Unbiased Analysis of Today's Healthcare Issues
In short, the answer is no. The CBO released an issue brief examining two types of demonstrations. Disease management and care coordination demonstrations have sought to improve the quality of care of beneficiaries with chronic illnesses and those whose health care is expected to be particularly costly. Value-based payment demonstrations have given health care providers…
For many years, fee for service payment was the status quo. FFS model encourages hospitals to adopt the following strategies to maximize market share and profits: Centered on short-term acute care Focused on specialist alignment Driven by a volume-based service-line strategy Using expensive medical equipment purchases to encourage physician referrals Attracting patients with new construction…
The answer is probably not. The NCQA defines 149 factors which would make a practice a successful medical home. These include physician access during and after office hours, electronic access to patients information, availability of clinical data and use of that data for population management, identification of high risk patients, ability to refer patients to…
In 2015, Medicare will begin implementing a value-based purchasing (VPB) program for physicians. Initially the program will target only certain physicians and groups of physicians, but by 2017 all physicians is participate in this program. The VBP program will evaluate physicians along two broad dimensions: quality and cost. In the final rule: Section 1848(p) of…
The California Health Care Foundation (CHCF)’s Health Care Almanac provides some unique insights on trends in health care quality in California and for the United States as a whole. Many of the national figures for the Almanac come from the CDC (BRFSS and Vital Stats) and AHRQ’s National Healthcare Quality Report. California quality figures come…
Medicare’s push to evaluate all types of providers is being extended to Inpatient Rehabilitation Hospitals (IRFs). According to Health Reform bill (specifically, Section 3004 of the Affordable Care Act), CMS is required to start publishing quality measures for IRFs by October 1, 2012. This newly created IRF Quality Reporting Program (QRP) currently has proposed two…
The Medicare billing system is complex. There an alphabet soup of acronyms, (e.g., RVUs, CPT, HCPCS, GPCI) and each of these affects payments in different ways. In addition to the standard payment terms, Medicare is also creating additional payment incentives. These payment incentives fall into three broad categories: Quality reporting e-Prescribing (eRx) Electronic Health Records…
CSC provies a nice overview of some of Medicare’s hospital quality initiatives. These initiatives include a value-based purchasing (VBP) program, reduced reimbursement for excessive hospital readmissions, and reduced reimbursement for hospital-acquired conditions (HAC). Each of these three broad quality initiatives is described in more detail after the jump. It is important to note that these…
Starting in fiscal year 2014, Medicare will start rewarding hospitals with high quality care and penalizing hospitals with low quality care. The rewards and penalties will be financial in nature. High-quality hospitals will receive a bonus and low-quality hospitals will receive a financial penalty. There is a lot of existing documentation on this hospital value-based…
Medicare beneficiaries have a choice: pick the standard Medicare fee-for-service (FFS) benefit or rely on managed care plans to supply their healthcare through the Medicare Advantage (MA) program. Many Medicare beneficiaries prefer MA because it offers them lower out-of-pocket costs and provide benefits not available in the traditional FFS Medicare program. Other beneficiaries prefer the…