The Organ Transplant Process from Beginning to End

Did you know that every ten minutes, someone signs up to save a life?

This is how often someone is added to an organ donor waiting list. It is a great way for those in need to get the support they require, but many people do not know exactly how the organ transplant process works.

Transplants can be financially stressful, we can help with our comprehensive organ transplant cost containment plan. If you would like to understand how all of this works, come check out our comprehensive guide!

The Organ Transplant List

For those who need an organ transplant, it all starts with getting a referral from their physician. Next, they gather information (including physician recommendations) and choose a transplant center.

They must then get an evaluation from the transplant hospital. Once the patient is deemed a suitable candidate, they are placed on the national waiting list.

Financing

The organ transplant process can be very expensive. This is because the candidate is responsible for financing many different steps along the way.

The costs include things like hospital stays, surgeon’s fees, transportation, testing, and rehabilitation. These costs add up, which is why it is important to put together a financial plan.

The first step is for the candidate to verify what their insurance company will and will not cover. The candidate is responsible for paying the difference, so it’s important to know what the exact amounts are.

It’s possible that either Medicare or Medicaid may help the candidate. These questions and questions about overall financing should be addressed towards the financial coordinator of the transplant hospital. Want to know more about reduced organ transplant costs? We have an organ transplant cost containment plan, contact us to learn more.

Matching Organs

The next step is to match the organ candidate with a corresponding organ donor. In many ways, this is the most complex step when it comes to organ donations.

It is the Organ Procurement and Transplantation Network that matches donors and candidates. They make these matches using certain criteria, such as matching the blood type of the individuals.

However, other factors are harder to quantify, including the overall severity of the candidate’s illness. And each possible organ has a different donation policy, so it’s important for candidates and donors alike to understand the policies surrounding that organ.

Post-Transplant Care

Many organ candidates think they are “home free” after they receive the new organ. However, post-transplant care is a very important part of living a healthy and productive life.

The candidate’s physician will want to conduct follow-up appointments and tests for several years after the procedure is complete. And the candidate often plays an active role in this, as they are expected to help monitor the new organ as well as their overall health.

It’s recommended that the candidate continue speaking with their original transplant team. They can help answer important questions quickly and provide a much-needed peace of mind.

The Bottom Line

Now you know every step of the organ transplant process. However, if you want to take part in the process, you’ll need someone who can help you each step of the way while saving time and money.

Specialty Care Management specializes in reducing the cost of your company’s healthcare. We even have an organ transplant cost containment plan. To see how we can help with the administration and management of transplant patient cases, reach out and contact us today!


5 Ways to Bring Down Healthcare Costs in 2018

In February 2018, President Donald Trump made a number of legal changes to Medicare. In doing so, he exposed the real healthcare costs in the U.S.

These rising costs don’t just affect patients. They also affect hospitals and employers offering health insurance plans.

Can healthcare costs be managed or reduced?

Most definitely. Using an oncology management program or even shopping around can help.

But read on to discover 5 ways to bring down costs in 2018.

1) Encourage Consumers to ‘Shop Around’

People don’t book hotels or even choose restaurants without looking at their options first. Websites like Expedia make it easier to compare prices and choose the best deal.

Why should health care be any different?

Healthcare costs vary even within metropolitan areas. Insurers don’t pass on cost information to patients. So they can’t compare prices.

Letting patients compare results and outcomes, as well as prices, puts the control back in their hands.

NPR and Kaiser Health News started their Bill of the Month feature to expose the truth behind medical bills. It’s the first step towards educating patients.

Payors can vote with their wallets, which forces healthcare providers to offer better value.

2) Make Greater Use of an Oncology Management Program

Oncology incurs more costs than many other health problems or diseases. Diagnostics, imaging, hospitalization, and drugs combine to create higher costs.

An oncology management program draws these varied elements together to help reduce healthcare costs. The combination of support, monitoring, and communication offer a better option to payors and less stress for patients.

3) Focus on Preventative Solutions

Much of modern medicine relies on diagnosing and treating a condition or disease. It’s a reactive model that only comes into force once a health problem arises.

