Affordable Healthcare Options – Dental & Medical Benefits for the Uninsured

In Pennsylvania alone, over 1.4 million people lack health insurance. My family was part of this statistic less than two years ago when my husband unexpectedly lost his job. To make matters worse, just five days earlier, we learned we were pregnant with our second child. The financial position we found ourselves in was terrifying. We dropped a full-time income and lost medical insurance in only one week’s time. Cobra was offered to us, but with the loss of income, we didn’t have the $400 it would cost for the monthly premium. Thousands of individuals and families find themselves in similar situations everyday. There are several reasons for the lack of insurance. But whatever the reason, it is important to know that you have options.

According to the Consumer Health Alliance more than 45 million Americans are without health benefits and that number is steadily growing. In most cases, for the households with no benefits, at least one person in the household is working a full-time job. The number of households that have insurance are dealing with rising premiums, rising co-pays, and a loss of benefits. In fact, health insurance costs are rising by 10% to 15% or more annually! The middle class is the hardest hit by these rising costs. They make too little to cover insurance premiums on a monthly basis, but they make too much to qualify for Medicaid. The Health Care Situation is distressing. But it’s NOT hopeless.

Consumer Driven Health Care is a relatively new concept but it should by no means be overlooked. The Consumer Health Alliance was launched in 1992 to regulate this new industry. The companies affiliated with the Consumer Health Alliance offer discount medical cards to their members. According to the Consumer Health Alliance, these discount cards are gaining popularity because they allow consumers to gain access to the healthcare they need without the exclusions, limitations, and paperwork typically associated with insurance. If you are suffering from a medical condition and can’t get insurance, a discount plan won’t exclude you! In fact, your medical history is of no concern to them. You can enroll in the plan and get affordable care immediately! And even better, the monthly membership fee is nominal.

The other benefit to these plans is that many offer supplemental packages that include dental, vision, prescription, and chiropractic benefits that are an affordable complement to insurance plans. Too many companies are having to scale back the benefits packages for their employees just to keep insurance affordable. Although a good dental plan is the 2nd most requested benefit, it’s also one of the first things to go when a company is forced to cut back.

The plans work this way. For a low monthly fee, members of discount plans gain access to wholesale rates similar to what large insurance companies pay. When care is received at a participating provider, the member pays the discounted fee at the time of service. It’s a benefit not only to the member, but also to the provider who is able to get payment up front with no paperwork to file. The services offered by the benefits companies will vary. For example, AmeriPlan Health® offers a comprehensive package for the uninsured that includes Doctors, Specialists, Ancillary care (labs, scans, hearing, etc.), Dental, Vision, Prescription, Chiropractic, and Hospitalization. They also offer a Dental Plan that includes FREE Vision, Prescription, and Chiropractic Benefits.

Should you look into a fee-for-service plan? That depends, every insurance plan is different. Some are very comprehensive and include a good dental and vision plan. Others don’t. If you’ve got kids that need orthodontic work, a discount plan could save you thousands. If you are looking into bridgework, cosmetic dentistry, or dentures, it would be worth your while to check out a discount plan. I can’t say enough about how great these plans are.

It’s my mission to get benefits to those who need them. I will never forget the stress our family faced when we didn’t have any medical benefits. If you are undinsured or underinsured, look into your options. You can get affordable care. And if you are uninsurable, there is help for you as well!

Healthcare for a Better and Healthier Tomorrow

Prevention has always been better than cure. Having annual physical examination and taking healthy food supplements are just two of the many ways to ward illnesses off. Yet there are times where illness strikes even if you are living healthily, having a great retail healthcare program will ease not only the patient’s mind but their families, caregivers and employers as well.

The Need

The moment a baby is born, health products are already needed. Nursing pillows, breastfeeding paraphernalia, and diapers are just few of the things that can be purchased in a health gift shop. As the baby reaches the toddler stage, trainer glasses and other utensils are needed. The mother needs to get fit, having exercise equipments and taking food supplements to aid in breastfeeding are needed. Stomach binders are also needed especially for mothers who underwent C-section.

Basically, in every phase of life, there is a healthcare product needed to prevent or cure illnesses.

The Solution

Health is a wealth that we must take care of, there are no cash-and-carry for body spare parts. Retail Healthcare Product is a solution to be provided for individuals, hospitals or healthcare facilities or systems.

The Benefits

Customers or patients will experience what health program or facility they need from hospitals or healthcare system. In this manner, there will be improvement in the patients outcome.

The Business Opportunity

Venturing into the healthcare business is very lucrative in the present times. Studies show that more and more people are health conscious. Succumbing to illness is not an easy ordeal. People flock in wellness centers for health seminars, fitness workshops and other healthful activities. Packaging health or fitness equipment and supplements as gift items make it one of the salable gift shop products.

The Healthcare Business Provider

If you are a hospital, clinic or a healthcare system provider – looking for the right people to trust in retail healthcare products is tough. Here are some guidelines that will identify a great provider:

must have an alliance with the leading healthcare industry experts and resources to assist in identifying and implementation of retail healthcare and e-commerce strategy
has a solid business plan
has a reward point system or point of sale to gain customer’s loyalty
has an online commerce system
can manage the implementation of a unique retail store concept
can provide successful business operation with years of experience
can provide plans and store design for the physical store (for gift shop solutions)
can provide store designs, operation instructions and management for retail pharmacy solutions
can provide the best brands of gift shop and pharmacy items
can improve retail healthcare offering

The Highlights

It is important that a retail healthcare product provider will be able to analyze the latest trend or statistics, facilities and operation to create or formulate recommendation for clients.

