The Inflation Reduction Act: The Impact of Medicare Negotiation of Prescription Drug Prices on Hospitals and Health Systems

Ken Perez

By Ken Perez, vice president of healthcare policy and government affairs, Omnicell, Inc.

In August, H.R. 5376, the Inflation Reduction Act of 2022 (IRA), was passed via partisan votes by both chambers of Congress and signed into law by President Joe Biden. Senate Majority Leader Chuck Schumer (D-N.Y.) described the $739 billion climate, tax and health bill “as one of the defining legislative feats of the twenty-first century,” and Biden similarly touted the IRA as “one of the most significant laws in our history.”

While its climate change provisions captured top billing, the IRA is also arguably the most impactful health legislation since the Patient Protection and Affordable Care Act of 2010.

Hospitals and health systems have long advocated for lower prescription drug prices. In March, in a statement to the Senate Finance Committee, the American Hospital Association contended that prescription drug price inflation constituted “an urgent need to lower drug prices in Medicare.” The AHA statement advocated for increased competition and innovation, greater drug pricing transparency, inflation-based rebates for Medicare drugs, and protection of the 340B Drug Pricing Program. However, the hospital association stopped short of advocating for Medicare negotiation of prescription prices.

Details about Medicare negotiation of prescription drug prices

As the centerpiece of the IRA’s various drug pricing reforms, Medicare is allowed to “negotiate” what it will pay for many single-source branded drugs that account for the highest total expenditures for Medicare. In practice, Medicare will be able to dictate those prices. Starting next year, Medicare will negotiate directly with pharmaceutical companies to set the maximum fair price (MFP) for certain prescription drugs, with application of the negotiated prices starting in 2026 for 10 negotiation-eligible drugs from Part D.

Continue Reading

Jobs in healthcare

The Ultimate Insole Buying Guide

Pinkiou 3/4 Orthotics Shoe Insoles Plantar Fasciitis Insoles, Shoe ...As we all know, the feet are the body’s foundation and play a vital role in one’s overall health. Our feet’ health largely depends on the quality of our shoes and the support they provide. One of the most important components of a good shoe is the insole.

An insole is a removable insert that provides additional cushioning and support for the foot. They are often used to correct foot problems or to provide extra comfort. There are a variety of different types of insoles available on the market, so it is important to choose the right one for your needs.

There are many factors to consider when purchasing new insoles for your shoes. This guide will help you choose the right insoles based on your needs and where to buy shoe inserts. First, consider the type of shoes you will be wearing the insoles with.

This will help you determine the size and shape of the insoles you need. Next, think about the activities you will engage in while wearing these insoles. This will help you choose the right material and thickness for the insoles. Finally, consider your budget when choosing insoles. This will help you narrow down your options to find the right insoles for you. Your local drugstore is a good place to start. Many stores sell a variety of inserts, and you can usually find them in the foot care aisle. You can also buy shoe inserts online. There are a number of websites that sell inserts, and you can often find good deals on inserts if you shop around.

Continue Reading

Jobs in healthcare

Don’t Wait To Get Sick: 5 Ways To Prioritize Your Healthcare

While many people get health insurance to help deal with emergencies, the truth is that we can’t be sure of when life will throw us a curveball that lands us in the hospital. This means that every day that you wait to do something to improve your physical and mental health, you’re potentially increasing your chances of having poor health at some point in the future. Don’t let yourself fall into the trap of getting sick before you take care of your own health and wellness—follow these five ways to prioritize your healthcare now and keep yourself healthy for years to come.

1) Know your numbers

Knowing your numbers is the first step towards taking care of your health. Blood pressure, cholesterol, triglycerides and blood sugar are all important numbers that will be measured during a routine checkup. The goal is to keep these numbers as close to normal as possible so you can avoid serious health issues like heart disease, diabetes, and high blood pressure later on. This includes getting your annual flu shot!

2) Track your symptoms

It is best to be proactive when it comes to your health and not wait until you are sick. Track your symptoms so that if you start feeling worse, you can share them with a doctor who will have a better understanding of your medical history. To track your symptoms, keep a journal where you list all of the things that make you feel bad, and put notes next to those entries about what was going on at the time.

Continue Reading

Jobs in healthcare

Creative Ways Urgent Care Leaders Can Retain and Attract Talent Alongside Increased Demand

Profile photo of Adam Steinberg
Adam Steinberg

By Adam Steinberg, EVP client experience, Experity.

