30.4.08

NHS Complaints Soar As More Patients Fall Victim To Hospital Superbugs

By Martin Nolan

In the UK we are blessed with a free healthcare system that provides good quality medical services for all residents.

Michael Moore's recent movie Sicko which lambasts the US healthcare system (and some would say rightly so) also makes a direct comparison with the UK National Health Service and suggest we are extremely lucky to enjoy superb medical care without the burden of insurance costs.

This is something few people in the UK would argue with. There is however another side to the NHS.

The service is under an enormous strain and right across the spectrum from nursing auxillaries through to highly skilled surgeons, pressure and heavy workloads are leading to record numbers of medical negligence or malpractice cases following serious clinical mistakes.

Many injured patients are turning to clinical negligence solicitors for help. There are a select number of recommended solicitors in the uk who have the expertise to deal with such claims. Injured parties should always seek firms who are members of the Law Society Clinical Negligence Panel.

As well as dangers caused by overworked doctors and nurses there is also the risk of acquiring a hospital superbug infection. The NHS system is having to deal with record levels of superbug outbreaks with strains of MRSA, MSSA and CDiff now rife in Britains hospitals.

Paradoxically, many patients are leaving hospital in far worse condition than they arrived. The superbugs are now regarded as one of the biggest causes of death in Britains hospitals and unfortunately the true scale of the problem is concealed by the governments method of gathering statistics.

Hospitals are able to nominate multpiple causes of death on official records in order to avert criticism.It may well be an unpopular decision but there are some instances where patients have no choice but to seek legal advice and pursue claims for compensation.

There is an alternative route to legal action and that involves making a formal NHS complaint, however no compensation is payable through this process.

For more on making a complaint about a medical practitioner, you can visit the official NHS website.

Martin Nolan is a legal marketer working for UK medical negligence solicitors

Lean Healthcare - Why Does It Work For Some And Not For Others?

By Mark Eaton

There has been a growth in the use of Lean in Healthcare but is it always delivering the desired returns? Experts are being brought in to support Healthcare "Lean" programmes but are they leaving the organisations with robust new processes and the competencies to deliver Continuous Improvement? We see a premium for Trusts when their imported experts successfully transfer knowledge, develop staff skills and help enhance the right culture for leading and embedding improvement and experience is already showing that the focus on simple effectiveness does not automatically lead to long term improvements or the most effective processes.

The same is true outside healthcare for organisations in manufacturing where "Lean" has its roots but where it is nowhere near as ubiquitous as many assume. Indeed, many manufacturing companies that were "going Lean" fell by the wayside on their journey and the government continues to invest heavily in helping manufacturers to implement Lean more effectively and to develop the underpinning skills that are required to embed the change.

The NHS can learn from the experiences in manufacturing, not only of those who succeeded but also of those who failed to realise benefits. Already some of the problems experienced in manufacturing are becoming evident in healthcare. For example we have seen some organisations focusing solely on 'Rapid Improvement Events' (i.e. the implementation of the improvements) without preparing effectively (i.e. designing the improvements) or setting up systems to maintain and embed the desired new ways of working. This (error) approach to "Lean" can convert Rapid Improvement Events into 'Rapid Ram Raids' where:

� Improvements quickly occur BUT are not sustained.
� New risks are introduced (i.e. patient safety).

The organisation wide outcome is a loss of inertia, misunderstanding and lack of buy-in, etc, resulting in negative staff attitudes toward "Lean".

Learning from manufacturing - Why has Lean not always delivered?

Some key reasons why Lean has failed to embed itself in some manufacturing companies are because the organisations have failed to:

� Set out an agreed vision and plan at the start
� Understand how the whole pathway functions prior to moving to 'Rapid Improvement Events'
� Build sufficient internal expertise and relying too heavily on external consultancy support
� Engage the team effectively and a failure to recognise the need to change attitudes (cultures) at the same time as changing processes

Whilst these same "Lean" failure modes are starting to manifest themselves in healthcare organisations, there are specific 'failure modes' unique to healthcare which need to be considered.

It is obvious the way that processes are organised and operated contribute to the success of healthcare organisations in delivering an effective patient experience and high quality patient care. They also create a unique pattern of patient safety risks. Some risks are more obvious (e.g. infection) whilst others are less obvious or are hidden (e.g. failure to transfer information between organisations in a timely manner) which can lead to an adverse event occurring.

Current ways of working will include risk / patient safety management controls (e.g. checks and procedures) and changes to this 'balanced system' change both the performance of the area under scrutiny and the pattern of patient safety risks. Given many of the sources of these risks are less obvious there is a danger that changes introduced will also introduce unintended risks. These risks may occur outside the area changed as the change may result in unidentified "interface" changes leading to unexpected or unplanned changes elsewhere in the organisation.

For example, focusing improvement activities on Outpatients to increase throughput may place unacceptable demands on diagnostics increasing their risk of errors. The failure to include representation from these supporting / interfacing areas increased the likelihood of problems simply being transferred elsewhere in the organisation.

In looking to become a 'Lean Healthcare' success story it is important to consider who needs to be communicated with and how will they be involved, how you will manage the on-going process of improvement, how to change behaviours and cultures as well as processes and most importantly what unexpected risks your improvement efforts might be introducing. Having said that, done effectively and with due consideration for managing patient safety risks and with a focus on sustainability of improvements, using Lean can make a significant difference to your organisation's performance.

In fact it could be said that doing Lean at the right time, in the right place and implementing it in the right way should lead to 'Sustainable, Safe & Responsible Service Improvement'.

This article has been prepared by Mark Eaton of Amnis (http://www.amnis-uk.com) and Mark Boult of DNV (http://www.dnv.com). The full article was first published in National Health Executive Magazine in the UK.

Protecting The Future

By Andre Zayas

Children are the greatest resource that this country has. Today's children will someday grow up to be the doctors, lawyers and even politicians that make the world the way that it is today. A child today in Terrell may one day become the doctor who finds the cure for AIDS or a better cancer treatment increasing the odds of survival. Protecting these children and making sure that they get the chance to grow up is important. The Texas Children's Health Insurance Program (CHIP) can help to ensure that they grow up healthy and strong.

Visiting a Terrell nurse practitioner or doctor regularly with your child can help to make sure that your child is as healthy as possible. Many childhood illnesses are fairly harmless. However, when some of these illnesses go untreated or unnoticed, they can become very serious and cause damage to the child or even death. Unfortunately, many children in Terrell are underinsured. The CHIP program has been established to make sure that no child has to suffer needlessly.

Children are not the only people who can be covered underneath Terrell's CHIP insurance. Because a child's health can be affected as early as pregnancy, CHIP will also cover a pregnant woman. She will be able to get coverage for any necessary medication as well as prenatal check ups to make sure that the child is born as healthy as possible. Since many are uninsured, prenatal visits are often one of the first things a woman will push to the wayside in preparation for the high costs associated with giving birth. The CHIP program allows the woman to get those prenatal visits as well as covering the birth.

Making sure that each child is given the best chance at life, the Terrell CHIP program is in place to help. Uninsured and underinsured children and mothers-to-be can receive all of the medical care they need without worrying about breaking the bank.

Andre Zayas is a professionally syndicated author.

The Benefits Of A Medical Alert System And Where To Buy One

By Craig Thornburrow

A medical alert system is a helpful device used by a large group of individuals. Senior citizens as well as single individuals who live alone are the large majority of individuals who have a medical system in their home to alert someone if they need medical attention and cannot get to a phone. There are many benefits to a system of this type and some of these will be described below along with information pertaining to where to buy this useful medical alert device.

Benefits of Medical Alert Systems

These types of emergency systems have many benefits associated with them. One of the main benefits is that they provide help to individuals when they cannot get to a telephone to call emergency medical services. Since the medical alert devices are worn on their wrists or around their necks, all they have to do is to reach up and hit the designated button and they will be contacted with the medical alert company right away. This convenience is one benefit of the medical system.

Another benefit to the medical system is that it provides independence to individuals who may not have been able to live alone without such a device. By having this type of system in place, if the individual is a senior citizen they will feel confident in living alone as will their family members who know that a medical alert system is right by their side.

Medical alert devices are also quite reasonable in cost. Depending on the type of system one orders, they may have to pay for the devices in addition to a monthly monitoring fee. The prices will vary from company to company but overall the price is reasonable and is usually around $30 per month. When viewing everything that one gets for this price it can easily be justified and seen as a great deal.

Where to Buy a Medical Alert Device

Because these devices are very popular they are available in a wide range of places. For those who are Internet savvy, ordering this item through a company online is an option. Simply use a search engine to enter in phrases like "medical emergency device" or "medical alert device" and you will find a number of company's websites pop up in your search results. Review the website information of each company and then narrow down the options based on service in your area, benefits included with the service and overall price of the system. Doing so will help you to make the best choice with regard to medical alert device company.

For those who prefer to shop in offline venues, you may find information pertaining to different companies through your doctor's office, in the yellow pages, ads in magazines and advertisements on television. Again, review the information and narrow down the options based on the best results found when it comes to the right type of medical alert system.