The Paquin Healthcare organization has a pool of consultants with expertise in retail healthcare, gift shop, retail pharmacy and e-commerce.

Drug Development Pipelines – New Alliances and Partnerships Critical to Keeping Pipelines Productive

The pharmaceutical industry is in the midst of an unprecedented change in its business model. Large pharmaceutical companies, while retaining remnants of their research divisions and some of their local manufacturing facilities, will soon cut to their core business of drug development. Emerging companies will fill the void, providing innovation and potential therapies for the development pipeline. And manufacturing will be contracted to third parties or conducted overseas where it is less expensive.

The current variants of this model-generic drug companies, contract research organizations, drug delivery specialty companies, and virtual pharmaceutical companies-will eventually fall into line, but not until large pharmaceutical companies acknowledge the new model and build a strong interface among themselves, emerging companies that provide innovative new therapies, and the regulatory bodies, such as the Food and Drug Administration in the United States.

M&A Activity Hampers Innovation A debate held at the American Association of Pharmaceutical Scientists (AAPS) annual meeting last November probed whether the last decade of mergers and acquisitions within the pharmaceutical industry had hampered innovation. The most compelling arguments concluded that it has. In fact, reduction in innovation is blamed for the scarcity of new chemical entities in development pipelines. As a result, major pharmaceutical companies are looking to emerging biotechs to supply compounds or technology platforms to license, acquire, or shepherd via strategic partnerships in an effort to bolster pipelines and allay shareholder concerns.

Exclusivity losses in one or more major markets will claim a number of blockbusters in the coming year, eroding innovators’ profits as the generics industry undersells them. Risperdal, Topamax, Lamictal, Depakote, and Fosamax are among those on the chopping block for 2008. And although there are 25 to 30 new products awaiting approval in 2008, 80 percent are specialty pharmaceuticals, according to IMS Health. It is hard to imagine there will be new blockbusters to replace those lost to generics. And considering the current rate of FDA approvals, it is difficult to predict how many of the new medications will even make it to market this year.

Global Market Growth The global pharmaceutical market is expected to grow 5 to 6 percent in 2008, to $745 billion, according to IMS Health. For the first time, the U.S. will comprise only one-third of the global pharmaceutical market as patients in China, Brazil, Mexico, South Korea, India, Turkey and Russia gain access to better healthcare. These emerging markets are driving new growth and opportunities for pharmaceutical companies, but the widening demographic argues more for specialty pharmaceuticals than for blockbusters.

Industry analysts report rising R&D costs and reduced numbers of new drugs approved each year. The reduction in drug approvals is blamed in part on the chronically understaffed FDA, in part on the lack of innovative drugs in the pipelines of major pharmaceutical companies, and in part on the inexperience and lack of funding that hampers smaller companies’ efforts to meet all of the regulatory hurdles in a timely fashion. In fact, many licensing deals are turning out to be more expensive than anticipated as licensees are finding it necessary to re-optimize their lead candidates.

Consider Regulatory Needs Early Now is the time for both large and small pharmaceutical companies to include relevant regulatory bodies in their development plans very early on. In the U.S., the FDA has been asking companies to engage it with greater transparency regarding development plans and study results. Although this might seem risky, obtaining early agreement on the path forward is likely to save time and money and avoid the dreaded “Approvable” letter. It might even prevent the lawsuits and public scrutiny of a Vioxx debacle.

In fact, pharmaceutical companies have a perfect opportunity to establish a more open relationship with the FDA by working with the agency to develop more predictive toxicity assays that eliminate problem compounds early in the development process. In an interesting article appearing in the November issue of Pharmaceutical Executive titled “FDA’s Approvable Problem,” senior editor Walter Armstrong discusses the controversy between the industry, the FDA, and public opinion. He notes the lack of public understanding that even though a drug has been approved, toxicity issues still can arise later. People don’t seem to understand all that talk about risk/benefit that is certainly a part of the approval process.

Communicate Risks Better This is something that will probably never go away. We cannot know everything about a drug before it is approved, but the industry needs to do a better job of communicating this to the public. It must make continual, concerted efforts to establish better methods for evaluating drugs before they are approved. That’s a “win” for everybody. The effort can be communicated to the public to show the industry’s concern and can help restore FDA credibility. In addition, information shared with emerging companies will ensure that these studies are implemented early in the development process before licensing.

As evidence of the new pharmaceutical business model in the making, the Financial Times published several articles last December on GSK’s new head of R&D, Moncef Slaoui, who inherited the much-heralded Centres of Excellence for Drug Discovery that CEO J.P. Garnier and then-head of R&D Tachi Yamada created in 2001. The centers were designed to separate the research organization into specialty units simulating autonomous biotechs; the units would identify quality lead compounds which they then handed off to the international development machine. After six years of experimentation, Slaoui commented: “It’s one thing to create an organigram. It’s another to change values…We’ve done well on the structure but more is required on behavior.” His resolution for the short term is to retain about four of the centers and work to re-focus them on the science and innovation, but at the same time to look for licensing opportunities to fill as much as 50 percent of the pipeline.

