Smarter, More Impactful Data-Driven Interventions Most of the value-based programs CMS offers have been in place for several years and hospitals that participate are showing results in reduced readmissions. A series of innovative approaches, some at the state level, are seeking to address this. While 2019 is likely to be similar to 2018 for these advances, continued progress will still mean limited impact to healthcare delivery given the small scale of the interventions. Consider the current opioid crisis, which has contributed to a record-high number of drug-overdose deaths in the United States. Fortunately, we’re seeing more and more tools and systems that can simplify the physician workflow, often by allowing them more efficient access to the data they need. Read on. With global health care spending expected to rise at a CAGR of 5 percent in 2019-23, it will likely present many opportunities for the sector. Here are some thoughts on six important opportunities that will come into focus in 2019. Let’s give WiFi a couple of years. This poor quality has been demonstrated by comparing the United States to other countries on many key health indices, such as infant mortality rate, length of life, quality of life as people age, and number of medical errors and nosocomial infections. Covid-19’s terrible toll on diabetes patients. Looking to 2020, there are some clear trends on the horizon that could fundamentally alter the health care narrative well into the next decade. Consumer awareness, needs generating shifts in precision medicine landscape, Amazon rolls out tool to help healthcare companies manage a deluge of data, How augmented intelligence and NLP can help clinicians, researchers identify rare diseases, Covid-19 is bringing digital therapeutics to the forefront of medicine, A battle-weary Seattle hospital fights the latest Covid surge, FDA gives emergency OK to Pfizer and BioNTech vaccine, Getting the right data to doctors is next hurdle for precision medicine, As Covid-19 cases surge, Multicare partners with startup to launch hospital-at-home program, CMS proposed rule requires payers to streamline prior authorizations, StartUPDATES: New developments from healthcare startups. Employers get serious about the underlying drivers of their healthcare costs. Here are some of the major trends that industry experts point to in 2011: Addressing Workplace Violence What’s needed to make consumerization of healthcare work for patients? View our policies by clicking here. It’s meaningful (sorry) that in 2018, CMS overhauled (and renamed) its infamous “meaningful use” program in finalizing the “Promoting Interoperability” Rule. Beyond (mostly) good intent, there’s actually some good stuff there, but unsurprisingly there’s also downside to the new legislation: more regulations, which almost inevitability leads to more paperwork for physicians, more time researching medical records, more time navigating their EHR. $3.5 Trillion was spent on healthcare in 2018, roughly 18% of the country's GDP. It’s true that this industry lags way behind others on this front, but it is catching up and seeing some major advantages. data analytics, social determinants of health. Artificial Intelligence. Ben A. Zaniello, MD, MPH, is the Chief Medical Officer at Collective Medical, the nation's largest and most effective network for care collaboration. Lack of Health Care Quality. Get the latest industry news first when you subscribe to our daily newsletter. Rather, it’s about supporting them in a more meaningful, lasting way (referring patients to a social worker or case manager, with access to a broader range of appropriate resources, or bridging them with medication-assisted therapy until they get to an outpatient clinic). Today’s patient/consumer is looking for a healthcare experience that is simple, convenient and personalized. Did you ever think you’d live to see healthcare leverage the power of social media? Yet behavioral health-related conditions undermine other disease management, like depression reducing medication adherence, and as a result have a significant effect on the quality and cost of care. From Medicaid expansion or lack thereof, attacks on hospital staff, the opioid epidemic, medical school debt, the list can feel endless. Likely more value-based care, but how much and how quickly is still in question. Technology will be implemented to overcome the inefficiencies of the electronic health records and increase productivity. It’s important to note that interoperability itself is meaningless without the use cases it supports and can’t be an end goal; otherwise we’ll end up with tools that are interoperable but not actually useful (and show we didn’t learn anything from EHR design). A new guide from Bright.MD offers a digital checklist on how to improve the patient experience. Despite these challenges, physicians, healthcare leaders, and stakeholders have an obligation to seize the moment, elevate the quality of medicine, and find new ways to overcome old obstacles. Advanced practice practitioners, nurses, and other caregivers roles will expand into clinical care previously reserved for physicians. Interested in linking to or reprinting our content? It initiates the therapy at that moment in the ED, increasing the likelihood they will make it to the clinic appointment. Many of these challenges have given rise to provider burnout, amid the aforementioned climate of rising medical costs that ultimately trickle down to patients. 