In January the Minnesota RARE campaign received the prestigious Eisenberg Award for reducing avoidable readmissions. Over an 18-month period, the campaign helped hospitals and community partners prevent more than six thousand hospital readmissions.
Although each hospital faces its own unique challenges in managing readmissions, the RARE campaign demonstrates what a supportive and collaborative effort can achieve. It involves 82 hospitals, 100 community partners, and 3 operating partners, including the Minnesota Hospital Association. Continue reading
An alien watching a 500 meter relay would think the race is all about the baton. Why else would these beings dedicate themselves to getting this object to its destination as quickly and flawlessly as possible? A relay race would not exist without the baton to bind the individuals together and create a team event. Although each team member’s leg of the race is important, the requirement that the baton be handed from one team member to the next turns four separate runs into a single, unified performance that can be evaluated and rewarded for its overall excellence.
In the relay that is the U.S. healthcare system, the patient is the baton—and the patient baton is not as fortunate as the white plastic one. In the current healthcare set-up, the hospital discharges its responsibility for the patient’s care once it discharges the patient. Then the patient is passed like a baton from one set of provider hands to the next, wobbles and all. Continue reading
Yes, this blog post is about population health, accountable care and the changing economics of healthcare payment. But first, a little bit about ice hockey from Walter Gretzky, father of Wayne “The Great One” Gretzky.
When Wayne was a young boy, Walter encouraged his son’s interest in hockey. In the family’s back yard he built an ice rink, the Wally Coliseum, where he taught Wayne and the neighbor kids to skate. Wayne was obsessed with hockey. Walter recalls seven-year-old Wayne’s fascination during a televised hockey match. On a pad of paper, the boy traced the path of the puck as it careened across the ice. To Walter, the lines on the notepad were scribbles. But to Wayne the pattern showed the places on the ice where the puck was most likely to be at any given time. The intersections, as he called them.
That was part of the Great One’s strategy, to know where the puck was most of the time.
In a way, the same strategy applies to accountable care and population health management. Continue reading
I believe my intentions are good—but probably not. When I download articles from healthcare journals—the meaty ones that can’t be skimmed—to my iPad to read some evening/weekend/plane trip when I run out of other stuff to do, do I really intend to read them? More likely I hope that by some digital alchemy between my documents app and the Amazon Windowshop app next to it I will magically become better informed about my profession.
If you are like me, sort of well intentioned but short on time and motivation to slog through articles that you don’t absolutely have to read, I’ll make you a New Year’s resolution type deal. Each new blog I write, I am going to choose a good-for-you article, read it myself, and tell you about it.
Hopefully this will be good for you and good for me. Good for me since now I have to actually read and understand those articles I never get around to. Good for you since you (if I do my part) will get a decent return on your blog-reading investment: a complex topic made more comprehensible. Continue reading
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