered “high risk” would likely still not be able to pay for the frequent coverage that they would require. However, my plan does a much better job at addressing the largest portion of Americans who are uninsured.

This plan is far superior to Barack Obama’s Affordable Care Act for several reasons.

First, there is no government healthcare pool that requires an individual mandate to ensure an equal distribution of costs. Let’s be honest, if the government must require that every uninsured American either buy healthcare or pay a tax in order to pay for its own subsidized healthcare, it is highly likely that the plan will crash and burn. Such an approach is just not smart. In my plan, neither the government nor individual citizens are responsible for ensuring that costs are equally distributed. The pure method of implementation is already much simpler.

Second, Obamacare provides no incentive for doctors or physicians. Many have already expressed concern over the healthcare industry and whether this law may negatively affect those that work in the industry. My plan provides an incentive for all in the healthcare field to provide more coverage. If we are seeking to reform healthcare, is it better to incentivize those in the industry or ultimately hurt them through government-subsidized healthcare that cuts into their profits and ability to make their own decisions?

Thirdly, the current Affordable Care Act is a job killer. If a business hires over 50 employees, then it is required to either buy every employee equal healthcare or pay a penalty. Why would any small business seek to hire if they are near this threshold? With this threshold removed, businesses can again feel free to hire new employees.

Career Opportunities in Healthcare Management

A healthcare administration career via online healthcare management training requires no medical background. This is the field relating to the leadership, management and administration of healthcare systems, hospitals and hospital networks. Healthcare administration covers a broad area of activities and there is usually a set of factors that determine the types of jobs that need to be done to run any given facility; these often include the size and scope of the facility in question and the kinds of medical/ healthcare facilities they have.

Healthcare administrators are vital to the successful operation of any healthcare system. The day to day running and financial sides to healthcare require dedicated professionals to work on areas from clerical to administrative to financial. Healthcare professionals, also known as healthcare managers or health services managers are regular business managers who plan, direct, coordinate and supervise the delivery of health services. These managers can be specialists in charge of a specific department or managing entire facilities. Healthcare education has recently found a new home on the internet, with thousands of people pursuing online healthcare education and online training in order to improve their professional skills and profiles or to take the opportunity to switch to this lucrative and satisfying career from another field.

The following is a brief description of some of the major areas in healthcare administration for which extensive online health care administration and management education and training is now available.

General Administration

Healthcare organizations, like all other types of businesses, are often profit based businesses requiring the highest quality of managerial oversight. A healthcare unit requires a whole top and middle management team in order to function. Matters related to budgeting, profit and future expansion is also, likewise, a managerial responsibility (especially in larger facilities like hospitals).

Healthcare managers in administration positions normally answer to the board of directors. The workload is higher than for many other areas, with administrators often required to work between 55-60 hours a week, however, compensation and career benefits are attractive and the work itself is stable to a great extent. Growth opportunities are numerous and salaries are also amongst the higher levels, with healthcare administration staff making $40,000-50,000 for a start and improving to $120,000-130,000 within 10 or 11 years.

Human Resource (HRM)

HR professionals specializing in healthcare are responsible to maintain a working, motivated staff for all departments. They are often responsible for the hiring of medical staff (doctors, nurses etc) and generally fulfilling HR duties as in any other organization. These professionals average a salary of around $35,000 to $100,000 per year.

Medical information technology (MIT)

With great advancements in information sharing and technology, healthcare has changed drastically over the last few years. With the continued application of new technology in healthcare, a team of professionals is required to operate and maintain information systems (and networks), diagnostic machines, computer systems and software. They are also responsible for upgrading and problem solving. Professionals in this area earn anywhere in the range of $40,000-$100,000; the job description itself varying with the type of facility.

Public relations (marketing)

PR managers in healthcare are responsible for improving the healthcare facilities’ image in the public eye and to keep the surrounding public informed about the facilities and services offered at the healthcare unit. PR managers are also responsible for providing coordination services and information in the event of an emergency or disaster. PR managers are also the spokespersons for their respective facilities, representatives for the unit, and speak for the organization (for instance in the event of a lawsuit etc). They fall into the same pay grade as MIT or HRM professionals.

Healthcare And Capitalist Evangelism

The success of any society is ultimately determined by how well its population lives and dies. Within this paradigm of “successful population” are two fundamental elements – individual and collective wellness. A successful society therefore embodies the notion that both individuals and the overall population are well, and these two measures are reasonable assessments of the wellness, and hence the success of any given society.