Union Organizing in the Health Care Industry – New Unions and Alliances Among Rivals

Though our nation’s economy has recently lost millions of jobs, the health care industry has continued to add them. Not surprisingly, unions are eager to sign up health care workers. In the last 10 years, the rate of union wins in the health care industry has grown faster than the national average. Unions are uniting to lobby for labor-friendly legislation to promote increased union membership in the health care sector.

In addition to traditional organizing, health care union organizers are using more radical corporate campaigns that target hospital donors, shareholders, community groups, and even patients. The unions push these target groups to put pressure on hospital owners to allow unions to organize their employees. Many critics have argued that some of these agreements with employers have greatly limited workers’ power and emphasized the union’s cooperation with management.

The following article provides an overview of the major unions involved in the health care industry, as well as strategies to ensure your organization is prepared and remains successful.

Service Employees International Union
The Service Employees International Union (SEIU) began in 1921 primarily as a janitor’s union and branched out to include government, security, and health care workers. By 2000, it was the largest, fastest-growing union in the United States, with much of that growth stemming from a series of strategic mergers with smaller unions. In June 2005, the SEIU and six other unions left the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) to form the Change to Win coalition. Citing the need for a renewed effort to organize workers, Change to Win purports to be focused on achieving fair wages, health care benefits, and secure retirement for all employees. The coalition also encourages workers to unionize on an industry-wide basis, consolidating smaller unions within larger unions.

SEIU Healthcare
In 2007, the SEIU announced plans to launch a new health care union to serve approximately one million members, such as nurses and service workers at hospitals and nursing homes. SEIU Healthcare combined financial and personnel resources from the 38 local SEIU Healthcare unions. Of the SEIU’s 1.9 million members, 900,000 work in health care. In September 2008, the SEIU reported it would begin several high-profile projects to bring business leaders, health care providers, community organizations, and elected officials together to work on the nation’s health care system. SEIU leaders were part of a May meeting held by President Obama to discuss a health care overhaul. More recently, SEIU members attended town hall meetings to speak out in support of the proposed health care reform. In August, the SEIU was part of a group-largely funded by the pharmaceutical industry’s lobby-that launched $12 million in television advertisements to support Obama’s health care proposal. This group, the Americans for Stable Quality Care, could spend tens of millions more this fall.

SEIU and NUHW
The SEIU attempted to consolidate three local units representing home health care workers into one unit last December, taking authority away from the local units. The SEIU accused the local unit officials of financial misconduct, and in response, the leaders of the local units criticized the SEIU’s practice of centralizing power at its Washington headquarters and making corrupt deals with employers. In January, a 150,000-member SEIU local unit in Oakland was put under trusteeship by the SEIU, and the local officials of that unit were dismissed. The ousted officials formed a new union, the National Union of Healthcare Workers (NUHW).

The NUHW announced the first workers had cast votes in favor of representation by the new union in March. A majority of 350 union-represented workers at four nursing homes in northern California managed by North American Health Care wanted to end their labor relationship with SEIU and join the NUHW. The day after this announcement, the SEIU filed unfair labor practice charges against the four nursing homes, charging that administrators of the facilities had illegally withdrawn union recognition and colluded with a competing labor union. In that same month, a National Labor Relations Board regional director ruled against the NUHW, saying that the contract between the SEIU and the hospital chain prevented the effort by a new labor union to represent 14,000 Catholic Healthcare West workers. Despite the ruling, the founding convention to formally launch the NUHW took place in April 2009. According to the NUHW, approximately 91,000 California health care workers have signed petitions filed at the labor board, stating they would like be members of the new union.

The NUHW also claims that, in response to these decertification drives, the SEIU has resorted to harassment and intimidation and tactics similar to union prevention. The SEIU argues that the new group has unfairly restrained and coerced workers, as well as complained to the National Labor Relations Board. A decisive battle between the two unions will come in 2010, when the SEIU-UHW contract with Kaiser Permanente expires and the opportunity for decertification elections reopens. Kaiser, the largest health care provider in California, has 50,000 workers that could potentially become members of NUHW.

California Nurses Association/National Nurses Organizing Committee
The California Nurses Association (CNA) began as a state chapter of the American Nurses Association (ANA) in 1903. The ANA has a federated structure: Nurses do not typically join the organization directly, but instead join their respective state organization, which has membership in the ANA. After several years of believing the ANA was not providing them adequate financial support to increase collective bargaining activity in California, the CNA broke ties with the ANA in 1995 and formed its own union, becoming the first state organization to secede from the ANA. Since its break from the ANA, the CNA has acquired a reputation as one of the most aggressive labor unions in the country. In 2004, the CNA began establishing itself in other states under the name National Nurses Organizing Committee (NNOC). The CNA voted to seek affiliation in the AFL-CIO in 2007. CNA membership has doubled over the last seven years and represents 80,000 members from all 50 states.

UAN-NNOC
In February, CNA/NNOC, United American Nurses (UAN), and the Massachusetts Nurses Association (MNA) announced the formation of another new union: the United American Nurses-National Nurses Organizing Committee (UAN-NNOC). With a combined membership of more than 150,000 affiliates in 19 states, it is the largest nursing union in the history of the United States.

