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Telemedicine Part One: Changing Healthcare for the Better

In this three-part series, we’ll analyze the growing use of telemedicine and the pros and cons associated. We’ll take a deeper look into what is telemedicine, how it’s changing healthcare, the regulations and guidelines involved, quality vs. convenience, and ultimately who is pay for it.

We’ll riddle each post with plenty of statistics, polls, and other fact-finding information, as well as let you know where you can read further on many of the issues (such as here).


Over the last 40 years, the use of telemedicine has seen major growth, but it’s the last few years that have helped it spread rapidly. We’re now seeing full blown integrations into the ongoing operations of hospitals, specialty departments, home health agencies, private physician offices, and even consumer’s homes and workplaces.

This growth in telemedicine allows organizations like Doctors Without Borders to relay questions from physicians in underprivileged countries to its network of over 280 experts around the world, and back again via the internet and other telecoms.

So, how would one formally define telemedicine? It’s pretty simple:

Telemedicine is the exchange of medical information from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.

Driven by quicker internet speeds, pervasive smartphones and ever-changing insurance standards, more health providers are turning to electronic communications to do their jobs—and it’s upending the delivery of healthcare.

For example, a growing number of doctors are linking up with patients by phone, email and webcam. They also practice consulting with each other electronically—sometimes even making split-second decisions on heart attacks and strokes. Patients, meanwhile, are using new devices to relay their blood pressure, heart rate and other vital signs to their doctors so they can manage chronic conditions at home.

Telemedicine also allows for better care in places where medical expertise is hard to come by.

As we mentioned, several times a day Doctors Without Borders will relay questions about tough cases from its physicians in Niger, South Sudan and elsewhere to its network.

Likewise, shifts of doctors and nurses work around the clock in Mercy Health’s new Virtual Care Center, a “hospital without beds” that provides remote support for intensive-care units, emergency rooms and other programs in 38 smaller hospitals across the Southeastern US. Many of the included healthcare centers don’t have a physicians on-site 24/7.

In the TeleICU section of Mercy, critical-care doctors sit at oversized video monitors that continually collect data on every far-flung ICU patient and can spot signs of imminent trouble. If a patient needs attention, Mercy physicians can zoom in via two-way camera—close enough to read the tiny print on an IV bag.

“It’s almost like being at the bedside…I can’t shock a patient, but I can give an order to the nurses there,” says Vinaya Sermadevi, a critical-care specialist.

In the past year, ICUs monitored by Mercy specialists have seen a 35% decrease in patients’ average length of stay and 30% fewer deaths than anticipated. “That translates to 1,000 people who were expected to die who got to go home instead,” says Randy Moore, president of Mercy Virtual.

So is the Virtual Doctor is on the Rise?

In the last year, the number of virtual doctors visits has grown 12-fold, from 1 million to 12 million. Additionally, the number of employers offering telemedicine benefits has grown from 48% to over 75% since last year.

So what does this rise prove? Well for starters, 72% of hospitals and 52% of physician groups offer telemedicine programs. It’s these kinds of positive statistics that show us telemedicine is on the rise and here to stay.

As a measure of how rapidly telemedicine is spreading, consider this: In 2015, over 15 million Americans received some kind of remote medical care; and that number is expected to grow by roughly 30% just this year.

However, none of this is to say that telemedicine has found its way into all corners of medicine. A recent survey of 500 tech-savvy consumers by HealthMine found that 39% hadn’t heard of telemedicine, and of those who haven’t used it, 42% said they preferred in-person doctor visits. In a poll of 1,500 family physicians, only 15% had used it in their practices—but 90% said they would it if were appropriately reimbursed.

What’s more, for all the rapid growth, significant questions and challenges remain. Rules defining and regulating telemedicine differ widely from state to state and are constantly evolving. Physicians groups are issuing different guidelines about what care they consider appropriate to deliver in what forum.

Some critics also question whether the quality of care is keeping up with the rapid expansion of telemedicine. And there’s the question of what services physicians should be paid for: Insurance coverage varies from health plan to health plan, and a big federal plans covers only a narrow range of services.

Telemedicine’s future will depend on how—and whether—regulators, providers, payers and patients can address these challenges.

 

medical waste market

The Five Treatments Fueling the Medical Waste Market

A new study from Transparency Market Research (TMR), a market intelligence company, says that the technical developments resulting in the adoption of non-incineration technologies and the increasing government regulation and legislations globally are amongst the chief factors fueling the medical waste market.

In addition, the expansion of the healthcare industry globally and the increasing count of off-site treatment methods have also impacted the market positively. So, we know that healthcare activities are aimed at curing patients, protecting the health of individuals, and saving lives.