Craig Thornburrow is an acknowledged expert in his field. You can get more free advice on medical alert systems and personal medical alert systems at http://www.medicalalertsolutions.com

A Closer Look at The Hospitality Business (3)

By Hans Bool

Reservations are used in industries where capacity is at stake and where the distribution of capacity needs to be organized as efficiently as possible. Examples are: the airline industry, hotels and other recreational services like (Movie) Theaters, and also hospitals, although the reservation there is based on a previous screening. In all these cases the supply of capacity is offered by a differentiation of price which controls the stream of clients.

Business Intelligence can be used in this area to examine patterns of demand. In most cases every business of this kind is dealing with a seasonal pattern, but there are other patterns too.

To attract additional customers in low-season-periods, management can organize special campaigns beside the normal reservation process. But also a campaign on itself is not enough, there must be something to draw the attention to. This can either be an existing event or an event that is organized especially to attract customers.

One example is the Olympic Games. It shows on its side that it is participating in the organization of the Games. This will increase the traffic to the hotels during that event. The effort to enter the Olympic Games will pay itself back easily. Internally, these different campaigns and the normal operational business should always be coordinated well. It is possible that the current business gets negatively affected by a mayor event.

Other events are more autonomous, with the single purpose to attract more traffic. These should be arranged during the low-season. The Short Story Award of NH Hotels is an examples of the last. Such an event generates more visitors and if it is organized during a low-season the hotel business becomes more stable, and with an increased REVPAR.

Another FAQ in the hospitality business architecture is: how do all the individual hotels coordinate their work in a way that different hotels have the same image? This is about style and culture.

To be continued...

ฉ 2008 Hans Bool

Hans Bool writes articles about management, culture and change. If you are interested to read or experience more about these topics have a look at: Astor White. On this site you will find more about business architecture.

Healthcare System Considerations

By Lance Winslow

In the United States it is often said that our Health Care System is broken. In other nations they claim to have free-universal health care to protect their people. Unfortunately, when looking at all the other nation's health care systems, they indeed fall short and adequate care is often not available. Or there are long waiting lists and lots of red-tape, excuses and qualifications to get certain types of care. So, it's not always as green on the other side of the pond as one might think.

Indeed in our country, we have private health care plans, which seem to work well, as insurance coverage is available to anyone wishing to buy it. Many companies offer some health care benefits to employees, but not all. Most small businesses do not have adequate coverage for their employees. But then again what is adequate, in other countries it's all free, but folks complain it is inadequate still.

Still, with all the choices we have in the US for health insurance in the private sector, and overlays to protect those with no insurance in the public sector, it is amazing that everything is so gosh-darn complicated. You see coverages from private health care plans vary so much, it's hard to be sure you are buying the right insurance.

When it comes to the government's health care system with Medicade, Medicare and the likes, it is truly insane how complicated it all is. For senior citizens it is downright unfair, because they have no idea what is going on and it is mentally taxing just trying to understand all the rules, rules that keep changing like the political wind.

"Lance Winslow" - Online Think Tank forum board. If you have innovative thoughts and unique perspectives, come think with Lance; http://www.WorldThinkTank.net/. Lance Winslow's Bio

Retiring At A Medical Center?

By Alice Lane

To some that may sound a bit bizarre and to others it sounds comforting. To those who are doing it life is grand. The Medical Center is Riverside and it is one of the top dogs in independent retirement living.

As a matter of fact, it is the only program of its kind in the Chicago area and in the greater Illinois healthcare system. Riverside Senior Living views retirement as a time for fun and leisure along with a time for learning and continuing to grow. One way the residents do this is by giving back to the community. Learning and growing often accelerate when you are helping others. By serving from their hearts, they not only help themselves but more importantly they help others including the other residents and the staff. A Riverside declaration that is not only said but lived is "Punctuate your life."

The belief that life is discovery is determined by the questions asked. The proof that life is a journey is often presented in the rough part of the road we travel down. Without the rough parts, much like the rain, there would be no celebration, much like the rainbow. The fact that we are all connected is illustrated when we help heal others, as we ourselves are then healed which in turn then continues to heal others. This is a simplified description of some of the beliefs at Riverside Senior Living. For a more detailed view please go to Riversidehealthcare.org.

The options for living are many and varied. You can choose from active independent living to 24-hour fully assisted Chicagoland assisted living when necessary. Another program offers compassionate and nurturing care for Alzheimer 's disease or Dementia. When you need assistance in your life it is good to know that caring and nurturing professionals don't see it as their job but more importantly see it as their calling.

They are there to assist you in every step of the way whether it is by asking the questions to interpret the discovery in your life, by helping you celebrate your life or by being there with a helping hand to do those things you can no longer do. Retiring at a Medical Center no longer sounds so bizarre but it should begin sounding more comforting.

Whether you are looking for the best assisted living Illinois or simply a fun and interesting place to hang out with people your age who have fun times and experiences to share, you will find looking at Riverside Senior Living may make sense for you and your loved ones. No one wants to think that something will go wrong but when and if it does, it is good to know that not far away are the facilities to handle almost any situation. Not only will the medical center be there to help get you back on your feet but they have the facilities to help with physical, rehabilitative, speech, occupational and respiratory therapy. All of this from one of the top 10 hospitals in Illinois.

The Riverside Medical Center is one of the best in assisted living in Illinois. With today's Illinois healthcare it can be tough to age the way you want to. Why not choose your independent retirement living from a professional in Chicagoland assisted living, check out RiversideHealthcare.org.

Choosing The Right Medical Center

By Alice Lane

For some people choosing the right medical center is a matter of life and death. For others it is a matter of quality of life. For a few it really does not matter all that much. If you fall into the first or second category and if you are choosing from hospitals in the Chicago area you may be considering Riverside Medical Center. You may find that Riverside Medical Center offers excellent choices when it comes to medical services that can save your life and provide a higher quality of life after medical procedures. They have a philosophy of providing good customer service by providing the latest technology, great physicians, excellent support staff, exceptional facilities, out of box thinking when it comes to holistic care and a place to retire and enjoy your life after working so long.

With regards to technology they offer the use of a daVinci robot in their cancer treatments and cardiac treatments. The daVinci robot is controlled by a surgeon which allows a more precise incision and a smaller incision to do the same operation as before the robot existed. The benefits of this include less blood loss, less scarring, less damage to surrounding tissue and nerves, less invasion to the human body, quicker recovery, less pain and more accuracy. These are important to the patient in terms of the surgery itself and also in terms of the quality of life after the surgery. If you need a robotic prostatectomy for instance, then you are probably concerned with nerve and muscle damage in the area surrounding the prostate. With the use of the daVinci robot, the surgeon is less likely to damage them due to the precision available with the robot.

Also, the technique is used in cardiac surgery. Those who need robotic heart surgery will find the Rush-Riverside Heart Center is the best in Illinois for surgery. The benefits of the robotic assisted surgery are the same in cardiac operations as in cancer treatment surgery. Less intrusion, less blood loss, less scarring, quicker healing time, and less likely damage to tissue around the heart are all results of having the daVinci robot on your side. The surgeon is able to be more precise and thus the patient benefits. The cardiac rehab program is also exceptional so after having the precise operation the rehab program allows the patient to recuperate and possibly have a better quality of life. You'll find the Heart Center is a wise choice for those who need to have help getting their heart health back on track.

For those who are looking for a place to retire, the retirement program at Riverside is next to none. They are very progressive and make the environment one where life is celebrated and lived to the fullest. A person can not only thrive but can live and grow by continuing to live a life of learning and fulfillment. You'll find a quality of life that will allow a person to be independent or have the luxury of assisted living when necessary. Riverside Medical Center is a place for helping you back to health and for living a quality of life that allows you to maintain that quality.

When you are searching for hospitals in the Chicago area, take a look at RiversideHealthcare.org. Riverside has the Cardiac experience you want in robotic heart surgery and cardiac rehab program to get you back to the way you want to live.

Medical Transcription Services and Specialties

By Ricci Mathew

Today medical transcription has almost become a popular term among the health professionals and services are available for all medical specialties. What is Medical transcription? It is the extensive procedure of transcribing voice-recorded reports done by doctors and healthcare professionals into text formats for various uses including for research and reimbursements.

A medical transcriptionist's job primarily involves converting significant, confidential, and up-to-date data into written text. This text is printed and included in the patients' records, archived and retained as an EMR (electronic medical record).

Transcriptionists can today work either from inside the hospital premises, from their homes or from any other distant global location. Electronic storing of medical records is preferred by modern medical institutions because of the huge volume of patient data being accumulated. Also it makes it very easy to incorporate all details including the medicine, diseases details and other diagnostic information. Maintaining of this type of records is primarily to facilitate the patient's healthcare and also to use it as a general use data bank while still maintaining confidentiality of patient data.