National Federation of Nurses
The National Federation of Nurses (NFN) was officially launched in April at an event in Portland, Oregon. The NFN represents more than 70,000 nurses in six state nurses’ associations, including New York, New Jersey, Ohio, Montana, Oregon, and Washington. Based on a federated model (much like the ANA), the NFN recognizes the independence of each member organization. Membership is open to state nurses’ associations and other labor organizations that represent RNs. The NFN is tied to the ANA, which outlines standards for nursing practices, but has historically opposed nurse unionism and includes managers in its leadership. Since nurse union leaders expect many of the 15 unions with nurse memberships to flood hospitals with authorization cards if the Employee Free Choice Act (EFCA) passes, they want to establish their own national union to ensure nurses are organized by nurses.

SEIU and CNA: From Violent Disputes to Cooperative Agreements
The SEIU signed a neutrality agreement in March 2008 with an Ohio Catholic hospital to organize 8,000 workers. The day before voting was scheduled to begin, members of the CNA distributed leaflets to discourage workers from joining the SEIU. After the workers received the leaflets attacking SEIU and its arrangement with management for an election, SEIU called off the vote. Then at an April 2008 conference in Detroit, SEIU staff and members protested at a banquet of CNA members, resulting in violence. The two unions have also launched raids and counter-raids across the country, and both have sent mailings to thousands of nurses (including nurses in other unions, as well as nurses whose unions are currently trying to organize) attacking each other.

After more than a year of fighting, the SEIU and CNA signed a cooperation agreement in March. They will work together to bring union representation to all non-union RNs and other health care employees, as well as improve patient care standards. The unions have also agreed to refrain from raiding each other’s members and will work together toward common goals, including lobbying for congressional passage of the EFCA. SEIU and CNA will coordinate campaigns at the largest health care systems and launch an intensive national organizing campaign. Catholic hospital chains will likely be among the first targets.

In June, the U.S. Conference of Catholic Bishops and the nation’s largest unions (including the SEIU and the AFL-CIO) signed an agreement describing how union organizing will be conducted at Catholic health care facilities. (The document is similar to the one Catholic Healthcare Partners and Community Mercy Health Partners created last year with the SEIU before the CNA protest canceled the vote.) This agreement is significant because Catholic health care providers represent the largest employers and providers of services in many communities. The agreement provides seven guidelines for management at Catholic health care facilities and unions, making it easier organize health care workers at these facilities.

What This Means for Your Organization
Many experts agree that expanded unionization, along with the passage of the EFCA, will negatively impact our health care system. Both health care providers and industry analysts fear that unionization could mean higher costs and more restrictive work rules, adding to the soaring cost of delivering health care. Hospital and health care facilities need to be aware of these issues and how they can educate their supervisors and workers about the threat of unionization.

Communication with your employees is a critical first step. Many issues are involved in the possible unionization of a health care facility (economic factors, working conditions, quality of patient care, employee satisfaction, etc.). To prepare for possible union activity, identify issues that are relevant to your facility and address those needs publicly. Train leadership and include information about your union-free policy in the employee hiring and orientation procedures. Assess your wage and benefit structure, and be sure to promote what you offer.

You can use brochures, meetings, video, webinars, e-mail, Web sites, or eLearning tools to reach your employees. The most effective efforts include an employee feedback system that encourages two-way communication.

Healthcare Tourism: An Eye Towards The Future

The healthcare tourism industry has been witnessing a remarkable growth in recent years. There are a number of reasons for the continuous growth of this industry especially in the Asian and African countries. One of them being the lure of affordable medical care, along with the scope of enjoying the scenic beauty of tourist destinations. One of the renowned experts, Marvin Cetron, founder and president of Forecasting International, have marked the growing trend of medical tourism and expect it to pose a serious challenge to the Western healthcare industry in the near future.

It is necessary to have a glance over the Western medical or healthcare scenario in order to have a clear picture of the kind of competition that can crop up between the former and the Third World medical tourism industry. In some undeveloped regions of the world, the medical facilities are hard to come by, whereas in other countries, the public healthcare system is so overburdened that it would take years to get needed care. For instance, in countries like Britain and Canada, the waiting period for a hip replacement surgery can be more than a year; while in Bangkok or Bangalore, a person can find himself in the operation theatre just after landing the very same day! Not only this, the cost involving the total process is much less than that charged in Western countries. For example, a heart-valve replacement that would cost $200,000 or more in the U.S. costs a mere $10,000 in India that includes round-trip airfare and a brief vacation package as well.

Doubts are often raised regarding the quality of service offered by medical tourist destinations. But such arguments have no solid ground as the facilities and services offered by them are almost equal or even better than the Western medical services. There are hospitals and clinics that cater to the tourist market that are often among the best in the world. Most of them staff physicians who have received training from famous medical centers in United States or Europe. Bangkok’s Bumrundgrad hospital has more than 200 surgeons who are board-certified in the US, and one of Singapore’s major hospitals is a branch of the prestigious Johns Hopkins University in Baltimore. Statistics suggest that the services offered in some of the leading medical tourist destinations often exceed their Western counterparts. As for example, the Escorts Heart Institute and Research Center in Delhi and Faridabad, India, performs nearly 15,000 heart operations every year, and the death rate among patients during surgery is only 0.8 percent–less than half that of most major hospitals in the US. These figures are enough to clarify whatever doubts some skeptics might have on their minds.

The Future of Healthcare: Physician Assistants and Nurse Practitioners In Demand

As the landscape of healthcare and medicine widens, there will be ongoing changes over the next several years. Workloads for medical professionals have been increasing as more people are being covered by insurance, and there will be more care provided by physicians assistants and nurse practitioners.