In other words, the success of a society can be assessed, characterized, and understood through these two main measures. To break it down, individual wellness consists of answering the question: does the society reasonably allow and encourage individuals to be well? Secondly, does the society allow and encourage wellness for the entire population from birth to death? To the latter question, the most important component of population wellness and hence, societal success, is the degree to which the sum of individual wellness creates collective wellness. The single-most important component of population wellness is a high level of population health, measured by the numbers of individuals who are well or have reasonable access to being well.

The four scenarios below represent a summary snapshot of healthcare systems currently in existence in the Western Hemisphere. The scenarios are predicated on the reality that the cost of healthcare is (next to purchasing a home) the most expensive cost one will experience during his or her lifetime and that these costs are expected to continue to escalate over time as new technology, treatments, and pharmaceuticals continue to drive costs. These four main approaches to healthcare are:

1. No healthcare programs (other than free market)

2. Universally funded programs

3. Insurance company funded programs

4. Combinations of the above

These four healthcare approaches are summarized below with respect to how well they represent the ability to create a successful society. Remember, a successful society is one that encourages, promotes, and allows for both individual and collective wellness, as measured by population health.

1. No Healthcare Programs: Countries which have no healthcare programs generally have lower than average population health. While some members of the population in these societies (namely the very rich) who are able to afford healthcare may be healthy indeed, the overall population health is often quite low. It is important to note that socioeconomic status is generally a good predictor of population health. In countries where no healthcare programs exist, and the reason for these lack of programs is lack of finances, then population health is usually comparatively low. Using our definitions of societal success, the success of these societies would be low, or unsuccessful.

2. Government Sponsored Programs: Countries with government sponsored and funded universal healthcare programs generally have a collectively higher level of healthcare than other countries. Again, if the one applies the definition of success of the entire population as the sum total of the wellness of all individuals within that system, then countries which offer healthcare programs that collectively confer benefits on the highest number of individuals are, by definition, successful. Since one cannot be more than well, there is no incentive for individuals to access more services than are required in order to be well. Leaving aside preventative programs and social marketing costs as key aspects of overall population health, health and wellness can be accessed within government sponsored programs up to a certain level depending on the aggregate overall need of the population. Therefore, by definition, and in spite of incentives and disincentives within the system, the societies that employ these systems are successful.

3. Insurance Company: Healthcare programs sponsored by insurance corporations can work well, provided that the insurance coverage provides all members of society with at least basic coverage and coverage through catastrophic illness. Nobody plans on getting leukemia, or ALS, or meningitis, or lupus, for instance. If you are well-educated and have a position with health benefits with a corporation or you have been successful in your career or business, then it is likely you will be able to afford the costs of healthcare. However, since healthcare and profit-motive are mixed within the same crucible, there is a strong incentive to cheat or to create environments where profit supersedes care if the two vie for supremacy – much as suggested in Michael Moore’s movie, Sicko. The active removal or denial of healthcare is a logical and inevitable outcome of a for-profit, insurance corporation controlled system of care delivery – particularly where the population is aging. Also, there is no compelling motive for insurance corporations to cover individuals susceptible to high healthcare costs (i.e., those with catastrophic physical illness; mental illness; the frail elderly; new mothers and infants), period. The outcome of such a system would be to spiral into category 1 – No healthcare programs – (mediated by a very few insurance companies) wherein the richest segments of society would be able to access services. The irony is, the richest citizenry often require much less healthcare than others. The upshot is this: there is an increasing disparity in the number of people who are able to access healthcare in the face of age and cost escalations. One needs to question the current and future success of these social systems.

4. Combinations of Above: Combinations of the above become extremely complex and difficult to assess. There are certainly advantages and disadvantages, as well as incentives and disincentives for a hybrid of the above systems. Each of these advantages and incentives (or lack of) are inextricably connected to the socioeconomic class you and your family belong to or are transitioning into as well as a host of external and internal factors. A government funded universal system provides healthcare to everyone, including those who are disadvantaged and could not possibly access care without subsidization. It also provides care to those who are charged by some who would abuse care (though unclear who this group might be as people do not consume unlimited healthcare once they are well). Alternatively, the system dominated by large insurance companies provides very high quality, responsive care to individuals who can pay or who are insured by corporations who in turn can pay. This system works well where individuals insured are reasonably healthy and young. A problem occurs when the population of employees becomes older and insurance premiums are either hiked to cover extraordinarily high costs (insurers will only cover healthcare costs where the profits of covering healthcare costs actuarially calculated costs) or removed entirely. Countries in which no healthcare programs exist (presuming healthcare is available) results in costly but accessible services for the very few. There is no need to get into the obvious personal suffering and strife in this latter healthcare system.