Placing more emphasis on preventative care helps to lower healthcare costs. It ensures patients take more control of their own health. With fewer health complaints, they require less treatment.

Teaching young people how to practice self-care is the first step. Introducing wellness programs in the workplace can also help people to manage their own stress.

4) Order Fewer Medical Tests

Many medical tests are vital to gaining a proper diagnosis. But many have no benefit, and can even cause harm. Unnecessary tests drive up healthcare costs with no benefit.

This requires a mindset shift for both doctors and patients. Doctors should rely only on those tests that they know are essential. Patients shouldn’t feel a medical visit must include a test.

This links to the previous point. Self-care includes knowing how to care for yourself when the need arises. So a patient with a viral infection shouldn’t expect a test if the doctor prescribes bed rest.

5) Allow Drug Prices to be Negotiated

The federal government is the top drugs buyer in the US. Yet legal restrictions mean it can’t renegotiate prices with pharmaceutical companies.

A two-pack of EpiPens costs $600. Even with insurance, it costs $300. The price is 500% more than it was in 2007. If providers could negotiate the prices, they could lower healthcare costs for common drugs.

Healthcare Costs Don’t Need to Spiral

With proper management, the cost of healthcare can remain affordable and accessible. That benefits administrators of health plans and employers who can pass those benefits onto patients.

With the aging population, oncology management is perhaps the area most within the control of payors.

If you’d like to know more about our oncology management program, contact us today.


The Annual Kidney Dialysis Cost in USA

Patients diagnosed with end stage renal disease (ESRD) have very few options.

If they’re very lucky, they’ll be to get a kidney transplant. Otherwise, they’ll need to go on dialysis. Dialysis patients need a lot of resources to stay healthy.

Most insurance companies will cover the bulk of the cost. However, your clinic is likely caring for uninsured patients paying for their treatment out of pocket as well. The kidney dialysis cost in USA is extremely high.

If you want to lower your clinic’s costs, you need to know exactly what the average rates across the country are. Let’s review the typical dialysis cost per year.

ESRD Statistics

End stage renal disease is a serious health problem that affects nearly 650,000 Americans every year.

Minorities are significantly more likely to be affected. African American patients are 3.5 more likely to be diagnosed with ESRD than Caucasians.

Researchers believe that incidents of ESRD are increasing significantly. If your clinic is treating a lot of dialysis patients, there’s a good chance that the number will increase over the next few years.

ESRD patients who receive a kidney transplant have a 3% chance of dying within 5 years of their procedure.

Patients who undergo dialysis have a 65% chance of dying within 5 years.

Types of Dialysis

There are two different types of dialysis.

Hemodialysis is by far the most common. About 90% of patients use this method. The patient’s blood is filtrated outside of their body before being replaced.

However, it’s very physically grueling. Hemodialysis patients need to come in for treatment 3 times a week. Each session last hours and can be very draining.

Only 35% of hemodialysis patients will survive 5 years of treatment.

Peritoneal dialysis uses a completely different method to filter the blood. A permanent tube is surgically implanted into the abdomen.

Cost of Dialysis Treatment

The cost of dialysis treatment varies widely depending on where the patient is treated.

Dialysis treatments are most expensive at the hospital. Some hospitals charge as much as $9,900 for a single emergency treatment.

Receiving the same treatment at a health clinic would cost an uninsured patient about $500. It’s estimated the annual cost for hemodialysis is $89,000. A year of peritoneal dialysis will cost around $53,000.

Costs are increasing but they can be managed.

$42 billion is spent on hemodialysis in the USA every year. The vast majority of the money comes from Medicare.

It’s likely that kidney disease care represents a large part of your clinic’s budget.

Kidney Dialysis Cost in USA

The average kidney dialysis cost in USA is very steep. Every year, only a fraction of the people on the kidney transplant are matched with a donor organ.

That means that the vast majority of ESRD patients still rely on dialysis. They represent 1% of the Medicare population but they use 7% of the resources.

