Healthcare technology is changing faster than most organizations can keep up. What are you doing to comply? Healthcare technology is a rapidly changing field. Some of the changes are required to comply with current regulations while others are to gain a competitive advantage. Lets’ delve into a few of these areas.
As a payer, what type of pain points are you facing? How are you overcoming these challenges? With the onset of the ACA and other healthcare regulation, payers are experiencing many issues. Complying with these regulations is both cumbersome and costly. What pain points are you experiencing as a payer? Exchanges Healthcare exchanges became effective October 1, 2013. These exchanges are basically marketplaces where individuals can shop for insurance in one place - comparing plans, costs, and benefits. Many payers jumped on the bandwagon and joined the exchanges.
A standardized definition for quality has been elusive; though most will agree that the term “quality” in healthcare refers to the patient’s overall experience, or, encounter with the healthcare system.
What will you decide for your organization beginning 2015? Will you “play or pay”? The “play or “pay” principle basically says that if employers with 50 or more full time employees don’t meet the minimum requirements of offering insurance coverage, they will pay very steep penalties. The provision will be phased in beginning in 2015. The “play or pay” principle is part of the PPACA, specifically under the provision of “shared responsibility”.
Historically, HMOs are notorious for incurring poor health among patients and bolstering already bloated administrative costs. When healthcare reform was on the horizon, the promise of Accountable Care Organizations in lieu of traditional HMOs lifted the wilted spirits of doctors and patients alike. A few years of ACOs, however, seems to have done little to assuage the initial fears of these groups that ACOs are just nicely dressed HMOs.
One of the greatest challenges in healthcare currently is not so much a matter of practice, but definition. How has ‘value’ been defined and do we need to alter our definition to reflect the ongoing evolution of our healthcare system?
You may recall some murmurings last year about a new Google venture cryptically called Calico. In the heyday of 23andMe, Apple’s many health apps and the hefty focus on technology in healthcare, Google wasn’t about to miss out on the hoopla. But just as soon as we started hearing chirps about “Google’s war on aging”, it sunk into the deep obscurity of the web.
There are many reasons a claim might be denied, but did you know that many of them are actually simple oversights that can easily be corrected? Check your denials against this list to see how many preventable errors might be costing your hospital money.
As most of us are aware, readmissions is a hot topic, especially in terms of the penalties assessed for readmission rates which are excessive. What can you do to reduce or eliminate your readmission rates? There has been a lot of talk about readmissions (avoidable), specifically the healthcare costs associated with them and the effects on the quality of patient care being provided. In order to crack down on these avoidable readmissions, CMS created the Readmissions Reduction Program. The premise of the program is to ding hospitals, with higher than average readmissions (readmitted within 30 days of discharge), by assessing penalties against overall Medicare payments. There has been a lot of hoopla surrounding the program, with many criticisms being cited, such as treating all hospitals alike, not accounting for socioeconomic factors, and the way the penalty is calculated.
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.