According to the World Health Organization (WHO), approximately 85% of the total amount of waste generated through healthcare activities is general and non-hazardous in nature. But, these healthcare activities also generate waste which may aid the spread of infectious diseases or cause injuries. Thus, the remaining 15% is hazardous material that may be radioactive or toxic in nature.

Poor waste management may jeopardize patients and their families, employees handling medical waste, care staff and the others who come in contact with it, and even result in pollution or environmental contamination. However, these risks can be significantly reduced using appropriate and simple measures. A number of new technologies have also penetrated the market to make this job easier. The working of these waste management systems has been elaborated below:

Treatments Fueling the Medical Waste Market

1. Incineration Technology

Incineration comprises a very high-temperature, thermal process and allows combustion of waste in controlled conditions to convert it into inert gases and materials. Incinerators often are either electrically powered, oil-fired, or a combination of both. Incinerators utilized for hospital waste management are of three main types, namely: controlled air, multiple hearth, or rotary kiln. All of these incinerators comprise both primary, as well as secondary, combustion chambers for ensuring an optimal combustion.

  • Controlled Air – commonly used for waste with organic matter, this process combusts and oxidizes waste, leading to a stream of gas with a CO2 and water vapor mixture
  • Multiple Hearth – a circular steel furnace containing solid refractory hearths with a central rotating shaft converts waste into ash
  • Rotary Kiln – a drum-shaped incinerator commonly used for medical and hazardous waste

Non-Incineration Technology:

This treatment incorporates four key processes, namely: chemical, thermal, biological, and irradiative. Non-incineration technologies majorly employee chemical, as well as thermal processes. The key aim of this treatment technology is the decontamination of waste by destroying of the pathogens.

2. Irradiation (i.e. Microwave)

Microwave Irradiation is based upon the principle of generating high-frequency waves inside of a microwave (no, not a real microwave oven). The waves cause the vibration of the particles present within the waste material and thus generate heat (but just like a microwave oven). The heat generated from this wave will kill all bacteria present or any other contamination in the tools.

3. Chemical and Plasma Pyrolysis

Chemical decontamination is primarily used for microbiology lab waste, human blood, sharps and bodily fluids, but cannot be used for anatomical waste (i.e. body parts).

Plasma Pyrolysis is state-of-the-art technology that might just be the most eco-friendly technology on the list, converting organic waste into by-products, which are then commercially used. The extreme heat generated by plasma results in the disposal of all kinds of wastes including biomedical waste, municipal solid waste, and hazardous waste in a reliable and safe manner.

4. Biological

This method employs enzymes to destroy organic matters found in medical waste. But while this sounds great, few non-incineration technologies have been based on this biological method. In fact,  this enzyme breakdown process is vastly underdeveloped and rarely every used.

5. Autoclaving

Autoclaving, a rather well-known process now, works on the principle of a standard pressure cooker and involves the utilization of heat at extremely high temperatures. The steam generated at these high temperatures kills all microorganisms in the medical waste. Autoclaving is of three main types, namely: pre-vacuum, retort, and gravity. Autoclaving is often used for bodily fluid waste, sharps, and microbiology lab waste.

The market for medical waste management is poised to experience exponential growth owing to a plethora of treatment technologies available in the market for medical waste management. However, the soaring costs of initial investments of these technologies may have a negative impact on the growth of the market.

 

The market for medical waste management is poised to experience exponential growth owing to a plethora of treatment technologies available in the market for medical waste management. However, the soaring costs of initial investments of these technologies may have a negative impact on the growth of the market.


Sources:

http://www.digitaljournal.com/pr/2929342#ixzz47t2LYBNn

Medical Waste Disposal – The Definitive Guide

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treating medical waste

“On-Site” vs. “Off-Site”: Guidelines for Treating Medical Waste

The following information is based on requirement guidelines from the Texas Commission of Environmental Quality (TCEQ). For more information, please visit their permit information on Managing and Disposing of Medical Waste.


Meaning of the Terms “On-Site” and “Off-Site”

The terms “on-site” and “off-site” are often used in reference to the location where medical waste was generated. Before jumping into the actual treatment of medical waste, we wanted to briefly outline the difference between the two as governed under the Title 30 Texas Administrative Code (30 TAC).

On-Site:

According to the rule in 30 TAC §330.1205 explains that “medical waste managed on property that is owned or effectively controlled by one entity and that is within 75 miles of the point of generation or at an affiliated facility shall be considered to be managed on-site.” An affiliated facility refers to a health care-related facility generating medical waste that is routinely stored, processed, and/or disposed of on a shared basis in an integrated medical waste management unit owned or operated by a hospital, and located within a contiguous health care complex.