What is the actual MT process comprised of? It generally includes,

  • Tying of documents
  • Active listening
  • Information formatting
  • Editing/proofreading
  • Checks for compliance with medico-legal policies and procedures

  • Medical transcription services are offered specifically for all the different medical specialists. Today we have experienced medical transcriptionists who do specializations in transcription of different branches of medicine. Thus there has evolved various specialty medical transcriptions like radiology transcription, pediatrics transcription, cardiology transcription and so forth.

    Though all medical transcription professionals have to be familiar with transcribing all branches of medicine, a specialty transcriptionist, (some one specialized in transcribing for a particular branch of medicine) often gets preferred by the respective specialist. Further specialty in each branch is also done. Thus if we take specialty transcription professional he will be an expert in transcription of all pediatric specialty areas such as allergy immunology, anesthesiology, endocrinology, cardiology infectious diseases, neurology, nephrology, orthopedics, sports medicine and general academic pediatrics.

    There is a recent increased trend in the usage and dependence of voice recognition software for transcription. However the technology for it is yet not perfect and if the documents are not well looked into and edited by humans, it can give irrelevant and absurd transcripts. One can expect the regular manual transcription to be around for some time into the future and the fear of voice recognition software based transcription totally replacing the human element is not valid. Th demand for health services and medical transcription is on the rise as the number of aging population is fast growing and the law requires transcription documentation of medical bills for the insurance benefits on worker's compensations.

    The author of this article is Ricci Mathew of Outsource Strategies International (OSI), a US based company that offers services in Medical Coding, Medical Billing, Medical Transcription for clients across the US.

    Change The System, Stupid (Part 2 of 3)

    By J. Deane Waldman

    This is the second Part of a three-part series on the U.S. healthcare system. In Part 1, we came to understand the causes of problems in our healthcare system, not just the obvious symptoms that everyone complains about: rising costs, bad outcomes and errors; medical malpractice; and personnel shortages. We know that to cure anything, you must treat the causes not the symptoms. To cure a headache, you remove the tumor rather than just give the patient morphine.

    Most of us feel the need to assign blame and take aim at rich, uncaring insurance companies; wealthy, arrogant doctors; or even wealthier, Ferrari-driving medical negligence attorneys. Let me help put the blame squarely where it belongs: with the system, not its parts.

    The reason we experience what we do from healthcare is because the system does not work. As presently constructed, it cannot work. That system is plagued with internal consistencies and contains a malprocess in place of an effective malpractice system. Lacking an effective decision-making process, it makes bad decisions.

    IT'S THE SYSTEM, STUPID!

    Internal Contradictions and Inconsistencies

    The healthcare system is replete with contradictions under which both white coats [providers] and the suits [administrators; managers] must try to function. Academic and business people believe that health care is or should be regulated by the market (supply and demand) while the Public has been told over and over that health care is an inalienable right.

    Everyone knows that the more information available, the better our health care: fewer errors; more consistent and less costly care; and better quality. Yet government regulations like HIPAA (Health Insurance Portability and Accountability Act) place a higher value on security and confidentiality that on quality or error prevention.

    The following scenario is real: an everyday occurrence. A medical receptionist is asked to FAX health information to another doctor. By HIPAA rules, she is forbidden to read the FAX. According to the Patriot Act, she is required to read the transmission. What should she do?

    Many hospitals are required by law to provide care to certain patients, even if the hospital never gets paid. Imagine a business that is required to give its services away for free. What games would it have to play, what tricks must it use to stay in business?

    The care a patient receives is a summation of decisions made by medical providers, health care managers and healthcare regulators. Yet the only group held responsible for the outcomes are the providers.

    Contradictions and inconsistencies abound.

    Medical Malprocess

    There is a complex structure built to deal with bad outcomes in health care called medical malpractice or med-mal. What do we want med-mal to do? Vengeance? Weeding out "bad apples" (incompetent providers)? No, we want two things from any such system: 1) help when injured during medical care, and 2) learning from bad outcomes to do better in the future.

    Our current system is an adversarial process in court where the injured patient receives compensation only if a provider, one with a deep pocket, is proven negligent. Furthermore, the med-mal approach shrouds the details in secrecy, preventing wide sharing and subsequent learning. Med-mal is a malprocess: a "bad system" that does not deliver what it is supposed to because it cannot, as presently constructed.

    A process is "a series of steps taken in order to achieve a particular end." The current practice of medicine is a process that fails to achieve the results we want. Therefore, healthcare as a whole is a bad (mal) process.

    Flawed Decision-making

    To accomplish anything, from opening a door to buying a hotdog to getting your hernia fixed, you have to make decisions. The better the decision, the better the outcome. The process of making good decisions requires two elements lacking in healthcare: evidence and feedback.

    You need evidence in order to know that what you decided will accomplish what you want. Feedback is necessary to tell you what actually happened so you can do better the next time.

    In healthcare, there is a strong commitment to evidence-based decision-making but only among providers. Managers, regulators, and legislators depend on logic and have no obligation to prove in advance that what they decide will work.

    For providers, feedback is weak and often prevented by med-mal secrecy, confidentiality rules, and security protocols. For healthcare managers, regulators and legislators, there is no feedback or consequences - to them - from the decisions they make. How can anyone learn to do better if they do not get feedback?

    Conclusion, Part 2

    As long as we focus on the big, bad insurance company, the drunken nurse or the lazy, incompetent bureaucrat [all rarities], we can ignore the real culprit: a system that was never intended to handle modern medicine and therefore, does a very bad job of delivering good health care. Details on all of these issues can be found in the forthcoming book Medical Malprocess, and at www.thesystemmd.com. In Part 3, we consider what we can do to create a good (bene) process.

    Note: Every statement made herein can be supported by evidence: they are not simply the author's opinion or bias. For examination of these references, feel free to contact the author.

    By J. Deane Waldman, MD MBA

    http://www.thesystemmd.com

    Medical Transcription Standard

    By Ricci Mathew

    MTIA (Medical Transcription Industry Association) along with AHIMA (American Health Information Management Association) recommends a standard unit of measure for medical transcription of patient medical records. It recommends the visible black character (VBC) measurement standard to be the best document counting method. What was the purpose of having such a standard?

    The final goal was to implement a standard for content measurement that the health information management (HIM) practitioners can use to evaluate in-house transcription staff and external transcription service suppliers. The earlier 65-character line standard (also called as the AAMT line) had previously been a standard industry wide unit of measure for content measurement that includes space bar, shift key, bold, underscore, and other keystrokes. With this system the cost for the line/character goes beyond just labor as the cost of the technology is bundled along with domain knowledge and human resources. Thus it became mandatory to develop/choose the best possible Industry standard. The benefits of having such a standard include ease in maintaining service level agreements, better business relationships and having a better tool for evaluation.

    According to The MTIA /AHIMA task force among all the different counting methods like ASCII line, the 65-character line, gross line, gross page, per minute pricing, and visible black character (VBC) measurement standards, VBC is the only counting method that can be easily understood, verified, and replicated by all parties in the medical transcription business processes.

    Whenever a transcription document is reviewed for quality what are the principles that establish the quality of the documents?

  • The transcribed report should be reviewed against the actual dictation. Reading the report without listening to the dictation does not provide an accurate comparison of the transcription to the dictation.
  • The review should apply industry-specific standards as provided by current resources and references. When evaluating style, punctuation, or grammar, The AAMT Book of Style is the industry standard.
  • The review should encompass attention to risk management issues and the documentation standards of accreditation and healthcare compliance agencies.
  • Accuracy scores (ratings) should be quantified with the use of a numeric calculation that weights varying degrees of error against the length of the report. AAMT recommends the following quality goals: 100% accuracy with respect to critical errors; 98% accuracy with respect to major errors; and 98% accuracy with respect to all errors in the report, including minor errors (see below for definitions of "critical," "major," and "minor" errors).
  • The reviewer (or the review process) should provide timely and consistent feedback to the medical transcriptionist in order to eliminate repetition of errors.
  • All measurements, standards, and benchmarks should be disclosed to the medical transcriptionist and should be set forth in written guidelines by the healthcare provider or transcription service.

  • The author of this article is Ricci Mathew of Outsource Strategies International (OSI), a US based company that offers services in Medical Coding, Medical Billing, Medical Transcription for clients across the US.

    Medical Classification is Medical Coding

    By Ricci Mathew

    What is medical classification and what is medical coding? Well, both the terms refer to the process of transforming details of medical diagnostic processes and diagnosis into medical code numbers that are universal. The four basic categories of coding are diagnostic codes, procedural codes, pharmaceutical codes, and topographical codes. The diagnostic codes are used to group and identify diseases, disorders, symptoms, and medical signs, and the procedure codes are numbers or alphanumeric codes used to identify specific health interventions that are taken by medical professionals. While the pharmaceutical codes are about medications the topographical codes indicate the concerned body part.

    From where are all these details about the patient's disease and his medical history taken? Some of the sources include,

    • Doctor's notes
    • Biochemistry Lab reports
    • Radiology reports

    What is the use of these medical codes? They are used to track diseases and quite useful for health insurance companies, government hospitals, worker's compensation carriers etc. These medical coding/ classification system applications are mainly used for reimbursements of the medical bills from insurance companies. It is also used for statistical analysis, in epidemic surveillance and for knowledge based decision support.