How Would Obama and McCain’s Healthcare Proposals Impact Medical Travel?

American Healthcare & Medical Travel

Today, more than 48 million Americans are uninsured, while millions more learn they are underinsured when they become sick. America spends more than $2.3 trillion, or 16% of GDP, annually on healthcare costs. By the year 2016, U.S. Department of Health and Human Services forecasts that health spending will be $4.3 trillion or 20% of GDP.

Though America spends more than any other country on healthcare, it is ranked 37th in overall quality among the world’s healthcare systems by the World Health Organization. According to the Organization for Economic Cooperation and Development, healthcare spending accounted for 10.9% of the GDP in Switzerland, 9.7% in Canada and 9.5% in France, all countries ranked higher than the U.S.

A recent Wall Street Journal-NBC Survey reported that the cost of healthcare is Americans’ number one economic concern. Growing numbers of underserved patients are turning to healthcare delivery alternatives such as traveling to foreign hospitals for necessary treatment. While the medical travel phenomenon started with cosmetic surgery, successes have emboldened patients who need joint replacements, cardiac surgery, spinal fusions and bariatric surgery to reach beyond America’s borders for alternatives. At the same time, health insurers and employers are noticing the opportunities for cost savings by outsourcing and the ability to reach new markets with tailored healthcare products.

Republicans and Democrats agree that current trends in healthcare are not sustainable. Not surprisingly, both presidential candidates, Senators Barack Obama and John McCain, have proposed equally radical remedies for America’s broken healthcare system. Though neither candidate addresses medical travel specifically, their healthcare plans suggest the likely impact on the medical travel market.

McCain’s Healthcare Plan

Sen. McCain would ask Americans to take on greater personal responsibility for their healthcare choices and rely on market forces to meet today’s healthcare challenges. According to Sen. McCain, increased competition and less government involvement will improve the quality of health insurance with greater diversity among plans, lower prices and portability.

Specifically, Sen. McCain would seek to make insurance more available by increasing variety and affordability of private plans. The Senator’s revolutionary idea is to eliminate the tax break that workers receive from employer-sponsored health plans, treating the benefit as taxable income, offset by a new tax credit of $2,500 for individuals and $5,000 for families. If the tax credit is more than the amount a person spends on healthcare premiums, the excess can be placed in a health savings account.

Sen. McCain believes that people who are covered by employer health benefits consume more healthcare services than is necessary. Presumably at least some of those excess services that can be redirected to the uninsured population. Putting patients in control their health spending will encourage competition among providers and insurers, reduce costs and improve the quality and portability of coverage.

Sen. McCain has proposed several policy initiatives to lower healthcare costs. These include: (1) greater competition in the pharmaceutical market; (2) improved systems for chronic disease prevention and management; (3) coordinated care among providers to render better outcomes at lower cost; (4) improved access through walk-in clinics in retail outlets; (5) use of information technology; (6) reforming the Medicaid and Medicare payment systems to pay for diagnosis and prevention but not treatment made necessary by preventable medical errors or mismanagement; (7) anti-smoking programs; (8) state spending flexibility; (9) tort reform to reduce frivolous lawsuits; and (10) improved transparency with better public information on treatment options, doctor records, outcomes, quality of care, costs and prices.

Can Government Healthcare Work in America?

Much has been written on this site and others, about the fallacy of a successfully run government healthcare delivery system in the United States.

Whether it is labeled single-payer, socialized medicine, national healthcare, etc., it is all the same and it will never work in America. In virtually every nation where the government runs the healthcare system, costs have risen well beyond expectations; long waits for treatment are commonplace; care is rationed and some treatments are denied; and taxes have increased to pay for the unexpected cost increases. There are no truly successful nationalized healthcare systems, when quality of care is compared to the gold standard: The U.S. healthcare system. By most measures however, the U.S. lags behind many other industrialized nations.

According to the World Health Organization, the U.S. ranks 24th in the world in life expectancy. This statistic alone should be cause for alarm, but upon further examination, we learn that the reasons have little to do with our healthcare system and more to do with the way we drive, what we eat, our violent behavior, our tobacco use, and our substance abuse.

