By Christina Perkins, NaviNet vice president of product management and strategy, NantHealth.
Christina Perkins
Efficient and effective ways of exchanging information between patients, providers and payers have become even more important during times of crisis, like the COVID-19 pandemic, with a greater demand for urgent, high-quality care. Physicians need more time to devote to saving lives as the healthcare system is overwhelmed with patients and still bogged down by administrative tasks.
According to Sage Journals, the average doctor spends about 8.7 hours per week on administrative tasks, which amounts to nearly a full work day. With the current pace of the pandemic paired with the need for maintaining preventative healthcare through regular appointments, such as physicals or cancer screenings, physicians need as much time as possible to pay attention to the task at hand: patient care.
Technology is the powerful tool necessary to streamline physician workflows by increasing efficient, effective communication between payers and providers in order to determine the most appropriate treatment plan for an individual patient based on their condition and health plan. One such workflow that can oftentimes be quite time-consuming for payers, providers and patients due to disputes or other disagreements around a therapeutic path is prior authorizations.
Streamlining the prior authorization process can alleviate the burden for all stakeholders, reduce delays, and offer providers and their patients confidence they are getting the most appropriate care with the highest chance for success. With the right technology in place, prior authorizations can be streamlined greatly.
Leveraging electronic tools to enhance administrative workflows can make it clear to providers when and why a prior authorization is required, what information is needed for each kind of service, and which services are within the guidelines for treatment.
By implementing digital technologies to streamline processes like these, there is a greater reduction of time and money spent to arrive at the best possible treatment plan – bringing about a new era of value-based care. Giving doctors tools they need to efficiently get tedious administrative tasks done will greatly improve the treatment process for all stakeholders. This is the gateway into enabling true value-based care.
Interoperability also plays a critical role in uplifting value-based care by boiling down the superfluous tasks, reducing heavy administrative lifts for providers. Allowing a range of healthcare information technologies to exchange, interpret and use data cohesively consistently leads to higher quality care by relying on a value-based and evidence-based care system. There are three foundational ways in which efficient and effective exchange of information through the use of technology can be extremely valuable to the healthcare system, including:
To say the least, 2020 was a difficult year for skilled nursing providers. Aside from the rapid, ongoing changes necessitated by COVID-19, providers are still reeling from recent, sweeping regulatory changes, including the CMS Patient Driven Payment Model (PDPM).
A year into life under the new model, some skilled nursing facilities are adapting to the new case-mix classification system mu
Russ DePriest
ch better than others, according to Russ DePriest, vice president and general manager of skilled nursing at PointClickCare.
“Under PDPM, CMS wants you to up your game when it comes to care outcomes, so fewer of your residents end up being readmitted to the hospital,” DePriest said. “As part of the new model, Medicare can withhold as much as two percent of reimbursements if a SNF has high readmission rates.”
The good news: Medicare pays facilities in full when they have low readmission rates, and offers added incentives up to 1.6 percent for exceptional performers. But what contributes to high readmission rates? For starters, a lack of automation, integration, and digitization across the resident journey.
Electronic Health Reporter recently spoke with Russ DePriest and Lauren Talbot, an EHR Consultant for Reliance Healthcare. Here, they discuss PDPM, the pandemic, and how digital transformation is driving outcomes in skilled nursing.
Question 1: Russ, how has the pandemic affected PDPM? And how have providers been leveraging technology to adapt to those changes?
Prior to COVID-19, PDPM was one of the biggest changes the SNF industry had seen to its system of operations. Prior to COVID-19, rather than focus on therapy, the new system incentivized treating the needs of the patient as a whole.
In terms of dealing with a high-needs population, PDPM is arguably better designed for a pandemic than the prior RUG system. Given COVID, where we know patients with co-morbidities are at a higher risk, paying on patient characteristics rather than therapy is beneficial to SNFs. So, although it wasn’t designed in anticipation of a pandemic, the new system is well-matched.
To help us further understand the impact of our technology on skilled nursing providers’ operations, including PDPM, we commissioned Forrester Consulting – part of an independent, objective research firm – to conduct a study and talk to some of our skilled nursing customers. I should note that Reliance Healthcare and Heritage Living were not among those customers.