Figuring out how to lower the costs would help a lot of patients. It would also ensure you have more funds to run your clinic.

We can help you trim your bottom line. Give us a call today to learn how.


Amazing Innovations In Cancer Therapy to Expect in 2018

Innovations in Cancer Therapy

Here’s a stunning statistic: 1 in 3 Americans will contract cancer in their lifetimes. 600,000 people will die from cancer this year.

Cancer is a disease whose death toll is incalculable at this point. But researchers across the globe have b

een working to improve cancer treatment and preventative care.

At the annual American Association for Cancer Research (AACR) conference, and other similar events this year, those same doctors and researchers have presented their progress. Here’s are a few impressive innovations in cancer treatment to expect in 2018.

Dr. Coussen Introduces Exciting New Treatment at the AACR Conference

At this year’s AACR conference, Dr. Lisa Coussen presented a new cancer treatment. It aims to treat cancer like a chronic disease. Coussen has been running clinical trials that regulate tumors through immune pathways. Doing this can slow or halt their growth.

Coussen’s research won’t cure cancer. But when coupled with cancer patient support programs, this clinical approach should allow patients to live longer, higher-quality lives with less pain.

At this same conference, Dr. Tony Hunter from the Salk Institute also introduced 26 new FDA approved drugs that can treat cancer as well.

Consumer BRCA Testing

BRCA is a gene that is often mutated and leads to breast, ovarian, and other types of cancer. In March, the FDA approved an at-home test kit that allows consumers to check to see if they 3 BRCA gene mutations that precede cancer.

The test-kit requires a saliva sample. The company 23andMe will then analyze it. Unfortunately, there are over 1,000 known BRCA gene mutations. So this test only scrapes the surface, but it’s a good start.

Intraoperative Breast Cancer Radiation

Typically, the surgery to remove tumors from your breasts, and the following radiation therapy, are two different treatments.

 

Yet, Dr. Shawna Willey, the chief of surgery at the MedStar Georgetown University Hospital is blazing a new trail. She has been delivering localized radiation treatment in one fell swoop during surgeries. This is a form of cancer therapy called Intraoperative Radiation Therapy (IORT).

A study of over 3,000 women with breast cancer that had intraoperative radiation therapy found that the mortality rates of these women and women that had more conventional radiation therapy were the same.

This isn’t particularly heartening news. But, the IORT group had far fewer serious complications as a result of radiation therapy. This makes the case that IORT can lead to a higher quality of life for those undergoing cancer treatments.

 

Also, having fewer trips to the hospital would make the patient experience far better. Unfortunately, women with more advanced stages of breast cancer had a higher rate of recurrence.

This is why researchers determined that IORT is best used among women in the early stages of cancer.

Are You a Hospital Administrator?

These innovations in cancer therapy like the ones presented by the AACR paint a sunny view of the future. As medical professionals, we have to keep looking for ways to provide better and more cost-effective treatment.

If you’re a hospital administrator looking to improve your hospital’s oncological services, consider taking some time to look at our cancer management services.


What Does Kidney Dialysis Cost on Average in the US for Employers?

Doctors Hospitals Kidney Dialysis Cost

Kidney failure affects more than 650,000 Americans; of those, more than 450,000 are on dialysis. Some fast facts about dialysis: there are two primary types — hemodialysis and peritoneal dialysis. Dialysis can cost over $100,000 per year when paid at the appropriate Medicare rate, however the reality is that most employer-sponsored health plans pay 8 to 10 times that amount annually.

I imagine you’re getting the picture. Dialysis is a massively expensive reality for many Americans and their employers, and is an equally massive factor for insurance considerations. So what is the deal with dialysis, and does it have to cost so much? Let’s dive in.

Two Types of Dialysis

Hemodialysis is the kind we all usually think of. A patient drives to a facility, usually three times a week, and spends four hours having toxins filtered out of their blood. A tube is hooked up to one arm, the blood is run through a machine that does the filtering, and the clean blood is returned to the body through the other arm.

