Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Quality/Cost, International Comparisons -- OUCH!

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The following lists are from  Note that the US ranks at the bottom of 19 industrialized countries in preventable deaths/100,000 population. Top 25 countries with the best healthcare systems The Top 10 Medical Travel Destinations How the Performance of the U.S. Health Care System Compares Internationally (Health Expenditures/Capita) Health Expenditures per Capita - Seven Selected Countries

Billing Beyond Customary

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Your health plan or doctor's office seems to see your heart attack, broken leg or laceration differently than you do.  They may want you to pay for that which one would ordinarily believe is covered.  In general, that is what consumer advocate, Ralph Nader calls "The Crime of Overbilling Healthcare." [Pub online August 31, 2014]

What's Non-emergent?

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Non-emergent? There are 2 schools of thought in health care cost-efficiency management: One is benefit limitation and the second is managing "non emergent" presentations with a triage payment for screening the patient. The following is a snippet from Charita Harmon, her LinkedIn MCO Executive discussion:

Protecting Practitioners With Compliance Programs

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When addressing possible administrative sanctions, an effective compliance program (CP) can protect physicians, so long as it was in place predating any investigation.  The burden, however, is on the physician practice to demonstrate that their CP is operational, effective and meaningful. 

Health Care Reform at the Office

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Francis J. Crosson, MD seeks "a rationale designed to influence the physician microenvironment so as to support physicians in developing patterns of clinical decision making that result in better health outcomes and lower costs."  

In computerized med. records, ignorance is bliss ….

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The electronic health or medical record (EHR/EMR) can be a technological advance, but only if it tells "who" got "what," "where," and "when."  IOW, it establishes a database that is, for all extents and purposes, more complete, accurate and available.

Delayed Everything

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Charlene Maurer Finerty, owner of Plans and Profits, a business plan writing and implementation service, speaks of the opportunity cost, delayed gratification and indebtedness that characterizes the long-haul of medical training. You'd think once you hang a shingle, your problems are over—but, actually they're just beginning.  For example, there's the hopeless bureaucratization of health care, the need to document every step and then some all along the claims trail and the lack of digital proces