The popularity of urgent care has grown continuously over the past several decades, but in just the last few years, the U.S. market has exploded as more and more patients look for nonemergent care options that are more affordable, accessible and convenient.

For many patients, urgent care offers more flexible hours than traditional physician offices and provides care that is both faster and less costly than a visit to the emergency room. The benefits of urgent care were further accentuated by the COVID-19 pandemic, as clinics across the country swiftly adapted to meet the evolving needs of patients and proved that healthcare can be high-velocity, high-quality and accessible to the masses.

Urgent care clinics served a crucial role in providing accessible testing and vaccination for the COVID-19 virus. As a result of urgent care’s impressive response to this demand, its status in the broader healthcare continuum has elevated it to the care site of choice for millions of patients, leading to a significant rise in daily patient visit volumes and expanded expectations for clinics nationwide.

While patient demand and visit volumes continue increasing for U.S. urgent cares, as do staffing shortages. Keeping clinics fully staffed and ensuring staff satisfaction is a top priority for clinic leaders and owners to continue meeting growing patient demand. To better understand the industry’s most pressing growth and retention challenges, and to provide urgent care leaders with actionable insights to support staff satisfaction at their own practices, urgent care leaders across the country were surveyed in the spring of 2022 to reveal beneficial strategies to boost success in these areas and fundamental changes necessary for urgent care clinics to retain and attract talent.

Keeping Staff Satisfied by Meeting Their Top Needs

As demands on clinic staff increase, meeting and prioritizing employee needs is essential for retention. According to the responses from urgent care leaders surveyed about key initiatives they’ve implemented at their own clinics to keep staff happy on the job, the top two initiatives for increasing job satisfaction and retention were offering flexible scheduling and financial incentives.

Clinicians, radiologists, and front desk staff are some of the most difficult positions to fill at clinics right now, all of which are essential to a clinic’s day-to-day operations. Providing the desired incentives for clinic staff will help retain the current workforce and entice new talent to join the team – helping to maintain a fully staffed clinic that delivers on the promise to provide quality, accessible, on-demand care.

Continue Reading

Jobs in healthcare

Continuous Cost Improvement: Drive Sustainable Savings Without Sacrificing Culture

Ryan Self

By Ryan Self, VP advisory services, Strata Decision Technology.

Health systems continue to prioritize lowering the cost of care as the waves of rising labor costs, volume volatility, and supply chain challenges persist. This time, hospital executives are coming to realize that establishing a continuous cost improvement program is key to improving margins for their organizations, but the question is how to integrate that broadly across an entire health system.

Cost reduction has gained a negative reputation within healthcare since it is often associated with staff cuts. Although cutting staff can provide temporal relief to an organizations’ bottom line, it rarely provides sustainable results and introduces new challenges when there are not enough bodies to complete the work that needs to be done, especially in an industry where lives are at risk. Shifting healthcare professionals’ perspective to view cost reduction as an ongoing opportunity to identify areas for improvement through collaboration with operational and clinical leaders will shift the stigma and allow for constructive efforts to take place that will benefit the organization in the long run.

Cost-saving programs can no longer be the sole responsibility of the finance team – they need to incorporate the individual operating departments and service lines. Historical messaging that implied each leader must take their fair share of a global labor reduction plan will not work, particularly with staffing shortages lingering in the industry. To be effective, the perception of the program must shift from one of top-down enforcement to bottom-up empowerment. Luckily, there are many hospital functions that can play an integral role in helping improve an organization’s margins.

The best way for an organization to approach its financial journey is to understand that cost improvement is not a one-time fix, but an ongoing process that must be ingrained in its DNA. Support from the CEO, along with the rest of the leadership team, is crucial to integrate financial enhancement programs. Without senior leadership on board, the efforts will fizzle out, and no one will be held accountable. A holistic approach to cost improvement involves the entire organization and allows for clear visibility and maximum savings potential.

Areas of opportunity

The Healthcare Financial Management Association (HFMA) recently conducted a survey with Strata Decision Technology that polled 185 healthcare finance, accounting, and revenue cycle executives. The survey revealed that although nearly 89 percent of participating healthcare organizations have some type of cost reduction program in place, only 6% characterize their program as extremely effective. The good news is that there’s a commonality among programs that reported successful cost improvement initiatives – a formal and ongoing process that is applied across the health system. When a system has the correct process in place, financial decisions become easier because advanced planning helps to avoid any major surprises down the road.