The U.S. spends more on healthcare, per capita, than virtually every other industrialized country. But again, if we examine why, we find that this has much more to do with factors other than the actual cost of healthcare, like legal awards and fees, defensive medicine, malpractice insurance, the high cost of advanced technology, and certainly not least; the high cost that we all incur for the government mandates placed on health insurance companies.

We pay more for prescription drugs than any other country. However, the cost of drugs still remains only about 10% of our total cost of healthcare. Upon further examination, we can thank our own government for this. More on this later.

There is no arguing against significant reform of our healthcare system, but the prescription for the cure cannot be written by our current government. The Democrats in control of the U.S. government have only one fix; more government. They know no other way, it is in their DNA. But even putting aside politics, there is no way for a single payer system to work in America. Here is why…

Our Legal System: The American Bar Association would have us believe that litigation accounts for only 1% of total healthcare costs. This may be true for jury awards, but they are leaving out the biggest drivers of legal costs within the healthcare system. Things like legal fees for the defense, defensive medical practices, and malpractice insurance premiums are not factored in to the ABA figure.

Countries that rank above us in healthcare, according to the W.H.O., all limit plaintiff awards and have nowhere near the medical litigation we have in the U.S. In fact, if we were to just copy the medical-legal reforms of France, we could bring down healthcare costs in a significant way. Healthcare reform without true tort reform is only a haphazard attempt.

Immigration Law Enforcement: Virtually none of the illegal immigrants in the U.S. have healthcare insurance, since one needs a valid Social Security number in order to obtain coverage. Knowing that emergency rooms cannot turn away patients, the illegals have turned so many emergency rooms across the country into their primary care providers and pay nothing. These costs must be paid, so they are shifted to paying customers, driving the cost of an emergency room visit up for everyone except of course, for those who do not pay.

Illegal immigrants get sick, they get pregnant, they get into auto accidents and work-related accidents, they are involved in violent crimes, etc. If one multiplies the likelihood of these events by the millions of illegal immigrants, the result is enormously costly to us all.

IAQ in Healthcare Environments

As the economy heads further down the slippery slope of what promises to be a deep recession, and our healthcare infrastructure continues to grow and age, it is a natural progression to see more and more IAQ professionals turn to what some believe is a recession resistant market. From ambulatory facilities to long term care, the buildings that make up our healthcare infrastructure are constantly in need of renovations and repair. This new and promising opportunity for IAQ pros offers many long term rewards but is not without new and complex challenges that must be addressed.

Every IEP realizes the importance of appropriate use of antimicrobials, containment barriers and personal protection. Though often times IEPs find the regulations and guidelines they encounter in healthcare facilities to be daunting to say the least. In traditional remediation environments the focus is to ultimately provide an environment free of dangerous pathogens or contaminants. While attention is give to the methodology, often times the end results dwarf the means of acquiring those results. With a host of accepted methods to address indoor air quality in businesses, homes and public spaces the contractor finds themselves able to select from a variety of methods to deal with each issue. In the end it is the air clearance that counts, not so much which method was used to obtain it.

While the end results are just as, if not more important in healthcare environments; far more attention must be paid to the processes used. As many occupants of a healthcare facility cannot be moved and are highly susceptible to infection, there are very specific guidelines in place that govern all maintenance, repair and renovation work in a healthcare facility. Organizations like CDC, APIC and JCAHO have placed standards that apply to all activities that may have an impact on a healthcare environment. This is done with good reason considering the number HAIs (Hospital Acquired Infections) reported annually due to airborne pathogens like Aspergillus, which is disturbed during common daily maintenance. Nosocomial infections caused from routine maintenance reach into the hundreds of thousands each year. These guidelines and regulations are enforced in a facility by ICPs or infection control professionals.

Hospitals continually adapt to new, more stringent CMS guidelines limiting what medical treatments are reimbursable through Medicare or Medicaid, this has caused hospital administration to look more closely at every aspect of infection control in their facility. Beginning in October of 2008, Medicare and Medicaid began limiting payments made to facilities for the treatment of preventable nosocomial infections or conditions. These new CMS guidelines are driven by Section 5001(c) of the Deficit Reduction Act, which could mean that as deficits climb the list of non-reimbursable conditions are likely to grow. Infections like Aspergillosis, which is caused by airborne A.Fumigatus, are common in healthcare facilities. Aspergillus is one airborne pathogen that is commonly disturbed and distributed throughout a facility after maintenance work or renovations. The argument could be made that Aspergillosis is a preventable condition by ensuring appropriate containment and disinfection of disturbed areas.

