Jun22

Welcome to the TEAM | Dr. Thinh Tran

We are pleased to announce that effective June 18, 2018, Dr. Thinh H. Tran joined PNS as President and Chief Operating Officer. Dr. Tran is an accomplished healthcare executive with extensive experience in hospital and health plan operations. He brings a unique and strong mix of clinical knowledge
and business acumen.

Dr. Tran received a B.S. in genetics and cell biology from the University of Minnesota’s College of Biological Sciences in 1987. He went on to receive his medical degree from the University of Minnesota Medical School in 1992 and completed an internal medicine residency at the University of Minnesota Hospital and Clinics in 1995. He earned an M.B.A. from the Isenberg School of Management at the University of Massachusetts-Amherst in 2014.

Dr. Tran has significant clinical experience in a variety of healthcare settings including working as a hospitalist at Bakersfield Family Medical Center in Bakersfield, California and an urgent care staff physician at Health Partners in Minneapolis, Minnesota.  While in Houston, Texas he served as the Chief Quality and Patient Safety Officer at Methodist Hospital, Medical Director of Patient Management for Aetna’s Southwest Region, and as Assistant Medical Director in the Department of Medical Management at MacGregor Medical Association. In 2007, Dr. Tran joined Baptist Health South Florida as their Chief Medical and Quality Officer where he founded Baptist’s Center for Performance Excellence to assess the impact, opportunities and management requirements of transformational innovations. Most recently he served as Chief Operating Officer at University of Miami Health System (UHealth), South Florida’s only university health system.  Under his leadership UHealth achieved greater operational efficiencies and strategic growth objectives.

Dr. Tran brings an extensive background and a history of innovation that has already resulted in efficiencies in both the medical and professional schematics of healthcare. The addition of Dr. Tran to PNS will ensure we remain well positioned to navigate the complexities of the healthcare market and take advantage of future growth opportunities.

Please join us in welcoming Dr. Tran to our team!

Jun05

Welcome to the TEAM | Dr. Thao Tran

We are pleased to announce that Dr. Thao Tran will join PNS as Chief Quality Officer, effective June 4, 2018. In this new role, Dr. Tran will be charged with implementing a Performance Improvement Program that will include UM and QI, and to help us prepare for a successful NCQA re-certification. As our company’s clinical and operational quality expert, Dr. Tran will work closely with the leadership team, compliance, and our network medical directors on performance improvement strategies to elevate PNS to a national level.

Dr. Tran earned her degree in Chemical Engineering from California Polytechnic University, and also holds a Medical Degree from University of Minnesota as well as a Master of Public Health and Healthcare Policy from Loyola University. She has practiced medicine in an academic setting for over 15 years and has assisted both higher education institutions and healthcare entities with federal and state regulatory compliance, legal issues, revenue cycle management, patient safety and quality outcomes.

Dr. Tran’s vast knowledge of healthcare, operational expertise and innovate approach have been instrumental in establishing various successful programs. During her tenure as Section Chief for Physical Medicine and Rehabilitation at The Methodist Hospital she established the academic department of Physical Medicine and Rehabilitation for Weils Cornell Medical College. She also established a comprehensive spine center where she integrated rehabilitation, orthopedic, and neurosurgery service lines to provide comprehensive and holistic care that resulted in improved patient outcomes.

While at Memorial Hermann Hospital, in Houston, Texas, Dr. Tran served as the Medical Director for the Rehabilitation Unit within the Level I trauma hospital. In this role, she innovatively incorporated comprehensive rehabilitation services into acute care programs and clinical pathway that effectively transition patient through the continuum of post-acute care with quality patient outcomes and effectively reduced overall costs.

Dr. Tran is passionate about providing integrated patient-centered care. As Medical Director for the Baptist Center for Spine Care at Baptist Hospital of Miami, she provided leadership to develop a multidisciplinary spine clinic. Dr. Tran developed a clinical pathway for spine care and established clinical measurements and implemented nationally recognized best practices for benchmarking.

Currently, Dr. Tran serves as Board Chair for Health Foundation of Florida as well as Chief Medical Officer for Yiling US.

Dr. Tran brings over 20 years of domestic and international healthcare experience that includes both a clinical and business focus. As we position the Company to innovate and grow in the future, Dr. Tran’s wealth of experience and fresh perspective makes her an extremely valuable addition to the PNS team.

