Integrating Shared Decision Making in the Healthcare System

Integrating Shared Decision Making in the Healthcare System[EXTRACT]
Shared decision-making is defined as a process in which decisions are made by both the patient and his or her healthcare providers. The ultimate goal of this process is to invoke patients to actively participate in the making of decisions especially those pertaining to their health. This is advocated in a patient-care oriented system as in the healthcare system, because of its ability to ameliorate the distinction of the result of the patient’s decision-making ability.A successful shared decision-making in the health care delivery system rests mainly on the presented threats and advantages of all given alternatives such as determining the setting in which the disease management or plan of care is viewed by the patient as something that’s valuable and considered vital especially in the promotion of his health, in discerning that the patient can fully grasp the exchanged information and discussed plan of care, and leveraging patients in making their decisions based on what’s more beneficial. It also involves extracting preferences of treatment, communicating disease management suggestions, and making the element of doubt unequivocal especially during the process of decision-making.

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Shared decision making allows room for open communication between the patient and his healthcare provider, wherein interaction and change of ideas mostly take place as they the decision-making is processed. What’s involved during this process is the provision of an informed consent by the patient to what, when and how the treatment should be implemented, and eliciting realistic outcome criteria for the planned treatment, preventing future conflicts between the patient and the care provider, encouraging and implementing autonomy on the part of the patient especially in making decisions pertaining to his health and explaining the risks and benefits during and after the treatment.A shared decision-making is considered a good one and will most likely come up with a promising outcome if both parties, usually involves at least two participants (the health care provider and the patient, and sometimes the patient’s relatives take part in the process) are well-informed, which means that information is properly disseminated and the decision is based and reinforced with on hand substantiation, conforms with the patient’s beliefs and values, gives regard to the preferences of the patient, if the pros outweighs the cons, agreement is achieved on the decision of the planned treatment, and patient satisfaction is warranted after the decision has been made and treatment is executed.To make it clear how both parties – the patient and the care provider take part in the shared decision-making process, the patient is the one that ventilates his or her experiences, values and preferences, and interaction takes place as the physician lays out the treatment options while weighing the pros and cons as the end does not justify the means.

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Shared decision -making would be very helpful in getting the outcome that’s convenient and beneficial to the concerned party – the patient. However, not all healthcare delivery systems have adapted this concept yet. A lot of barriers still occur that can lead to poor decision making.CallCareNet provides an environment that’s patient care oriented and eliminates the barriers to a good decision-making by building rapport to patients and clearing out the roles of both parties. The people at CareNet sets up realistic goals and objectives, values and considers the patient’s interests and expectations, lays out varying options that are more beneficial rather than not, provides freedom of choice to patients and family members, and rationalizes the agreed decision, because CallCareNet cares.

The Concept of Having a Universal Healthcare System

The Concept of Having a Universal Healthcare System[EXTRACT]
For most societies health, birth and death is something that falls into the society’s responsibility and people prefer to pay taxes to have this administrated. USA is the only civilized country that doesn’t have universal health care.The ideas and thought behind a universal healthcare:For most people to have a system dealing with life and death in the hands of incorporated businesses, seems grotesque and scary. The grotesque part is that people are getting profit from matters of life and death. The scary part is that a greedy organization might kill people for profit, by not paying for treatments. Another scary part is that when you might need healthcare the most, as when you can’t work because of ill health, that’s when you don’t have a health insurance. Besides it’s not only about yourself and your family it’s about the health of the society. There are more to life then yourself, and when other people suffer, so will you. Shouldn’t citizen’s health be more important than the concept that some people should earn money by squeezing sick people out of treatment options?