One of the keys to developing this kind of program is implementing technology that can help supply insight into an organization’s financial health. Technology gives organizational leaders the ability to unlock the lakes of healthcare data that previously had little to no functionality, as many organizations have both the clinical and financial data they need to improve operations, but they have yet to integrate the IT systems that allow them to do so. Standardizing existing data and using it to perform analyses allows for comparison and identifying opportunities for improvement. This kind of operational benchmarking is a defining factor in cost reduction strategies because it allows healthcare organizations to reflect internally, as well as benchmark their performance against others.

Continue Reading

Jobs in healthcare

Providing a Way For Employees To Manage Hypertension Will Pay Off For Employers In the Long Run

Byron Crowe

By Byron Crowe, MD, chief medical officer, Solera Health.

Chronic disease remains a leading cause of disability and death in America. With 40% of adults experiencing two or more chronic conditions, the clinical and financial burden of these conditions are widespread and accounts for reduced life expectancy and $4.1 trillion in annual health care costs.

Hypertension in particular is a widespread public health concern given its clear linkage with cardiovascular and kidney disease. The CDC estimates that nearly half of U.S. adults – 116 million people – have hypertension, contributing to hundreds of thousands of avoidable deaths from cardiovascular disease each year.

The cost of hypertension for employers and employees

Employers can expect to have large numbers of individuals with hypertension, with some portion experiencing major complications such as heart attacks and strokes every year. In addition to the human toll taken by uncontrolled blood pressure, hypertension-related employee absenteeism costs employers roughly $10.3 billion annually. Not only are employees with high blood pressure four times more likely to die from a stroke, but it puts them at significant risk for developing cardiovascular diseases, leading to $1,100 in lost productivity annually.

When an employee suffers from hypertension, the medical costs are up to $2,500 higher annually than those who do not. Additionally, about $29 billion is spent yearly on blood pressure prescriptions, including $3.4 billion in out-of-pocket spending. Managing conditions like hypertension can be costly and extremely difficult – especially in conjunction with intersectional diseases and symptoms.

But the time and money spent by each party do not have to be significant. By driving sustainable lifestyle modifications, ensuring medication adherence, and offering accessible and continuous care, digital solutions can help address gaps in hypertension care by meeting the diverse needs of both employers and employees.

Continue Reading

Jobs in healthcare

How Remote Therapeutic Monitoring (RTM) Is Changing the Way Patients Address Their Overall Health

Jared Goldstein

By Jared Goldstein, COO, Wizecare.

Over the past few years, and specifically due to the COVID-19 pandemic, the health and medical industry had to rely on technology to help with patient access, diagnosis, and treatment. The huge successes of Remote Patient Monitoring (RPM) enabled the expansion of Remote Therapeutic Monitoring (RTM) designed for physical and occupational therapists to collect patient physical data and measure adherence. With RTM technology providers can have a significant reach to patients beyond the walls of the medical facility, doctor’s office, or hospital.

The key differentiator between RTM platforms is whether the patients need to wear sensors and/or wearables or if the technology is so advanced that the technology can track the patients’ movements without wearables simply through a smart device or computer.

What is RTM and how does it work?

The innovation of Remote Therapeutic Monitoring came from allowing patients at health care practices to receive care and achieve optimal physical results from MSK (musculoskeletal) disorders while enabling the professionals to have direct observation of the patients beyond the walls of a medical facility. What differentiates RTM solutions, is how the technology works and if it can track the patient’s movement and provide feedback in real-time. Real-time is key to this equation as it allows the patient to know if they are doing the exercise correctly for optimal healing and results.

This type of therapy also allows therapists to monitor patients and screen for deterioration or improvements. Clinical study results have shown an improved outcome in 5 out of 6 patients and increased patient engagement rates by close to 80% with the use of technology that meets the criteria discussed above. Patients are more compliant in their treatments versus the normal industry rate. Many patients, specifically the elderly, those in rural communities, and the underserved are now able to get the prescribed program to address their MSK concerns, and from the comfort of their own homes.

Continue Reading

Jobs in healthcare

Driving Healthcare Operational Efficiency with IoT-Sensing-as-a-Service 

Profile photo of Guy Yehiav
Guy Yehiav

By Guy Yehiav, president, SmartSense by Digi.