Please join me in welcoming Dr. Tran to PNS and wishing her much success.

Sep21

Extension of Statewide Medicaid for Florida Approved through 2022

On August 3, 2017, federal officials in Florida approved a five-year extension of a statewide Medicaid managed care program and agreed on a $1.5 billion pool of funding to help with charity care. The state submitted a request to extend Florida’s Managed Medicaid Assistance (MMA) program through a CMS section 1115 demonstration waiver. The request met CMS’s guidelines to plan effective healthcare procedures that improve health outcomes for vulnerable Floridians.

The announcement by the federal Centers for Medicare & Medicaid Services did not come as a  surprise since state and federal officials have been negotiating for months on issues including the details of the $1.5 billion for the “Low Income Pool” (LIP) program.

This announcement does mean, however, that millions of Medicaid beneficiaries will continue to receive care through HMOs and other managed-care plans until as long as June 30, 2022.  This extension also means that hospitals and providers such as federally qualified health centers will be able to tap into LIP (low income pool) money to cover costs of caring for uninsured individuals. This is a significant source of funding for Florida’s largest public hospital, Miami’s Jackson Health System.

CMS administrators believe this managed care extension will have a positive impact on people in Florida and their access to care as well as set an example for ways to overcome Medicaid challenges.

This announcement on the Low Income Pool came almost four months after Gov. Rick Scott voiced that the state and federal government had agreed on $1.5 billion in funding for the program. Despite the tentative agreement in April, state and federal officials continued to work out details.

The funds from the Low Income Pool are designated for institutions such as hospitals, federally qualified health centers, rural health clinics and medical-school physician practices, according to details of the LIP money posted online by CMS. The pool funds exclusively pay for charity care provided to uninsured low-income people — these funds do not help pay for care of low-income people who have insurance.

The $1.5 billion is an increase from $607 million last year and involves local government sources putting up money that draws down federal funds. Since the overall amount that will be available will depend on how much money the local sources provide it is not clear that the entire $1.5 billion will be tapped.


Republican Sen. Marco Rubio expressed his support for the announcement stating, “the extension will enable our state to continue providing care to Medicaid recipients through a managed care program, and the annual $1.5 billion LIP allotment will provide federal resources to Florida hospitals to ensure the most vulnerable patients have access to quality health care.”

Jul12

Future of Concierge Medicine

If you’ve ever wished for more time during your regular doctor’s appointments or wanted to email your physician a question after designated hours, an increasing number of doctors are now offering additional access to added services.

In what is referred to as direct primary care or concierge medicine, your doctor provides additional services when you pay a fee in addition to what your insurance pays. In other words, this is a private form of practice where doctors charge patients an out of pocket retainer fee for full access to their services.

The service is available as a monthly, quarterly or annual fee paid directly to your doctor for a range of personalized care options when you need it. Direct primary care allows you, and your doctor, to know exactly how you or family prefer to be treated. It also saves time, as you don’t have to wait very long at doctor’s offices or repeat your medical history each time.

A growing number of primary care doctors are bringing concierge medicine, which in the past has been considered health care for the wealthy, to middle- income, Medicare & Medicaid populations.  And more importantly, concierge medicine is becoming more attractive to both physicians and patients.

In fact, a recent survey of 862 independent physicians found nearly half are considering this alternative method of practice management.

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Source: Kareo and the American Academy of Private Physicians (AAPP)

The main attraction to concierge medicine from the perspective of the physician is one of control. Patient loads typically decrease when a physician transitions from a fee-per-service practice to concierge medicine. A concierge doctor may have 500 patients, while a doctor in a traditional practice may have around 2,000. The doctor with the 500 patients is on retainer and has predictable revenue. The physician also spends more time with the patient and really gets to know them. The doctor with thousands of patients, on the other hand, may not have the time or resources to form the same type of relationship and is paid only when the patient comes in.
Concierge medicine can be a great option for physicians who are ready for a change of pace thanks to the smaller patient panel and reduced dependence on insurance reimbursements and for patients seeking more personalized care. While concierge medicine is not meant to replace traditional insurance it is a way to enhance the patient-physician relationship.  How likely are you to consider trying concierge medicine?