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Somehow the Americans have lived with this system and according to the polls, at least 40% of the population do not find it disturbing at all, but want to continue having a privatized health system. I’m not sure why, however when listening to the politicians their argument is that without a privatized system you can’t choose your own plan or your preferred hospital and doctor; meaning the quality of the treatment is better.Are the treatment and the quality in a privatized health care better?I believe this is difficult to answer because it depends on the people creating the healthcare system and what they find important. The first measurement should be if there is a healthcare system for everybody, and it seems that the privatized system fails at its foundations. I have lived under both systems and I have noticed that under a universal healthcare system that nurses and doctors might become lazy and maybe arrogant toward the patients. However I don’t think this is an issue connected to the universal health system, but the regulation of accepted behavior and the right to complain.

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Another issue is the lines for certain treatments. However, I don’t believe is connected to the universal health system either, it’s more an issue connected to small countries with few surgeons and experience in certain health issues. For small countries this is something that might and are solved – by sending patients abroad to neighbor countries.In countries that have based their healthcare on a universal health care system, there are options for a private clinic for those who want to pay for themselves and don’t want to wait in line or for the appointment. It’s not either universal healthcare or private healthcare, it’s both.

Does the United States Healthcare System Need an Overhaul?

Does the United States Healthcare System Need an Overhaul?[EXTRACT]
Healthcare is undoubtedly one of the United States’ biggest challenges today. Having been declared “broken” by experts over ten years ago, the system has still not shown any improvements. Supposed “fixes” promised by managed care have not surfaced. Instead, health insurance premiums are rising, hassles for patients and physicians continue, and more than 45 million Americans are uninsured.If the challenges with healthcare that the United States faces are not met swiftly and wisely, the current problems will worsen and new challenges will arise. Even considering that new technology, such as online medical consultations, will increase efficiency, the cost of new tests and treatments are projected to outweigh the savings. As physicians and online doctors get better at treating ailments and illnesses, they will in turn lengthen patients’ lives, thereby increasing the number of people requiring medical care.Additionally, as costs rise, many employers will not be able to handle providing healthcare benefits to their employees. This is just one contributing factor to the growing number of uninsured citizens.Is Healthcare Reform in Our Near Future?President Obama has plans in motion to ensure each and every American has access to high quality health care, deeming it “one of the most important challenges of our time.” He stated that the number of uninsured Americans is growing, premiums are skyrocketing, and an increasing number of people are being denied coverage every day. In addition, President Obama believes that an improved healthcare system – including one that supports the use of telemedicine and online doctor consultations – is also essential to rebuilding the U.S. economy, in that an improved system will benefit people and businesses – not just insurance and pharmaceutical companies.

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According to Darrell M. West, Vice President, Governance Studies at Brookings Institution, “the biggest obstacle to health care reform is fear of the unknown. Anytime you make fundamental changes in the system, there is going to be anxiety from doctors worried about reimbursement levels, patients concerned over access to care, insurers about market competition, and hospitals about cost structures. In this situation of complex proposals and unknowable consequences, it is easy to play to people’s fears and scare them into resisting change. What President Obama has to do is persuade people that diving into the unknown future is less risky than the current status quo. If he can overcome the fear hurdle, he will get health care reform.”We Have Evolved…It’s Time for Healthcare to Evolve, TooThe way of approaching healthcare in the United States has become outdated. With the rapidly expanding array of technology that is available to the people of the United States, it is no wonder why the way research is done has changed; and the ways in which people communicate has also changed. So what about change in the healthcare system? It is due time for physicians and other healthcare providers to evolve with the times and incorporate telehealth services, such as online medical consultations and online prescriptions, into their practices.Datamonitor has predicted that the global telehealth market is expected to exceed $8 billion by the year 2012. Telemedicine (often used synonymously with telehealth) is the use of medical information being exchanged from one to another via electronic communication, whether it is the internet or phone. This exchanged medical information in the form of online doctor consultations and printable doctors’ excuses online in turn is used to improve the patient’s health or direct them in the right path.Commonly referred to as online medical consultation services, telemedicine is not different from the actual practice of medicine; it is just the application of the standard, accepted practice of medicine, to electronic communication, thus making it more widely accessible and easier to obtain by the general public. With technology at everyone’s fingertips, it is no wonder that a rapidly increasing number of people are turning to the internet for online doctor consultations and printable doctors’ excuses. To date, approximately 36 million Americans have already been treated by telemedicine through online doctor consultations and/or prescriptions. A survey showed that over 70% of patients indicate that they are willing to try online doctor consultations and online prescription services rather than going into an office when they have a minor illness.