Amid widespread staffing shortages across the healthcare sector, the need for IoT-enabled digital transformation in hospitals and patient care facilities is increasingly clear. For the first time since 2004, a lack of staffing has overtaken financial volatility as the No. 1 concern among healthcare CEOs in the American College of Healthcare Executives’ annual survey.

Meanwhile, from canceled appointments to delayed surgeries, more than half of all U.S. patients report reductions in care quality due to personnel shortages. The problem is even further magnified in rural areas, with rural-based primary healthcare professionals ranking care quality as a greater concern than access to care within their communities.

With that said, healthcare providers should get proactive about leveraging digital adoption to “do more with less” and ensure quality care despite their staffing challenges. There’s no better place to start than with IoT Sensing-as-a-Service. Beyond supporting product efficacy and asset protection, the IoT SaaS framework can be a critical workforce empowerment tool that helps improve therapeutic outcomes for patients. Why? Because in addition to eliminating elongated and error-prone manual compliance procedures, it also provides digital task management capabilities with automated prescriptive insights that enable healthcare employees to streamline workflows and enhance operational efficiency.

What Exactly is IoT Sensing as a Service?? 

IoT SaaS is the interconnected use of remote IoT sensing and monitoring tools with AI-powered prescriptive analytics – essentially an enhanced version of traditional IoT sensing and monitoring technology that empowers healthcare facilities to collect, analyze and act on inventory performance data for compliance and patient safety. The IoT sensors are placed on medical assets, as well as inside of freezers and refrigerators where vaccines and medications are stored, and perform real-time monitoring of those assets to track and trace location and confirm compliance. Fully operable with Bluetooth, the sensors do not need to be added to the hospital’s IT infrastructure. These easy to deploy sensors can sense anything from CO2, O2 levels, humidity and temperature to current consumption and noise.

Furthermore, the sensors measure asset performance, automating the detection and prediction of maintenance issues that could lead to a future excursion. The raw data collected by each sensor flows through a continuous feedback loop via the prescriptive analytics system, which provides actionable insights to operations teams so they can take the necessary steps to ensure all assets are fully functional and in good condition.

Continue Reading

Jobs in healthcare

Recapturing Revenue During the COVID-19 Pandemic: A Critical Healthcare Imperative  

Victoria Wickline

By Victoria Wickline, SVP of partnership success, Get Well.

More than 2.5 years after COVID-19 was first identified as a global health crisis, the healthcare industry continues to grapple with the challenges the pandemic has laid bare, including harsh realities surrounding unequal distribution of care and health inequities.

Further exacerbating these devastating care gaps is the fact that the pandemic caused many people to put off aspects of their healthcare, with 41% of U.S. adults reporting that they have delayed or avoided medical care — either because of job loss, health insurance coverage losses, closed facilities, or just simply wanting to avoid being exposed to the virus.

As patients avoided hospitals and doctors’ offices, conditions like cancer, heart disease, and other chronic illnesses went undiagnosed or untreated during the pandemic. In the first four months of 2020, breast cancer screenings were down by 89% and colorectal cancer screenings were down by 85%. As a result, The National Cancer Institute anticipates a surge in cancer death and predicts that the number of people who will die from breast or colorectal cancer in the United States will increase by nearly 10,000 over the next decade because of COVID-19’s impact on care.

Healthcare System’s Loss in Financial Revenue:

Besides the obvious detriment to public health, especially for vulnerable and underserved populations, these care gaps have drastically cost health systems financially. Revenue lost in 2021 was projected between $53 billion to $122 billion due to the lingering effects of COVID-19.

Fast forward to 2022, U.S. hospitals and health systems continue to struggle with regaining their financial health and many are facing another year of negative operating margins, with most organizations seeing declining margins, revenue, and inpatient volumes following the surge of the Omicron variant. Just this past month, the healthcare industry was reported to have the most job cuts compared to any industry in 2022 with a 54%  increase in layoffs compared to numbers reported in June 2021.

Re-Engaging Patients Through Personalized, Digital Experiences:

Today, the healthcare industry is trying to pick up the pieces and health systems are looking to re-engage patients in their care —  and improve the overall health of their patient populations as a result. To do so, health systems must redefine what the patient experience looks like. This re-engagement should center on providing a personalized, digital experience. Innovative AI-driven technology layered with an empathetic human element that adds a personal touch can lead to engaged patients and improved outcomes.

