WASHINGTON, Jan. 27 (UPI) -- Dr. Robert Corrato was a young, Pennsylvania internist in the mid-1990s, filling in for physicians on vacation, when he came face to face with the complex problems caused by the lack of coordination among hospitals, doctors and health insurers.
Doctors were not giving patients the best care possible, hospitals were losing money by providing inefficient or unneeded care, and insurance companies were denying too many claims and not reimbursing providers properly.
Corrato, who also holds an MBA from the Wharton School of Business, moved on to become deputy director of the Office of Health Policy and Clinical Outcomes at Thomas Jefferson University in Philadelphia, where he worked on solutions and later began consulting with hospitals on ways to bring everything together.
In 1997, he founded Executive Health Resources -- now a team of 25 physicians -- which contracts with hospitals nationwide. The EHR team arrives at the hospital, evaluates problem areas, and liaisons so the physicians are connected to the hospital, the hospital is managing each patient's care efficiently, and the insurance companies are properly paying for the care provided.
"Once we come in, we usually don't leave," Corrato told UPI's HealthBiz.
For example, an EHR physician -- Corrato calls them physician advocates -- will work with doctors on everything from best practices to scheduling patient admissions and tests. In the hospital, EHR works with case managers, mainly the nursing staff, to ensure a proper length of stay, develop a discharge plan and monitor patient care. EHR doctors also make those dreaded calls to insurance companies, fighting denials and working for better reimbursements.
Formally, its programs are called Goals for Effective Management Strategies -- or GEMS -- and MedForce, which focuses on reimbursement denials. EHR now operates in 60 hospitals nationwide, large and small.
At Main Line Health System in Philadelphia, EHR helped to reduce inpatient hospital days by 2,245 in 2002 and slash insurance denials by one-half. Those efforts produced "a seven-figure savings," Corrato said.
EHR literature claims MedForce provides a 500 percent return on a hospital's investment while GEMS gives a 1,000 percent return.
PREACHING TO THE CHOIR ON MALPRACTICE
President George W. Bush got an earful about malpractice from healthcare providers at Baptist Hospital in Little Rock, Ark., where he pushed his proposals for capping lawsuit awards and reducing frivolous litigation to lower the cost of malpractice insurance.
He probably was preaching to the choir as medical liability premiums for Arkansas docs increased by an average 150 percent last year and 71 percent of physicians in the state are considering early retirement because of it. At Baptist, annual premiums increased by 175 percent, to $4.2 million.
"People are just filing these lawsuits right and left and it's running up the costs -- doctors' premiums, the cost of doing business, they're rising," Bush said. "That makes it hard on the docs. It makes it hard on docs to do what they're called to do, which is to heal lives."
Lynn Cook, a nurse for 27 years, said doctors are unwilling to see patients with special or difficult problems because of the fear of lawsuits if the outcome is bad.
"We need to talk about tort reform," she told Bush.
Frank Wise, head of the rural Fulton County Hospital, said his facility no longer can afford to deliver babies because of the high cost of malpractice insurance. He said people are desperately looking for obstetricians and some babies have been born in the hospital parking lot and in the emergency room.
NEW EMERGENCY ROOM TECHNOLOGY
St. Joseph Mercy Health System in Ann Arbor, Mich., is using a new, $1.7 million electronic information system designed for its three hospital emergency departments.
The paperless system, called, Healthmatics ED, was developed by A4 Health Systems of Cary, N.C., and it is designed to automate emergency departments. It allows simultaneous access to patient care information on multiple computer terminals. Computer entry of orders helps eliminate mistakes made by handwriting glitches.
All three emergency departments will be on the same system so staff will have access to information about previous patient visits to other facilities.
UNIQUE HEALTH IDENTIFIER
Long in the talking and planning, the Centers for Medicare and Medicaid Services this week finally came out with its final rule establishing a National Provider Identifier.
The NPI, mandated by the Health Insurance Portability and Accountability Act of 1996, is a standard identifier healthcare workers will use to file and process claims and healthcare transactions.
There is no rush to get a NPI, however, as the system required to handle assigning the identifiers will not be ready until the effective date of the final rule, which is May 23, 2005.
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Ellen Beck's e-mail is [email protected]