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The American Medical Association (AMA) has reported that possibly 70% of all doctors visits are for information or a consultation of sorts that could easily be handled over a phone. All of these visits cost medical providers and patients alike for the unnecessary trips. It has been estimated that as much as $300 billion of health care costs are wasteful and unnecessary, thus resulting in higher insurance costs for groups and individuals alike.Are These Goals Within United States’ Reach?The three targeted goals when it comes to improving the U.S. healthcare system according to President Obama are the following:o Reform the healthcare system;
o Promote scientific and technological advancements; and
o Improve preventative careWith the rapid advancement of telemedicine, or online doctor consultation and online prescription services, the aforementioned goals are most definitely within our reach.

Maximized Living: New Rankings for US Healthcare System

Maximized Living: New Rankings for US Healthcare System[EXTRACT]
The American healthcare system continues to crumble. Bankruptcy due to medical expenses is at an all time high. While the health of Americans is at an all time low. From medical errors, unnecessary procedures, and drug prescription side effects to increases in heart disease, cancer, and degenerative illness, the truth continues to be uncovered. Startling statistics are being yanked from the most respected scientific journals to prove our medical system is clearly not only not getting people well, it is harming the people more than it is helping.The latest report published in Health Affairs reveals the United States is 49th in life expectancy and rank 41st in infant mortality rates. If those numbers don’t strike a nerve with you, remember there are people you know putting their faith in life in the hands of our healthcare system. In America, we put the most money into healthcare. We have the best hospitals, best technology, put most money put towards medical research, and our rankings have dropped 20 spots in the last seven years! How is that possible? The answer is simple. The system is broken and it does not work at getting people well. In fact, the prestigious New England Journal of Medicine described the American healthcare system this way; “The American healthcare system is at once the most expensive and the most inadequate system in the developed world.”

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Until fraudulent activities are stopped between governing agencies, doctors, and pharmaceutical companies; until alternative measures other than drugs and surgery are explored to get people well; until we have enough Americans who have had enough of the increased disease, depression, suicides, and infants dying; until families across the country decide they will not put their family’s health on the line in this system; until there is a radical paradigm shift in American healthcare: you can expect the numbers to drop again seven years from now. The medical model of healthcare was designed for emergencies only! Use it for emergencies only, and decide now to take control of your health.For real healthcare and true prevention, don’t rely on a broken system. The Maximized Living view is health care and not medical or wellness-based disease care. If you’re sick, follow the 5 Essentials to become a healthy person again. Most importantly, if you’re already healthy – follow the 5 Essentials and stay healthy! If you look at the 5 Essentials of Maximized Living and study the available research done for each, you’ll find 1000’s of studies showing their positive impact on cancer, heart disease, high blood pressure, childhood disease, pain, depression, etc. However, unlike the current health care model – it’s not about “treating” disease, it’s about living. It’s about a lifestyle that does not interfere with the body’s physiology, function, or structure – thus allowing the body to produce health. It’s treating health – not treating disease.