  1. Leveraging AI-driven Technology for Patient Retention:

Healthcare organizations must reach out to patients where they are, with the information they need. This means not waiting for the patient to proactively engage and request care; information and scheduling resources should be at their fingertips. While everyone may not have access to the internet, the vast majority of the population – 97% – own a cellphone with access to text messages. In healthcare’s effort to digitize, we must also keep in mind not to marginalize underserved populations with lower socioeconomic statuses. However, with a read rate of approximately 99%, text messaging provides a solution to engage populations across all socioeconomic statuses with personalized messages to re-engage people who have been avoiding or delaying medical care, while fostering healthcare plan loyalty and closing care gaps.

But for this type of outreach to work, it must go beyond simple text messaging. Automated text messages sent to patients who need to schedule appointments is only a small slice of effective re-engagement. Successful personalized digital outreach should be based on a comprehensive 360-degree patient profile, ensuring that patient needs and offered resources are tailored to their particular health journey. This comprehensive patient profile should include patient-specific engagement data, such as the last time they visited their primary care physician, and personal preferences, including language choices. It should also incorporate location data, like what relevant providers are practicing in the patient’s preferred location.

The key is that behind the actual text messages is a real human providing personalized healthcare guidance. The combination of targeted outreach and human touch points will provide that personalized, digital experience that healthcare systems have been struggling to prosper. A tailored message that sounds authentic and empathetic can make a significant difference with re-engaging patients and driving them to take action with their care.

  1. Don’t forget the Human Element:

The support of someone who can intervene, scale care, and escalate to care teams if needed means that the patient can more quickly get back on track with their care, and the healthcare organization can scale outreach and non-clinical tasks without additional internal resources.

“How do I access my medical records?” “I’m unsure how to schedule an appointment through my primary care provider?” “Where can I access this healthcare information?” These are all questions patients ask when navigating the healthcare system that need the human touch to ensure patients’ needs and resources are tailored to their particular health journey.

A high-tech digital strategy paired with high-touch human intervention combines the best of both worlds: innovative AI-driven technology and a caring touch that leads to engaged patients and improved outcomes. As an organizational retention strategy, this kind of holistic virtual care navigation can be a win for both health systems and the patients they serve.

  1. A Digital-First Strategy That Yields Tangible Results:

Take Adventist Health for example, a nonprofit integrated health system that designed a digital-first patient outreach service that initially targeted adults who had not had a routine wellness appointment in the past 18-24 months. This outreach leveraged community-based virtual navigators  and consisted of multiple SMS messages to engage patients and offer assistance with scheduling appointments with a primary care provider. Within four months, this digital-first strategy reached over 160,000 inactive patients and produced the following results:

The Bottom Line

A digital-first consumer experience enables organizations to retain patients in networks, provides an enhanced experience, and improves patient health — all invaluable benefits, for both patients and providers alike. Every patient who receives outreach to re-engage them with their care is one more patient who is more aware and active in their own health journey. Revenue recapture is a positive side effect of ensuring that the healthcare industry is succeeding with what it’s meant to do — keeping populations healthier for the benefit of society.

Jobs in healthcare

Essential Questions To Ask a Potential Home Healthcare Worker 

A home health care worker might be a good option if you need help with activities such as bathing, dressing, and toileting. They can help with light housekeeping, meal preparation, and providing transportation to medical appointments. This article will discuss essential questions to ask a home health care worker before signing a contract.

Questions to ask a home health care worker

Here are questions to ask a potential home health care worker before signing a contract.

What experience do you have? 

The experience of the home health care worker is vital to consider, especially if you’re looking for someone to care for an elderly family member. Ask about their experience working with patients with similar needs to your loved one. Their experience should also be considered when determining the type of tasks they’ll be able to handle.

Their experience should be able to give you some idea of whether or not they have the skills to care for your loved one. It’s also essential to ensure they’re comfortable with the type of care your loved one needs.

What is your availability? 

It’s essential to ensure that the home health care worker you’re considering is available when you need them. If you need someone to be available all hours a day, seven days a week, then you’ll need to make sure they can commit to that schedule. If you only need someone for a few hours a day, then their availability might not be as big of an issue. However, you’ll still want to make sure that they’re able to work around your schedule.

What are your rates? 

Before signing a contract with a home health care worker, ask about their rates. Their rates will vary depending on their experience and the services they offer. Make sure to get a breakdown of their rates to know what you’ll be responsible for paying.

Continue Reading

Jobs in healthcare