With hospitals moving toward a value-based payment system there is more demand now than ever for strategies that will help healthcare systems hone in on population health. The Triple Aim, an initiative set forth by the Institute for Healthcare Improvement, covers three main checkpoints for all hospitals as they make this transition.
What do the ACA, ACO, FFS, DHS, and QHP all have in common? They are healthcare acronyms and most are related to the Affordable Care Act. The healthcare industry is not unlike any other industry or almost any aspect of our lives these days, especially with the advent of texting. There is always a shorter way to say something i.e. “BFF” – best friends forever or one of my favorites “*$” - Starbucks. By the way, the title “FFOF” is Fun Facts on Friday. The ACA, which is part of the “PPACA” - Patient Protection and Affordable Care Act of 2010, is regulated by “HHS” - the division of Health and Human Services, the “DOL” – Department of Labor and the “IRS” – Internal Revenue Service. HHS designates many responsibilities to “CMS” – the Centers for Medicare and Medicaid Services.
What are the latest trends with concierge medicine? What are the pros and cons associated from both a patient and physician perspective? How does the ACA play into concierge medicine? How are healthcare trends affecting the future of healthcare? Is concierge medicine the answer? It is no secret that the physician shortage is growing in leaps and bounds, especially in terms of primary care. The creation of the Affordable Care Act has amplified the issue, adding more insured to the mix. The supply and demand ratio is completely unbalanced. As a result, both physicians and patients are looking for alternatives.
Pundits began outlining the downfall of Obamacare as soon as the President was elected in 2008. Now that many programs have come to fruition, many folks who originally voiced concerns are tallying up the negative outcomes.
Summary: Are you ready for a shift in risk from payer to provider? Will you be ready for value-based purchasing when it becomes required? Are you utilizing other reimbursement models such as bundled payments, Accountable Care Organizations, and Population Health Management? From a provider perspective, healthcare reform is aimed at tightening the purse strings, working more efficiently, reducing waste, and improving quality. The shift of risk has begun which will transform healthcare from a fee-for-service to fee-for-value. When the ultimate transformation ends, is still uncertain. As such, fee-for-service is still being utilized and providers are still generating profits and revenue based on the volume mentality while simultaneously trying to transition to a volume and quantity mentality. Juggling the opposite ends of the spectrum is no easy task.
On April 30, 2014, CMS announced proposed IPPS regulations to become effective January 1, 2015. The ruling covers: Hospital Value-Based Purchasing Program, Hospital Readmissions Reduction Program, Hospital-Acquired Condition Reduction Program, Quality Reporting Programs, and Wage Index – Updated Labor Market Areas. CMS just announced proposed regulations to become effective January 1, 2015. These regulations further the goals of the Affordable Care Act: increasing patient outcomes and reducing healthcare spending. These proposed regulations are Medicare specific and, if approved, will be applicable to general acute care and long-term care hospitals.
New rules put forth by the ACA will require hospitals to be transparent about the costs of care at their facility. They can do this in one of two ways: either by releasing a list of procedures and their costs, or, releasing the information after an inquiry by a patient.
Accountable Care Organizations (ACOs) are gaining in popularity as a result of the ACA. BHM Healthcare Solutions, a healthcare management consulting firm, has a team of experts dedicated to providing assistance to organizations as they transition from a traditional fee-for-service model to an ACOs assisting in the critical transition to provide quality of 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.
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.