Admittedly, the law only recently went into effect. But given that SB 1160 passed in October 2016, organizations have had nearly two years to prepare. So why are so many still not compliant?

My answer is twofold: effort and expense. 911³Ô¹Ï first navigated the complex path to URAC accreditation in 2008 and has undergone three reaccreditations since. We know firsthand how time consuming, resource intensive, and financially demanding the process is for an organization. It is an enterprise-wide commitment. In addition to daily processes the UR team must document and follow, our Technology, Compliance, Talent Management, and Marketing departments must also enact and adhere to detailed protocols. The cross-departmental efforts and sophisticated infrastructure needed to establish and maintain URAC accreditation, coupled with the financial investment necessary to meet the accreditation’s requirements, is likely why so few California providers have pursued it.

What remains to be seen is how long these non-accredited providers can hold out. According to the WorkCompCentral article, the California Division of Workers’ Compensation is drafting new regulations which may include penalties to ensure organizations comply with the law. But no amount of penalties can expedite the URAC accreditation process, which takes 10 to 12 months with no guarantee of success.

I urge companies currently processing California work comp claims to verify their UR vendor’s accreditation status. For those who discover their vendor is among the non-compliant 40 percent, now is the time to consider an alternate solution. With the lengthy accreditation timeframe and the likelihood of increasing provider disputes over the validity of UR determinations by non-accredited UR organizations, it’s wise to be proactive.

The post 40% of CA Utilization Review Providers Non-Compliant with New Law appeared first on 911³Ô¹Ï.

The tragedy at Orlando’s Pulse nightclub was horrific, with 50 total deaths.  Everyone can understand and see the sheer scale of the largest shooting in US history.

Our nation has 8,000 times that many people die each year from medical mistakes – or 400,000 deaths annually. That’s equivalent to 22 of these shootings…every single day of the year. These deaths may not be making daily headlines, but they are happening – one person at a time, one treatment at a time, all across the United States.

A recent news story on the subject shows how easily it can happen. If you , the story of how this child died is at the end of the clip. She was given the wrong medicine, a compound medication, 20+ times stronger than what she needed. The pharmacist signed off, without making it or reviewing it. Her father found the IV bag in the trash, so it’s likely nobody would have told him had he not caught it. It’s also very telling that his settlement would have been significantly higher had he agreed to a confidentiality clause, but he thought it was important for the memory of his daughter to speak out. These cases are usually not spoken about publicly.

I am a big proponent that less is usually more in healthcare. I am very proud of what we do at 911³Ô¹Ï. For patients involved in 911³Ô¹Ï’s medical care management, utilization review and surgical care programs, every unnecessary medical service we prevent could be the one that saves a life. Every surgery we keep out of a hospital can reduce the risk of error or infection and increase the odds of a successful recovery. There is no doubt that these precautions help reduce devastating health issues for our patients every day.

The post An Observation – Deadly Healthcare Mistakes & Orlando’s Tragedy appeared first on 911³Ô¹Ï.

An estimated​ 440,000 people die each year in the hospital – and not from the cause that initiated their hospital treatment.  That represents the third leading cause of death in this country, behind only cancer and heart disease.

Consider this:

40,000 people die annually in automobile accidents.  Mothers Against Drunk Driving (MADD) and other groups focus on drunk drivers and car safety, saving lives every year.  It’s a worthy cause, and to be commended—but does anyone know that approximately 10 times more people die each year from medical errors in hospitals, than from all auto accidents in the US?

Less than 12,000 people a year are murdered in this country.  A horrible statistic, to be sure—but 3,688% more are accidentally killed by our own hospital system on an annual basis.  Which do we hear about on the news?

It is a terrible situation.

When it comes to hospital treatment, here are a few points to keep in mind:

• Avoid summer treatment.  New doctors (residents) start in the summer, and they have very little experience. The more experienced residents are looking for jobs to pay for their massive debt and are not as engaged.  A lot more full-time doctors are on vacation.  Due to these dynamics, the hospital accident rate is highest during the summer months.
• Ask about every medication being administered.  If it does not feel right or necessary, do not take it.  You can ask for a case manager or advocate if you do not understand or agree with treatment or medication.  Overtreatment and/or overmedicating are primary causes of accidental deaths.
• When possible, avoid procedures in the hospital.  If something can be done in an office or outpatient surgical center setting, try to have it performed there.  Remember, many physician groups are being purchased by hospital groups, and they are now incentivized to drive care to the hospital setting.  The bottom line is, as an individual patient, you need to look out for yourself. You are your own best health advocate.

As a company, this is why discharge management is one of the top goals of our care management programs—to get patients out of inpatient treatment as quickly and safely as possible. It is also a main driver and value proposition of our Surgical Care Program (SCP), which moves surgical care out of hospitals and into quality, ambulatory surgical center settings. It just makes good healthcare sense to mitigate these very real risks whenever we can.

The post Third Leading Cause of Death in the US? Hospitals. appeared first on 911³Ô¹Ï.

The article also shows how people’s health issues have changed over the last 100 years.

Unfortunately ​I often see people throw around healthcare “facts,” based on data that provides little justification or poor logic behind the facts. One that has always bothered me is the “increase in cancer and chronic disease” rates I often hear cited.  I often hear the facts cited go back many, many years to justify the increases.  For example, I have heard people cite long-term increases in “cancer” over the last century as “proof” our environment or food is way worse than in the past.

My problem with this is that life expectancy has gone up dramatically in the last 100 years.   Life expectancy was about 45 at the turn of the century.  Even in the 1960s, it was about 65.  Almost nobody lived long enough to get “chronic” diseases.  If they did, there was often no diagnosis or central record keeping so the data from back then would be inaccurate or understated.  Therefore, any data citing increases in diseases over a long-term are likely meaningless.

I am not AT ALL saying that there are no environmental issues we need to worry about. However, people should just take a critical look at the data first before presenting a problem or solution.

The post The Power of Case Management & Other Interesting “Facts” appeared first on 911³Ô¹Ï.