Since last fall, the Recovery Audit Contractors have greatly slowed their requests for charts from hospitals nationwide. The program, which has been under fire from the American Hospital Association virtually since it’s inception in 2006, is currently undergoing reform. That being said, for many involved in the previous audits the damage has already been done.
Summary: As a result of the ACA and the increase in patients while the physician shortage is magnified, efforts are under way to address the lopsidedness of supply and demand. One of those efforts is telemedicine.
The influx in individuals who are recently eligible for insurance coverage has added fuel to the fire in terms of the number of physicians who can provide care. Telemedicine is expanding in popularity and use as a means to address this issue, while also reducing healthcare costs and increasing both accessibility and affordability.
Summary: What is contributing to the rapid expansion of ACOs? What programs are currently being piloted? What are the initial results of current ACOs?
What is an ACO?
An ACO is a group of healthcare providers who work together and accept accountability for reducing costs and increasing quality of care.
Strategic planning for a healthcare organization needs to incorporate several focuses, but a great place to start is by defining your core values. An organization’s core values guide all members of the healthcare system as they work to bring the best care possible to their communities. By defining core values, they can share these with patients and the mission becomes clear to all.
Chances are, whether your on the administrative or clinical side of hospital operations, lowering readmission rates is high on your priority list. For administrators and financial officers, lowering the costs accrued from readmissions is paramount to staying under budget and for doctors and nurses, having patients prepared for life at home after discharge is the mark of truly community minded care. The patient-centered medical home purports medical decision making as an equal playing field; particularly when it comes to post-discharge measures of patient care.
Summary: Accountable Care Organizations (ACOs) are gaining in popularity as a result of the Affordable Care Act. Have you considered the benefits of ACOs from both the patient and provider perspectives?
One of the goals of the Affordable Care Act (ACA) is to provide coordinated care which, in turn, increases quality and efficiency within the healthcare field, and reduces costs.
ACOs – What is an ACO?
ACOs are groups of providers which form an organization based upon the Medical Home (or PCMH) concept. The Medical Home places responsibility for the coordination of care with the primary physician. The primary care physician coordinates with other physicians and providers such as specialty physicians, laboratories and diagnostic imaging, providing a central point for the patient’s medical information.
The pay for performance model of payment has been the preference of health insurance companies for several decades. Previous models made it too easy for money to be paid for services that were not truly needed, were poorly documented or in some cases, were entirely fabricated for the purpose of payment. Pay for performance measures are meant to validate payments to physicians in accordance with The Affordable Care Act by using data mining techniques to keep tabs on physician costs.
The “patient is always right” model has been the primary driving force behind healthcare for the last several decades. But is this the right approach? Classifying patients as “customers” is a slippery slope. While you might be able to barter with a customer at a shop about the price of a necklace, should doctors ever barter with a patient about their treatment? What about when their patient satisfaction scores are drooping low?
As Obamacare policies have gone into effect, more and more people are realizing their quality of care has been sacrificed. They are unable to schedule an appointment with their doctor, and their insurance covers little of what it used to.
Unfortunately, the Affordable Health Care Act could have used more work before going into effect, and both the doctors and patients are suffering. As people and government officials are beginning to realize, the solution to healthcare cannot be fitted with a one size fits all package.
As a result, direct primary healthcare (private healthcare) and concierge medicine is growing in popularity amongst both physicians and patients. Here are three reasons why.
Physician practices may be lagging behind hospitals when it comes to implementing coding software. The hesitation to do so is costing them not only efficiency in coding, but reimbursements withheld due to avoidable errors.
