It might still be early in the year, but it looks like 2015 is already shaping up to be a big year for value-based purchasing initiatives. In large part thanks to the announcement by the Department of Health and Human Services last week outlining the year’s worth of expectations for hospitals and healthcare providers. HHS’ goal is that by 2016, 85% of Medicare’s payments to providers will be under the VBP model, rather than fee-for-service. The shift to VBP from fee-for-service has been ongoing, but the pressure is on for providers and healthcare systems who have been lagging behind in embracing alternative payment models.
Medicare cuts have been crying wolf for almost a decade now; each year the cuts are proposed and then postponed, with the deficits continuing to pile up, meaning the financial impact of any intended “fix” would be astronomical.
Recent reports show that 89 new Accountable Care Organizations have now joined the Medicare Shared Savings Program, so that over 400 ACOs are participating in the program. So what are the new regulations for this group of ACOs? They seem to be changing over time.
Open enrollment for health insurance under the ACA may have ended February 15, but an extra enrollment period (Special Enrollment Period) will take effect March 15 to April 15. So if you missed the deadline, you might have a few options to get coverage.
As payment continues to become more closely linked with patient experience and patient reported outcomes, the information gleaned from assessments such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) will be a major area of focus for hospitals and providers in 2015. One area that has not previously been included within the HCAHPS, or any federal or statewide assessments, is the perspective of parents of pediatric patients.
When was the last time your organization performed a SWOT analysis? If you aren’t familiar with SWOT (strengths, weaknesses, opportunities and threats) it’s a widely used strategy in many industries, not just healthcare, for identifying areas for improvement. You can break SWOT down even further: Strengths: What sets your hospital apart from all the rest? What can you offer that makes you competitive? Weaknesses: What puts your hospital and employees at a disadvantage compared to other hospitals? What of these factors can you change? Opportunities: How can you show your strengths to others? Threats: What could cause big trouble for your hospital or employees?
The number associated with mental illness in the Unites States are staggering, mind-boggling. The supply and demand for mental health services is completely off kilter. As we are aware, there is a national shortage of physicians, and an even shorter supply of psychiatrists. The need for mental health diagnosis and treatment is soaring, in part due to Medicaid expansion and in part due to the stigma which has been associated with mental health diminishing somewhat.
Are you one of many hospitals being dinged with CMS penalties? Are you ready to be dinged for Hospital Acquired Conditions, in addition to readmissions and value-based purchasing? How can a hospital remain profitable? In terms of hockey, the penalty box is where players are sent when they have committed an act which is against the regulations of the game. The player is forced to sit in the penalty box for a period of time, causing the team to play with less players, until the penalty time has lapsed.
What are you doing to make sure you are not one of the 66% of hospitals who will be assessed readmission penalties in the next round? Can you afford the penalties which are increasing again in 2015? Are you aware of the proposed conditions to be added in 2015? What do you get when you combine Medicare, high readmissions, within a 30 day window, for specific conditions? A reduction in Medicare spending to the tune of about $280 million annually. Of interest is that penalties were assessed in 49 states, all with the exception of Maryland, who has a unique reimbursement payment system.
The Readmission Reduction Program is designed to reduce healthcare spending while improving quality. There are both proponents and opponents of the program. Let’s delve into the improvements that could be made to the current system. So, as most of you are aware, CMS under the direction of HHS created the Hospital Readmission Reduction Program in order to reduce healthcare spending while improving the quality of care. The program is being phased in beginning with a 3 year baseline period in which hospitals were required to report all readmissions (within 30 days). CMS assessed and analyzed all of the available readmission data to determine how penalties should be assessed, for which conditions, and excluding certain circumstances. Beginning in October 2012, penalties were assessed to over 2,200 hospitals, equating to about $280 million. The phase in included an increase in penalties from 2013 to 2015 from 1% to 3%, where it is currently capped. Initially, there were 3 conditions included: Acute Myocardial Infarction, Heart Failure, and Pneumonia. For 2015, CMS is proposing 2 additional conditions: Chronic Obstructive Pulmonary Disease and Elective Hip and Knee Replacements.