Statutes in U.S. Healthcare System

Statutes in U.S. Healthcare System[EXTRACT]
The healthcare field is the subject of a host of federal statutes, regulations, guidelines, interpretive information, and model guidance. There are a considerable number of statutes and regulations that have an impact on the delivery of healthcare services. A statute is legislative enactment that has been signed into law. A statute either directs someone to take action, grants authority to act in certain situations, or to refrain from doing so. Statutes are not self-enforcing. Someone must be authorized to do so to take action. A statute may authorize the Department of Health and Human Services to take action, and it is up to the department to implement the law. Regulations, or rules, are made by administrative personnel to whom legislatures have delegated such responsibilities. It is a tool for developing policies, procedures, and practice routines that track the expectations of regulatory agencies and departments. The statutory and regulatory requirements are subject to judicial interpretation.A very important element of healthcare management is to understand the key regulatory environment. One government statute that effects patient healthcare is the Anti-Kickback Statute. The Medicare and Medicaid Patient Protection Act of 1987 (the “Anti-Kickback Statute”), has been enacted to prevent healthcare providers from inappropriately profiting from referrals. The government regards any type of incentive for a referral as a potential violation of this law because the opportunity to reap financial benefits may tempt providers to make referrals that are not medically necessary, thereby driving up healthcare costs and potentially putting patient’s health at risk. The Anti-Kickback statute is a criminal statute. Originally enacted almost 30 years ago, the statute prohibits any knowing or willful solicitation or acceptance of any type of remuneration to induce referrals for health services that are reimbursable by the Federal government. For example, a provider may not routinely waive a patient’s co-payment or deductible. The government would view this as an inducement for the patient to choose the provider for reasons other than medical benefit. While these prohibitions originally were limited to services reimbursed by the Medicare or Medicaid programs, recent legislation expanded the statute’s reach to any Federal healthcare program. Because the Anti-Kickback statute is a criminal statute, violations of it are considered felonies, with criminal penalties of up to $25,000 in fines and five years in prison. Routinely waiving copayments and deductibles violates the statute and ordinarily results in a sanction. However, a safe harbor has been created wherein a provider granting such a waiver based on a patient’s financial need would not be sanctioned. The enactment of the 1996 Health Insurance Portability and Accountability Act (HIPAA) added another level of complexity to the Anti-Kickback statute and its accompanying safe harbors. HIPAA mandated that the OIG (Office of Inspector General) furnish advisory opinions to requesting providers that are either in an arrangement or contemplating an arrangement that may not fit squarely within the law. For a fee, the OIG would analyze the arrangement and determine whether it could violate the law and whether the OIG would impose sanctions on the arrangement. In many of its advisory opinions published over the past few years, the OIG has stated that it would not impose sanctions, even though it found that the arrangement in question could violate the statute. A common reason the OIG has given for not imposing sanctions has been that the arrangement provides an overall benefit to the community. Healthcare finance professionals need to ensure that all business transactions comply with the Anti-Kickback statute.