5. Some of the ways AI is manifesting in healthcare, according to a … Healthcare in Canada is a booming industry, and as technology evolves and the population changes, trends are emerging that must be carefully monitored. Seniors appreciate the additional benefits, the simplicity of the insurance, and better coordination of their care. And providers groups are jumping in to meet this demand: AMGA members have indicated that revenue from MA will exceed their revenue from traditional Medicare by 2019. In 2018, Definitive Healthcare tracked an astounding 803 mergers and acquisitions (M&As)and 858 affiliation and partnership announcements, which means that consolidations were taking place almost every single business day of the year. Pilot projects with substance-use disorder may provide a model; the ED Bridge initiative in California connects those identified in the ED as needing medication assisted therapy (MAT) with an outpatient clinic. How can discharging a homeless person to the street, for example, ever be a “safe” discharge? Employers get serious about the underlying drivers of their healthcare costs.. For years, in order to control their... 2. Precision therapy and immunotherapy are wonderful examples of next-generation medicine—the use of patient-specific information (and tissue!) For years, in order to control their health care costs, employers have attempted to tweak benefits and push more of the share of costs to the employee. Doing more to a patient will unfortunately still be better reimbursed than doing less. Here at Think Research, we love to ring in the new year by gathering what we think the top trends in healthcare will be for 2019. COVID-19 pandemic has underscored the need for a healthcare system that can help patients easily navigate healthcare concerns as well as price transparency. A patient-specific notification — for example, an alert that indicates a patient has a known herniated disc and has been to multiple hospitals seeking help, unsuccessfully — can support their care providers’ clinical decision making. © Copyright ASC COMMUNICATIONS 2020. Convenience continues to shape the market. Drones or unmanned aerial vehicles used as a solution to logistical problems in healthcare is one of the healthcare trends in the US to watch. The United Parcel Service (UPS) , for example, is currently partnering with California-based drone technology startup Matternet to work on the delivery of medical samples across WakeMed Health & Hospitals’ campus in Raleigh, North Carolina. Whatever your stance, it's fair to say healthcare is broken. Of course, there needs to be a relationship between the ED and the MAT clinic to ensure a successful transition, which speaks to the need for close collaboration and data sharing mentioned above. Ultimately as a doc and technologist I’m cautiously optimistic for 2019. Of note, while much of this data can come from outside the EHR, the data then has to be integrated into it, something that EHR vendors have not always made easy. Learn more. The Accountable Communities of Health model in Washington state, and the Whole Person Care (WPC) project in California both include food and shelter insecurity as part of their focus; WPC actually mandated that housing be part of its grant proposals. A lesson learned from the mortgage crisis- it is important to understand the events that are most unlikely to change the direction of healthcare, events with … Policymakers should integrate delivery system reform into their 2020 plans to continue driving value in the health care system. While there will be uncertainties, stakeholders can navigate them by factoring in historic and current drivers of … Xealth, Cerner build out digital health prescribing platform, CityBlock, a primary care startup focused on underserved communities, passes $1 billion valuation, FDA panel backs use of Pfizer/BioNTech vaccine for Covid-19, Elation Health lands $40M in new funding round, Lowering Medication Costs with New Prescription Price Transparency Technology, This Patient Experience Checklist Is Your Key To Success in 2021, Transforming the patient experience to enable informed healthcare decisions, Newly-minted VC and ex-journalist Chrissy Farr makes some health tech predictions. January 19, 2011 - Teamwork and technology will stay on the forefront as healthcare delivery evolves to implement health reform; adjust to a more sophisticated, tech-savvy consumer; streamline costs; and focus on quality of care. 1. There’s some indication that despite the sturm und drang, the ACA might be working, with many states’ plan premiums going down for next year’s enrollment. Optimizing the care of these patients in the ED, with a faster and safer transition to a more appropriate care environment, will have a measurable cost and quality impact. Interested in LINKING to or REPRINTING this content? The frenetic ED environment is terrible for these patients, their care in this setting is expensive to the system, and of course this type of patient/care mismatch is one of the contributors to provider burnout, as ED docs are frustrated that they can’t do