The IMPACT Act: Legislating Care Coordination

Posted by Jill Reeves, MHA on 10/18/16 8:32 AM

There is no question that cross-continuum care coordination is a good thing—the more various healthcare entities work together to deliver appropriate and timely interventions, the better off patients will be. That said, care coordination has often been viewed as a nice to have rather than a critical mandate. However, that is changing as the federal government approves legislation that requires diverse healthcare organizations to cooperate.

One such mandate is the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. While predominately aimed at the post-acute community and their preparations for risk-based care, the legislation’s overarching goal is to enhance collaboration among all members of the care team.

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Topics: Care Coordination, Health-care reform, Care Coordination Software

Strategies for Managing Post-Acute Risk: Key Steps for Hospitals

Posted by Kyle Salem, Ph.D. on 5/16/16 12:51 PM

Published by Becker's Hospital Review

Every day, hospitals assume more risk as they enter into payment arrangements that directly tie their reimbursements with care quality and cost containment.

This is clearly apparent in the Centers for Medicare and Medicaid Services (CMS) Comprehensive Care for Joint Replacement (CJR) model that went into effect on April 1, 2016. Up to this point, participation in similar bundling models has been optional, but this is the first time that CMS is requiring hospitals to participate in a value-based care initiative without the ability to opt out.

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Topics: Health-care reform

Why CJR Should Be Keeping Hospital CEOs Up at Night

Posted by Wayne Sensor on 4/26/16 9:00 AM

Published by Becker's Hospital Review

The Comprehensive Care for Joint Replacement (CJR) rule and the idea of bundled payment reimbursement is a wake-up call if there ever was one. It's Health & Human Services saying in this election year that value-based healthcare is here to stay. To hospitals, it's a paradigm shift of massive proportions because it's turning departments that were once revenue streams into cost centers. In the new world order of bundled payments, no longer is the government going to reimburse for every scan or additional procedure ordered. The government is going to pay a fixed amount for the care of a patient over a period of time. CJR is just the first step of what will become the bundled payment norm.

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Topics: Health-care reform, Value-based payment models

3 Ways Hospitals Can Navigate “Act One” of CJR Payment Rule

Posted by Mike Cassling, Chairman and CEO of CQuence Health Group on 3/21/16 11:25 AM

The stage is set and the curtain goes up April 1. That’s when the Centers for Medicare & Medicaid Services’ (CMS) new Comprehensive Care for Joint Replacement (CJR) value-based payment rule will take effect.

This marks the first time CMS has required participation in a value-based program. In the CJR model, hospitals are financially responsible for the quality and cost of an “episode of care” for hip and knee replacements, from admission all the way through 90 days post-discharge. The episode includes all related items and services paid under Medicare Part A and Part B for all Medicare fee-for-service beneficiaries. Honestly, hips and knees are likely just the beginning. Consider this “Act One” of bundled payments for common inpatient surgeries.

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Topics: Health-care reform, Care Transitions, Medicare Readmission Penalties

Predictions for Health Care in 2016 and Beyond

Posted by Kyle Salem, Ph.D. on 1/26/16 1:21 PM

 crystal_ball.jpgWriting a set of health care predictions for the coming year isn’t an easy task. The industry changes so fast, and then in many ways, so slowly. To make predictions for 2016, I really had to come back to the global ideas that are shaping health care as we know it. So let me start there. I think there are four key trends in the health-care industry that we should continually keep our eye on. They are:

  • Consolidation
  • Consumerism
  • Access
  • The Shift to Value

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Topics: Health-care reform, Value-based payment models

Focus on Medication Management Translates to Real Dollars, and Real Sense

Posted by Wayne Sensor on 6/23/15 3:00 PM

Medication adherence is key to reducing 30-day readmissions and return ER visits

A recent article in H&HN Daily tells the story of Chicago-based Mercy Hospital & Medical Center and its quest to maintain better medical oversight of patients being discharged.

For organizations such as Mercy, who serve an estimated 300,000 at-risk, uninsured patients, the need to create innovative programs to help reduce readmissions is rooted in their very mission, but also in the practical realities of today’s health reform. Increasing penalties for avoidable readmissions is an outcropping of the Affordable Care Act and finding ways to reduce repeat emergency room visits that result in readmission translates into real dollars and cents.

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Topics: Health-care reform, Care Transitions, Patient Outcomes, Health-care Technology Solutions, Reducing Readmissions

Data, Technology Offer Sustainable Solutions to Address Readmission Risks

Posted by Wayne Sensor on 2/18/15 10:31 AM

I’ve had the privilege of talking to hospital administrators across the United States about the creative BLOG_Emergency_Roomstrategies being implemented to address the triple aim of the Affordable Care Act. One major outcome of health-care reform that I hear discussed time and again pertains to the associated migration of risk from the payer community to the provider community.

The one thing nearly all find problematic is identifying solutions to mitigate the financial risk of avoidable readmissions. This is not an easy task and one that can prove quite costly for organizations from both a time and financial standpoint.

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Topics: Post-acute Care, Care Coordination, Health-care reform, Reducing Readmissions

Hospital Boards Get Down to Business

Posted by Jill Reeves, MHA on 10/7/14 8:53 AM

Be prepared to roll up your sleeves. That’s the message health systems across the country are sending to current and future board of directors.

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Topics: Health-care reform

Using Your Post-Acute Network to Reduce Readmission Penalties: An ANI Sneak Preview

Posted by Wayne Sensor on 6/12/14 9:22 AM

Last year, two-thirds of eligible hospitals felt the blow of readmission penalties, which totaled $227 million, according to the Healthcare Financial Management Association. Since CMS announced it would enforce these regulations, hospitals have been searching for effective strategies to address the complicated factors involved with readmissions.

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Topics: Post-acute Care, Care Coordination, Health-care reform, Medicare Readmission Penalties, Ensocare News

Breaking Down Barriers to Effective Care Coordination

Posted by Wayne Sensor on 6/4/14 9:47 AM

At the National Readmission Prevention Collaborative Summit a few weeks ago, I spoke about the challenges health-care organizations face today in facilitating effective care coordination and how addressing those challenges can impact the patient experience.

Namely, when discharge planning and care coordination are successful, hospitals and health systems are better equipped to navigate patients through the care continuum, reducing readmissions and ultimately improving patient outcomes. However, realizing effective care coordination can be challenging as there are several barriers organizations must first overcome.

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Topics: Post-acute Care, Care Coordination, Length of Stay, Health-care reform