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Fraud And Abuse A Major Reason For Waste In The Us Healthcare Spending

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Health care fraud and abuse is an important and conspicuous factor in the resource and finance drain in the US healthcare system and is responsible, to an extent, for the escalating healthcare costs.

According to a report by Thomson Reuters on US healthcare spending, the US healthcare system wastes between $505 billion and $850 billion every year, out of which the waste caused due to Fraud and abuse constitutes $200 billion, or 22% of healthcare waste every year.

The following chart shows the percentage of waste caused due to different parameters in the US healthcare spending.

Source: Healthcare analytics, Thomson Reuters

What is healthcare fraud and abuse?

Health care fraud is a criminal act in which a consumer or physician(s) deliberately misrepresents facts or information, for the purpose of undeserved or greater reimbursement. Health care abuse is a reckless disregard or conduct that goes against and is inconsistent with acceptable business and/or medical practices resulting in greater reimbursement.

How to prevent it?

Health care fraud and abuse has played such a vital role in increasing the cost of health care and has become a pertinent issue for the government as well as the general public. The question is how to prevent it?

Both Consumers and physicians have to be alert to the possibility of fraud and abuse and work to prevent it. Consumers need to get involved with their health care beyond the point of going to the doctor and taking medication. They need to be educated on their insurance plan, how much they pay, the proper names of their ailments, and they need to keep track of the services they receive and why they receive them. Simple tips that may help prevent fraud and abuse include:

“Review Explanation of Benefits to ensure accurate dates of service, name of providers, and types of services reported
“Protect insurance card and personal information at all times
“Count pills each time they pick up a prescription
“Research providers with state’s medical boards
“Report suspected fraud and abuse as soon as possible

Along with consumers, physicians too must check for any unintentional fraud and abuse happening around them. They can have training and awareness amongst their staff to prevent unintentional fraud. These joint efforts would definitely check the fraud and abuse rate in the United States and ultimately bring down the overall cost of healthcare.

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Healthcare Training – Your Own Lottery Ticket

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The healthcare sector has been one of the largest industrial sectors in the US for the last 5 to 8 years. As a matter of fact the top 20 sectors with the highest annual growths include around 10 health related sectors. Hence it is obvious that there has been a significant increase in the employment opportunities for students pursuing a healthcare training.

This growth has largely been caused due the increase in the elderly population. With the development of modern technologies and their growing applications in the health industry the scope of the health sector has also grown phenomenally. It is estimated by the US Department of Labor that almost 3.2 million new jobs will be generated for the students coming out of a medical training school by 2018.

The pay scales in the health sector are much higher in comparison with other large industrial sectors by about 13%. This estimation is done excluding the amounts paid for work in odd hours and that’s not all. People employed in the medical sector also get other benefits like pensions, health insurances and also not to forget paid holidays and sick leaves but for all this you first need to join a medical training school.

So let us take a look at some good medical training schools and healthcare training programs which will lead you to a successful career in the medical sector. There are around 160 medical colleges in the US. Admission to these colleges for a post graduate or graduate degree is through common entrance tests like the MCAT. Also qualities like involvement in social work are considered for admission.

University of Arizona College of medicine, University of California Davis School of medicine, Yale University of medicine and University of Pennsylvania School of medicine are some of the oldest and renowned colleges of medicine which offer a variety of healthcare training programs. These courses include osteopathic medicine, dental medicine, pathology etc.

It is important to have a specialization to be successful in the medical industry. Nowadays many nursing and technical diploma courses which are much shorter than the traditional graduation courses are in demand. Thus specific training programs will help you to stand firmly in the medical sector and make good money as well.

Though the scope in the medical sector is growing exponentially only a good educational qualification from a recognized medical training school and even more than that the passion to serve people will make you successful in the medical sector

LVN school offers LVN programs and other vocational healthcare programs in their campuses in California.

Hospitals Expand To Attract Well-insured Patients Despite Pressures Of Healthcare Reforms

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Several hospitals are looking for well-insured patients beyond traditional market boundaries, both in prosperous suburbs and in nearby areas with growing, well-insured populations. According to a study by the Center for Studying Health System Change (HSC) hospitals seeking a competitive edge in the marketplace are targeting geographic expansion into new markets which are well-insured.

The study based on HSCs visits to 12 nationally representative metropolitan communities, depicted that hospitals are expanding despite the pressures of the healthcare reform. Hospital strategies mainly include building full-service hospitals, establishing freestanding emergency departments and other outpatient services, acquiring physician practices, and operating medical transport systems with several hospitals building near major highways to be accessible.

Hospitals expansions survey findings

In all 12 markets surveyed results depicted that hospitals are looking for full-service hospitals or freestanding emergency departments, buying or establishing physician practices and developing a regional presence through emergency medical transport systems

Recession rather than diminishing has heightened the drive among hospitals to pursue well-insured patients beyond traditional hospital market boundaries

Expansion appears more frequent where large hospital systems were pursuing significant employment of physicians and where service-line strategies, such as cardiac or cancer care, were well entrenched

Impact on Hospitals & Independent physicians

The overall impact of hospitals geographic expansions is still to be observed, there are conflicting views within the industry regarding these new hospital competitive strategies, if they will increase costs, improve care or both. Hospitals are of the view that the expansions will increase efficiency, increase access and improve the quality of patient care, while payers and competitors argue such strategies will lead to elevated costs.