A 2004 Medical Group Management Association (MGMA) Cost Survey Report revealed that the number of full-time equivalents of Physician Assistants, Nurse Practitioners, and other people involved in a healthcare team increased in many specialty groups. Those numbers have increased even more in recent years due to the Affordable Care Act (aka “Obamacare”), and are projected to keep going up through 2020 because of aging and population growth.

This is great news for people who aspire to become healthcare professionals because they will be in high demand, but on the other side of that there has been concern for patient safety and the quality of care offered by non-physician providers. Stakeholders such as local and national government, patient care delivery organizations, health care provider education programs, the health insurance industry, and the general public face some level of anxiousness and uncertainty.

There are nurses who are looking to end laws that mandate doctor supervision, however, there are already nurse practitioners in many states who are working without primary care doctors.

To alleviate the increased risks of medical malpractice, there are many organizations that have stepped up in recent years, aggressively promoting the importance of patient safety and quality care. There’s the World Alliance for Patient Safety, which was launched in October 2004 by the World Health Organization. The National Patient Safety Foundation came about in 1997 with a vision “to create a world where patients and those who care for them are free from harm.” Each of these organizations have various programs and workshops to educate and enhance the culture of patient safety.

NPs and PAs are perceived now as being more than just health care providers. PAs are essentially trained based on the same model as doctors while NPs have a more comprehensive approach with the focus on health promotion.

Despite the education difference of NPs and PAs versus doctors, experience and patient rapport play a role in how patients feel about the level of care they receive. As long as everyone is doing their best, there is constant communication between everyone providing care, and the patient feels like their needs are being met, that’s all that matters when all is said and done.

Best Practices For Hospital Peer Review

When done properly, peer review is an important process that helps hospitals and their doctors ensure consistent, high quality patient treatment. Hospitals can identify at-risk physicians; physicians can help improve quality of care for patients. Why is this process so difficult? It’s simple – hospital politics, economic advantage and personalities.

The current physician peer review system, created by Congress in 1986 through HCQIA legislation, was intended to promote higher quality patient healthcare. Unfortunately, Congress did not foresee that hospital peer review actually puts physicians into an environment where political, economic and personality conflicts can easily render the process ineffective. Nor did it foresee that hospitals would sanction doctors for speaking up on behalf of patients regarding quality of care concerns.

In the hospital environment, peer review is considered an ugly task that is just one more action item for a busy medical staff and is easily pushed to the bottom of the priority list. Often it just doesn’t get done. Why?

Physicians on peer review or quality management committees too often find themselves in conflict of interest situations. They compete for the same limited geographic pool of patients and for professional recognition within a very narrow specialty. There may also be personality conflicts with the physician under review or pressure by their hospitals not to seriously scrutinize a fellow physician who has stature in the medical community. The tight-knit social and professional relationships found in a hospital environment can lead to bias and reluctance to pass judgment on associates. This reluctance tends to lead to unusually long delays in resolving critical quality management issues. By the time a critical situation is actually dealt with, the costs and risks to a hospital or group can be catastrophic.

Backlash

The breakdown in a hospital’s quality management system can be very damaging. Inadequate peer review can result (and has) in negative consequences for hospitals and hospital groups, such as:

o Negative publicity

o High profile lawsuits

o Multi-million dollar fines

o Management shake-ups

o Loss of investor confidence

o Damage to physicians’ careers and practices

o Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

sanctions and loss of accreditation

o Scrutiny by state and federal agencies and other public organizations.

These negative events, combined with rising consumer frustration with the healthcare system, make it increasingly imperative that hospitals pay close attention to their quality management and adopt best practices whenever possible.

Peer Review as a Risk Management Tool

A well-executed peer review process can easily avoid such negative events by using best practices in risk management. The earlier a physician performance issue is detected and dealt with, the lower the costs and potential negative consequences to the hospital and the physician.
Basing effective peer review on medical evidence and adhering to the intent of the law — to improve the quality of patient care — helps discover, highlight and deal with quality problems quickly and efficiently. Issues surrounding internal politics, competition, and personality conflicts should be considered when setting up a peer review committee.

Involving Outside Parties in Peer Review

The most effective quality management process involves using a “neutral” outside party in addition to the hospital’s own peer review committee. This neutral party can review sensitive cases where there is a potential conflict of interest. Hospitals with the need for an outside case review have often turned to affiliated hospitals or searched for “like” specialists through personal connections. While this is an effective method for solving the problem, it has its own set of challenges:

o How do you quickly locate the right specialist?

o How do you convince them to take time to do a peer review?

o How long do you have to wait to get it done?

Unless you have a well-developed process and pre-arranged agreements with affiliates or physicians to perform peer review, it can be very costly and time consuming to arrange for this each time it’s needed.

IROs: A Cost Effective Solution for Hospital Peer Review

Many hospitals, today, are turning to Independent Review Organizations (IRO) to aid in fixing their peer review process. An IRO serves as an objective third party that can provide hospital peer reviews based upon medical evidence and improve the fairness of the process for both physicians and the hospital.

An IRO can match doctors with the right specialist expertise to effectively review sensitive cases and reach an unbiased determination. Reviews are conducted by board-certified physicians in active practice, who are usually located in a different state than the physician being reviewed. Hospitals pay only for the reviewing physician’s time at pre-determined hourly rates.

