Clinicians are in a knowledge management crisis – massive amounts of data but getting the right information to clinicians, IT personnel and others at the right time is the challenge. What was missing from the RAND report were biomedical informatics perspectives.
Nursing informatics (NI) is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. NI supports consumers, patients, nurses, and other providers in their decisionmaking in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology.
Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP) have a special, limited opportunity to innovate. Waivers exempting MSSP ACOs from certain legal requirements and other benefits enable MSSP ACOs to experiment within certain limits. The Medicare Shared Savings Program requires 33 measure that must be self-reported by the ACO to CMS. After a limited period, self-reporting will not be allowed and third parties will be required to perform reporting.
Update August 2, 2013 - CMS published a list of 2,225 hospitals in 49 states that will lose up to 2% of their Medicare reimbursement that had too many patient readmission within 30 days of discharge because of three medical conditions: heart attack, heart failure and pneumonia. Under the PPACA, the maximum penalty will increase to 3% by 2015 and expand to include re-admissions for other medical conditions. ICD-10, a standard the describes the condition of the patient, will modify these quality measures when it goes into effect. We have published an interactive, searchable version of the penalties, by city, state, county and hospital for the healthcare industry and consumers to use to easily find the data relevant to their geography or organization.
Increasing Health Data Interoperability, BigData, Cloud, Exchange, ICD-10 Lay Foundation for Accountable Care
These are important foundations that enable ubiquitous digital health data in a standard interchange, enabling in-depth analysis and increasingly, Cloud and Software as a Service methods to deploy, store and use the information to improve healthcare. These in turn are important foundations to enable Accountable Care. ICD-10 is the new data standard that will express the condition of the patient and how providers get reimbursed.
December 20, 2012 - HHS Secretary Kathleen Sebelius announced three more states that are tracking on time to implement health care law by establishing Health Insurance Exchanges (HIX). HHS issued the first conditional approval of a State Partnership Exchange to Delaware and Minnesota and Rhode Island. Second Order Effects of the HIX Movement State Exchanges [...]
Out of Network Claims Explained One of the most significant inefficiencies in health care is the pricing strategy of health plans regarding their policy on reimbursement for members who receive medical services from health care providers who are not contracted as part of the network that is managed by the health plan. In other words, [...]
To protect against this high risk of significant financial loss, the Accountable Care Organization should plan at its inception for methods of payment and/or protection for these cases, such as secondary coverage (insurance).