Jun15

Three Health Care Trends that will Prevail even without the Affordable Care Act

Last month, House Republicans voted to repeal and replace the Affordable Care Act (ACA). Subsequently, Republicans in the Senate began working on their own legislation. The latest Congressional Budget Office (CBO) analysis of the American Health Care Act passed by the House of Representative suggests that Republicans in the Senate have some work to do — but should focus on distinct opportunities as well — as they seek to repeal and replace Obamacare. While the fate of the Senate bill is uncertain, these three trends in the U.S. health care system are not likely to change, according to a report from the Harvard Business Review.

The first trend is demographic. In 1960, the median age of men and women in the U.S. was 29.5 years; it is now 37.9 years, and in the next 12 years, it will exceed 40 years. Per capita annual health care costs are approximately $4,500 for people 19 to 44 years of age. This amount doubles for those ages 45 to 64, and doubles again for those over 65. Thus, as the population ages, health care services will expand, along with the pressure to find efficient ways to deliver those services.

Secondly, technology has become a prevalent element across the health care system, with a major impact on diagnosis, treatment, and communications. In 2004, 20% of practicing physicians used electronic health records (EHRs) in the U.S. Today, 90% of physicians regularly employ EHRs. Beyond EHRs, digital health tools—apps, wearable devices, and other hardware and software that measure and monitor health—are becoming common in consumers’ lives. More than 3,000 apps are now available to help manage diabetes alone. Such technology has become rooted firmly in U.S. health care and, as elsewhere, consumers will choose many of the winners, according to the article.

Third, regardless of the changes made to the ACA, discoveries in the life sciences that enhance the quality and extend the length of life will continue to emerge from research laboratories. These advances are being driven by two major trends: the availability of personal health data, and the plummeting cost of integrating massive health data-sets in the cloud. These two foundations will help promote the emergence of personalized medicine.

Taken together, these three trends will drive dramatic changes in health care, regardless of fluctuating government policies.

May09

5 Ways Healthcare Will Change in 2017

With so many uncertainties in healthcare today, it is challenging to predict what the future of healthcare will hold. Below we will highlight five trends in healthcare that could drive the landscape in 2017 and beyond.

  1. Shift from Volume to Value: This evolution towards a value-based reimbursement system is in the interest of patients, healthcare providers and payers alike. A value-based reimbursement system incites healthcare providers to deliver the best care at the lowest cost while patients receive a higher quality of care at a better value.
  1. High-Tech Healthcare: 2016 has been a key year for healthcare technology, not only with innovations in medical devices and software, but also in the way healthcare is managed and administered, both from a care and financial perspective.  The North American health IT market is expected to reach $104 billion by 2020, according to a recent report by MarketsandMarkets. A majority of this growth is due to the adoption of various healthcare IT solutions by healthcare providers in order to improve the quality of healthcare while upholding the operational efficiency of healthcare organizations. Artificial intelligence, robotic care, wireless wearable sensors, and telemedicine are among key advances that will transform industry. For more on technologies to look out for visit here.
  1. Power of Consumerism: For years, consumer demands have played a large role in the service, airline and hotel industries. Today, as patients begin to assume a greater portion of their healthcare costs, they are putting more time, effort and research into making informed decisions related to their care. As this trend in consumerism moves towards the healthcare industry, providers must be willing to better cater to patients’ demands for transparency, value and convenience.
  1. Effects of an Aging Population: The population throughout the world is rapidly aging. In 2050, the population aged 65+ in the US is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012.The change in age distribution will have overwhelming and multifaceted health, social and economic repercussions. Along with a rapidly aging population comes an increase in the pervasiveness of chronic diseases and their effects. The elderly often have multiple health conditions, take several medications and require more frequent communication with healthcare providers. Providing adequate care efficiently and cost effectively will be essential over the next several decades. One part of the solution will be telemedicine which allows providers and patients to connect remotely for follow up visits, medication supervision and the management of chronic disease.
  1. Move from Population to Personalized Health: In the United States, despite recent advances, our healthcare system still generally operates as a one-size-fits-all model. Some refer to this as the “population model”. This model suggests that the majority of people benefit from a homogeneous course of treatment whether that be for a cold or a broken arm. Personalized medicine, on the other hand, supports the customization of health care. It aims to focus on preventative medicine, as well as tailor treatments to an individual so a disease or illness can be targeted in a way that promises the highest chance of success based on the characteristics  of the individual.