Because these specialists are already on board, reviews can be completed in much less time and at significantly lower costs. Peer reviews are conducted using a standard reporting format, and the typical turn-around time is less than 21 days. Since IROs review thousands of cases annually, per case review costs are kept to a minimum.

An IRO can give peer review the high priority and timely consideration it deserves — without impacting the hospital staff or tarnishing a hospital’s reputation.

Using an IRO for objective peer review may be one of the best solutions for helping hospitals get back to the intent of the law – improving healthcare quality for patients. An IRO can also help reduce costs, avoid expensive litigation, enhance hospital reputation and protect JCAHO certification.

Peer Review Best Practices

To ensure an evidence-based outcome for peer reviews, hospitals should consider this nine step process:

1. Develop a culture of accountability within the hospital.

2. Make sure that the peer review process is well defined, understood, accepted and adhered to by all.

3. Watch for “sentinel events.” Bring patterns of recurring or clustered problems to management’s attention in a timely way.

4. Assure that questions posed during the process are precise, and that responses are precise as well, including the hard questions, with rationale and associated guidelines.

5. Make sure that each peer review case is reviewed by a “like” specialist

who is unbiased and has no potential for conflict of interest in

rendering an opinion.

6. Make sure the peer review committee meets monthly and that cases and replies are distributed, reviewed and responded to in a timely manner.

7. Make sure there is a re-review of each case after the subject physician input has been received.

8. As much as possible, conduct all reviews in a non-accusatory and

professional format.

9. Systematically send your most sensitive peer review cases out to an Independent Review Organization.

Choosing the Right IRO

Choosing the right IRO as a partner for hospital peer review can be as confusing as the process itself. Here are some simple questions to ask in the selection process:

1. Is the IRO URAC-accredited? – There are dozens of companies

that claim to offer medical review services. There are only a few

that are actually accredited by the American Accreditation

HealthCare Commission, also known as URAC. By selecting an IRO

with URAC accreditation, the hospital partner with a standards-

based organization can deliver the quality and objectivity

needed for the peer review process.

2. What types of doctors are on staff at the IRO? – It’s extremely

important to work with an IRO that has doctors on staff trained to

make fast decisions, who are board certified and still in active

practice.

3. How deep is the IRO specialty panel? – The IRO under consideration

should be able to deliver the specialists needed on a moment’s

notice. Not only do these physicians need to be in the same

specialty, but also from the same type of institution. A heart

specialist from Los Angeles may not be the right physician to review

a related case coming from a rural hospital in Iowa.

4. What are the standard turn-around times? – The IRO selected

should have a strong track record of turning around reviews quickly

and accurately. Find out what the average turn-around times are

and what process the IRO offers for expedited reviews. A standard

of 21 days or less for hospital peer review should be the minimum.

5. How accessible are the IRO physicians? – Many IROs offer basic

peer review services. The best IROs, however, are the ones that

truly act as partners to the hospital peer review committee and

make themselves fully accessible to the physicians under review. By

becoming a part of the process, the IRO can truly act as the neutral

third-party and help keep the relationships between all parties intact.

Healthcare and Life Sciences

Drug, pharmaceuticals, and biotechnology constitute the main constituents of Healthcare & Life Sciences field. Since the area caters to the lives and existence of humans, it is a matter to strict regulatory mechanisms needing dedicated expertise in knowledge processing, with enhanced quality, and devotion to international standards. Hence, it has become a chief thrust zone for the worldwide giants in the IT industry and also for corporates involved in investigation and development of new products.

IT solutions for healthcare

IT solutions for healthcare aid improve healthcare delivery and patient results by facilitating the respective solution providers being more capable, price effective, and inventive.

Complemented with comprehensive partnerships and established know-how, the IT solutions aid you to:

• Allow clinician movement through unified, safe access to acute Windows, web, mobile, and custom applications, along with file sharing services and collaboration tools, on their own device of preference

• Accomplish functioning competences and quicken time-to-value for acquisitions and healthcare consolidation by offering IT as a cloud service

• Guarantee confidentiality of individual health facts and guard sensitive data wherever, however and by whomever it is gained access to

• Strengthen patient-focused care and advance outcomes across locations and specialisms through, telemedicine, mobility, and social alliance

Healthcare IT solutions

Healthcare IT solutions make over healthcare IT with the help of desktop, enterprise mobility management, application virtualization, data sharing, societal collaboration, remote support, and cloud networking. The solutions help transmute healthcare IT with safe access to apps, information, and data to provide best care.
The innovative and all-inclusive clinical information solutions are the need of the hour for the Healthcare industry.

Healthcare solutions

Healthcare solutions increase the clinician contentment, develop care team competence, generate higher-quality clinical documentation and, finally, drive patient protection care. Healthcare & Life Sciences solutions aid the experts regain control over paper-intensive clinical, billing, supervisory, and managerial procedures.

The healthcare solutions aids healthcare experts accomplish extraordinary competence along with noteworthy cost savings, greater safety, enhanced traceability, and improved productivity.

Life science solutions

Life science solutions aid relevant companies respond effectively to challenges. Offering cohesive end-to-end Healthcare not just caters to the apparent needs, but brings about an assimilated change.

Healthcare solutions and services cover the complete Healthcare & life sciences value chain right from corporate to back office operations. Henceforth, they aid you to streamline costs, improve operational efficacies, and develop business agility all across all significant business procedures. Innovative solutions made help the industry to meet its dynamic requirements.