    Here are the different types of medical classifications;

    • Reference Classifications
    • International Statistical Classification of Diseases and Related Health
    • International Classification of Functioning, Disability, and Health
    • International Classification of Health Interventions
    • International Classification of Primary Care
    • International Classification of External Causes of Injury
    • Anatomical Therapeutic Chemical Classification System
    • Technical aids for persons with disabilities: Classification and terminology
    • International Classification of Diseases for Oncology, Third Edition
    • ICD-10 for Mental and Behavioral Disorder
    • Application of the International Classification of Diseases to Dentistry and Stomatology
    • Application of the International Classification of Diseases to Neurology
    • International Classification of Functioning, Disability and Health for Children and Youth
    • Procedure Coding System
    • Diagnostic and Statistical Manual of Mental Disorders
    • Systematized Nomenclature of Medicine
    • TNM Classification of Malignant Tumours
    • Unified Medical Language System
    • Mendelian inheritance in Man
    • Current Procedural Terminology
    • Health Care Procedure Coding System
    • North American Nursing Diagnosis Associates
    • Logical Observation Identifiers Names and Codes
    • International Classification of Headache Disorders 2nd Edition

    The author of this article is Ricci Mathew of Outsource Strategies International (OSI), a US based company that offers services in Medical Coding, Medical Billing, Medical Transcription for clients across the US.

    Change the System, Stupid (Part 1 of 3)

    By J. Deane Waldman

    When Bill Clinton was running for President in 1989, his campaign manager James Carville had three short but powerful messages printed on poster board and displayed in the wings so that Clinton couldn't miss them as he went on stage to speak. They were the following.

    1. "Change versus more-of-the-same,

    2. The economy, stupid,

    3. Don't forget health care."

    It worked for Clinton. Maybe it will work for our broken health care system with slight revisions and in reverse order.

    1. Don't ignore (healthcare) causes.

    2. It's the system, stupid.

    3. Change versus more-of-the-same.

    The following series of three articles � one for each of Carville's slogans � discusses what is really wrong with healthcare and how to cure it, not just make things temporarily seem or sound better. The first (below) will describe some causes of healthcare dysfunction: wrong measurements; fiscal fantasyland; as well as cultural confusion and conflict. The second will show why the system is at fault, not its parts: internal contradictions; medical malprocess; and ineffective decision-making.

    The first two articles are descriptive: they describe what is wrong. The third is prescriptive: it suggests what we need to do to cure the patient. Details on all of these issues can be found in the forthcoming book Medical Malprocess, and at www.thesystemmd.com, which is also where the recommended national dialogue could start.

    DON'T IGNORE (HEALTHCARE) CAUSES

    When describing our sick healthcare system, most people confuse what doctors call signs and symptoms with causes. Rising costs; unequal and diminishing access; errors and bad outcomes (not necessarily the same); and shortages, especially of nurses and doctors: these are all symptoms. If we treat Them, we will mask the real problems and not cure the patient. Therefore, the first step in true healing is diagnosis of why, the causes of the sickness in our healthcare system.

    OOOPS, WRONG MEASURING CUP

    Experts in business and management constantly remind us that you get what you measure. This means that what you pay attention and measure is what the workers will do better and more of. The outcomes measured in healthcare are: deaths; complications; errors; costs; and lawsuits. Is that what we want? That is what we get.

    Healthcare tracks deaths, errors and costs because measuring them is simple: they are all short-term and easy to quantify. The outcomes we truly want are hard to measure and long-term: long, healthy life; less money spent; continuously better and better care. If we start measuring the outcomes we seek, many of the inconsistencies, confusion and symptoms in healthcare would vanish.

    FISCAL FANTASYLAND

    The word "cost" does not have the same meaning in healthcare as it does in common usage. When you go to the cleaner to pick up your skirt, you pay a bill that is equal to the cleaner's actual cost plus some profit. In healthcare, no one knows the true cost of anything. That is no exaggeration and bears repeating: no one how much your hernia repair or heart surgery actually cost! In healthcare, so-called cost is an allocated number and has nothing to do with what gets paid. That statement too bears repetition: what gets paid in healthcare is generally a very small fraction of what is billed.

    For all healthcare services and products, there are payment schedules regulated by the government and the insurance companies follow suit. So, payment or supply (of money), called allowable reimbursement, is fixed. Demand (for services) is variable. Anyone who have ever balanced a checkbook, much less a trained economist, will tell you that a system with fixed supply and variable demand cannot be stable. This is a recipe for disaster. Welcome to healthcare fiscal fantasyland where words do not mean what they usually mean and where people running for high office promise better and cheaper and quicker. They cannot deliver, not with the system we currently have.

    CULTURAL CONFUSION AND CONFLICT

    The culture of healthcare is a third source of dysfunction. It is complicated by confusion and conflict.

    Confusion is ubiquitous. Providers � nurses, doctors, social workers, allied health personnel � are constantly told to put the patient first: in school, by their mentors, and according to the sign at the front door of every hospital, clinic and office. Then reality sets in. Talk to the patients, sure, but we do not have enough translators: the budget does not allow. Be caring of course, but do the history, physical, think, make decisions and write out the prescriptions in 14 minutes: doctors must be efficient. Sorry, but that catheter or particular drug or certain specialist is too expensive, not covered in the plan, and therefore you cannot use it or consult her. Yes, it is very hard to get to the hospital from the parking structure, but that is the cheapest way to build the structures. Etc. Etc. The provider is imbued with a cultural value that the welfare of the patient comes first, but the budget is king.

    Those who deliver the care, called the white coats, have a different culture than those who control the resources needed to deliver that care, called the blue suits or suits for short. Even though they work in the same place and share (unknowingly) core values, they think differently, were socialized to different standards and approach problems in fundamentally different ways. Worst of all, each sees the other as the enemy. This conflict, coupled with limited resources, oppressive rules, and a mountain of contradictory regulations assures that collaborative problem solving will not happen.

    CONCLUSION, PART I

    In order to cure anything, from your golf slice to our healthcare system, we must treat the reasons for illness not just the symptoms. Some of the major causes have been discussed above. You can consider these and others in greater detail at www.thesystemmd.com. In Part 2 of this series, it will become clear that the system as a whole, not individuals or parts of the healthcare system, is at the root of our problems. Part 3 will show what we can and must do to fix healthcare.

    Note: Every statement made herein can be supported by evidence: they are not simply the author's opinion or bias. For examination of these references, feel free to contact the author.

    By J. Deane Waldman, MD MBA http://www.thesystemmd.com

    Google and Microsoft's New Battleground - Your Health

    By Paul Fezziwig

    The concept of online patient medical records is taking off after Google recently released 'Google Health' and Microsoft a few months earlier released 'HealthVault'. AOL was first out of the block with 'Revolution Health' but hasn't made quite the same splash as the big two behemoth's.

    Online medical records will allow patients to access their complete medical records (have you ever wondered what's in your paper file, now you'll know) wherever they go. With most people moving many times in a life time and seeing many different doctors this will lead to more informed and better healthcare decision making as their complete records follow them wherever they go.

    Currently when people move they usually just start a new file with their new doctor, leaving their medical history behind. When they also see different specialists these doctors will likely not see the patients complete medical history and just base decisions on the current diagnosis, including emergency situations. Now these doctors will have a lifetime of medical history at their fingertips instantly.

    This also cuts down on a great deal of administration expenses and delays which may be reflected in lower healthcare insurance premiums if implemented.

    The technology has been available for years to make this a reality for everyone, it will improve patient healthcare decisions and cut down on administration expenses. So why haven't we put everyone's medical history online previously?

    For starters, current healthcare records are primarily on massive amounts of paper, about 14% is currently stored on a computer in the USA. Transferring the mountains of medical records to a digital format is no small task and could induce more than a few cases of carpal tunnel syndrome typing all that data in. Most other industrialized countries have 50-90% of their records currently stored on a computer.

    So why has the USA been so slow to put medical records on a computer?

    In the USA hospitals are really business's, and they don't want to share information with their competition. Why should they help a patient/customer go see another doctor at another hospital? So they will drag their feet as long as possible.

    Despite this Google and Microsoft are getting many people to volunteer and join their programs. These eager volunteers may be in for a bit of a surprise down the road.

    Medical record privacy laws were written 12 years ago and addressed doctors, pharmacists and patients. There are no references to anything that may cover Google and Microsoft. In other words you will need to trust these large multibillion dollar corporations to look out for your best interests. Most of you are probably having a good chuckle after that last sentence.

    Why should you care if Google or Microsoft sells or grants access to your medical records to the highest bidders?

    Those bidders will be insurance companies and it would be pure gold to them. They could raise premiums or even deny you health insurance based on the slightest medical problems you have, and if you have a 'suspicious' gene it gets worse. Now you can adversely affect your children and relatives seeking medical insurance as they may be deemed carriers of this questionable genetic trait because of their relation to you.