This type of dialysis requires less patient participation, but it’s inconvenient to say the least.

Peritoneal dialysis is done at home. Rather than filtering the blood directly, a fluid called dialysate is placed into the stomach through a permanent catheter (a small tube leading into the stomach from outside the body). When blood passes through the stomach lining, the dialysate filters out the toxins.

After a few hours, the dialysate is flushed out of the stomach, more is put back in, and the process begins again. This must be done three or four times a day.

While it is more convenient than treatment at a dialysis center, it means the patient must be more involved, and they risk infection.

Kidney Dialysis Costs

According to the United States Renal Data System, in 2013, hemodialysis cost on average $100,000 per patient per year. In 2015, Medicare paid out nearly $100 billion for patients with kidney disease.

Peritoneal dialysis tends to be cheaper than hemodialysis, largely because it is done at home. But home hemodialysis is possible, too — and more cost-efficient. In fact, between 2003 and 2007, the number of kidney dialysis patients using home hemodialysis increased by 35%, with cost being a factor in that trend.

Lowering Kidney Dialysis Cost

There are complications, though, with insurance in terms of lowering kidney dialysis cost. Training patients can take a lot of time and up-front money from dialysis centers, and face-to-face visits are often still required.

On the other hand, if you know how to navigate the legal system, you can greatly reduce kidney dialysis costs. Renal case management is an excellent way to approach this.

This is only the tip of the iceberg when it comes to kidney dialysis cost. The system can be overwhelming and expensive. But there are ways to keep costs to a minimum. Services like Specialty Care Management have programs, such as their Renal Re-Pricing, which significantly reduce costs.

Total care for a patient in End Stage Renal Failure can come to over $1 million per year. If you’re looking to reduce those health care costs, get in touch with us today. We’re dedicated to reducing costs as much as possible. In most cases, we are able to cut costs for you by up to 80%.


SCM Founder Talks Self-Funding Across the Pond

 

Specialty Care Management (SCM) recently traveled to London for the Transcontinental Self-Insurance Symposium (June 4-6) to help self-funded entities from across the globe ‘mind the gap’ between rapidly changing political and business markets and how these could affect them in the future. During this new symposium organized by the Self-Insurance Institute of America (SIIA), SCM’s own Founder and Chairman, Robert Clemente, spoke about the future of self-funding and discussed solutions to the challenges self-insurers continue to face.

 

Bringing together industry executives from both sides of the Atlantic, the Transcontinental Self-Insurance Symposium aimed to connect self-funding innovators from the U.S., U.K., and EU to discuss key market trends and business opportunities related to emerging risk transfer solutions.

 

Speaking to these self-funding delegates at Lloyd’s of London, Mr. Clemente provided insight on both the latest developments within the self-insurance marketplace as well as the industry-exclusive risk solution that SCM offers.

 

Supplying a complete risk solution to help support the self-insurance community even as changes occur within the industry, SCM will continue to lead the conversation about the future of self-funding—both at home and abroad.


SCM Discusses How to Put Out “Claims Fires” With Captive Audience

Speaking at Pareto Captive Services

SCM set the captive world ablaze during their recent visit to Pareto Captive Services in Nashville as they discussed how SCM can act as the firefighters of the high-cost claims arena. During their address to the audience of 500 people, SCM COO Craig Clemente, who presented along with President and CEO Rick Garrison and Katz/Pierz representative Shay Cowan, donned a fireman’s helmet as they discussed how SCM not only extinguishes the fires of high-cost claims but also can help prevent these fires from ever happening.

Just like a fire can happen to anyone at any time, high-cost claims, such as those for dialysis, can crop up without warning and spiral quickly out of control. Through a real Pareto Case Study, SCM illustrated how their different approach to managing dialysis claims enabled them to reduce provider charges to the captive by 90%—which equaled over half a million dollars in savings.

Putting out and preventing these claims fires is at the core of what SCM does for its clients and we look forward to generating even more savings for Pareto and other captive groups going forward.