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The Anti-Kickback statute effects the patient. The main aim of this statute is to improve patient safety, provide satisfaction and avoid risk. The result of the acquisition of a physician’s practice would serve to interfere with the physician’s subsequent judgment of what is the most appropriate care for a patient. It would also interfere with a beneficiary’s freedom of choice of providers.Physicians have direct patient care responsibilities. Any incentive payments to such physicians that are either tied to overall costs of patient treatment or based on a patient’s length of stay could reduce patient services. Also, the profits generated by cost savings may induce investor-physicians to reduce services to patients. Health care programs operate on the good faith and honesty of health care providers. It is important to ensure that quality services are provided at the hospital. The Anti-Kickback statute helps the government not to tolerate misuse of the reimbursement systems for financial gain and hold the responsible parties accountable for their conduct. Such conducts can also prompt patient complaints. The hospitals and physicians who are interested in structuring gainsharing arrangements might adversely affect patient care.The Anti-Kickback statute creates a protective umbrella, a zone in which patients are protected so that the best health care is provided. This statute helps to improve efficiency, improve quality of care, and provide better information for patients and physicians. The Anti-Kickback statute is not only a criminal prohibition against payments made purposefully to induce or reward the referral or generation of Federal health care business, it also addresses the offer or payment of anything of value in return for purchasing, leasing, ordering of any item or service reimbursable in whole or part by a Federal health care program. It helps to promote quality and efficient delivery of health care transparency regarding health care quality and price.There are millions of uninsured patients who are unable to pay their hospital bills. Giving a discount on hospital charges to an uninsured patient does not implicate the Federal Anti-Kickback statute. Most need-based discounting policies are aimed at making health care more affordable for the millions of uninsured citizens who are not referral sources for the hospital. For discounts offered to these uninsured patients, the Anti-Kickback statute simply does not apply. It is fully supported that a patient’s financial need is not a barrier to health care. Furthermore, OIG legal authorities permit hospitals and others to offer bonafide discounts to uninsured patients and to Medicare or Medicaid beneficiaries who cannot afford their health care bills. The Anti-Kickback statute is concerned about improper financial incentives that often lead to abuses, such as overutilization, increased program costs, corruption of medical-decision making, and unfair competition.There are risk management implications of this statute. There are risks associated with the Anti-Kickback statute and its good to prevent them. Rather than be an imposing and daunting challenge to understand, the outcome can be development of risk management systems to guide the delivery of health care. This fact is recognized that such statutes are an important attribute of the risk management professional. For example there are potential risks under the Anti-Kickback statute arising from hospital relationships. In case of joint ventures there has been a long-standing concern about arrangements between those in a position to refer or generate Federal health care program business and those providing items or services reimbursable by Federal health care programs. In the context of joint ventures, the chief concern is that remuneration from a joint venture might be a disguised payment for past or future referrals to the venture or to one or more of its participants. The risk management should be done by having a knowledge of the manner in which joint venture participants are selected and retained, the manner in which the joint venture is structured and the manner in which the investments are financed and profits are distributed. Another area of risk is the hospital’s compensation arrangements with physicians. Although many compensation arrangements are legitimate business arrangements, but may violate the Anti-Kickback statute if one purpose of the arrangement is to compensate physicians for past or future referrals. Risk management is to follow the general rule of thumb that any remuneration flowing between hospitals and physicians should be at fair market value for actual and necessary items furnished or services.

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Risk management is also needed in entities such as in cases where a hospital is the referral source for other providers or suppliers. It would be prudent for the hospital to scrutinize carefully any remuneration flowing to the hospital from the provider or supplier to ensure compliance with the Anti-Kickback statute. Also, many hospitals provide incentives to recruit a physician or other health care professional to join the hospital’s medical staff and provide medical services to the surrounding community. When used to bring needed physicians to an underserved community, these arrangements can benefit patients. However, recruitment arrangements pose substantial fraud and abuse risk. This can be prevented by having knowledge of the size and value of the recruitment benefit, the duration of payout of the recruitment benefit, the practice of the existing physician and the need for the recruitment. Another area where risk management is to be applied is when the discounts are given. The Anti-Kickback statute contains an exception for discounts offered to customers that submit claims to the Federal health care programs. The discounts should be properly disclosed and accurately reported. The regulation provides that the discount must be given at the time of sale or, in certain cases, it should be set at the time of sale. This will help in risk management. It is also needed in medical staff credentialing and malpractice insurance subsidies.The key areas of potential risk under the Federal Anti-Kickback statute also arise from pharmaceutical manufacturer relationships with 3 groups: purchasers, physicians or other health care professionals, and sales agents. Activities that pose potential risk include discounts and other terms of sale offered to purchasers, product conversion, consulting and advisory payments. The pharmaceutical manufacturers and their employees and agents should be aware of the constraints the Anti-Kickback statute places on the marketing and promoting of products paid for by federal and state health care programs. To that end, the draft guidance recommends pharmaceutical manufacturers ensure that such activities fit squarely within one of the safe harbors under the Anti-Kickback statute. The Department of Health and Human Services has promulgated safe harbor regulations that protect certain specified arrangements from prosecution under the Anti-Kickback Statute.Healthcare being one the most regulated of all sectors of commerce, it is important that all facts and circumstances with respect to the statutes and regulations are evaluated.