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Allen Miller, Chief Executive Officer, COPE Health Solutions

Key Trends in 2018 for Health Care Organizations Moving to Value-based Payment and Population Health Management

By Allen Miller
Chief Executive Officer
COPE Health Solutions

Healthcare is in a tumultuous time and what's for certain is that nothing is for certain. The passing of the recent Tax Cuts and Jobs Act of 2017 (TCJA) has broad but still not completely understood implications for the business community and economy, including non-profit health hospitals and health care systems, generally adding more complexity and uncertainty. It is also unclear what impact the elimination of Accountable Care Act (ACA) individual mandate penalties will have on uninsured rates. This uncertainty has not stopped, and perhaps has fueled, interest by employers and investors in creating alternative health care financing and delivery models, as evidenced by the recent announcement between JPMorgan Chase, Berkshire Hathaway, and Amazon.  Read article
Data Entry Clerk Entering Claim Information

Coding Errors May Render Receivables Uncollectible

By Adam G. Wentland
Attorney, Theodora Oringher PC

"Double check your coding!," is the harsh lesson to healthcare providers from the recent California Court of Appeal's opinion in YDM Management v. Sharp Community Medical Group. The Court ruled that the defendant, an independent practice association, was not required to pay a single cent more than it had due to the provider's CPT coding mistakes - costing hundreds of thousands of dollars.  Read article
Front of Medical Clinic

Puget Sound Fourth Quarter 2017 Real Estate Wrap-Up

By Paul Carr, CCIM/MBA
Senior Vice President, CBRE

$1,000,000,000 is the new normal. The scale of new development projects and mergers in the national healthcare and biotech world is grand, with billion dollar figures becoming commonplace and with possible repercussions in the Puget Sound region. This is despite worries about changes to the ACA including the recent removal of the individual mandate. In Modern Healthcare’s 12/9/17 article on the CHI Dignity “mega-merger,” authors Alex Kacik and Tara Bannow report that “Hospitals and health systems have been consolidating at a rapid clip in both horizontal and vertical mergers. While hospital executives claim that scale is needed to lower costs, researchers point to the contrary and say consolidation often produces higher prices and insurance premiums.” Read article
Teen girls in group therapy setting

Promising Early Results on the Road to Whole Person Care

By Julie Lindberg, LICSW
Vice President, Health Care Services, Molina Healthcare of Washington

One out of five individuals experience behavioral health issues – both mental health and substance use disorders (SUD) – at least once in their lifetime. Behavioral health conditions also have physical and social consequences, such as worsening of health prognoses (e.g. heart disease, diabetes and cancer), homelessness, and loss of employment. Fortunately, these individuals can benefit greatly from a whole person care approach. Read article
Medical Staff Meeting to Discuss Organization Effectiveness

Challenges to Overcome to Operate an Effective Healthcare Organization

By Sergey Gorbatov, PMP

The healthcare industry in the United States has transformed and evolved throughout the decades, continuously adapting to changes in regulatory policy, technology, patient preferences and economic climate. Consequently, these factors not only affected the delivery of healthcare as whole, but heavily impacted organizational and operational structures of healthcare companies. Further changes in business operations produced new, or underscored existing challenges with managing organizational behavior and human resources that leaders had to understand and effectively manage to continue operating successful businesses. Borkowski (2011) suggests a set of challenges that leadership would encounter and would need to overcome to operate an effective healthcare organization: (1) diversity of the workforce as it relates to ethnicity, culture, geographical location and age; (2) effectiveness of communication; and (3) ensuring an efficient and productive work environment through appropriate evaluation and management of staff's attitudes. This article will focus on each challenge in greater detail. Read article
Medical Staff Receiving Training on TPE Program

CMS's Targeted Probe and Educate ("TPE") Program - Get Counsel Involved Early!

By Richard S. Cooper, Esq.
Member, McDonald Hopkins LLC

On October 1, 2017, CMS expanded its pilot Targeted Probe and Educate (“TPE”) program to include all MACs. CMS’s stated purpose for the expansion is “to reduce appeals, decrease provider burden, and improve the medical review/education process.” CMS has described the program as “designed to help providers and suppliers reduce claim denials and appeals through one-on-one help.” This is a 3-round program conducted by the provider’s local MAC. It offers one-on-one education and is intended to reduce payment error rates for the provider. Hopefully, the provider is also able to use the program to avoid an overpayment demand or payment suspension.  Read article
Smog of Downtown Los Angeles

Climate Change and Human Health

By Paul S. Auerbach MD, MS, FACEP, FAWM, FAAEM
Redlich Family Professor in the Department of Emergency Medicine, Stanford University School of Medicine

From the vantage point of emergency medicine, climate change is a clear and present danger to human health. One needn't be a climate scientist or pulmonary specialist to appreciate the impact of thick smoke on the tenuous lungs of a patient with chronic asthma. When mosquitoes move north into habitats made newly favorable by global warming, they will breed at higher rates and more effectively incubate vectors of tropical diseases previously unknown to these human populations. Superstorms are becoming the norm as warmer oceans evaporate more moisture into cloud formations and render cataclysmic events. Coral reefs and oyster beds have been decimated. Droughts, heat waves, floods, and wildfires dominate the news. So, where does the medical profession stand on all of this?  Read article
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