Also Independent Physicians in most markets due to health reforms who are faced with financial pressures along with difficulty in hiring younger physicians, who often prefer employment in larger organizations, are actively seeking the stability and security of employment in larger physician-owned or hospital-owned groups. According to the HSC study in fast growing and well insured Greer, SC, there are no more independent primary-care practices left.

Revenue cycle management amidst hospital expansion and reforms

Hospitals backing expansions as necessary countering that even though there are costs increases, their efforts provide increased high-quality care; will need to cater to higher patient influx and increased medical billing. Hence in this scenario along with the growing pressure of health care reforms, services of skilled service providers possessing the requisite credentials can be availed by hospitals and practitioners to maintain favorable revenue cycles management.

Medicalbillersandcoders.com the largest Consortium of Medical Billers and Coders, servicing over 50 specialty US physicians, are constantly updated with the requisites of the industry and healthcare reforms are the right choice for hospitals and practices. Medicalbillersandcoders.com has in-depth knowledge and expertise in the delivering the best quality services to hospitalists. Hospital employment will affect patients, hospitals and doctors as healthcare will require greater coordination, greater use of clinical data and collaborative provider teams which MBC is best positioned to deliver.

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China Healthcare Sector Analysis

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China’s healthcare industry is entering into a new era with advance development of the infrastructure system. The industry is blessed with several advantages like large population of the country, increasing ageing population, increasing prevalence of lifestyle disease and many more. The government has also boosted the industry growth by blessing the sector with a US$ 120 Billion reform package. Backed by these all factors, healthcare sector in China is expected to outperform all other sectors in the country in terms of growth.

According to our new analytical study on the sector called -China Healthcare Sector Analysis- the China healthcare spending is forecast to grow at CAGR of over 18% during 2010-2012. Currently, the market is characterized by major changes in rural healthcare infrastructure. Anticipating the future growth, many private sector giants are looking to invest in the sector to get a pie of the chunk.

Our report has found that medical device market is expected to grow most in all other segments. The government decision to improve the healthcare infrastructure in rural areas will result in increasing demand of medical devices and equipments. Backed by this increasing demand, the medical device market is expected to grow at a CAGR of around 20% during 2010-2012. In this regard, our report provides rational analysis of various factors which will drive this market segment over the forecast period.

It also provides extensive information on Chinese pharma market with the detailed description of traditional Chinese medicines and western medicine market. It also highlights several emerging market trends like medical tourism market, healthcare IT market, telemedicine, etc. The research study gives detailed statistical and analytical review on demographics, macroeconomic indicators, disease profile, healthcare services market, key drivers and restraints. It contains all the vital information that will help clients to draw up their market strategies and assess opportunity areas in China’s healthcare market.

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About RNCOS:

RNCOS, incorporated in the year 2002, is an industry research firm. We are a team of industry experts who analyze data collected from credible sources. We provide industry insights and analysis that helps corporations to take timely and accurate business decision in today’s globally competitive environment.

Emr – Shaping The Future Of Healthcare

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We all are aware of how the CMS multimillion dollar plan for EMR adoption created waves in the Healthcare IT industry. EMR was a proven tool to optimize practice operations and workflows. Large hospital corporations and technology enthusiasts were already reaping its benefits long before the government’s incentive program. Within the last two and a half years, EMR has managed to change the face of the Healthcare industry in the US. The adoption rates are now higher than ever. With the introduction of affordable, web-based EMR solutions, smaller practices can now look to automate their clinical and administrative processes as well.

While a practice may benefit from cost savings and improved productivity, the real benefactors are the patients themselves. An EMR offers increased quality of care through built-in interaction checks, improved accountability and ease of access, thus the future of healthcare backed by EMRs looks very promising indeed.
With increased focus on EDI and security, it is easier to anticipate what may come next. Healthcare portals are slowly gaining popularity amongst patients. With access to electronic personal health record, a patient is remains informed. The CMS wants to establish a new, more efficient method for care delivery by promoting online healthcare information exchange. This is also keenly reflected within the meaningful use objectives for stage 1 and the proposed stage 2.

Utilizing the technology available today, physician-patient interaction can be transformed completely. Integrated EMR Portals remove care delivery barriers and keep patients synchronized with real-time data to manage their health better. These may include online follow ups along with clinical alerts and reminders through instant messaging (email and text). With patients already using a patient portal to book their appointments, access lab results, request prescription refills and review visit notes, the next step may be a completely virtual clinical checkup.

With the development in online healthcare information exchange, patients can manage their health better and transport vital health information anywhere, anytime. EMR is definitely changing the healthcare system and a lot of us are just beginning to realize its significance, with the dawn of a new era of accountable and accessible care for all.