    Then employers will be bidding on those precious records. Perhaps they will conclude you are likely going to cost them a lot of medical expenses, therefore you can forget about a promotion or if you are applying for a job you're out of luck.

    These online medical records have the potential for great benefits but until legislation to protect patients catches up with the technology those early volunteers signing up are in for a big surprise down the road, after all, Google and Microsoft are interested in the health of their bottom line, not your medical health.

    Paul Fezziwig is a contributor for Healthcare Reviews, http://www.healthcarereviews.com , a free patient resource to rate and review their doctor, hospital, dentist and more.

    Medicare & Medicaid Doctor Directory - How to Find Doctors Who Accept Medicare and Medicaid

    By Jackie Jones

    If you are receiving Medicare and/or Medicaid, it can often be difficult to find a doctor, be it a general practitioner or specialist, who will accept your insurance. Unfortunately the payment schedules set up by the government have resulted in many doctors opting out of the system because they simply cannot afford the substantially lower payments for Medicaid/Medicare services as well as afford to pay for the substantially greater paperwork involved in taking such patients.

    Sadly, government has had a tendency to reduce reimbursement payments, not increase them, and do not seem to be interested in covering the actual cost of providing services.

    Not only that, but private insurers are not longer willing to "subsidize" public patients by paying higher rates, so doctors cannot shift the ever-increasing costs to them.

    As a result, at a time when more and more doctors are opting out of the system, those doctors who still take Medicare and Medicaid patients generally limit the number they will serve, so finding a doctor who will take your Medicare or Medicaid insurance is not as easy as simply opening the phone book and making a phone call. Indeed, it probably will take some real time and effort on your part.

    There is not, and never has been, any requirement that doctors treat patients insured by Medicare or Medicaid. Therefore, people with Medicare or Medicaid are increasingly turning to federally funded clinics, or even to emergency rooms that cannot, by law, turn them away. Sadly, using emergency rooms for non-emergency health care is unbelievably expensive, making the lower reimbursement Medicare/Medicaid rates not financially wise in the long run.

    So, how do you find a doctor that will take new Medicare/Medicaid patients?

    Well, first of all, do not expect to find a doctor or, should you find one or a clinic taking Medicare/Medicaid patients, do not plan on getting an appointment quickly. Sadly, that will not happen very often. Indeed, if you need quick care, the emergency room is likely to be your only recourse.

    To track down Medicare/Medicaid providers, you can contact your local health department or social service agencies to find out more information and there are a number of Medicare and Medicaid doctor directories online. While they cannot guarantee you an appointment, they do have access to information about current providers.

    You can also go to the Medicare website at Medicare.gov or call them at 800-633-4227 (TTY 877-486-2048) to find Medicare providers in your area, although there is no guarantee they will be accepting new patients. It is worth a try, though.

    Also, managed care is probably a better bet than private practice. HMOs organized by private insurers have a practical interest in having HMO doctors taking government-insured patients, while Prepaid Health Plans (PHPs) are generally run by hospitals or medical schools, and often only accept Medicaid patients.

    To learn more about your Medicaid or Medicare health benefits and for many more informative and helpful articles and guides, such as how to choose the right Medicare plan, visit the Medicare Newsline today at http://medicarenewsline.com

    Understanding How Hospitals Buy Medical Technology

    By Alec Alpert

    Modern hospitals depend heavily on medical technology to diagnose, treat and prevent diseases. A typical mid-sized hospital has hundreds of items of medical equipment, from simple stethoscopes and blood pressure monitors to highly sophisticated MRI machines and linear accelerators. Hospitals are complex enterprises with entire departments dedicated to technology planning, assessment, acquisition, maintenance, upgrade and replacement at the end of the product life cycle. They have elaborate systems, programs, policies, procedures and protocols in place for purchasing new medical equipment.

    To sell successfully to healthcare providers, marketing and sales professionals have to be well versed in the buying processes that healthcare providers use. Medical device marketing is quite different from any other marketing. Typically, hospitals have a review process to qualitatively and quantitatively evaluate their medical technology needs. The review's scope depends on the cost of the technology, and may involve many departments. For expensive equipment, the review most likely will be elaborate. For less expensive and disposable items, the review may simply assess the department's current needs, and the proposed purchase's operational and financial impacts. In either case, a market survey and literature search take place to some extent, and this is supplemented with extensive data collection and analysis when needed. This is why white papers and case studies published by medical device manufacturers are very useful during the review process - the decision-makers look for every bit of information they can find. Hence, white papers and case studies can significantly influence the decision-making process. A typical review process includes the following phases:

    1. Strategic
    2. Assessment
    3. Acquisition
    4. Utilization
    5. Repair and maintenance
    6. Replacement and disposal

    The process starts with strategic planning. In this top-level phase, the relevant stakeholders (e.g., Directors, Professors, Managers, Doctors, Engineers, Purchasing, etc.) review key issues, success factors and resource allocation, and assign responsibilities for sustained improvement in technological performance. They identify the services their facility provides, and the technologies that would complement their existing services. The typical questions to answer are: Where are we? Where do we want to be? How are we going to get there?

    Because medical technology greatly impacts the cost and structure of healthcare delivery, hospitals include technology assessment in their planning process, which typically includes cost-benefit and cost-effectiveness analyses.

    Cost-benefit analysis calculates the costs of applying the technology and compares them to the benefits resulting from its application. It provides criteria upon which to base decisions of whether to adopt or reject a proposed device. The device is adopted if its benefits exceed its costs. However, one limitation of this analysis is that it expresses all benefits, including therapeutic effects, in monetary terms. Hence, hospitals also conduct cost-effectiveness analyses to quantify therapeutic effects in terms of reduced patient hospital stays, and compare these to the costs of the technology's implementation. Although at first glance the chosen technology may seem to have limited impact on other facility operations, stakeholders also examine the likely effect of the new equipment on existing services.

    Other aspects of cost-effectiveness analysis include assessment of long-term replacement strategies and identification of emerging technologies. Since medical devices have finite longevity, hospitals have replacement plans to minimize the effects of unforeseen capital replacement. By identifying emerging technologies that fit into the projected plans of the hospital's service area, the hospital tries to avoid investing in nearly obsolete technologies.

    Purchase of a new technology is justified only when an increase in equipment's cost-effectiveness is clearly demonstrated. The typical questions asked during the analysis are:

    * Will the new medical device increase the volume of the service?
    * Will it raise the costs of the service?
    * Will the device generate additional revenues and, if so, how much?
    * What is the new device's expected lifespan?
    * What is the device's reliability and the costs associated with its repair and maintenance?
    * How reliable and reputable is the manufacturer?
    * What impact will the new device have on routine operating costs?
    * What will the disposal cost be?
    * How easy is the device to operate?

    Once the technology has been assessed and the decision to purchase has been made, the next phase in the process is technology acquisition, which typically includes the following steps:

    * Preparation of general and functional specifications
    * Clinical, technical and cost evaluations
    * Review of proposals and evaluations, and making a final decision on a device manufacturer
    * Contract negotiation for the device's acquisition
    * Preparation and issuance of a purchase order
    * Contract award

    A contract award is the green light for the medical device company to deliver and install the product.

    Alec Alpert is a business-to-business copywriter specializing in lead-generating white papers, case studies and articles for medical technology. Visit http://www.alecalpert.com to learn how his copy can boost your lead-generation campaign.

    Medical Billing and Coding Certification

    By Ricci Mathew

    Like in all other industries, the medical coding/ billing industry also has its own certification exams that can be taken by aspiring/working medical coding/ billing professionals to prove their expertise in the field and make a career for themselves.

    Today medical coding and billing has become a profession in demand and an important part of the fast growing and expanding healthcare industry. This is because medical data and details of a patient are very important evidences; it helps us to keep clear of possible legal issues and is also required to immediately execute the reimbursement process for the medical expenses incurred by a patient. With proper coding and billing, the healthcare service provider also gets his payments in time.

    What is it that the medical billers and coders actually do? They are responsible for the collection, maintenance and analysis of all patient data that is required by the doctors/ hospital for the right treatment and cure of the patient. There are many medical coding and billing certification programs offered online by various colleges and Universities. These courses are usually targeted at those individuals who plan to start a new career in medical coding and medical billing. There are courses also for those who are already working as medical coders/billers and want to take the industry's valued certification exam and further their career.

    Some of the major curriculum inclusions at these preparatory courses are the coding principals for inpatient and outpatient hospitals and aspirants will have to study well the three main coding manuals: CPT, ICD-9-CM, and HCPCS.

    Here are the three different important certifications exams that may be taken and the respective certificates /certifications that can be obtained by the aspirants.

  • American Medical Billing Association (AMBA) CMRS Exam to become a Certified Medical Reimbursement Specialist (CMRS).
  • American Academy of Professional Coder's (AAPC) Exam to become a Certified Professional Coder (CPC )
  • American Health Information Management Association's (CCS or CCS-P) board exam.

  • Completion of the online medical billing and coding program can not only help students in getting the university's certificate and help in the preparation for the certification exams in medical billing and coding but also earn them semester credits. Government aid programs are usually available for the students pursuing degrees and taking credits per term.