Infection control professionals in healthcare environments have become increasingly diligent in monitoring the actions of contractors that work in their facilities. It is ICP’s responsibility to ensure all components of the infection control risk assessment are adhered to. While these key people can complicate the lives of the contractors working in healthcare facilities they are also actively saving lives by doing so. ICP’s will monitor and log details about each project to ensure that all compliance issues are being addressed. Two primary issues that impact infection control and prevention in healthcare settings are disinfection of contaminated surfaces with broad spectrum EPA registered disinfectants and appropriate containment of airborne particulate and pathogens.

Choosing the best disinfectant is one way to ensure the best possible level of microbial control during any abatement project in a facility. Healthcare facilities present the IEP with a unique set of challenges in regards to pathogens beyond the standard fungal and bacterial flora. Many of these pathogens can be highly infectious as well as drug resistant making them far more dangerous to the many immunocompromised patients housed in a healthcare facility. When selecting a hospital grade disinfecting it is imperative to keep several things in mind.

Does your disinfectant have sufficient kill claims to address the microbes you might encounter?
While no disinfectant can list every possible organism, it is important to find a disinfectant with the most possible EPA registered kill claims. Look for efficacy data. Disinfectants that do not show efficacy & testing data often have few or irrelevant kill claims and are not sufficient for the challenges found in healthcare facilities. It is also a positive if your disinfectant has EPA approved efficacy in the presence of 98% soil load as opposed to 5% which is required by the EPA. This higher soil load represents real world conditions. Beyond fungicidal kill claims, other claims that you might require involve infectious pathogens like MRSA, E-coli, HIV, Salmonella and Avian Influenza. You may also want to look for a product that can be used on both porous and non-porous surfaces and has disinfectant and sanitizing claims.

Understand what the active ingredients are in your disinfectant
It is essential to know what type of disinfectant is appropriate. Most common disinfectants are formulated using Alcohol, Phenol, Chlorine or a Quaternary Amine Base. There are arguments for each type of disinfectant and it is important to know the facts about the products you are working with. Each has advantages, but some have dramatic disadvantages that might make you think twice about using them.

Healthcare Staffing Business Opportunity

Have you ever wondered how hospitals staff their facilities? Of course you haven’t. Hospitals have a human resource department that screens, qualifies and hires healthcare professionals that fit the facilities needs right? Well sort of. In reality most healthcare facilities are staffed using nursing registries or healthcare staffing companies. You’ve probably never heard of a healthcare staffing agency (also called a medical staffing company) but these companies provide a great service to hospitals and other acute care facilities. Staffing companies help save hospitals time and money by screening, qualifying, and paying healthcare professionals.

Often when people learn about what a healthcare staffing company does, they react by saying “wow I’ve never heard of that before. What a great niche.” However, recent events beg the question, is this really a niche business or could medical staffing be the quiet gorilla in the room of the growing healthcare industry? Obama’s healthcare reform and the aging population will drive up demand for healthcare in the United States. A core realization of an increase in demand for healthcare is the need for more healthcare professionals. However, while we are seeing the potential for large demand for nurses, nursing assistants, and allied healthcare workers, we are not seeing enough growth in these employment sectors to keep up with demand. This point bring us back to the question; is healthcare staffing a niche business or a business on the verge of breaking out into something bigger than its 8.8 billion dollar size already entails?

The answer to this question is yes. Healthcare staffing represents a great business opportunity in the growing healthcare industry. Hospitals and other care facilities will turn to staffing companies and nursing agencies as the hospitals become swamped with people taking advantage of the healthcare reform and our older population who will require more hospital visits. The demand for medical staffing will only increase as the demand for healthcare increases. Medical Staffing represents a business that is poised to become huge.

You may be wondering, “How can I take advantage of the potential in the medical staffing industry?” Healthcare staffing offers many job opportunities to people without a healthcare background. You could become a recruiter and enjoy your day recruiting and finding qualified nurses to work as your agency’s healthcare work force or you could enjoy the fast paced work of a staffer who quickly matches a hospitals needs with a qualified healthcare professional. However the great thing about this business is that with the proper training and support, most people can run their own healthcare staffing office.

Healthcare Reform: How Doctors and Nurses View Universal Care

Background:

Even with a bill passed in both houses of Congress, Healthcare reform and the issue of a universal or national healthcare system continues to dominate discussions on the hill. There is talk of repealing the bill and potentially leaving millions more Americans vulnerable and uninsured. Some argue that repeal is for the best because the current bill gives the government too much power and circumvents our individual rights and freedoms. Still others argue that the bill does not go far enough to grant every single American the right to healthcare services. These views are polarizing both the Representatives on Capitol Hill and their constituents who live on main-street.