Some of the interviewed facilities were able to save over $200,000 per year in PDPM-related penalties. This is because our platform enables digital transformation, and allows facilities to trace all treatments and associated results delivered to a resident. As a result, it’s easier for management to standardize and improve their evidence-based care plans, translating into better outcomes for residents. The result: facilities using the PointClickCare platform are better positioned to maintain the low readmission rate necessary to avoid penalties.
This is a common question for those weighing the options of whether to get insured or not. Over the past few years, affordable health has sparked debate in America and across the world. This has received prodding by the rise in infections and other lifestyle diseases over the last decades. The truth is insurance has played a massive role in dealing with the rising mortality rates. However, until today, the insurance narrative has not yet sunk deep into people’s minds. Many are still in doubt whether to purchase medical covers or wait for the time when visiting the hospital is necessary and pay the bills from their pockets. Many still believe that insurance is a waste of money, and at times one never enjoys its benefits.
The truth is the cost of receiving medical care is not getting down any soon, but instead, the graph is continually rising. It is evident how hard scientists and other medical industry stakeholders are trying so hard to come up with effective ways of handling specific issues. Medical technologies are advancing every time the sun sets to rise. As such, it is difficult for the prices to go down considering the effort put towards making services and success rates even better. Insurance aims to help everyone plan and budget for their medical needs in time, and by so doing, the burden of hefty bills gets taken away.
How Medical Insurance Works
The basic idea of health insurance is that when one buys premiums with a given insurance provider, they will gain their medical bills taken care of either in part or whole, depending on the cover details. It goes hand in hand with what happens in the care sector, where the car insurance’s objective is always to restore the beneficiary to where he/she was before the car got damaged. In some instances, one might get an accident that writes-off the car’s value calling for an entire replacement.
Though these two types of insurance covers might work in the same manner, health insurance is way more comprehensive than car insurance. A medical cover covers a range of activities apart from accidents and treatment expenses. Most health insurance covers a range of goings-on like routine medical checkups, vaccinations, and many more.
There are so many signs that should make you book an appointment with a neurologist. But first, let’s understand who a neurologist is. A neurologist is a medical professional who can diagnose and treat conditions that affect the brain and the nervous system.
Innovation is at the heart of the healthcare sector as technology brings new tools and approaches to the table. For this reason, practitioners and healthcare providers are always looking into methods that revolutionize the way they detect and treat certain diseases.
One of these innovations is light therapy. Although controversial, this approach has been the subject of numerous studies that vouch for its effectiveness across different fields. Also known as phototherapy, this method has encouraged further research into the usefulness of artificial light in the medical sector. So far, experts have identified a number of ways in which light therapy could be applied:
Treating seasonal affective disorder
In countries where there are extensive periods of no sunlight, seasonal affective disorder or SAD is mostly common. Weather changes and changes in the light-dark cycle are also important factors that contribute to SAD. While antidepressants are usually administered to people experiencing this mood disorder, light therapy can also provide an alternative approach.
According to an article by the Harvard Medical School, patients with SAD can be exposed to artificial light for a certain amount of time depending on how drastic the weather changes in their location. Although there has yet to be a significant link between light exposure and winter depression, light therapy can still help with optimizing the effects of medication and reduce a patient’s reliance on antidepressants.
When men start to reach the age of 40, their testosterone level can start to decline by 3 percent almost every year. However, testosterone is still an essential hormone when it comes to men’s health and although this decline will not always mean that you will be in need of therapy, there are still symptoms and conditions that can emerge and will ultimately make testosterone replacement necessary.
Good thing there are Testosterone Replacement clinics that are qualified to provide you with the testosterone replacement that you are going to need. By being able to maintain the necessary testosterone level, you will also be able to maintain a healthy sex drive and it can increase your overall energy.
When a man is still in his adolescence stage, he still has adequate testosterone levels and this will continue to produce largely through the ages 20 to 30. However, after that certain age range, men will then tend to suffer testosterone deficiency thereby leading to a lot of issues that can be resolved easily through testosterone replacement treatments.
While it may seem an ignorant question, understanding psychiatry is more complicated than one might think. Yes, it’s the practice of helping individuals define, understand, and categorize mental, emotional, and behavioral disorders. Still, these same healthcare professionals also determine the best treatments for individuals experiencing mental health issues.
In simple terms, “psychiatry” is the medical specialty that expands and experiences the human brain’s complexity challenges. Still, they also research a broad spectrum of mental conditions, correlated treatment options, and contribute to the new approaches and fields of study.