    The author of this article is Ricci Mathew of Outsource Strategies International (OSI), a US based company that offers services in Medical Coding, Medical Billing, Medical Transcription for clients across the US.

    Everything You Need To Know About Medicare Prescription Drug Coverage

    By Joel Williams

    A healthy life is a better life. Medicare strives to make sure you can get the health care and prescription coverage you need and the quality of care you deserve.

    Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs or experience unexpected prescription drug bills in the future.

    Everyone who currently has Medicare is eligible for prescription drug coverage. This is regardless of income, health status, or current prescription expenses.

    You are eligible for Medicare prescription drug coverage three months before the month you turn age 65 until three months after you turn age 65. If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments. If you don't sign up when you are first eligible, you may have to pay a penalty. If you didn't join when you were first eligible, your next opportunity to join will be from November 15, 2008 to December 31, 2008. So mark these dates on your calendar so you won't miss them. There are generally no prior notifications.

    Medicare prescription drug coverage benefits depend on the kind of health care coverage you have now. There are two ways to get Medicare prescription drug coverage. You can join a Medicare prescription drug plan or you can join a Medicare Advantage Plan or other Medicare Health Plan that offers drug coverage. Whatever plan you choose, Medicare drug coverage will help you by covering brand-name and generic drugs at pharmacies that are convenient for you.

    Like other health insurance, if you join, generally you will pay a monthly premium, which varies by plan, and a yearly deductible. You will also pay a part of the cost of your prescriptions, including a copayment or coinsurance. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium. If you have limited income and resources, and you qualify for extra help, you may not have to pay a premium or deductible.

    Medicare prescription drug coverage provides greater peace of mind by protecting you from unexpected drug expenses. Even if you don't use a lot of prescription drugs now, you should still consider joining. Most people need prescription drugs to stay healthy, as they age. Joining now means protection from unexpected prescription drug bills in the future.

    If you have limited income and resources you may also qualify for additional help. Medicare will pay for almost all of your prescription drug costs.

    Medicare is your partner in staying healthy. They are committed to providing you with benefits that meet your needs and the information that can help you make informed health care decisions.

    Joel Williams is a recognized authority on the subject of senior health care. His website, http://seniorlivingmatters.com/care provides a wealth of informative articles and resources on everything you'll ever need to know about senior health care.

    10 Must Haves In A Clinical Quality Management System

    By Dave Morin

    Throughout the country, clinics and practices are tackling the problem of quality improvement--not only to meet new pay-per-performance standards, but also to provide a higher level of care. Many providers are finding that a well-chosen CQMS supports their efforts and greatly improves their success. This ongoing series will highlight ten essential features for any clinical quality improvement system.

    The Must Haves

    1. An all-problem, all-patient registry of clinically-verified information not dependent on billing optimization

    2. Problems documented in a structured and coded manner, using clinical terminology

    3.cA sophisticated rules engine of clinical care guidelines that thinks like a physician, not like a computer system

    4. Point-of-care functionality to provide easy identification of due items and increase visit efficiency

    5. Tools to reach patients due for services but not scheduled for a visit

    6. On-demand reporting providing actionable data for quality improvement

    7. Features to allow the entire care team to focus on quality

    8. Extensibility to other HIT systems to share relevant clinical information

    9. Vendor-supported, secure and scalable technology

    10. A customizable framework to meet the unique needs of a practice

    # 1: An all-patient, all-problem registry of clinically-validated information not dependent on billing optimization.

    To truly achieve clinical quality improvement, practices need to focus comprehensively on care delivery and track all patients and all patient problems. Simply tracking a subset of patients or a few chronic diseases is cumbersome and rarely results in long-term improvement.

    Often, the only data available for documenting a patient's problems is administrative data, the data used for billing. This information was never intended to be a source of clinical information on a patient and, as such, does not provide the necessary picture of information when delivering care. The difficulty of culling usable knowledge from this source of incomplete and unrepresentative information is frustrating for practices trying to meet quality benchmarks and improve their level of care.

    Seeing a complete picture of a patient population.

    A Clinical Quality Management System uses a registry to capture patient information. An effective registry must track the entire patient population of a practice and the entire set of problems associated with each patient. It also must track problems in a manner unbiased by the needs of administrative data and verifiable by a clinician.

    An effective registry must track the entire patient population of a practice and the entire set of problems associated with each patient in a manner unbiased by the needs of administrative data and verifiable by a clinician.

    With an all-patient, all-problem registry of clinically-verified information, a practice benefits in many ways:

    � Allows providers to manage all of their patients, and manage them based on multi-morbidity
    issues. For example, patients with both diabetes and depression can have different treatment recommendations than those with just diabetes.
    � Ensures care decisions are based on an accurate, documented set of problems.
    � Helps practices meet the needs of existing pay-per-performance programs and provides a solid foundation for meeting future quality initiatives yet to be defined.
    � Correctly identifies patient populations, ensuring quality calculations are based on the correct denominator of a population measure to avoid negative financial implications.
    � Improves the delivery of care by allowing providers to track patient episodes of care, supplying a complete picture of a condition as it progresses over time.
    � Makes the CQMS an integral part of every patient visit, ensuring the system becomes part of a practice's standard workflow.

    Choosing an effective registry.

    When evaluating different clinical quality management systems, ensure the registry component tracks all patients and all patient problems. Registries that are limited in their scope will add little long-term benefit and will be costly; building registries on a diagnosis-by-diagnosis basis is expensive and time-consuming.

    Make certain that the registry only uses clinically-verified information. Using administrative data that is not reviewed by a clinician can lead to incorrect care and waste a provider's time. Finally, providers should consider how use of the registry will incorporate into their daily operations. A well-designed CQMS will be developed with clinical workflow in mind and should integrate transparently into a practice's routine activities.

    Choosing the right system for quality improvement is crucial to any 21st century medical practice. The registry is a key component of any strong Clinical Quality Management System and should be evaluated against the highest of standards.

    Next issue: Problems documented in a structured and coded manner, using clinical terminology

    Dave Morin

    A Cielo cofounder and veteran senior executive, Mr. Morin brings to the Cielo team over 18 years of experience in both the management of information technology within organizations as well as the management of technology companies. His vision in launching and leading Cielo has always been to help physicians and other healthcare professionals to improve the quality and efficiency of healthcare through the intelligent application of information technology. He holds a B.S. degree in computer information systems, with distinction, from the University of Michigan, where he has also pursued graduate business studies.

    The Truth Behind Rising Health Care Costs - Is There a Scam or Fraud Behind it?

    By Hillary Patz

    Fraud and scams affect thousands daily, those with Medicare and Medicaid, as well as those with private health insurance. They contribute to the rising cost of health care and ultimately may lessen the quality of your health care.

    The majority of physicians and other health care providers are honest and legitimate, but a few are not. Those people steal billions of dollars from the health care system each year. Even more dollars are lost to errors in billing that are never found.

    So what can you do to help? You are the first line of defense against Medicare fraud. Why? Because you are in the best position to spot fraud from the beginning, right in your own home. You can spot questionable charges when your Medicare Summary Notice (MSN) comes in the mail.

    Your first step is to check each Medicare statement you receive and answer these questions:

    Did you receive the service or product for which Medicare was billed?
    Did your doctor order the service or product for you?
    To the best of your knowledge, is the service or product appropriate for your diagnosis or treatment? (If you have a question about a procedure or test, ask your doctor to explain it.)

    Your next step is to get a second opinion, if you spot something questionable. Check with a knowledgeable relative or friend to confirm you are reading the Summary Notice right. Then call your doctor or other health care provider. The charge could be a simple billing error. If so, your doctor or other health care provider will inform Medicare.

    Take the third step if you can't resolve your questions. Report the questionable charges to your Medicare carrier using the phone number at the top of your Medicare statement. Medicare will then investigate and determine if a fraud has been committed.

    Hillary Patz is an internet marketing guru with a desire to help people find success through BTTW. To learn more about Hillary Patz and her team of Marketing Mentors Click Here.

    Killed, Then Billed! Nightmares in the Health-Care System

    By Melinda Thomas

    Are you sick of the abuses of the American Health Care system? Did your relative die in a hospital due to medical malpractice or gross negligence? Were you in a hospital that simply did not take care of your needs or were you in a hospital that made your condition worse than it was before you entered into the building? Are you being billed for services or products that you simply did not receive while you were in that hospital? When you look at your hospital bills, do you think that something is wrong, but you are not sure what is wrong? Did you know there are hospitals that will bill and charge you about seventy dollars for a box of ordinary tissues? Shocked at that statement? Did you know there are hospitals that have billed people about one hundred or two hundred dollars for a teddy-bear pillow (billed as a "cough-device")?

    Most hospitals are good and most hospitals have good employees doing an honest day's work. Most times when you enter a hospital, you get good or adequate care. We have never met anyone who came from a hospital that claimed they got great care but we have met some that claimed they had adequate, good or horrible care. What kind of hospital are you in or were you in? Were your family members inside a hospital that made their illness or condition worse than it was?

