Health Care Quality Measures Are Not Part of Physician Incentives
Clearly health care payment reform will not work unless the fee for service model is changed to a capitation model with shared risk for physicians and a focus on quality.
Accountable Care Organization: New Risk in ACO Model vs. Prospective Payment System
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).
Medical Loss Ratio Provision of the Affordable Care Act – Less For ICD-10 and Other Reform Issues
on November 22, 2010 the Obama Administration's regulation implementing new standards for the “medical loss ratio” provision of the Affordable Care Act will make the insurance industry more transparent and is intended to enable consumers to purchase health insurance that provide more value for every dollar paid for premiums.
ICD-10 Implementation Contention – Only 55 Hospitals in the U.S. Are at Stage Seven for Electronic Health Records
ICD-10 implementations have competition for resources within hospitals. According to HIMSS Analytics, Stage seven healthcare organizations support the true sharing and use of patient data that ultimately improves process performance, quality…
ICD-10 Implementation and Medical Management are Co-mingled with Revenue Cycles
Implementing ICD-10 is more than just IT. Medical management under ICD-10 will require a new view of clinical data and an audit trail from ICD-9 to ICD-10. An ICD-10 assessment from a knowledgeable company can help show where opportunities are for your company.
ICD10 – Don’t Delay, Make Sure You Do an Assessment
Many providers and hospitals are putting off ICD-10 conversions, because they are already struggling with EHR and meaningful use. Funding is another challenge. Durel has heard from people who don't think ICD-10 is a big deal. He thinks otherwise. "... if you don't get it right, you're not going to get any bills out after Oct. 1, 2013," Durel said.
Healthcare
Y2K Problem
ICD10 – Companies To Gain From Health Care’s ‘Y2K’ Problem
"Some venture-backed companies that serve hospitals and health insurers are getting a boost from what analysts call the “Y2K” of health care. [ ICD10 ]
Born This Way #1, Mubarek Resigns, Health Care Reform Continues
Sensationalism creates a sense of temporary urgency to know more. Mubarek steps down, Lady Gaga is #1, however, in health care reform more than 50% of all health care companies in the U.S. are not prepared for a new reimbursement system called ICD-10. This is a slow steady march to what could be a sensational event in the future. If a large percentage of health insurance firms and hospitals cannot submit or process claims in the new medical coding system, then it could lead to the next Federal bailout - but this time in health care not financial services.
How to Organize a Corporate Advisory Board
A Corporate Advisory Board is a council of senior representatives from a handful of key clients at which future plans and strategies can be discussed frankly and confidentially. Paul Sloane, a member of the No World Borders advisory board has facilitated several of these boards for different companies
ONC HIT Publishes List of Certified Inpatient EHRs
The Office of the National Coordinator for Health Information Technology published the latest list of electronic health record solutions, vendors and certifying bodies. This list is for Inpatient EHR only. Many health care providers have been distracted with electronic health record implementations and meaningful use and are just starting to work through HIPAA 5010 and ICD-10 issues now.
Accountable Care Organizations and Medicaid
Accountable Care standards may be fluid for some time, however it is clear that there will be a need for core competencies in population management, coordination of care and other areas for an ACO to function effectively. Blum emphasized that CMS will be looking for innovative models, with different payment systems, and with different “on ramps” to formation and approval. It was also acknowledged that improving quality and reducing cost through coordination of care will at times be at odds with and the Accountable Care Act’s continued focus on patient choice of providers.
ICD-10 Software Selection for Health Care Coding
If you are shopping for a tool for converting ICD-9 to ICD-10 diagnosis and procedure codes, make sure that you include subject matter experts in the area on your selection team, and create challenges for the vendors to overcome that represent real-world clinical scenarios - not canned demonstrations.
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