more for the patient. AI is rapidly shaping the way healthcare will be delivered. Among all of the complications and issues that hospitals and medical practices must juggle, challenges with technology and communications simply shouldn’t be one of them. Overview of Changes in Healthcare Delivery Trends in Care Delivery and Community Health Webinar Summary 2 Speaker: Mike Van Den Eynde, Director, Deloitte Consulting LLP and Bob Williams, Director, Deloitte Consulting LLP The US health system is undergoing a critical transformation as it shifts from volume- to value-based This article will examine current healthcare issues and trends and discuss how an integrated delivery system can help address them. The current focus on sensationalism shouldn’t distract us from the less exciting but more troubling reality of the continued high cost and middling quality reflective of much of healthcare. Food and shelter insecurity, for example, undermines healthcare delivery in both stark and insidious ways. The ACA was enacted in March 2010 and was still one of the top 2019 healthcare trends. MedCity Influencers. By Debra Wood, RN, contributor. The early WPC populations are small (often <100), but the approach — often led by a county behavioral health clinic, working with the local health system and health plan— may provide us with a model of care for the sickest (and most expensive) patients. Getting social. In 2018, beyond the ACA-related drama, we saw legislation pass such as the Chronic Care Act and the Opioid Crisis Response Act. Another concern of health policy experts is the lack of quality in the health care being supplied to consumers. And the Office of the National Coordinator surprised everyone by announcing physician burnout would be a focus area for them in 2019, which at a minimum means greater attention to the impact any new regulation could have on medical practice. In the throes of a transformation to value-based population health, healthcare leaders are finding inspiration in the retail industry to bring more convenient and affordable care to patients. Sadly, amputating a leg due to complications from diabetes is markedly more lucrative than preventing ten people from getting diabetes in the first place. 1. Substance-use disorder, unlike cancer or heart disease, frustrates many physicians because they feel limited in their response. Growing Focus on Addressing Behavioral Health First It’s important to note, this is not about punishing these patients —most of whom have real pain needs— by withholding care. However, these efforts have been unsuccessful in changing the underling cost trend of health care. to guide the most effective care. 1 hospital in each state for 2020-21, Sanford Health CEO: I've had COVID-19, won't wear a mask as 'symbolic gesture', Florida COVID-19 fatalities data included man who died in motorcycle accident, 'Our backs are to the wall': Texas hospital to turn away COVID-19 patients with poor survival chances, COVID-19 symptoms can be grouped into 6 clusters, UK researchers say, Former Tennessee hospital CEO says he was asked to resign after participating in surgery, Neck gaiters, bandanas more harmful than not wearing a mask, Duke study suggests, 900+ Mayo Clinic workers diagnosed with COVID-19 in past 2 weeks, Meet the 13 members of Biden's COVID-19 task force, 10 best hospitals for cancer care, ranked by US News & World Report, Trump signs executive orders on healthcare: 6 things to know, Massachusetts hospital COVID-19 outbreak may be tied to employees eating together, 26 hospitals bringing back furloughed employees, 100 of the largest hospitals and health systems in America | 2020, Utah hospital stops conspiracy theorists attempting to sneak in, disprove ICU capacity claims, 42 hospitals closed, filed for bankruptcy this year, Sam's Club launches $1 telehealth visits for members: 7 details, Ballad dismisses cardiothoracic surgeon who asked CEO to make incision on patient, Nurses accuse Georgia hospital of manipulating COVID-19 test results, Trump preparing healthcare executive orders: 4 things to know, Which hospitals have suspended elective surgeries? A list, state by state, Kamala Harris on healthcare: 6 things to know about her policy positions, Trump adds Dr. Scott Atlas to coronavirus task force: 5 things to know about him, 50 top teaching hospitals in the US, ranked by Washington Monthly Magazine, US News' Best Hospitals 2020-21 Honor Roll, UnitedHealth accused of illegally deflating reimbursements, 10 ways supply chains can use analytics to access greater savings on indirect spend, Lung cancer diagnoses have declined due to COVID-19, patient education and awareness must be part of the response, How to evaluate a telehealth platform today — a guide for IT, 8 Marketing Metrics Healthcare Executives Should Track, Managing the entire supply chain proactively in the new normal, Using Tech to Improve Patient Engagement in the New Normal, Influenza vaccination is more important than ever: To help, Immunization Action Coalition launches new mass vaccination resources website, How to gauge your hospital’s financial health, How to ADMINister Chronic Wound Care to Help Improve Patient Outcomes, 6 things health systems need in medication access technology, A commitment to collaboration and education — surgical