    Just what is the purpose of a hospital anyway? Yes, hospitals are to help people get better and some of the hospitals have floors that are designed to help people die better and to be in less pain while they die (these specific floors are the hospice floors). But most hospitals are designed and have the purpose of either treating , diagnosing illnesses and disease or curing illnesses or disease.

    Have you seen your hospital in the news lately? How do you find out about the reputation of a particular hospital? Do this, go to Google and search for the name of the hospital in the news. See what you come up with. Interesting results, yes? Just do it. Search for hospital names in Google and search in the news section and in the web section and see exactly how many articles were written about this hospital in the news. Before you make judgment about the hospital know this --if a hospital has a lot of good publicity , that good publicity was probably generated by the hospital itself. That is a new trend in hospital news. Yes, businesses and corporations and some hospitals are turning our newspapers into advertising places for themselves in an effort to turn around the really bad news that is real news -about their particular hospitals.

    I am not saying that all hospitals are bad. What I am saying is that there are hospitals out there that are specifically in the money-making business and as their patients get more ill and as their patients are dying from negligence and malpractice they are making even more money from those things happening. Think about it. Someone goes into the hospital with something minor or ordinary or something relatively simple to handle, cure or treat. And somehow the negligence of the hospital causes that patient to become more ill. What happens? If the patient has no family or has family that cannot visit, usually that patient will be staying in that same hospital that caused the illness to worsen and at that same time, that hospital is getting paid more and more money to treat that same individual, even though there is a lack or care or care that makes the illness worse than it is.

    For example, a patient goes in with an ordinary asthma attack and winds up dying. Why ? Read the news, then search the name of the hospital. Another patient goes into the hospital and gets worse or dies. Why? Read the articles that are written about these hospitals and check out the true stories, not the gossip and you will learn what is really happening inside some of our large teaching hospitals. (This article is not about all teaching hospitals but it is about the negligent ones, the ones that simply are not helping patients but making patients worse than they are).

    And what about the bills that you get after the hospital has done malpractice or negligence? Are you going to pay for their negligence too? Everyone is legally obligated to pay their hospital bills, but what lots of people do not know is that lots of the bills are in error. Yes, that's right. There are so many errors on some bills that it would be laughable if it wasn't so sad.

    What about the hospital that would not allow a patient's family to visit but allowed the billing department to have constant contact with the patient? What about those hospitals that have collectors or billing agents and they call themselves "patient representatives"? Yes, that happens in some hospitals. There is hope for you even if you have been a victim of this kind of billing abuse. Whatever your situation is and whatever your hospital bill is, you need to read this one book --to start and then look for other books on the subject so that you can be well-informed.

    Here is some print from the back of one such book, the link for the book is near the middle or end of this article:

    "Arm yourself against the abuses of the American Health Care System. Ready for a real medical horror story? Nine out of ten medical bills contain errors. The average error per patient is $1,300. And the total yearly overcharge nationwide is a staggering $10 billion. Counting on your insurance to pick up the slack? Don't even think about it. Now a leading consumer advocate for patients everywhere gives you the knowledge you need to fight back. THE MEDICAL BILL SURVIVAL GUIDE will help you get back what's yours-- and make sure you'll never have to spend an extra, unnecessary dime on the care that you deserve, ever again.

    Discover:

    • What hospitals don't want you to know--and how not knowing can cost you a fortune.
    • The unbreakable code of medical-bill language--and how to shatter it.
    • Excessive, duplicate, hidden and undocumented charges --and how to bust them all .
    • What insurance companies mean by usual, reasonable, and customary treatment--and how to reverse your claim denials.
    • The patient's financial bill of rights-- ten common courtesies worth fighting for. "

    This and so much more is included in this book. If you have ever been in a hospital or if you are in a hospital or have relatives, friends or co-workers in hospitals or in rehabilitation and care centers, you need this book. Consider this book a necessity, not a luxury. You need this book if you are going to avoid being a victim of wrong hospital billing .

    I have heard from patients about improper billing and incorrect billing and overcharging, but worse than that is hearing from patients that some hospital employees allowed billing workers more access to patients than they allowed their own families access. What is wrong with that picture? It appears, yes, just seems to appear that some hospitals first concern is with their bills not with their patients' health and well-being. And what about the bills? What are some of the errors in bills that patients and families are not catching due to codes? Check your bills. They are usually not itemized and there are many items marked as miscellaneous or codes that you do not understand. Check this out from the book that I recommend that everyone buy:

    "What I have found through the years is a system so convoluted that it actually discourages accuracy and encourages errors: Just what kinds of errors am I talking about? Consider these examples:

    • One Virginia hospital billed a couple for the circumcision of their newborn. Not an unreasonable charge, really, except for the fact that the couple had a baby girl.
    • An Illinois hospital billed a man $186,000 for "heart valves" . Two hundred heart valves, that is.
    • Another Virginia hospital billed a patient for the use of its delivery room. Odd, since the man was in the hospital for heart surgery. "

    So, why do I write this article? I write this article as a personal experience article because too many people have come to me with their own stories and with their own personal experiences of horrible care at the hands of health care professionals that simply are not doing their jobs and then added insult, patients and families are being billed for things that they should not be billed for.

    Right now, this very week, another family member of a patient who recently died has been telling me about their story, their true story of the malpractice of some health care professionals and yet they cannot complain about it, because they are grieving, they are still in pain and they are still trying to get over the shock of how their family member died. Yes, there are unnecessary deaths happening every day in hospitals.

    Yes, too, many people die in hospitals of natural causes that is already known. But the part that is unknown is that many times people are dying, and people are losing their health, limbs and sanity at the hands of unscrupulous workers, and under the hidden protection of administrators who have money in mind but not patient health care in mind.

    So, we write because the grieving families cannot write or have no time to write or they just simply emotionally cannot handle complaining. So we write here to let you know what is happening in the American Health Care system. To anyone saying, "STOP!" your article is wrong!, let me assure you that this article is not about ALL hospitals but only about those parts of some hospitals that are totally offending and totally not taking care of patients. And, to make matters worse, these offending hospitals are billing patients and families for their errors.

    Is that not adding insult to injury? Can you imagine yourself as such a victim. Could you even imagine going to a hospital with an ordinary emergency, perhaps a severe asthma attack or minor heart problem, and then ending up with illnesses or injuries ten times worse than those and then getting billed for the care in the hospital? You probably could not imagine that unless you have had the experience. But know, that as you are reading these words, there are some health care workers killing patients and then the hospitals and doctors are billing families and getting paid for their errors. Wow. What an sad statement that is. But it is a true statement of fact. Negligence kills patients. It might take a while, perhaps weeks or months for a patient to die from negligence, and you will never see "negligence" written on the death certificate, but when a patient goes into the hospital for one thing and dies of a totally unrelated -another thing, then you need to really examine what is happening in those hospitals and medical centers. Has that happened, probably, possibly , and yes, it has happened. Where has it happened? Check the google section of your computer and search the words negligence and names of some hospitals and see what you come up with.

    Here are some things that you can do to help yourself at times when you are having a long stay in the hospital. Some of these things might be helpful to you:

    1. Always know the name of the doctor or hospital staff person that you are speaking to. (It is easy to shift blame and responsibility when the patient or family does not know the name of the person who is treating them.
    2. Write everything down. You will not remember staff names or happenings. Hospital stays are entirely too complicated for that. Get a notebook for each time that you are in a hospital and write every single thing down. Write down the names of the medicines or treatments that you are receiving and write down the names of everyone. If you are in a rehabilitation and care center or nursing home, insist on using the recreation computer and write your things in there on a flash drive or on removable storage. Always keep records. Residents are permitted to use that computer, so go with the patient to the computer and assist them in making journal records or any records they need that detail their stay at the center.
    3. Ask for spelling of names. So many doctors shorten their names, "Dr. V" , or so many doctors use their first names as their names. If something happens and you later need to know which doctor that is , try finding Dr. G, in a hospital that has 100 doctors whose names begin with "G". (These names are only examples and not real doctors' names).
    4. If you can safely do this, insist on an immediate copy of any paper that you sign, this includes release forms and consent forms. This saves you the problem of trying to find copies or paying for copies later on . Ask your lawyer if you are entitled to immediate copies. Don't leave these copies in the hospital but send them home with your family or your friends. I would tend to think that any paper you sign is a legal contract (otherwise they would not need your signature, correct)? And usually , it used to be that you were entitled to an immediate copy of any legal contracts that you sign. I do not know if the medical doctors or hospitals are exempt from this but ask your lawyer who can give you correct advice. ATTENTION: all lawyers, can you please advise me and let me know if a patient is allowed or permitted to have an immediate copy of any release forms or papers that a patient signs while at the hospital? My readers and I would love to know the details regarding this point. And, meanwhile, readers, consult with your own lawyers to find out the truth in this matter.
    5. If you have a person in serious condition who is weak, undernourished and cannot communicate well, wait for that person to be out of the hospital before you complain to the HHC, because if you complain while they are in there, they will just bother the patient with questions and interviews while the patient is trying to recuperate from their illness. That will not be a fair investigation as when you interview or question people who are weak , in pain and malnourished, most likely that person will not want to speak at great length and probably is not in good physical condition to give any information. So if you can, wait until the patient is stronger --released from the facility before you complain to the HCC.
    So what came up when I googled some hospital names? First, Google with intelligence. Use many words in your search of the hospital name or you will probably just come up with hospital publicity (articles that hospitals pay for - to make the hospitals sound good). Do your search like this, take a hospital name and add the word negligent to it. Then search for those terms. For example, (and this is just an example - a sample , instructions on how to search and the results of my search). I put in the words "woodhull negligent" into the search bar, and this is what I came up with (this one article and some other articles),