Evolving Healthcare Trends

The model trends in the healthcare system have been changing over the period of time. The old trend gave importance to the individual patients and the emphasis was on treating illness. The goal of the hospitals was to do inpatient admissions, fill up the beds and more emphasis was given to acute inpatient care. The role of managers in the old paradigm was to run the organization and coordinate services. In the old system, all providers were essentially the same. The hospitals, physicians and health plans were separate and not integrated.

The newer trends that evolved gave importance to the population as a whole. It not only treated illness, but emphasized on promoting the wellness of the people. The goals of the healthcare system after being transformed over the years is to provide care at all levels which is continued. The role of managers in the new paradigm is more broad. They see the market and help in quality and continued improvement. They not only run the organization, but also go beyond the organizational boundaries. In the evolving system, the providers are differentiated according to their ability. The hospitals, physicians and health plans have formed an integrated delivery system.

One of the current trend in the healthcare delivery model is that continued care is emphasized. The key professionals are not only treating patients for their illness, but they are promoting and managing quality of health. For example, a patient with high cholesterol visits a doctor. He is not only given one-on-one medical treatment, but he is also offered to attend a group session where information is provided on how lifestyle and behavioral change can help. The patients learn from the clinicians and also from each other. Another current trend is to take care of the health of the defined population and not only individual patients. All the health needs of the population as a whole are identified and served. It is emphasized that the community uses the health and social services provided. Healthcare has become more population-based. Another trend that has evolved is that the hospitals, physicians and health plans have got connected and have formed an integrated delivery system. More investments are being made with a goal of providing services to the customers and retaining them.

There is a beneficial impact in the transformation of healthcare towards emphasizing continued health. The way healthcare has been viewed in the past has been changing. The shifting of care from treating acute illnesses to providing continued care is resulting in enhancement of the health of the people. The only appropriate and feasible model is to provide a continuum of care with the emphasis firmly on the family and community. The health of the population and community is considered as a whole. This is advantageous as it creates value in the healthcare delivery system. The healthcare providers work with the community as a whole and consider to improve the health of the general population. Even though this requires new kinds of ways of organizing and managing healthcare services, it helps in understanding the health needs of the target population. By studying their needs, the right health and social services could be provided to them. Examples of promoting wellness of the whole community are organizing health campaigns and providing preventive education to the people in general. Another example is providing awareness about flu vaccines and encouraging people to get the vaccination.

Integrating the healthcare delivery system has led to certain advantages to the patients. For example, they can be offered alternative sites of care depending on their convenience. It helps in meeting the needs of the customers and their preferences which is taken into account. The number of providers are expanded and the patients get to have a choice. The relationship between providers and health plans are organized in the current trend and this ensures that the right care is provided in a convenient way to the customers.

There are defined budgets and expenditure targets for the populations which implies that there is a need to be efficient and productive. The formation of strategic alliances, networks, systems and physician groups can also add value. There are capitated payments and budgets allotted to the healthcare organizations. These are used to provide care to the defined population. The organization might like to improve on the payments and budgets as the expenditures of the companies increase. This results in the management to make decisions like forming strategic alliances with other organizations and increase the total resources. The growth of such networks will help in providing better care to the customers. Financial resources greatly influence the efficiency and productivity of the organization.

The aging population is influencing the healthcare delivery. There is increased demand for primary care of people over 65 years and for chronic care of people over 75. The ethnic and cultural diversity is also influencing the healthcare delivery. This provides a challenge in meeting patient expectations on one hand and diverse workforce on the other. Biological and clinical sciences have met with technological advances and have led to new treatment modalities. This has led to open new treatment sites and manage across the organization. External forces change the supply of certain areas of health professionals like physical therapy and some areas of nursing. The management needs to compensate for such shortages and they need to develop different teams of caregivers at different work sites. Changes in education of health professionals implies that the management be more creative in offering healthcare services. With an increase in diseases like AIDS and morbidity from drugs and violence, there is more and more need to work with community agencies, form social support systems and there is a need for more chronic care management. Advances in information technology is another area where there is a need to train the healthcare employees in new advances. They also need to manage issues of confidentiality and rapid information transfer. Increasing expansion of world economy has led to more competitive management of strategic alliances, care of patients across the nations and of different cultures.

Current environmental trends impact the healthcare delivery model. Organization’s success depends on its external and internal environment. The complex environments made up of uncertainties and heterogeneity of components leads to different organizational designs. The current environmental trends influence managerial and organizational decision making. The unique challenges facing the healthcare delivery organizations should be analyzed in order to develop and implement new and effective operational processes and strategies. As an impact of current environmental trends, the healthcare delivery system needs to improve individual, team, and organizational accountability and performance. The impact of advances in medical knowledge and information technology on the process of healthcare delivery should also be examined, and it should be leveraged to improve quality of care, process and cost controls, and revenue. New strategies would need to be identified and implemented for learning and performance improvement to create a culture that supports accountability, safety, and high-quality care. Innovative models in healthcare delivery would also be required in order to develop and implement strategies that promote organizational success and competitiveness.

Due to the current environmental trends, more emphasis is given to the customers and there is more of a patient-focused care. The healthcare delivery model has been shifting to the community based care. There has been an increased modification in care processes. The traditional ways are being challenged and more experiments are being performed to fulfill the demands to improve the quality of care. Due to the shift in the environmental trends in the healthcare delivery model, more emphasis is given to quality improvement. This will help improve the performance levels of key processes in the organization. The performance levels are being measured, the defects are eliminated and new features are being added to meet the customer’s need efficiently.