What Does A Psychiatrist Do?
Psychiatrists are mental health professionals. Mental disorders cover many categories, including:
Mood disorders, including depression and bipolar disorder;
Anxiety disorders, including post-traumatic stress disorder, and obsessive-compulsive disorder, among others;
Personality disorders;
Psychotic disorders, including schizophrenia; and
Eating disorders, such as anorexia nervosa and bulimia.
Psychiatry is always changing as approaches to care, and medication responses evolve. In the not-too-distant past, mental health conditions and those afflicted with them often experienced a stigma or public disgrace. This is becoming less and less true.
Psychiatrists should not be confused with psychologists. Psychiatrists require more schooling. They are medical doctors, not just providers with a master’s or a doctorate. They also can prescribe medication.
Treatment of patients
Psychiatrists must address several questions about their patients’ struggles, such as:
The best and most helpful ways to classify mental disorders
Determining what is “normal”?
How treatments designed for categories of people are tailored to individuals
Current medical diagnosis and treatment of mental health conditions rely on tools ranging from neuroimaging to transcranial stimulation. Psychotropic medications remain the most commonly sought and prescribed treatments, but the psychiatric landscape increasingly includes more than drugs and pharmacotherapy.
If you’re a man in your mid-40s or older and have not undergone a prostate exam, you should consider doing so as soon as possible. To understand why such testing is critical for men in these age groups, we only have to look to a study published by the American Cancer Society. According to the study data, by the end of 2021, roughly 250,000 men are likely to be diagnosed with prostate cancer. Of those, an estimated 34,000 are likely to lose their life to the disease.
The data further notes that these new prostate cancer cases and associated deaths will consist primarily of men in their 40s and older. While we are on the topic, it seems only appropriate to note that prostate cancer is the second-most-common cause of death among men in the United States when it comes to cancer-related deaths, lung cancer being the first. Colon, pancreas, and liver cancer make up the third, fourth, and fifth of the most deadly cancers among men, respectively.
Who Is Most at Risk of Developing Prostate Cancer?
Before delving into what prostate cancer is and why it is so common, let’s take an even closer look at just how prevalent the disease is in America. In terms of scale, the over 34,000 men expected to die from prostate cancer by the end of 2021 is about the same number of people that could fill a Major League Baseball stadium. And that averages out to roughly 91 deaths each day or about one man dying every 16 minutes. Of course, this is all based on future projections. Currently, some 3 million men in America are reportedly living with this life-altering disease. While all men are at risk of developing prostate cancer as they get older, the risk is higher for some than others. And several things go into explaining why this is the case.
Firstly, some men never undergo a digital rectal exam (DRE), which can help detect prostatic nodules that sometimes turn into cancer. Second, prostate cancer can be hereditary for some men, which means that they have inherited gene mutations that make it highly likely that they will fall victim to the disease. And this is backed by a study published by the Memorial Sloan Kettering Cancer Center, which revealed that 5 to 10 percent of all men diagnosed with prostate cancer inherited gene mutations that predisposed them to the disease.
Along with inherited gene mutations and forgoing routine prostate exams, a man’s race can also increase their likelihood of developing prostate cancer. Studies show that African-American and Hispanic men are at a higher risk of developing and ultimately dying from prostate cancer. Asian men, when compared to their Caucasian counterparts, African-American, and Hispanic men, are less likely to develop or die from prostate cancer.
What Is Prostate Cancer and Why Is It So Common?
The long and short of it is that prostate cancer, aside from targeting the prostate gland, specifically, is not too dissimilar from other cancers in that it occurs as a result of changes in DNA, which is precipitated by cells within the prostate dividing uncontrollably. Along with age and race, hormone imbalances can trigger this out of control cell division that ultimately gives way to prostate cancer. For example, a study published by Science Daily revealed that men over 40 with high testosterone levels, meaning 1,100 nanograms per deciliter (ng/dL) and above, are at risk of developing prostate cancer. High testosterone levels in men can result from any of the following:
When men start to reach the age of 40, their testosterone level can start to decline by 3 percent almost every year. However, testosterone is still an essential hormone when it comes to men’s health and although this decline will not always mean that you will be in need of therapy, there are still symptoms and conditions that can emerge and will ultimately make testosterone replacement necessary.