One Year Since CMS Cracked Down on Readmissions | Where Are We Now?
October 1st of last year, CMS cracked down on readmission rates for hospitals nationwide, handing out millions of dollars in penalties. The Affordable Care Act put these measures into place in order to curb the problem of readmissions, which are not only costly, but reflect an overall poor population health in the U.S. – especially for those patients with chronic conditions.
For FY ‘14, 2% was withheld from payments per the guidelines for penalties. By 2015, the rate of withholding for penalties is expected to top 3%. In addition to the higher payments, there will also be additional diagnoses included in the readmission criteria list – it began with heart attacks, pneumonia and heart failure and will now expand to include COPD and complications from chronic lung conditions.
2-Midnight Rule Continues to Confuse
It’s been almost a year since CMS’ final ruling on the Inpatient Prospective Payment System went into effect and in that twelve month period there have been several additions made regarding conditions of payment and certifications. In case you need a refresher, the “2-Midnight Rule” is frequently talked about in healthcare and refers to criteria for determining if a patient should be classified as an admission or observation status for coding and billing purposes. While the level of treatment may not necessarily seem different from the patient’s perspective, there are subtle differences that are extremely important to how the account is coded and ultimately billed for. It also needs to be explicitly documented with intention as an inpatient admission in the patient’s chart.
The Doctor Will Skype You Now | Changing How We Go to the Doctor
With flu season upon us, healthcare providers and patients alike are gearing up for a busy time of year in the office. As office schedulers know, trying to accommodate all the patients a doctor needs to see in a given day is tricky enough without the added stress of flu season – when doctors are likely to need to see even more patients and hospitals will no doubt see an uptick in admissions and emergency room visits.
Don’t Like the Sound of ACOs? Here is an Alternative
Most experts agree that it’s still too early yet to know for sure if ACOs will succeed, but many who are poised for its failure have started designing alternatives. One of them seems a little counter-intuitive: Non-Payment.
Healthcare Spending | Administrative Costs out of Control
When we talk about healthcare spending being “out of control” does anyone ever say why? The Commonwealth Fund survey breaks down the costs of healthcare administration- which make up a quarter of all healthcare spending in the U.S.
Did You Miss BHM’s ACO Webinar – 2nd Showing 9/24
BHM Healthcare Solutions, a healthcare consulting firm, announced today that due to the success of their last live webinar, BHM will provide a complimentary encore presentation of their webinar titled, “Succeeding as an ACO: A Guide To Transforming Your Organization,” on Wednesday, September 24th from 2:00 pm to 3:00 pm eastern standard time. The webinar will offer expert advice from Anthony Grimaldi, SVP Provider Division and Gwen Roberts, SVP Government Payer Division.
Top 5 Reasons Physicians Are Unhappy
Research completed by Jackson Healthcare yielded an incredibly array of data on physician satisfaction. While healthcare is increasingly interested and motivated to obtain and analyze patient satisfaction, perhaps not enough attention is being paid to provider satisfaction. According to the data, which assessed not just provider disatisfaction, but also satisfaction, it might behoove the healthcare industry to keep an eye on physician happiness, too.
5 Trends in Healthcare Reimbursement
The subject of physician compensation is a hot one as of late. With all the changes in the financial sector of healthcare, and the push to save money, there has likewise been a focus on how- and how much- physicians are being compensated.
ACOs
A major change that has already begun to take place in many healthcare systems nationwide is Accountable Care Organizations (ACOs). While it’s likely too soon to know if they will work long term, in theory they will reduce the tendency of ‘silos’ in healthcare and lead to better coordination of patient care.
Have ACOs Failed to Incentivize Providers?
Since there has been an ongoing and rather enormous shift away from fee-for-service models, payers are tasked now more than ever being with finding a place for financial incentives to continue with ACOs now in place.
Payers know that medicine, like any business, is not immune to the pull of financial incentives. Providers, while they are noble in their careers as healers, are just as likely as a Wall Street banker to leap at the chance to accept a financial perk. Time is money in any industry, and perhaps medicine most of all.
Will Physicians Ever Embrace ACOs?
Healthcare is changing, there’s no question about it. The question of the hour, however, is are we ready for it? Healthcare providers know that they have to stay on top of the latest research regarding treatment and medical technology, and so to they must keep abreast of the changes in policy. Not only do the changes affect how they will ultimately practice medicine, but perhaps most pressing, how will they be compensated for it.
Enter, accountable care. These provisions have created confusion in the healthcare arena in general but perhaps a large share of that burden is being borne by the providers themselves, who must not only embrace new treatments and meet the demand of patients who are more educated on their conditions than ever before – but all the while keep in mind that the way they will be paid for their efforts has evolved, too.