Off-Site:

Medical waste management practices that do not meet the above criteria are simply regarded as off-site management.


Treating Medical Waste

Medical waste may be treated on-site, or off-site at an authorized treatment facility, following the requirements of 30 TAC §330.1219 and 25 TAC §1.136.

On-Site Treatment

On-site treatment may be conducted by a waste generator, provided the generator notifies the TCEQ as required under 30 TAC §330.11(f). Additionally, on-site treatment can be conducted via mobile, on-site services officially registered under §330.9(m) and operating in accordance with the requirements of §330.1221.

A generator intending to treat medical waste on-site must indicate in their TCEQ notification that an approved method will be utilized, as required by 25 TAC §1.136. In addition, the generator should maintain records of the treatment process, as required by 30 TAC §330.1219(a).

Furthermore, on-site treatment should follow the disposal guidelines in accordance with §330.1219(b) through (e).

Off-Site Treatment

Off-site treatment, which again is anything not defined above, must be conducted at a treatment facility authorized to accept “untreated” medical waste.

Owners or operators of medical waste treatment facilities must obtain an MSW Type V registration as specified in 30 TAC §330.9(n).

Owners or operators of Type V processing facilities that accept delivery of untreated medical waste, for which a shipping document is required under §330.1211, must ensure that a shipping document accompanies each shipment and that it is properly completed as required by §330.219(h).

Medical waste that has been treated according to the requirements of 30 TAC 330.1219(a) may be managed and disposed of as routine municipal solid waste, provided labeling and other requirements of §330.1219(b), (c), and (e), §330.171(c)(2), and 25 TAC §1.136 are met.

 

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invoice

8 Common Medical Billing Errors

Billing is never an enjoyable process. For anyone. On average, 40 percent of small businesses are 60-plus days delinquent on at least a third of their receivables – and unclear or incorrect invoices can certainly be at fault.

In the medical field, reports say that upward of 80% of invoices are overcharging patients. To ensure you’re not making errors and overcharging your patients, keep in mind the following tips (or share these tips with them and build further trust):

1. Double charging:

Whether you refer to it has double charging or duplicate billing, this error occurs when patients are billed more than once. Human error is the most common example, say, through a doctor and nurse not fully communicating to each other that a particular medication was given – thus a bill could be incurred when the medication was prescribed and administered.

Another common example is billing multiple “first days” in a hospital, which often cost more than subsequent days during a hospital stay. Patients should always carefully read through invoices,  as double charging is the most common reason for unexpectedly higher medical bills. To combat this issue, insure your patients receive an itemized bill, making it easier to spot duplicate charges.

2. Upcoding or mismatched codes:

Upcoding occurs when a medical billing code is improperly changed to one which represents a more severe diagnosis or treatment. While the most common occurrences include things like coding a regular checkup as inpatient care or coding for name-brand versus generic medication, the error of upcoding is still a serious offense. To your patients, it’s basically like getting billed for an expensive bottle of Advil instead generic Acetemenophin….but much worse. And highly illegal. Patients should ask their healthcare providers to correct the charge immediately.

Mismatched codes are another similar error. When a medical bill upcodes your diagnosis, but a patient’s treatment code is left alone, the insurance company will typically reject the patient’s claim due to the mismatch between the treatment and diagnosis codes. This is a double whammy; not only will a patient’s bill be more expensive, but the claim will also get rejected.

3. Unbundling:

Unbundling is the separation of charges that are normally charged under the same billing code. Instead of receiving a package rate for, say, multiple tests of the same code, patients who experience unbundling on their medical bill can often pay multiples of their original bill.  This type of mistake can be tricky to identify, and patients who experience unbundling should reach out to the National Correct Coding Initiative by the Centers for Medicare and Medicaid Services for further advice on arguing the charges.

4. Incorrect quantity:

This mistake could be as simple as an extra “0” placed at the end of a number. Patients should carefully check quantity to make sure they weren’t charged extra for an incorrect amount of items or medications. Talk about a headache for the patient.

5. Incorrect info:

Another of the most common billing errors are simple misspellings and misprints, including incorrect names or policy numbers. Claim denials or being bill for a full amount can occur because of a simple incorrect insurance ID number. Talk about a headache.

The main reason these errors occur are because of how many hands influence a medical bill – sometimes up to a dozen people have something to do with it. One mistake entering incorrect information can be passed down the line just like the childhood “telephone” game, causing severe problems when a patient’s claim is submitted to their insurance company.

6. Balance billing:

Balance billing occurs when a health care provider bills the patient for charges other than co-pays or any other amount than what was negotiated with the insurance company. Balance billing is most common when a patient is treated “out-of-network” for non-emergency care, as doctors can set the rate to charge the patient and bill them for anything over the agreed amount. 