Now, more than ever, it is essential that we anticipate what is next, navigate the changing landscape and solve the toughest healthcare challenges. Here at PNS we will keep a pulse on these trends and keep you up to date.

Apr15

PNS Cares Tees Up its 1st Annual Golf Tournament

Last weekend PNS Cares, Provider Network Solution’s nonprofit arm, held its first public event, the 1st annual Let’s Play Around Golf Tournament & Dinner Party. The event was held in honor of Andrew Bravo, one of Provider Network Solution’s founders, who passed away too soon after losing his short battle to cancer. Because Andrew was an avid golfer we thought the best way to honor him was by playing the game he loved and supporting a cause close to his heart, The First Tee. All proceeds of the event are going to The First Tee of Broward. The First Tee is a youth development organization introducing the game of golf and its inherent values to young people. Through after-school and in-school programs, they help shape the lives of young people from all walks of life by reinforcing values like integrity, respect and perseverance through the game of golf. Hosting this event brings great honor to our company as it reflects our company’s core values: empathy, honesty, respect, kindness and dependability.

PNS Cares was founded in 2015 and we are happy to be living our philanthropic mission: Share Love, Spread Hope. We hope that by leveraging our own strengths and resources, we will raise awareness of the importance of corporate philanthropy, and encourage others  to participate in and contribute to the development of social responsibility.

Special thanks to our sponsors & volunteers:

Sponsors:

Veramonte

Simply Shades

Confessions Nail & Beauty Bar

305 Photography

PPN (Physician Providers Network)

MAC Beads

Gonzalez Bayas Famlia de Vino

MSO Solutions of South Florida

Physicians Advocate LLC

 

Volunteers from PNS Cares:

Cristina Fernandez

Daniela Cardoso

Anelba Baez

Katherine Garcia

Jeremy Gutersohn-McCoy

Daniel Owens

Carolina Diaz

Celia Morales

 

Volunteers from The First Tee of Broward:

Cory Cody

Garry Bismore

Therone Phillips

Charles Schmidt

Chloe, Bill & Conner Walsh

Brenda Pearse

Robert Ferzoco

 

To view photos from the event visit www.pnsclassic.splashthat.com

Mar16

What to know about AHCA & CBO Predictions

President Trump is looking to check off another promise from his campaign to-do list– repeal and replace Obamacare. Last Monday, with the announcement of the American Health Care Act (AHCA), the Trump administration and the majority of the Republican Congress debuted their plan. Below is a brief summary of what is staying from the Affordable Care Act and what Republicans plan to change:

2010 ACA

2017 AHCA

Stay on parents’ plan until 26   Check mark symbol
Pre-existing condition coverage   Check mark symbol
Lifetime limits ban  Check mark symbol
Tax subsidies  Check mark symbol *however, tax subsidies will be based on age and income
Medicaid expansion  Check mark symbol *however, AHCA stops adding new people in 2020 for medicaid


The bill struck down Obamacare’s mandate for Americans to have health insurance by getting rid of tax penalties for people who do not purchase healthcare.The new government would help people pay for coverage with age and income-based tax credits. The AHCA would also pull back on funding for Medicaid starting in 2020.

Those are the main differences, but what does this really mean? Late in the afternoon on March 13, 2017, the Congressional Budget Office issued a cost estimate on the House Republican leadership’s American Health Care Act (AHCA). CBO projects that, if AHCA is enacted, the number of uninsured would grow by 24 million, from 28 to 52 million by 2026. AHCA would reduce the budget deficit by $337 billion over the 2017-2026 period, mainly by cutting: 1) Medicaid by $880 billion 2) The current Affordable Care Act means-tested tax credits and 3) the cost-sharing reduction payment by $673 billion. Meanwhile, the bill would cut taxes by $883 billion.

Premiums in the individual market would be on average 15 to 20 percent higher in 2018 and 2019 than under current law. By 2026, however, they would be 10 percent lower than if Obamacare persisted.

After the report’s release, the Trump administration quickly criticized its conclusions, indicating it does not take into account other administrative actions it plans to take after the bill is passed.

Democrats criticized the estimated rise in uninsured people and raised concerns that seniors would see the brunt of the cost increases. House Speaker Paul Ryan, on the other hand, highlighted its estimated effect on the deficit and maintained that it would increase consumer choice and bring down costs.

