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May 11, 2017
Volume VIII |  Issue 19      
Chronic Care Management Services as a Solution   
Jason Walter

It can probably go without saying, but hospital stays are incredibly expensive. Hospitalization alone accounts for one-third of the $2 trillion spent annually on healthcare in the United States, and there is a high rate of hospital re-admissions due to poor planning and transitional care.

In just the Medicare program, the 30-day readmission rate for patients with some chronic conditions is as much as 23 percent. Research has shown that millions of these re-admissions may be preventable, saving billions each year in Medicare spending. One way to manage hospitalization, help with transitional care, and prevent many of these costly re-admissions is through the use of chronic care management services.



This orthopedic surgery is the world's most common. But patients rarely benefit, a panel says
Casey Ross | STAT

The world's most common orthopedic procedure - knee arthroscopy - is frequently a waste of time and money and should almost never be performed on patients with degenerative knee disease.

That's the conclusion of an international panel that strongly recommends against arthroscopic surgery in a new guideline published by the BMJ. The panel found that, while performed 2 million times per year worldwide, knee arthroscopy offers minimal benefits to patients with degenerative knee disease, which affects about 25 percent of people older than 50.

Whether it's ACA, AHCA or some other acronym, the trend in health care is unchanged 

Accountable Care Options, LLC

No matter what repeals or other modifications are made to the Affordable Care Act, the direction of health care will not change. We will continue to see a push from private insurers and from the Centers for Medicare & Medicaid Services for improved outcomes and better value.

We know the Republican Party favors competition and an open marketplace. We have heard some Democrats and Independents call for a one-payor system. These are among the many models of health care that have been proposed in our country and are being used in other nations.

Recently, we have seen the rise of accountable care organizations, or ACOs, which share in Medicare savings. Today, payors are implementing bundled payment systems and emphasizing primary care coordination. Regardless of the model, the goals in the U.S. remain the same: improve population health and outcomes, and slow the rise in health care expenditures.

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Health care trend unchanged 

The federal government and private insurers are aligned in giving financial rewards. They're also providing negative reinforcement such as penalizing hospitals and skilled nursing facilities for re-admissions. Payors are conducting clinical observations of chronic and acute illnesses that send patients back into a higher, more expensive level of care and asking, "Could that have been avoided with better health care management?"

Tough questions such as that are part of a move toward pay-for-value systems that create a healthy amount of diversification and competition in the marketplace. Going forward, we can expect multiple models of health care that improve outcomes and levels of beneficiary satisfaction. They will emphasize efficiency and effectiveness. In the U.S. health care marketplace, the most successful model will prevail.
Five Points Your Physician Employment Agreement Should Address Regarding Med Mal Coverage

Jessica Hoehn | Danna-Gracey

Physician employment agreement clauses about complex issues regarding your med mal coverage often are muddled at best, and some even create more questions than they would if they just didn't deal with the important malpractice insurance issues. Confusion and ambiguous wording in contracts creates lawsuits so fully understanding these five points will help immensely...