Patients should check with their insurance company about whether or not all of the hospital’s charges are covered under their policy. If they are, then this balance bill is illegal, and patients should not have to pay for it.

7. Overcharge time:

After undergoing a procedure, patients should check medical records to confirm how long they were in the operating room or under anesthesia. Patients are usually billed in 15-minute increments, therefore, mistakes can add up quickly.

8. Canceled procedures:

Patients can sometimes accidentally be charged for a test or procedure that ended up being canceled. They should make sure this doesn’t happen by carefully reviewing their itemized medical bill. If a patient thinks they were wrongfully over-billed, they should collect all the necessary documents to prove they did not receive the service, thus disputing the charge.

Related: How Do I Fix Medical Bill Errors?
Future of healthcare

5 Healthcare Innovations to Watch For in 2016

Back in October, Cleveland Clinic released their 10th annual list of the Top 10 Medical Innovations for 2016.  The list included such marvels as faster vaccine creation methods, a process for rewriting genetic code and even a highly detailed, affordable system for bringing water purification to developing countries.

Now that it’s finally the New Year, we thought we would dig up the list and bring to you five of the top 10 and what you can expect to hear in health care news in 2016. Here are the five (in no particular order):

1.) Naturally Controlled Artificial Limbs

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IMAGE: THE JOHNS HOPKINS UNIVERSITY APPLIED PHYSICS LABORATORY

If you remember back to late 2014, a story broke of a double-amputee man operating two artificial robotic arms using his mind. Les Baugh (pictured right) was able to move, and feel, everyday objects using the robotic arms and fingertip sensors. The video went viral.

Since then, researchers have discovered that neural signals associated with limb movement can be de-coded by computers. In Sweden, scientists have also unveiled the first mind-controlled prosthetic arm directly connected to a man’s natural bone, nerves and muscles.

More recently, researchers have demonstrated that sensors implanted in the brain can control prosthetic arms, wheelchairs and even a full body exoskeleton. It’s only a matter of time until such prosthetics are produced on an affordable scale, potentially helping millions of amputees worldwide.

2.) Water Purification System and Developing Countries

According to the World Health Organization, over 700 million people worldwide are drinking unsafe water everyday due to large amounts of sewage pools in cities. That’s ridiculous, right? Well, a new sewage processor plant may offer the next affordable solution.

In Dakar, Senegal, health officials say they’re testing a new type of waste treatment plant that would essentially turn these seeping sewage pools into sources of clean drinking water. The processor, which will cost roughly $1.5 million, would be able to support the waste of nearly 100,000 people a day.

Researchers think more processor plants like the one in Dakar will begin showing up in 2016.

3.) Battling Epidemics with the Rapid Development of Vaccines

Researchers are developing effective vaccines faster than ever to prevent epidemics. It’s an effort given new urgency by the 2014 Ebola epidemic in Africa and of Meningococcal B outbreaks in America. According to Steven Gordon, MD, chair of the Department of Infectious Disease at Cleveland Clinic:

“The rapid scientific response to recent epidemics indicates that we’ve achieved a new level of sophistication in the area of vaccine development. It was a global effort involving thousands of people, aided by information technology and instant communication.”

The most promising Ebola vaccine emerged in only 12 months. While it has not yet been licensed for human use, Cleveland Clinic experts estimate a safe, effective Ebola vaccine will be available this year.

4.) CRISPR Offers a New Spin on Gene Editing

Altering the DNA of human embryos has long been associated with that of science fiction. Now, with a new, inexpensive technique, “clustered regularly interspaced short palindromic repeats,” or CRISPR (which sounds a lot cooler), gene editing is being adopted by labs everywhere.

CRISPR is boasting the ability to eliminate a whole range of genetic diseases. It can more quickly develop and test cures, identify and remove bad genes from a DNA strand, and can cost as little as $30.

Great, but how is it being tested?

CRISPR is now being used in animal testing models but could eventually be used for a wide range of human applications, from treating debilitating genetic diseases to increasing food crop yields. What’s clear is that CRISPR’s impact on the human population will be immeasurable.

CRISPR is now being used in animal testing models but could eventually be used for a wide range of human applications, from treating debilitating genetic diseases to increasing food crop yields.

5.) Protein Biomarker Analysis and Cancer Screening

A new biomarker platform hits the market this year and will offer more accurate cancer screenings and better chances for early detection. Protein biomarker analysis focuses on changes in the structure of certain proteins circulating in the blood, so that, as opposed to examining genetic mutations, which can indicate the risk of cancer, these new tests give real-time information on cancer’s presence.