Health Care Reform: Frankly My Dear, We Should All Give a Damn

For the last 2-3 years, the whole country has been in the grips of the Health Care Reform changes - meaningful use, health benefit exchanges, HIPAA 5010, ICD10, ACA, and Value Based Purchasing.  Still many aspects of the health care industry as we’ve known it are already gone with the wind.

Health Care Reforms are divided into two nations: the nation of Insurance companies and government payers vs. the nation of the Health Care Provider industry

As reforms relate to the insurance industry, we can honestly say, “I will never be without health insurance, again!”

For example,

Being denied insurance for a pre-existing condition is gone with the wind. Health insurance companies won’t be allowed to deny coverage to Americans in frail health.

Insurance companies that drop you when you get sick are gone with the wind. As a result of health care reform, health insurance companies will not be allowed to end your coverage once you are sick.

By 2014 your child’s policy that may exclude coverage for certain illnesses will be gone with the wind. Insurance companies won’t be permitted to write child health policies that exclude coverage for certain illnesses.

While the Insurance company reforms serve to guarantee human rights, it remains to be seen if the reforms of the health care industry will do the same or if it will be like the burning of Atlanta.

ICD9 codes are soon to be gone with the wind and ICD10 codes will replace them. For the last few years, the single biggest issue facing the health care payer industry has been to figure out how to assess the impact of ICD10 on their technical systems, processes, payouts, benefit designs, and staff.

Health care as a craft-based culture (centered around episodic illness and variation in treatment modalities) is gone with the wind. Health care as an information-age culture (centered around health maintenance and prevention) where patient needs and the provision of understandable information are given top priority is in. Health care is transitioning into a new era of accountability. This era demands heightened awareness of the measurable quality, cost, and safety of health care, with value (quality/cost) and safety being the crux of accountability.

Payment for volume is gone with the wind. Payment for value (quality/cost) is in.

“Physicians have been paid on a fee-for-service basis since Hippocrates made his first house call,” said Michael L. Millenson, president of Health Quality Advisors LLC. “Value-based purchasing represents a true paradigm shift to paying for value instead of volume.” Doctors might be facing payment for performance, and unless we change the cost structure, the inflation of healthcare dollars will rise.

We will likely see a shift in the winds or, shall we say, a shift in the way patients are treated with the focus going forward on a more evidence-based approach to prevention of diseases and other illnesses.

Once the smoke clears, the future of Health Care reforms and the new united nation that arises from the reconstruction period will ultimately, hopefully, be stronger.

During this period of civil unrest, be sure and keep up to date with the many changes through Inquisit and our offerings in Health Care online, on-demand education. (We also recommend our classes on obstetrics so all are up-to-date on birthing babies).

I welcome your responses, comments and any questions or requests for additional information because “Frankly my dear, when it comes to Health Care Reform, we should all give a damn!” 

Register with www.inquisit.org and be the first to correctly guess this movie reference to be rewarded with Inquisit IQCards for free education.

 

Dee-Mystifying Health Care Education: The Game is Afoot!

The world of health care education is *NOT* elementary, my dear Watson. It is riddled with obscure regulations, bewildering rules and perplexing requirements. This blog is dedicated to Dee-Mystifying the world of health care education for all who work in this arena; specifically, by answering commonly asked questions, directing readers to additional resources of information and imparting my years of experience and wisdom in managing Inquisit: The Resource for Better Health Care Knowledge.

To begin unraveling the mystery, let us look at the most commonly asked question of all:

What is the difference between education and training?

During my career as both a medical technologist and an adult educator, I have participated in many a discussion on the difference between education and training.

It's the difference between know how and know why. It's the difference between, say, being trained in the procedure to crossmatch blood  (the how) versus being educated as a medical technologist and thereby knowing why the compatibility of the blood is vital, what may cause unanticipated results and how to improve the process design so that it is completed better, faster and less costly.

Clearly, both training and education are necessary, as in all walks of life.

As stated in the ancient Chinese proverb that we hear so often, “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.” 

However, if I may presume to augment this proverb, I say, “Train a man/woman to fish and you feed him/her for a lifetime. Educate a man/woman on why it is important to fish, why it is necessary to find better ways to fish, and to improve their catch when they do fish and you help create a self-confident, critically thinking, and productive person.”   

Let’s continue unraveling the mystery of health care education by examining the puzzling and complex enigma of educational requirements:

Certain professions require that practitioners earn a specific number of Continuing Education Units (CEUs) or Hours per year to ensure that they are up-to-date with current practices in their field. A CEU is a unit of credit equal to 10 hours of participation in an accredited program designed for professionals with certificates or licenses to practice various professions. Proof of credits earned is necessary in order to renew a license to practice.

Note the most curious element: The number of credits required varies by industry and state.

For some professions, like nursing, not only does the number of hours vary from state to state, but some states require specific content. The great state of Florida has the renewal requirements of 25 contact hours of CE every 2 years (waived during first renewal period if you were licensed by exam), including 1 contact hour on HIV/AIDS, 2 contact hours on prevention of medical errors and 1 contact hour on domestic violence. A registered nurse in Florida may substitute courses in end-of-life or palliative health care for courses in HIV/AIDS education or domestic violence.

Compare that to the state of California, where nurses have a renewal requirement of 30 contact hours to be completed within the past 2 years. Whereas, nurses in Nevada also have a renewal requirement of 30 contact hours to be completed within the past 2 years, but 4 of the hours must be a course on bioterrorism.

To add yet another level to the complexity of this mystery, the term for the educational unit that is required to maintain a license varies from profession to profession:

Allow me to illuminate,

·        Professional Development Hour of Unit (PDH or PDU) is defined as one contact hour of instruction, presentation or study. The term PDH is commonly used in the engineering community.

·        Learning Unit (LU) is used by American Institute of Architects' Continuing Education Systems (AIA/CES) and is based on a 60-minute hour.

·        Continuing Education Unit (CEU) is a nationally recognized and uniform unit of measure for continuing education and training and the one primarily used in health care. One CEU is awarded for each 10 contact hours of instruction or study.

You are probably wondering, “How do I convert CEU to a PDH or LU?”

The answer is at least consistent, if not simple:

·        1.0 CEU (Continuing Education Unit) = 10 PDHs or 10 LUs

·        1.0 PDH (Professional Development Hour) = 1.0 Clock Hour (minimum 50 minutes)

·        1.0 LU (Learning Unit) for architects = 1.0 PDH for engineers.

The key here is to note that in the case of 1.0 CEU, it equates to a unit of credit equal to 10 hours of education participation, as opposed to the 1 to 1 relationship of PDHs and LUs

So as we see from these examples, the world of health care education is indeed complex and in need of Dee-Mystifying.

Fortunately, my proficient and capable colleagues at Inquisit can keep professionals up-to-date on all their educational requirements and professional development based on their needs as well as their location and area of expertise.

In closing, I welcome your responses, comments and any additional questions or requests for additional information.

Your health!

For more information on cost effective, quality education for your professional development visit www.inquisit.org