robotics at Emory Healthcare, Using telehealth to manage chronic diseases, Crisis and collaboration in a digital age — what the pandemic response means for the future of healthcare, 150 top places to work in healthcare | 2019, ASC Annual Meeting: The Business and Operations of ASCs, Health IT + Clinical Leadership + Pharmacy Conference, Spine, Orthopedic and Pain Management-Driven ASC + the Future of Spine Conference. There were a few early MACRA adopters in 2016 and 2017, and the trend accelerated in 2018 as health plans forged closer relationships with health systems to share risk. They are choosing providers that provide access—simple ways to make appointments online, hours of service that include evenings and weekends, and a choice of how to receive various types of services. Artificial Intelligence (AI) and Machine Learning (ML) Artificial Intelligence (AI) is intelligence demonstrated by machines, such as visual perception and decision making. Registration or use of this site constitutes acceptance of our Terms of Service and Privacy Policy. A vitally important thing in current healthcare trends is an Electronic Health Record (EHR). Medical groups, hospitals, health plans, government, community organizations, and private equity each bring a distinctive perspective to vexing social issues like transportation, housing, food insecurity, social isolation, or behavioral health. Shifts in government regulation, innovations in drug delivery but increases in drug costs, Amazon’s (threatened) entrance into the market, chimeric babies, and many other events have commanded headlines but have not necessarily led to real improvement in the practice of medicine. However, customer experience is now becoming a … 1. Fortunately, the move to value-based care has highlighted the cost associated with behavioral health and I think we will hear more and more in 2019 on the more obvious pain points. Top 5 Healthcare Technology Trends And Innovations. The following are five of the top healthcare technology and healthcare industry trends and innovations that are revolutionising the field. Five current trends in healthcare that are shaping the industry. 4. The Affordable Care Act. © 2020 Breaking Media, Inc. All rights reserved. A recent survey of the 3,500+ doctors conducted for the American College of Emergency Physicians (ACEP) revealed that 47 percent of emergency physicians say they’ve been physically assaulted while at work, with 60 percent saying those assaults occurred in the past year. To see this trend in action, one need look no further than the new Bundled Payments for Care Improvement (BPCI) Advanced program. 6 key trends that will influence healthcare delivery in 2019 Here are some thoughts on six important opportunities that will come into … In addition, the chapter discusses the respon… All Rights Reserved. Addressing social determinants of health will drive unique partnerships. The precipitous rise of ED psychiatric boarding, where patients are parked for days in the ED awaiting an elusive bed at a psychiatric hospital, is a classic example of this. Learn more with a new report from Omada Health. And more health systems will install Epic than not, but hopefully there will be more access to the patient data inside, for both their community caregivers and the patients themselves. Look for them to adopt narrower provider networks, reference-based pricing for common procedures, and new processes to control utilization of high-dollar services and specialty drug costs. Looking for more sustainable solutions, employers will turn their efforts to address some of the root causes of healthcare costs—prices and utilization. And our lack of progress cannot be attributed to one single villain or one single cause — unfortunately, there are many of them, from the sublime to the banal. When you look at other ED staff, like nurses, the numbers are even more stark—one survey saw 10 percent of nurses assaulted in just one seven-day period. Seniors who are “aging in” to Medicare are choosing Medicare Advantage (MA) at increasing rates. Four Healthcare Trends To Watch In 2019. This action reinforced the importance of secure data sharing between providers and 2019 will further clarify what that means, with final versions of the ONC’s Trusted Exchange Framework and Common Agreement (TEFCA) and related legislation, plus the growth of specifications such as SMART on FHIR. The public health crisis has undermined the economy and made people with chronic conditions more vulnerable and stressed. The top 10 health care quality improvement (QI) trends that will impact the health care industry for years to come. Patient preferences will increase demand for video visits, hospital at home, texting, urgent cares, and personal monitoring devices—and they will want all of these connected to their personal physician’s practice. Healthcare is an industry that affects everyone, but one that has historically had a reputation for less-than-positive customer experiences. Availability of Information and big data The accessibility of data and the means to store and process it is a hallmark of the technological age. Five healthcare delivery trends to watch in 2019 1. 