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industry lowdown
Anne Law

Industry Lowdown: Health Care Sector

by Anne Law | Dun & Bradstreet Editor

August 4, 2016 | No Comments »

D&B First Research reports offer insight on hundreds of industries to help guide professionals in their business decisions. Take a look at some of the trends, challenges, and opportunities from industry profiles in the Health Care Sector updated by D&B First Research editors in the past month.

Trend: Patient-Centered Care Models Found to Reduce Length of Stay
Efforts to control health spending and improve quality of care through patient-centered care models are reducing the length of time patients spend in nursing homes. In the patient-centered care model, medical decisions are coordinated among providers and are based on the patient’s preferences and needs. While the care model is not yet widely adopted, it is incorporated in new Medicare reimbursement models that seek to boost value and outcomes. In two patient-centered care programs adopted by US integrated health systems — the Allina Health LifeCourse Program and the Priority Health Tandem365 Program — the initiative reduced skilled-nursing-facility expenses for advanced and chronically ill patients, according to a recent study from the SCAN Foundation.

For more insight into the Nursing Homes & Long-Term Care Facilities industry, see our report.

Challenge: Home Health Services Face Fraud Scrutiny
Excessive improper payment in the home health industry has prompted Medicare to launch a pilot program to review home health bills prior to reimbursement. Home health spending has reached more than $83 billion annually, with federal health plans paying for the bulk of services. Nearly 60% of claims received by the Centers for Medicare and Medicaid Services (CMS) last year were deemed improper (indicating potential fraud), and fraud convictions are on the rise due to increased scrutiny of health care costs in the US. Medicare’s proposed pilot program would alter the home health reimbursement process in five states — Florida, Illinois, Massachusetts, Michigan, and Texas — by requiring claims to be reviewed in advance of Medicare payment, according to The Dallas Morning News. The goal is to eliminate risks and costs from fraud and abuse investigations taking place after claims are paid. Some industry groups have voiced objections to the program, stating that delays in claim approval could put patients at risk. The program is one of several CMS payment-reform initiatives impacting the home health industry.

To learn more about this and other industry trends, see our Home Health Care Services profile.

Trend: More Paramedics Use Body Armor to Protect against Violence
A growing number of ambulance service organizations are adopting body armor as violence against public-safety personnel escalates. One entity in Maine will spend $12,000 on two dozen bullet-resistant vests using funds from the towns it serves, according to EMS1. The organization will also use grant money to buy tactical armor, helmets, and goggles for use in active-shooter incident response. Active-shooter training is another expense for first responders, who are also dealing with a rising number of overdose patients becoming violent after recovery. Santa Clara County in California recently announced heightened training and body armor for firefighters and EMS workers in response to rising concerns over active-shooter violence, NBC Bay Area reports. The trend is spreading to emergency response organizations in rural communities across the US as problems such as gun violence and drug abuse spread into smaller towns.

See our Ambulance Services report for more on this and other industry trends.

Trend: Online Eye Exams Banned in Some US States
Some US states are banning online eye exams, supporting the optometry industry’s pronouncement that online testing can’t replace a comprehensive exam or provide accurate prescriptions. Three states — Georgia, Indiana, and South Carolina — have recently banned such exams, and other states are considering similar rules. (In some states, existing telehealth legislation already bans the practice.) State legislative efforts have focused on startup Opternative, which provides testing and prescriptions in about 34 states, according to the Chicago Tribune. Optometrists claims the testing technology poses patient safety concerns, while Opternative maintains the tests provide an innovative, affordable, and convenient vision-care option. Opternative’s tests use a computer monitor and smartphones to test a digital eye chart, and results and medical records are sent to a contracted ophthalmologist for review. However, the tests don’t cover portions of comprehensive exams such as checks for glaucoma and cataracts.

Find more information in the Optometrists profile.

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