Nurses and physicians work in the field taking care of the insured, the under-insured, and the uninsured. These healthcare professionals see first-hand how the ability to pay for healthcare services shape people’s perception of illness and their willingness to seek medical assistance in a timely manner. Given how highly charged the issue is, it is important to know what these nurses and doctors think of all the hoopla that still surrounds the issue of healthcare.

Healthcare Workers’ Viewpoint:

The opinions in this article are those expressed by the nurses and physicians at a Dallas hospital. For confidentiality reasons the names of said nurses and physicians, as well as, the name of the Dallas area hospital where they work will not be used. Based on their experience in the system, these healthcare workers pointed out their frustrations with the current system, reform, and universal healthcare. The issue is healthcare reform and universal healthcare. How do nurses and doctors view this?

CONs:
On the other hand, there are some nurses and physicians who vehemently oppose the idea of universal healthcare and reform that have been passed. These healthcare workers state the following:

  1. Healthcare is not a right. It is the responsibility of each individual to work hard and pay for the care they require. Many people do not think their hard earned money should be syphoned to take care of individuals who are not pulling their own weight. A system that provides healthcare for all rewards people who are not contributing members of society. Even more, those who oppose healthcare reform and universal healthcare insist that it is not their place to take care of individuals who are lagging in their duties to self and society. These people become a drag on the system. Universal healthcare encourages the weaker members of society to stay weak and non-productive. If people had to pay for the services they receive, they are motivated to find work and everyone wins.
  2. Paying for such a system will require an increase in taxation. This means more money taken from hard working Americans; money they can use to take care of their families, co-pays and deductions, as well as anything they think necessary. Increased taxation also limits funds available during retirement.
  3. Some physicians and nurses believe that Medicare is a blithe on the healthcare system. In a free market society, insurance companies should be allowed to compete freely without a government run system that undermines the free market. Ideally, a free market will take care of pricing and completion will reduce the overall cost of healthcare. Hospitals and insurance companies that meet the demands of society will prevail. People who work hard will have access to healthcare services.
  4. It is common knowledge that physicians in the United States earn more than physicians in other industrial nations. Extensive training and hard work is rewarded by respectable pay checks. Many worry that their living standards will drop if a national healthcare system is passed. Moreover, current reform advocates preventative care which may live certain specialties out of the loop. After years of training to be of service to society, these specialties may become obsolete.
  5. Many people like to know that if they are insured, the care they need will be available to them when it is needed. It is perceived that extending healthcare benefits to all will lead to long waiting lines and if this were the case, many individuals are rightfully afraid of the cost to their lives and quality of living.

PROs:

  1. Patients are more likely to get preventive care if they are insured. Healthcare services cost a lot of money. Many people have been bankrupted as a direct result of their inability to pay medical bills, which include hospital stay, physician and auxiliary care visits (home health nurses & therapists), as well as, pharmaceutical aids and medical supplies. This means that the health and financial well-being of patients are affected by any laws that offer improved access to healthcare services.
  2. Preventative care saves hospitals and tax-payers money. Although not a primary concern for nurses, they were quick to point out that the under-insured and uninsured patients who make it to the hospital only arrive when they are so sick that they may never be completely healed from a disease that could have been prevented with the right out-patient care. Due to the advanced progression of their illness upon admission, these patients stay longer in hospitals and respond less to conventional therapies. The result is a very high cost for the care provided. Since these individuals cannot pay, in many instances, the hospitals are stuck with the bills. In order to pay off debts accrued the hospitals increase the cost of care for those who can pay. It is a logical solution that now affects law abiding tax payers which could have been prevented.
  3. People that are chronically ill cannot work and pay for healthcare. Some end up homeless and become society’s problem relying on assistance from private parties or city government. If everyone was insured, many people who require frequent medical care will be taken care of, thus reducing the number of homeless people in society.
  4. The U.S. is the only industrial nation that does not offer healthcare coverage to all its people.
  5. In a system that relies solely on profit motivated insurance companies to provide compensation, access to certain needed therapies become limited if they are not approved by the patient’s insurance company. These used to be most prevalent with the introduction of HMOs and have since improved. Still it is a stain many organizations prefer not to discuss. As people whose sole reason for being is the care of patients it is no wonder that many will like a system where compensation did not play such an indelible role.