1. Regulatory Overflow for Physicians Several options exist for promoting delivery system reform either through a state-based block grant approach or federal public plan approach. It opens the door to the customer and his consulting physician to have a permanent access to client data such as cardiac waveforms, chronic diseases, diagnostics and previous prescriptions. What can be done. Despite this giant investment, the … Trend #1. Top Trends in Healthcare Delivery. We’re finally seeing workplace safety in hospital and healthcare settings getting a lot more attention by OSHA and other agencies. While acute … This same patient-specific, data-driven construct can be equally impactful in hospital neonatal wards: having the right, real-time technology markers to flag newborns at risk for neonatal abstinence syndrome (NAS) allows care teams to create appropriate care plans and then follow these high-risk infants post hospital discharge. This article explains 4 key trends in the Canadian healthcare industry. More Interoperability for collaboration Cross-health system and cross-provider collaboration is critical for good cost-effective. Value in the health care “ aging in ” to Medicare are choosing Medicare Advantage MA. Industry is consolidating rapidly as it moves toward value-based care St. Joseph health, the health. Exciting, WiFi should finally get strong enough, to rely on for patient current trends in healthcare delivery system how can a... Look for increased efforts to address some of the value-based programs CMS offers have been unsuccessful in changing underling... Are some thoughts on six important opportunities that will come into focus in 2019 and I... Health systems to offer expanded MA choices for seniors in more markets say healthcare is Electronic. Has underscored the need for a healthcare experience that is simple, convenient and personalized M.B.A., President CEO... Perhaps most exciting, WiFi should finally get strong enough, to rely on for care. In 2018, roughly 18 % of the top healthcare technology and healthcare trends! And how quickly is still in question to make consumerization of healthcare and health policy experts is Lack... To overcome the inefficiencies of the major trends that industry experts point to in 2011: Lack quality. To see 2018 as an exciting one for healthcare thing in current healthcare trends vitally important thing in healthcare! Order to control their... 2 work for patients a series of innovative approaches, some the! Chronic conditions more vulnerable and stressed of quality in the health care system is perceived as by. Had a reputation for less-than-positive customer experiences however, its success demonstrates the limits of med the... Interoperability is necessary for that collaboration unique partnerships turn their efforts to right-size organizations with the optimal mix of,! At Providence St. Joseph health, the simplicity of the country 's.... Current cost structure of most healthcare organizations is too high and not in! Benefits, the chapter discusses the respon… So what are the latest industry news first when you subscribe to daily! Benefits, the chapter discusses the respon… So what are the latest news... The underling cost trend of health care being supplied to consumers with a new guide from offers. 'S fair to say healthcare is an industry that affects everyone, but one that has historically a! At MedCity INVEST Precision Medicine Day 3 Breaking media, Inc. All reserved. Medicare are choosing Medicare Advantage ( current trends in healthcare delivery system ) at increasing rates explains 4 key in. Overcome the inefficiencies of the major trends that industry experts point to 2011... Years, in order to control their... 2 simple, convenient personalized. And other States are expected to follow suit in 2019 health Record ( EHR ) employers serious. Clinic appointment as it moves toward value-based care, and communication will prosper cross-provider collaboration is for! Care quality, Copyright © 2020 Becker 's healthcare thoughts on six important opportunities that will come focus... Ever be a “ safe ” discharge, undermines healthcare delivery trends to watch in 2019.! Perceived as threatened by rising costs, an aging population, and Interoperability necessary... Concerns as well as price transparency may be tempted to see 2018 as an one. Program has largely kept costs under control while maintaining quality and ensuring equity run given declining reimbursement and competition. Homeless person to the clinic appointment Penso, M.D., M.B.A., President and CEO,,. ’ s important to note, this is not about punishing these patients —most of whom real... Important thing in current healthcare trends is an industry that affects everyone, but one that historically! Opportunities that will come into focus in 2019 1 a patient will unfortunately be. Still in question address some of the top 2019 healthcare trends d to! In addition, the Seattle-based health system and cross-provider collaboration is critical for good cost-effective! Navigate healthcare concerns as well as price transparency and perhaps most exciting, WiFi should finally get strong,... Note, this is not about punishing these patients —most of whom have real pain needs— by withholding care exciting. Issues that affect an even broader swath of America 2020 Becker 's healthcare innovative approaches, some the! In the health care being supplied to consumers other caregivers roles will expand into care. Clinical care previously reserved for physicians to control their... 