There is a new emerging contemporary trend in the U.S. healthcare system. Presently, the management research and assessment have been offered increased recognition. The emerging trend seen is that this is slowly forming an integral part of managerial and organizational effectiveness. With the emerging efforts in information management, it is leading towards clinical and financial networking. The trend seen among the physicians and nurses is that they are being increasingly involved in managerial activities. The managerial trends are also changing with respect to role performance and changing values. The managers role is getting more and more recognized in managing finance and human resources. Management training, lifelong and distance learning is being offered in preparing future managers.

The healthcare executives and managers will be faced with the major responsibility and challenge in the years ahead. They will be working with other healthcare providers and will be creating a competitive future for their organizations. They will not only be managing organizations but also a network of markets, services and joint ventures. Formation of more and more strategic alliances and partnerships will lead the management to manage across boundaries. The management will change from managing a department to managing the continuum of care. The management will be following a community-based approach. Trend in management is also shifting from just coordinating services to providing improvements in quality.

As the demands in healthcare are increasing, the management is responsible for forming performance standards. The management is also challenged to maximize the productivity and quality to serve the health needs of the community. The management is looking after the demands of the external environment as well as attending to the performance of the internal environment. The management is responsible for the performance of the organization.

Healthcare organization leadership will be responding to new trends and competitive forces. It will respond to continuum of care, overall health status of the population and more complex organizational structures. These emerging trends in the healthcare system will effect the organization’s leadership. The future managers would need leadership skills and vision to integrate the organizations and help in providing the best care. The managers will have to be committed to leadership and work on giving their organizations the best place and help their organizations adapt to the changing circumstances. More value will be given to leaders who will be able to lead the change process. As changes are inevitable for the betterment of the organization, the leaders should be able to identify how the change is to be received and how it is to be communicated at all levels of the organization without damaging the implementation process. The leaders might have to deal with increased pressures due to organizational complexity.

The leader in the organization provides strategic direction to the organization, manages diverse stakeholders, becomes mentors for management, is willing to take risks, helps the organization interact with the external environment and attends to the internal needs as well. Where required the leader will involve physicians in governance process and align physician and organizational interests. There will be a need for formation of learning organizations. Transformational leadership will create the required vision for the organization. Leaders will have a greater role complexity and they themselves will have to adjust rapidly to new situations. The healthcare organization leadership will have to live up to the values of the organization and will help in fulfilling the mission of the organization.

Individuals and groups within the healthcare organizations require more and more competencies. An enhanced lifelong learning is required due to the fast, changing environment. The individuals and groups within the healthcare organizations will be benefitted as there will be rapidly developing medical technologies which will result in increased services. More sophisticated health services will be provided to the consumers. The range and quality of services provided will be regulated for the benefit of people requiring home care, long term care and ambulatory care. The anticipated future development will also result in the increased competition among the health services organization. The individuals and groups will be involved more and more with the community for issues like drug abuse, teenage pregnancy and violence.

Individuals and groups will be faced with increased strategic planning and management in the healthcare organizations as there will be ever increasing involvement by the trustees and physicians. As the future environment in the organizations will be more complex, the individuals and groups in the healthcare organizations might feel more pressurized. They will need to serve the changing demands of the community as the population of elderly patients will increase. These individuals will require more professional training, increased levels of education and should be taking part in continuing education programs.

Due to the anticipated future development in the healthcare organizations, those individuals and groups will be valued, who are adaptable, committed, are able to add value and embrace change. These individuals will be required to experiment more and help in redefining the mission and goals of the healthcare organizations.

Meenu Arora has contributed her articles for both online and hard copy magazines. Her articles have also been published in international magazines. Presently working in the healthcare industry, she has also written and edited Health Q-A columns for international magazine for 5 years.

Hospitals In Philadelphia – Three Of The Top Rated Facilities

Philadelphia is well known for many things whether it is in the professional industry or with regards to the extensive recreational opportunities. The medical facilities in particular are amongst the most renowned, and doctors are falling all over themselves trying to find posts in and around the area. Here are three of the top rated hospitals in Philadelphia you should get to know about.

Mercy Philadelphia Hospital

Mercy Philadelphia hospital is renowned for its services particularly when it comes to acute care and emergencies. It has recently received the Premier Award for its quality from the Premier Healthcare Alliance. Within the hospital are a number of divisions, each of which is accredited and acclaimed in its own right. The radiology division has received numerous accreditations for ultrasound, MRI and nuclear medicine. The cancer, heart and stroke divisions have also been named for outstanding performance. This is just some of why Mercy is one of the top hospitals in Philadelphia.

Temple University Hospital

Temple University is one of the great academic hospitals in Philadelphia. It is best known for its superb clinical training of students and doctors who are specializing. It boasts over 700 beds and services a comprehensive range of people in the surrounding community. It is one of the major attractions for those hopefuls who want to study at the Temple University School of Medicine.

Thomas Jefferson University Hospitals

The Thomas Jefferson University Hospitals are well known for their attention to patient-centered care. They feature world renowned specialists in the fields of orthopedics, gynecology, pulmonology and rehabilitation, to name but a few. As with any academic hospital the teaching that future doctors get is top drawer. The state of the art equipment and skilled team of specialists is a big part of why these are top hospitals in Philadelphia.