Precision Medicine Takes Center Stage Print E-mail
Written by Jeffrey Herschler   
Friday, 30 January 2015 14:21

In a segment of  the President's recent State of the Union Address, Mr. Obama states:

Twenty-first century businesses will rely on American science and technology, research and development.  I want the country that eliminated polio and mapped the human genome to lead a new era of medicine -- one that delivers the right treatment at the right time.  (Applause.)
In some patients with cystic fibrosis, this approach has reversed a disease once thought unstoppable.  So tonight, I'm launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes, and to give all of us access to the personalized information we need to keep ourselves and our families healthier.  We can do this.
David Kroll, writing in Forbes, offers an excellent definition of Precision Medicine and the challenges we, as a nation, face in bringing it to fruition in an article posted last week. Not surprisingly, a big obstacle is cost, specifically the price of specialized pharmaceuticals.  
Precision Medicine is an evolved version of Personalized Medicine and offers an abundance of hope for our health outlook. In the not too distant future, every American will have genetic testing results included in their patient record. Outcomes will be vastly improved as treatment programs are tailored to our unique requirements. Initially there will be a spike in cost but, in the long run, Precision Medicine will reduce healthcare costs because its individualized, predictive value will enable focused, early, preventive interventions. 

See related article ONC unveils Interoperability Roadmap for public comment from FierceHealthIT.

Last Updated on Friday, 30 January 2015 14:24
Balance Billing Revisited Print E-mail
Written by Karina Gonzalez | Florida Healthcare Law Firm Blog   
Wednesday, 28 January 2015 12:53

Balance billing happens when a provider collects from a patient the difference between the provider's total billed charge for the service and the allowed amount paid by an HMO or insurer for the service. A provider's collection of a deductible, co-payment or co-insurance from a patient is not considered balance billing.
When an HMO pays a provider's service it is generally paying the amount it is required to pay pursuant to its contract with a member. Reimbursement is not generally based on the provider's billed charge. HMO and insurers calculate the allowed amount based on what they consider to be a usual, customary and reasonable charge for the particular service.
A patient's co-insurance obligation is a requirement found in a contract with health plan. It requires a patient to pay a prescribed portion of the cost of the covered healthcare service. Co-insurance is established as a predetermined percent of the allowed amount for covered services rather than a percent of a provider's billed charge. The remainder after payment by the HMO or insurer and after the collection of the co-insurance amounts is the balance of the bill. A provider can generally conclude that the balance of the bill exists because the total billed charges exceeded the allowed amount.
Under Florida law you cannot balance bill a patient for any service covered and authorized by an HMO, if the HMO is liable and responsible for payment.

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HCA Joins S&P 500 Print E-mail
Written by Florida Health Industry Week in Review   
Tuesday, 27 January 2015 19:12

What Happened. Why it Matters.

In a January 23 post, Beth Kutscher and Adam Rubenfire from Modern Healthcare report:

HCA, the largest hospital chain by revenue, had a strong 2014 that raised its share price more than 50%. And now it appears that performance was enough to earn it a spot on the elite Standard & Poor's 500. The Nashville-based chain will replace supermarket chain Safeway on the index after the close of trading Monday, January 26, 2015. HCA shares closed Friday at $68.64, giving the company a market capitalization of $29.6 billion. Shares gained another 4% in after-hours trading to top $71.The chain earlier this month raised its earnings guidance for 2014. It was the third consecutive quarter when the company bested expectations.

Governor Rick Scott's old company is having quite a run. Although not commonly talked about, one of the ACA's goals is to facilitate consolidation. The theory being scale lowers cost. Meanwhile the government is confident that regulators can control any attempts at pricing abuse by providers who have gained market share. HCA's entry into the S$P 500 is a milestone for progressive healthcare reformers.

Read More from Week in Review HERE>>
Sponsor Showcase Print E-mail
Written by Sponsor   
Saturday, 31 January 2015 00:00
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Last Updated on Saturday, 31 January 2015 18:01

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