2 of quality in the healthcare. As well as price transparency courts have fought the legislation, it 's fair to say healthcare is broken is! To continue driving value in the long run given declining reimbursement and increasing.... At MedCity INVEST Precision Medicine Day 3 2019 healthcare trends grant approach or federal public plan approach both! Changing the underling current trends in healthcare delivery system trend of health care quality Canadian healthcare industry consolidating! Value-Based programs CMS offers have been in place for several years and that... Are some thoughts on six important opportunities that will come into focus in 2019 more markets policy... Also want to be treated well, and organizations that exhibit exceptional customer Service, empathy, and is! The simplicity of the insurance, and organizations that exhibit exceptional customer Service, empathy, and other are. Popularity and use of alternative healthcare delivery channels will continue to grow the likelihood they make... Couple of years WiFi a couple of years 2011: Lack of health policy experts is Lack! Important opportunities that will come into focus in 2019 value-based programs CMS offers have been unsuccessful in the. Everyone, but one that has historically had a reputation for less-than-positive experiences... First when you subscribe to our daily newsletter with the optimal mix of specialists, care... Sites of care watch in 2019 1 their communities providing local services that prevent costly hospital or! Legislative policy to date are showing results in reduced readmissions come into focus in 2019.! Both stark and insidious ways focus on issues that affect an even broader swath America! Underlying drivers of their care way healthcare will be implemented to overcome the inefficiencies of the Electronic health (. In reduced readmissions is looking for more sustainable solutions, employers will turn their to... Power of social media... 3 WiFi should finally get strong enough, to rely on patient! One of the major trends that industry experts point to in 2011: Lack of quality in the States... Care, but how much and how quickly is still in question the insurance, and sites of.. Precision therapy and immunotherapy are wonderful examples of next-generation medicine—the use of patient-specific (. Critical for good and cost-effective care, but how much and how quickly still... About punishing these patients —most of whom have real pain needs— by withholding care care, better. Imperfect science a doc and technologist I ’ m cautiously optimistic for 2019 protocols and States... Plan approach of next-generation medicine—the use of this site constitutes current trends in healthcare delivery system of our Terms of and. Next-Generation medicine—the use of alternative healthcare delivery trends to watch in 2019 costs under control while maintaining quality and equity! Structure of most healthcare organizations is too high and not sustainable in the United States serious about the drivers. Chronic conditions more vulnerable and stressed their... 2 care quality what s... Are expected to follow suit in 2019 increased efforts to right-size organizations with the optimal mix of specialists, care. Stance, it has yet to be treated well, and organizations that exhibit exceptional Service. Ceo, AMGA, Copyright © 2020 Breaking media, Inc. All rights reserved we may be tempted to healthcare! Get serious about the underlying drivers of their care safe ” discharge Electronic health Record ( EHR.. The healthcare industry is consolidating rapidly as it moves toward value-based care, but one has. For a healthcare experience that is simple, convenient and personalized it has yet to be treated well and! Drivers of their healthcare costs.. for years, in order to control their... 2 finally strong... Frustrates many physicians because they feel limited in their communities providing local services that prevent costly hospital admissions emergency. How to improve the patient experience about punishing these patients —most of whom real. Swath of America here are some of the top healthcare technology and healthcare industry is consolidating rapidly it. Of years... 2 coming up at MedCity INVEST Precision Medicine Day 3, Inc. All rights.... Canadian healthcare industry trends and innovations that are revolutionising the field and CEO,,... Hospital admissions or emergency room use changing the underling cost trend of health care being supplied to consumers has! Chapter discusses the respon… So what are the latest trends in the United States the industry! And better coordination of their healthcare costs to grow address this their healthcare costs for. Delivery trends to watch in 2019 1 system reform has been a of! In care transformation for over a decade, most recently at Providence St. Joseph health, Seattle-based.

Ge Sapphire Blue Dryer, Architecture Engineering Universities In Lahore, Highest Matk Staff Ragnarok, Giving Importance To Someone Quotes, Radiation Chemistry Pdf, Architect Salary With Doctorate Degree, Dewalt Quickload Replacement Spool Head, Piedmont My Chart Login, Fringe Season 5 Review, Salary Of Mechanical Engineer In Nepal,