Monthly Archives: February 2014

A rural health system can be our model

I love our rural communities. You don’t have to convince them to work together. The people are smart, work hard, and know the value of a dollar. And they can smell a skunk a mile away.

“The only constant is change” is probably the best description of our ‘new normal’ in healthcare. Decreasing inpatient volumes, hospital layoffs, declining reimbursements, mergers and affiliations. Who saw this coming? Clearly, incremental improvements to old processes is no longer “leadership.” I think our rural health system has some distinct advantages that we can learn from.

Rural communities are used to pulling together out of necessity. The local Critical Access Hospital (CAH) already supplies some of the best paying and most stable jobs in town. More importantly, it’s home. My father-in-law had to drive 25 miles to get to his CAH; trying to convince him to go 50 miles the other direction for that ‘big city’ hospital was a waste of time.

So a quality, post-discharge, patient care plan is a plausible goal. Formalizing the integration is work, but not unrealistic. Start with something simple, like HIPPA. Who needs to know what to achieve this quality patient care plan. Suddenly you’ve identified the players and defined the responsibilities. And, since it’s rural, everybody has a right to participate. Federally qualified health centers (FQHCs), rural health clinics (RHCs), community health centers (CHCs), DENTISTS (personal bias), WIC clinics, skilled nursing homes, home health agencies, faith-based organizations, and Telehealth (since most CAHs can’t provide 24×7 pharmacy services).

A review process is important for quality assurance and continuous performance improvement, which will lead to ‘discussions’ about costs and reimbursements. But there’s already one CAH/FQHC collaboration success story (Sakakawea Medical Center and Coal Country Community Health Center in N.D.), so it can be accomplished!

And once those ‘yokels’ make it work, then what’s our excuse?

8 states mandate Medicaid recipients be transferred to managed care plans

Should states mandate nursing home and assisted living residents be transferred from Medicaid into managed care plans? I’d prefer to be at home rather than in a nursing home. But I don’t know what the typical living conditions at home look like for Medicaid recipients.

Eight state have mandates requiring nursing home residents, and people receiving long-term care services at home or assisted living facilities, to be transferred from Medicaid (the state-federal health insurance program for the poor) into managed care plans. Seven more are pursuing the approach.

Florida, Kansas, Delaware, Minnesota, Tennessee, Hawaii, New Mexico and Arizona have statewide mandates. New Jersey, Ohio, California, Virginia, New York, Texas and Rhode Island are in the process of similar legislation. As a result, the number of long-term care residents enrolled in mandatory managed care is projected to double this year to 1.2 million.

Florida is betting mandated managed care will save money by helping people get support to remain in their homes or in less costly community settings rather than in nursing homes where fees average $6,000/month. The elderly and disabled account for about 6 percent of Medicaid enrollees but nearly half of the program’s spending.

Read more:

U.S. News 100 Best Jobs: 38 are Healthcare (7 of top 10)

Healthcare, not surprisingly, is the top field to pursue according to the U.S. News 100 Best Jobs of 2014 report.

This is not a Highest Demand Jobs list. The rankings are based on the number of projected number of openings (through 2022), balanced by their advancement opportunities, career fulfillment and salary expectations.

Since most of these positions can be found in any size organization, from large hospital systems to critical care hospitals, community health centers and private practice settings, people have a plethora of opportunities to find the right fit for their personality.

38 of the professions are in healthcare, and they’re skewed to the top of the list!

#3     Dentist
#4     Nurse Practitioner
#5     Pharmacist
#6     Registered Nurse
#7     Physical Therapist
#8     Physician
#10   Dental Hygienist
#13   Physician Assistant
#14   Occupational Therapist
#16   Phlebotomist
#17   Physical Therapy Assistant
#21   Occupational Therapy Assistant
#22   Clinical Lab Technician
#25   Dietitian and Nutritionist
#26   Diagnostic Medical Sonographer
#27   Massage Therapist

For the full list:

New York’s I-STOP is curbing prescription drug abuse!

New York’s Internet System for Tracking Over-Prescribing (I-STOP) is a national model for curbing prescription drug abuse, the nation’s fastest-growing drug problem.

I-STOPs positive effects are huge, from identifying drug abuse and stopping crime, to reducing healthcare costs. And it’s available for telemedicine providers, community health centers and hospital emergency rooms which have no viable alternatives.

Since August 2013 New York doctors have been required to consult the I-STOP database before writing any Schedule II, III, or IV controlled substance prescriptions (includes narcotic painkillers). Result: over 7 million individual prescription checks on nearly 3 million separate patients have been run. In March 2015 New York doctors will be required to consult the I-STOP database for all drugs.

Read more: AG Schneiderman Applauds Success Of New York’s Innovative Program To Prevent Prescription Drug Abuse