Download the Pareto Case Study


5 Hospital Expenses You Can Cut Right Now

Are you struggling to keep the expenses at your hospital under control?

You’re not alone. Just as consumer healthcare costs are rising, hospitals are dealing with rising expenses and many will face greater cost containment challenges in 2018.

Cutting expenses without jeopardizing the livelihood of employees or patient safety is a serious challenge, but it can be overcome.

Read on to learn five ways you can cut hospital expenses to keep the business running profitably!

1. Employee Healthcare Costs

Putting employee health first should be a priority at any hospital. You might be surprised that this is the first expense mentioned on this list.

However, by implementing wellness and disease management programs for employees hospitals can actually cut healthcare expenses while improving employee health.

For example, a wellness program for chronic illnesses like diabetes can help employees manage their health.

A healthier lifestyle will mean fewer trips to the doctor or hospital, fewer health incidents, and fewer insurance related costs for your hospital.

2. Shipping Costs

By keeping a closer eye on inbound and outbound shipping, hospitals can reduce expenses from the delivery of surgical supplies, equipment, and medicine.

Rising shipping expenses are often a result of poor accounting.

To remedy this issue, prepare a separate coded section for shipping, rather than lumping costs into the general hospital ledger.

3. Landscaping Expenses

Improving the irrigation systems in your hospital will cut down on water-related expenses.

By removing dying plants that no longer need sprinkler attention, your team can reduce water waste that drives up bills each month.

4. Inefficient Energy Costs

Speaking of inefficiencies, energy costs can get out of control quickly in large hospital settings.

Remove unnecessary lighting. Reduce bulbs in light fixtures. Reduce usage in areas that don’t need to be lit at all hours. By doing so, you can cut down on this expense right away.

While making the initial investment to join the ranks of energy efficient hospitals may seem daunting, the payout in savings can be enormous.

5. Proper Waste Management

Last but not least, monitoring of hospital waste is another way to cut down on unnecessary expenses.

Hazardous material, such as needle sharps, is more expensive to process. Properly sorting between hazardous material and non-red bag items can help reduce costs.

Wash scrubs and jackets in order to reuse these materials, rather than replace them.

Another way to reduce waste management costs is by monitoring food waste. Start by monitoring the amount of prepared food versus food that is thrown away.

Doing so will allow the kitchen staff to adjust preparation practices. The goal should be reduction of the amount of food wasted each month.

Keep Your Hospital Expenses Under Control

By implementing these five cost-cutting strategies, you’ll see success in keeping healthy hospital margins!

These expenses are just the tip of the iceberg, so talk with your team and get creative to decide what hospital expenses you can cut and which you can’t.

Do you still need help managing your healthcare costs? Contact us and let’s discuss how we can help!


What Employers Need to Know About Stop Loss Insurance

As a business owner, one of your primary goals is to reduce your expenses.

However, this is not always possible. In an overly competitive marketplace and a harsh economy, administration and operational costs can easily spiral out of control.

It’s for this reason business owners turn to insurance. With adequate insurance, your business is protected from several risks.

Still, not all businesses take up traditional insurance policies, unless they’re mandatory. If you choose to self-insure, you risk losing a lot of money due to unexpectedly high bills.

This is where stop loss insurance comes in.

In this article, we’re telling you all you need to know about this insurance product. Read on!

Protects You from High Expenses

You already know stop loss insurance shields your company from unforeseen liabilities, but how exactly?

Let’s say you establish a medical fund for your employees’ health benefits, instead of taking up a group health insurance policy. Perhaps from your data, you can tell your business spends about $10,000 on health benefits annually. You assume this will continue to be the annual trend.

Not a bad assumption, but in business, the unexpected can happen. Maybe one or two employees get serious injuries on the job, and their medical bills quickly pile up and hit $20,000 or more.

Since your medical fund holds $10,000, you have to dig deeper into your revenues to settle the rising bills. If you fail or are unable to pay, the employee can sue the business. Needless to say, medical bills or lawsuits can drive a business to bankruptcy.

