Tag: American Coalition for Healthcare Claims Integrity

5 Biggest Issues in Healthcare Today

The healthcare industry has experienced a lot of interesting changes during the last few years, and it will not exempt 2015.

However, there are still a lot of major healthcare programs being practiced all over the world. There are still recurrent issues concerning healthcare today. In this article, we will discuss more about the 5 biggest issues in healthcare.

Wasted Health Funds
According to the recent report of Institute of Medicine Health, there are billions of dollars of health costs that are being wasted each year. Some of the funds were used for unnecessary programs.

Excessive and Needless Care Rendered
Half of all healthcare costs were used for unnecessary and excessive health care. According to the American College of Obstetricians, these healthcare issues have been around for more than a decade. A lot of healthcare organizations carried this burden for so long yet did not dare to do something to fix it.

Chronic Disease Rates Are Extremely High
According to recent surveys, out of the seven countries being examined, Americans have the second highest rate of chronic disease next to Australians. Where in fact, Americans pay the most expensive healthcare costs. How did it happen? Authorities were not able to focus more on preventive care. Majority of adult Americans are becoming at risk to diseases and illnesses due to lack of healthcare support.

Preventable Harm to Patients
This is considered to be one of the most common healthcare problems. According to research, one of four health insurance recipients that were admitted suffers harm during their hospital stay.

Absence of Transparency
Transparency stimulates healthcare change like nothing more. Regardless of getting a lot of warnings from respected national health organizations and other medical societies, the rates of healthcare problems continues to rise. There were a lot of early elective deliveries reported since 2010 but were not taken care of due to unexplained loss of funds.

Medicare Hospital Issues

The House Ways & Means health subcommittee held a hearing last May 20 on hot-button Medicare hospital issues, specifically focusing on CMS’ two-midnights inpatient admissions policy, brief in-patient stays, out-patient observation stays, auditing and appeals, subcommittee Chair Kevin Brady (R-TX) said. Inside Health Policy said that the hearing was in the works. The hearing also will look at appeals trapped at the third level of the system, Brady says in a hearing statement.

hospitalIn introducing the hearing, Brady says, “There are a number of problems associated with brief hospital stays and the way medical centers are audited. The Ways and Means Board battled hard to ensure that sufferers are getting the proper care they need and that Insurance coverage is properly paying medical centers for the care they offer. While we were able to offer some relief last March, it was only a short-term fix. We must work on a lasting solution. We don’t want suppliers needlessly looking over their shoulder area for auditors. We want medical centers to be perfectly refunded so that they can focus all of their time on providing the right type of care to sufferers.”

Brady is making reference to Congress’ decision, as part of the short-term doctor payment patch passed in March, to put on hold until March 31, 2015 Restoration Audit Contractor audits on most brief hospital stays related to medical requirement during an elongated transition to the two-midnights plan. A representative for the American Coalition for Healthcare Claims Integrity, which symbolizes RACs, says that the coalition facilitates continuous developments to the RAC system. “We hope this hearing will light up the impressive volume of waste in Medicare and the value of the RAC system to recipients, tax payers and the Medicare Trust Fund,” the representative says. Recent quarterly reviews from CMS show that the RACs’ recoveries have dropped since the two-midnights plan and other changes to the system were applied.