Many lawmakers have been waiting for this CBO report to decide whether or not to vote for this bill. Now that it’s out, expect the GOP to be on the defensive.

Feb14

Provider Directory Errors: More Common than you Think

Last month Federal officials warned 21 Medicare Advantage insurers with high rates of errors in their online network directories that they could face consequences if the issues are not corrected.  These consequences include heavy fines and stopping the insurers from accepting enrollments.

This action comes after the government’ first comprehensive review on the accuracy of Medicare Advantage provider directories, which members have criticized for some time. Nearly one third of Medicare beneficiaries, about 17 million Americans, are covered through HMO Medicare Advantage plans rather than traditional Medicare.

Medicare Advantage members rely on provider directories to locate in-network providers and these inaccuracies present significant access-to-care barriers and cause great inconvenience.

One Medicare plan in Virginia had the highest rate of inaccuracies among the 54 insurers evaluated. About 80% of their directory (87 out of 108 doctor entries) had errors including incorrect locations and doctors who should not have been included.

The federal review focused on reviewing primary care doctors, cardiologists, ophthalmologists and oncologists. Officials called to check on the listings for 108 doctors in each health plan. The results demonstrated that many of the directories were extremely outdated with providers who had been retired or deceased, sometimes for years.

The CMS report discovered that most health plans had inaccurate information for between 30 to 60 percent of their providers’ offices. The report pointed the finger at health plans for failing to do enough to keep their directories accurate. The main issue was a lack of internal audits and testing of directory accuracy. The number one error they found concerned doctors with multiple offices who only serve members in certain locations.

Since January of 2016 PNS has been assisting their health plan partners in keeping their provider directories up to date and reviewing provider directory requirements per CMS guidelines. The Provider Relations team has developed a process for checking in with providers every other month to verify and update their information. They make sure the directories are current, accurate and that all the doctors in the directory are eligible. In verifying and updating the provider directory every other month they exceed CMS guidelines and help the Health plans to stay ahead of the quarterly deadline.

 

Jan26

Sunshine State Health Care Regulation Debate Rekindled

Florida lawmakers could be rekindling the debate about easing healthcare industry regulations in the state. Two weeks ago, a House panel began reconsidering the “certificate of need” program – a regulatory process that requires certain health care providers to obtain state approval before offering certain new or expanded services such as skilled nursing facilities, intermediate care facilities for the developmentally disabled, new hospitals and certain hospital services. Bills concentrating on the regulation of ambulatory surgical centers and clearing the way for direct primary care agreements between doctors and patients were also filed in the House and Senate.

It is worth noting that these issues are not new: In recent years House leaders have repeatedly pursued to reduce ‘certificate of need’ laws and implement other regulatory changes. The House and Senate are having a difficult time agreeing on these issues as lobbyists push them in different directions regarding competing parts of the healthcare industry.

Many House leaders have supported eliminating the ‘certificate of need’ process for hospitals, debating that a free market approach would improve access to care. Those who disagree with eliminating the certificate of need process, on the other hand, have argued that such an act would lead to hospitals being built in affluent areas to support insured patients, while established public and community hospitals would be left to treat low-income and uninsured patients.

This debate concerning revamping healthcare regulations in Florida comes amidst broader questions from a national perspective about changes in the industry as a whole. Many of these questions revolve around the push from Donald Trump and Republicans in Congress to drop the Affordable Care Act, which would affect providers, patients and insurers.

Along with the ‘certificate of need issue’, lawmakers will also likely revisit proposals concerning ambulatory surgical centers and ‘recovery care’ centers. Currently overnight stays at ambulatory surgical centers are prohibited but two bills filed (HB 145 and SB 222) call for allowing the operation of recovery care centers, a new entity where patients could stay 72 hours after surgery.

Legislature could also take another look at proposals that would accept “direct primary care” agreements between doctors and patients. Direct primary care agreements typically involve monthly payments that patients or their employers make to a health provider. These payments cover the routine primary care services for a patient and cut out the role of the insurer. HB 161 and SB 240, which were both filed, would make it clear that direct primary care agreements are not considered insurance and are not governed by Florida insurance laws.

Here at PNS, we are keeping a pulse on these state legislations and the potential affects they could have on you. Thank you for tuning in this week!