In a legislative report on the Accountable Care Collaborative (ACC), the Colorado Department of Health Care Policy and Financing details how the program helped the state avoid $44 million in costs during the 2012-2013 fiscal year. That’s less than one percent of the total federal and state spending for Colorado Medicaid this year.
The ACC program has assigned about 350,000 Medicaid clients to patient-centered medical homes. These clients make up about half of Colorado’s Medicaid population. Primary care medical providers and case managers coordinate medical and non-medical care and services within seven regional care collaborative organizations.
The goal is to improve health outcomes within a sustainable care delivery system. Continue reading
Well, the federal government is back to work after two and a half weeks off. I will refrain from any political comments. However, I would like to discuss the implications it might have on the OPPS changes for 2014.
All comments on the proposed rule were due about the middle of September. Normally CMS would have six to eight weeks to review the comments and publish the final rule on November 1st. However, with the government shutdown, there is not going to be anywhere close to six weeks, let alone eight weeks, to review the comments and publish a final rule.
Our government teams are back, and now the question: What is going to happen with the final rule? Continue reading
Full disclosure – I’ve spent the better part of the last few weeks reading and analyzing the latest move on CMS’ part to help control observation services – the invention of the Two Midnight Rule or TMR as I like to call it. For those of you who do not spend all your time analyzing regulations, the TMR is not really a bad idea since CMS is using it to try and reduce unnecessary hours and days in observation. On the surface, they are looking to help reduce the higher beneficiary co-pays, but they are also making their auditor’s lives easier and less costly to the Trust Fund. Getting folks on the right path in the first place is much more cost effective than chasing after them to pay attention later on.
CMS held an open call on September 26, 2013 to reiterate their intent of keeping the two midnight plan. During the call, they also announced their ‘Probe and Educate’ plan, which consists of MACs auditing only cases of less than two midnights between October 1 and December 31, 2013. There will be no RAC or MAC audits of two night stays during this time. However, the OIG, ZPIC, etc., can still review any claims they deem necessary during this period – including two midnight stays.
Rather than take you down the long and winding path of how observation services got out of control, I’ll focus on what TMR means and suggest a few things you can do to survive and thrive under this new requirement. Continue reading
My husband and I just bought a house, which required that we go through the tedious exercise of applying for a mortgage. As part of the process our lender requested a credit report for both of us. This report included a credit score.
A credit score is a number ranging from 300 to 850. It is calculated based on five categories: payment history, amounts owed, length of credit history, new credit and types of credit used. However the number itself bears no relevance to these categories. It is a single measurement, like weight, that can be either relatively high or low along a scale.
In other words, my credit score does not offer any insight into why I got this score or how it could be changed. Furthermore, it does not take into consideration one significant factor–my husband, whose credit score is different from mine. Continue reading
Wow, the last couple weeks have been busy, considering the 2014 Outpatient Prospective Payment System (OPPS) proposed rules . Every year CMS publishes an OPPS proposed rule with a 60 day comment period, giving affected parties a chance to review it. CMS includes descriptions of changes to grouping logic, updated packaging policies, modifications to payment rules, and other pertinent topics affecting OPPS. The final rule is usually published on or about November 1st. The 2014 proposed rule was published July 8th with a comment period set for September 6th. This rule represents the largest change in hospital payment since OPPS was introduced in August 2000. Continue reading
Two weeks ago, CMS announced first-year results of the Pioneer ACOs, including the names of nine organizations that are leaving the program. The announcement culminated months of discussion about downside risk and the challenges of establishing pay-related benchmarks.
The public focus has been on benchmarks since these financial and clinical measures are the basis for reimbursement or penalties. Surprisingly little has been said about hospital economics or how to improve cost efficiency through methods such as activity-based costing (ABC).
ABC is a costing method that has gained traction in healthcare over the past decade. In a nutshell, it identifies cost drivers, allocating all fixed, variable, and overhead costs to a product or service based on the resources consumed during production. Continue reading
by Kristine Daynes and guest blogger Lisa Lyons, RN, Product Marketing Manager with 3M Health Information Systems
The media is flooded with discussions about the demands of accountable care on information technology. There isn’t as much public discussion, though, about the implications for health information management.
Without a doubt, accountable care will change health information management, as will other models that combine payment reforms with changes in delivery of care, such as bundled payment and patient-centered medical homes. Accountable care requires health information beyond single encounters, sometimes from multiple providers and facilities, often concurrent with a patient visit. It also requires a combination of information—business, claims, and clinical data—aggregated in one place for reporting and analysis. Continue reading
In December, states had to let the Department of Health and Human Services know whether they would set up their own state-operated health insurance exchanges. The deadline was not a surprise, although several states protested they didn’t have enough time to consider the issue. The mandate originates with the 2010 Accountable Care Act. What is surprising is the number of states who declined the opportunity to create their own insurance exchanges.
Federal health law requires states to establish health insurance marketplaces to serve individuals and small businesses that need access to affordable health benefits. HHS outlined a federal model, which was intended as a default option, fully expecting most states to choose local control and operation of their exchanges. Continue reading
Two weeks ago, the Centers for Medicare & Medicaid Services posted hospital readmission rates for three conditions in the Hospital Compare database. Almost immediately, critics pointed out the lack of improvement—only a 0.1 point decrease across the board. While that is true, the ensuing debate misses the real story.
An article in The Washington Post, published online July 19, was titled “Hospitals’ readmission rates still too high, government says.” It quotes a Harvard professor saying, “Either we have no idea how to really improve readmissions, or most of the readmissions are not preventable and the efforts being put on it are not useful.” That is an easy conclusion in light of the Medicare data. But it isn’t correct.
Several Medicaid programs currently are demonstrating widespread innovation at the state level to reduce hospital readmissions. According to an NAMD policy brief, published the day after the WP article, these programs have found effective methods of identifying preventable readmissions and focusing efforts where they can improve patient outcomes. Continue reading