    If you value the life and finances of anyone that you love or of yourself, you owe it to yourself to get that book for yourself. There is another book that is quite helpful; please get this book from the bookstores or libraries:

    Take This Book To The Hospital WIth You

    The following is just an example, set here for an example of what could happen inside a hospital, and of what did happen inside of a hospital. I place this here for those of you who think that "all hospitals are good", or that "everyone gets good care inside of hospitals". I place this article here just to enlighten you if you are one of those who are in the dark about hospital practices, and hospital emergency rooms. I heard about this case as it happened in the news, and I read the full details of the case and was totally horrified at the account of what actually happened. I am sure that the hospital has saved some lives (though no one has told me this), but as printed in the news, this hospital has lost one, at the very least. Read the details in the news article.

    This is just ONE example of a lack of care inside of a large teaching hospital:

    Woodhull search.

    In that article there was a story of a girl who died at that hospital -and the complete story is there. Read the words in the article and then judge for yourself. Make your own opinion. And look at the result of the court actions in this case. The family either settled or was awarded millions. Does that prove that something was wrong? Yes. Get this one book today if you do nothing else.

    The author, Melinda Thomas, has read and studied psychology, health, business and consumerism for many years. And has attended courses in one of the largest cities in America. Contact her through Ezine, by clicking on the icon above.

    The Importance Of A Medical History Form

    By Sharon Rowe

    It is so important to keep an updated medical history form on hand at all times. I'll give you a case scenario.

    You arrive at the hospital ER with your loved one. First you're stopped at patient access where you have to provide all of your insurance and physician information. From there you give your health history to the ER nurse, and sometimes the doctor will even have you to repeat it (depending on the line of communication between the hospital staff). Then you arrive on the floor, and it's time for the hospital admission and you're asked the same questions again. All you want at this point in the whole process is for medical care to begin. Now...the questions asked are essential to good quality care, but when you're worried about a loved one the last thing you want is to keep repeating the same information. It can be redundant, especially during a stressful time.

    Then there are times when a person comes in to the ER and family can't stay until the patient is assessed and sent to the appropriate floor. This could be a problem if the patient is too weak to speak or has dementia. It impedes care. Many patients will already have a list of medications on hand when they arrive, but with your medical history form on hand.... you arrive to the ER or the main floor.... allow medical personnel to make a copy of your health history form while you spend time with your loved one. Any information that they need they can obtain from the health history form that you provided them with. Basically with the exception of a few more questions all that remains is the primary reason for the hospital visit, any tests that need to be done and the head to toe assessment. Working as a medical nurse for over ten years, I have come to learn that having a health history form can make the world of difference.

    Your medical history form should include (but does not have to be limited to the following) name, address, emergency contact, any allergies, insurance information, brief medical history, surgeries, any current medications, flu and pneumonia information, advance directive, living will, and primary physician information. This is enough so that medical personnel can properly and quickly begin to facilitate care.

    It takes a little time to prepare a good thorough medical health history form but the end result and your peace of mind will make any time spent well worth it. Once you complete your medical history form put it in a safe place (one you will remember) and then be comforted in the fact that should the time present itself you will have all of the information needed to quickly begin care for your loved one.

    For more information about The medical history form visit http://www.yourmedform.com

    The Great Medicaid-Asset Shelter Debate

    By Mark Possones

    As the baby boomers come to retirement and become more elderly, the great debate of the 21st century may be, "Should people be forced to use all of their assets to pay for nursing home care before Medicaid kicks in or might they be allowed to shelter some of their assets?"

    This argument can quickly turn heated on both sides of the issue.

    Nobody wants to think that he or she may wind up in a nursing home at the end of his or her years, but the sad statistics say that is very likely what the future holds. An estimated 60% will indeed spend some time in a nursing home or care facility.

    Proponents of sheltering assets say they have paid into the system all of their working years and want what is due to them. They have worked hard and want to be able to pass on an inheritance to their children.

    Opponents say that the system will be bankrupt before long. Medicaid was designed to assist the truly poor and the tax burden on future generations would be astronomical if all of the baby boomers demanded benefits to match their contributions. It isn't a savings account where you get back all that you put in plus interest.

    Proponents say that one spouse shouldn't be forced to subsist in poverty because the mate entered into a nursing facility. Opponents claim that you loved and lived with your mate for fifty years, now is not the time to refuse to take care of your spouse.

    And so it goes. The one thing everyone can agree on is that planning needs to be done and should be done early. Long-term care insurance is definitely something to investigate while you are healthy enough to obtain it.

    If long-term care insurance is no longer an option and you still want to preserve your assets, seek competent help immediately. Do not delay, because some of the means to preserve your assets are time sensitive and cannot be implemented when the possibility of needing Medicaid is staring you in the face.

    Analyze the company into whose hands you will be putting your trust and your future. As your authorized representative to Medicaid, will they be able to handle the bureaucracy and relieve your family of the pressure of dealing with constantly changing government requirements? Select a company that has vast experience working with Medicaid and has a variety of options that will give you flexibility and choices. Choose a company that has employees who make you feel comfortable working with them as a partner with only your best interest in mind. Find a company that will personalize a strategy for protecting your assets while being sensitive to the needs of you and your family.

    Sometimes the price of peace of mind is as little as the amount of time it takes to make a few phone calls. Don't delay; take action on protecting your assets and your family today.

    Mark Possones decided that it was time to start planning for the future. Watching his parents lose the earnings for nursing help he researched about Medicaid qualifications, long term care facilities and the longterm care, he got help - a company that guards his assets and guarantees acceptance into the Medicaid system.

    How Will the Internet Impact Healthcare?

    By Carl George

    Whether communicating with friends and family, trading goods and services, researching favorite topics, or enjoying music and other entertainment-the Internet is simply a different delivery channel for the things we've all been doing, and still do, in other ways. It is these three factors - convenience, low cost and timeliness - that make the Internet so compelling.

    Changing the way clinicians do business
    Effective healthcare delivery, beyond pharmaceuticals and devices, is contingent on ready access to accurate, timely information. The best healthcare information is of no value if it cannot be located, shared and applied. The value of information-sharing and the idea of cooperative medicine are well known and appreciated. To effectively facilitate information-sharing, and provide a higher level of value and customer service, healthcare organizations are taking advantage of technologies that facilitate sharing - most importantly, the Internet.

    The basic premise of the Internet is to enable people to quickly and easily access and share web-based documents and applications. With pressure to be cost-effective, web-based "software as a service" applications are growing in popularity - mainly because they require no additional expensive software or servers to buy or maintain, and the data that resides in these applications is available in a timely manner at the cost of a workstation loaded with a web browser. In addition, the information stored in these applications can be accessed from any computer in any location, by anyone with the required security access. Security has advanced to the point where data can be protected and the risk of data theft is much lower than in the recent past.

    One example of a new web-based "software as a service" application is Kardia Health Systems' EIMS (Echocardiography Information Management System), a comprehensive echo lab workflow solution. EIMS supports data acquisition, diagnosis and interpretation, clinical reporting, patient scheduling, and coded billing within one application. EIMS facilitates ready access to patient records and enables physicians to review echo measurements and generate structured echo reports via a browser from any location. This is especially useful for cardiologists working for multiple practices and from remote locations. This web-based application provides one central location for patient data with permission-based access from a secure common data server set.

    Changing the patient provider relationship
    The benefits inherent in "software as a service" also have the potential to greatly improve healthcare delivery and patient care. Because the Internet removes geographical restrictions, physicians can analyze data regardless of the location of the patient or physician. This gives patients and healthcare institutions access to qualified physicians, regardless of the location of the patient or the physician, and allows multiple providers to review the same data and collaborate on diagnoses. Healthcare organizations that embrace timely information delivery to deepen the customer relationship will be rewarded with more loyal customers because they have removed levels of customer frustration from the operational process.

    The integration of secure, timely information via the Internet with healthcare delivery ultimately provides a higher level of service and patient care, both from a collaborative medical perspective (providing the patient with a more knowledgeable diagnosis) as well as from an educational perspective (allowing physicians to more easily learn from one another). It improves the operational efficiencies of the practice, enhances the health and longevity of patients, and creates a deeper, more rewarding practitioner/patient relationship.

    http://www.kardiahealth.com