When you buy stop loss insurance, the insurer will take over your bills after they’ve hit a certain set amount. For instance, if this amount is $10,000 and you’re facing a $20,000 medical bill, the insurer will pay out the additional $10,000.

When you are looking at the cost of Dialysis, it is very clear why you would need coverage to protect your business from exorbitant expense. Dialysis cost averages about $827k in billed charges per year, per patient. And paid claims average around $500k/yr. Specialty Care Management protects you from that risk.

Two Types of Stop Loss Insurance

You can opt for an individual claims policy, or an aggregate claims policy.

An individual claims policy will shield your business when a single claim surpasses the predetermined threshold. On the other hand, an aggregate claims policy kicks in when the value of all claims rolls over the pre-set limit.

Even though you’re free to buy either of these policies, many businesses go for both. You should, too.

Stop Loss Amounts/Premiums Typically Vary

The question you’re probably asking now is “how much does this coverage cost?”

The truth is there is no predetermined amount.

When you go to an insurance company offering this policy, it will need to know more about your business. This involves analyzing your cash flow statement, claims record and number of employees among other things.

Depending on such factors, it will set an amount for you. The amount could be payable in a lump sum, or in installments. You’ll work out the details with your insurer.

Is Stop Loss Insurance Right for You?

Now that you know the basics of this insurance product, you’re certainly wondering whether it’s right for your business.

If you don’t fancy the idea of buying traditional insurance policies, then this product will come in handy.

You never know when an employees’ compensation claims will wipe out your dedicated fund, or when a malpractice lawsuit will compel you to pay more than you had in your budget.

At Specialty Care Management, we will help you make the most of your healthcare revenues. Get in touch and let us help you find the right carrier for your business.


Providing a Life Line: Cancer Patient Services and Support Programs

This year alone there will be an estimated 1,688,780 newly diagnosed cancer cases.

Each of these new cases is a person with a life that will be totally changed with this diagnosis.

This is where cancer patient services come in with hopes of making this hard time a little more bearable for your employees and their loved ones.

Keep reading to learn more about these services and how they change lives:

Why Cancer Patient Services Are Important

The fight against cancer can be draining physically, emotionally, and financially. Cancer patient services aim to help lessen the impact of this burden.

The benefit of these services allows your employees to connect with others that can help them through the cancer journey. Services spanning from simple support to logistical things like rides to and from doctors appointments can be life-changing.

Types of Services Available

Support Groups

Support groups come in many different shapes and sizes to meet the needs and comfort levels of anyone who may need them. Of course, there are traditional face-to-face support groups available. However, there also plenty of phone and internet-based support groups for those who may not feel comfortable with in-person interactions.

Being a part of a support group for cancer patients can help to ease the feelings of anxiety, stress, and confusion that can come with a diagnosis like this.

Another benefit to support groups is the proven higher levels of compliance and tolerance of treatments among those who are active within a group.

As a whole, being surrounded by people who are going through the same or similar circumstances can help to enhance quality of life and the ability to fight the disease.

Lodging Programs

Oftentimes cancer patients have to travel away from their homes to receive the best care possible.

The added financial and emotional toll that this travel can put on patients and their families is heavy.

Through programs like the Hope Lodge, patients, and their caregivers are given free places to stay while they seek out treatment away from home.

Transportation Programs

From the beginning of their cancer journey, patients will need rides to and from doctor’s appointments and treatment sessions.

In cases when family and friends aren’t always available and a patient cannot drive themselves, getting to these appointments can be difficult.

Luckily, programs like Road To Recovery help by providing rides to those who need them.

Health Navigators

A health navigator is a unique part of a cancer patients journey.

The role of a health navigator is to help guide a patient through their healthcare and connect them with providers and services that they may need.

A health navigator can also help you to better understand your diagnosis and treatment options.

Find the Help You Need

If one of your employees has been diagnosed with cancer, know that there are plenty of resources out there for them. You can contact us to learn more about the specifics of these resources.

It also may be worth getting a second opinion, as cancer misdiagnosis is more common that one may think.

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