IRO | Decision Making
In any industry and, in some regards, in any life – there are times when an outside perspective is the difference between progress and an impasse. In the world of healthcare, where often the bottom line of organizations can be at odds with the wants and needs of the patients and payers, a third-party perspective can help to untangle the web of miscommunication.
In the alphabet soup of healthcare accreditation, chances are there are at least one or two accrediting bodies that you aren’t entirely sure about – one of those might be NCQA. Who are they, what do they accredit and do you need their accreditation in your organization?
Who is NCQA?
The National Committee for Quality Assurance is an independent, non-profit in the United States that is concerned with establishing quality standards for healthcare organizations that aim to identify key areas of improvement within the organizations themselves. NCQA was established in the early ‘90s, a time in United States healthcare where there was a discernible shift in healthcare reform throughout The Clinton Administration.
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We remember the lives that were lost
We are thinking about the remaining families
We admire the courage that was portrayed
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When it comes to the financial bottom line, medicine has evolved to be a business. While this certainly creates a host of difficulties, it also means that those who are charged with monitoring the overall financial success of an organization are privy to the use of standard business models for assessing productivity- particularly where physician productivity is concerned.
Since we are moving toward value-based payment models for physician compensation, finding a way to assess and track physician’s productivity is one of the most pressing issues for healthcare organization’s in this time of great reform. However, how productivity is measured is going to vary grately depending on the size of the organization, the demographic of patients treated, and what the financial benchmarks will be during a given fiscal year.
Since its rebranding in 2007 to simply The Joint Commission (formerly “Joint Commission on Accreditation of Healthcare Organizations or “JCAHO”) the way that TJC surveys hospitals has evolved from its original process, which was originally put into place in the 1950s.
Traditionally, TJC surveys hospitals every three years for accreditation (laboratories are on two-year accreditation cycles). While the information garnered from the surveys is relatively comprehensive, most of it is “need to know” in terms of public consumption – the gritty details are left up to the hospital to decide if or how much they want to share with the public.
The Chief Information Officer in a healthcare system has perhaps one of the most complex and ever-evolving roles in the hospital C-Suite today. Since information technology has now permeated our entire culture – and particularly in medicine – executive level information management is hot field nowadays.
Strategic planning within an organization tends to encompass many areas – but for the Chief Information Officer, most of their planning requirements fall under the category of information management. For most modern hospitals, information management is largely to do with electronic health records and the business transactions that surround them. While CIOs are not down in the trenches laying the groundwork for databases or troubleshooting minor issues, they are overseeing the purchasing, implementation and staffing needs to make the whole operation run smoothly.
When we talk about revenue cycle management systems it’s easiest to draw comparisons to physicians working in an ambulatory setting. This setting allows for accurate and timely charge capture of fees by their electronic medical record system. However, their inpatient counterpart physicians are less likely to reap the benefits of the EMR’s billing functions – if they’re reaping the benefits of an EMR at all.
FICO 9 | Medical Debt and Your Credit Score
According to a statement made earlier this week by FICO, the company’s analytics are undergoing major changes that will affect the way medical debt is factored in to a person’s credit score. FICO 9 has arrived.
How Does Medical Debt Affect Credit Scores?
Credit scores are figured by looking at a person’s financial history, including any debts that they have accrued. In the United States, millions of Americans have medical debt, in some cases upwards of thousands of dollars, even though many are either privately or publicly insured. These debts, which were often the result of some unforeseen serious illness or injury, have traditionally had the potential to drastically lower one’s credit score.
For many healthcare organizations, the emergency room is the hub of high-speed drama and intrigue, and with these qualifiers comes the reality of financial impact. An emergency department’s ability to consistently bring in revenue will either make or break it – so, how can hospitals assure that they’re throughput is sufficient?
Many people who talk about managed care don’t realize that it has actually been undergoing a bit of a renaissance since the late 1980s – and has existed conceptually since the ‘30s.
Since the late ‘80s, MCOs have progressed through several phases:
Phase 1: Using utilization review and pre-admission certification to manage access to care.
Phase 2: The addition of fee-for-service networks and managing benefits.
Phase 3: Shift from utilization review to utilization management with an emphasis on the ‘appropriateness’ of care as well as the care setting.
Phase 4: The current phase of MCO development, which has only started in the last couple of years, looks at establishing a continuum of services, lessening the tendency for providers to operate in ‘silos’ which has been the dominant structure of healthcare in the U.S. for years.
