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Hc Matters October 2011


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Home Care Matters - October 2011

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Hc Matters October 2011

  1. 1. October, 2011 Vol 2, Issue 10 Patient Experience – The New Measure of SuccessDuke University’s Fuqua School of Businessrecently released a study that compared patientsatisfaction surveys with clinical performancemeasures to see which is a better gauge ofclinical quality. Interestingly, researchers foundthat satisfaction scores were more closelyaligned with fewer readmissions within 30 daysthan the traditional clinical performance Supreme Court to Rule on Providersmeasures. What does this information tell us? Challenge to Medicaid CutsHospitals that want to improve their readmissionrates may want to focus on improving the The U.S. Supreme Court has agreed to rule on ainteractions between patients and staff California case involving providers who haveespecially at the time of discharge. challenged the state’s right to make across the board Medicaid cuts on the grounds that such actionA recent HealthGrads report noted that 81% of would harm the quality and availability of carepatients said they were most satisfied at the time required by Medicaid statute. With states facingof discharge because they received instructions years of tight budgets and the imminent prospect offrom staff about follow up care. What we are millions of new Medicaid enrollees entering theseeing is that patients want, need and appear to system under the health care reform law, this caserespond favorably to discussions about how to could have consequences for Medicaid providersstay out of the hospital and these discussions nationwide.lead to a better experience overall. The Ninth Circuit Court of Appeals in San FranciscoIn the new world of ACO’s, follow up home care agreed with providers and blocked the Californiapost hospital is another sure way to improve cut. The case could have ended there; but with thepatient satisfaction and reduce hospital Supreme Court agreeing to hear arguments, thisreadmission rates. The new models bring might signal a potential increased risk for alltogether the different component parts of care Medicaid beneficiaries that there may be nowith the patient clearly in the center- primary recourse when their benefits are slashed andcare, specialists, hospitals, home care, all burned by state governments.working synergistically for the patient. The goalsof this collaboration are first and foremost to It is interesting to note that the 2012 OIG Work Planimprove the patient experience, improve overall was recently released and made note that stateshealth status and bend the cost curve. Each of may not arbitrarily deny or reduce the amount,these goals is achieved when the patient comes duration or scope of Medicaid services based onfirst and the totality of their experience counts. diagnosis, illness or condition. We will watchPatients are clearly at the center of the new developments in this case with continued care world! ,
  2. 2. October,2011 – Vol 2, Issue 10 Accountable Care Organizations (ACO) Final Rules ReleasedThe ACO rules for the Shared Savings Program arefinally out and the healthcare world is abuzz. Let’stake a look at what the new ACO is and is not.The ACO model is a collaborative network ofphysicians and hospitals that share the responsibilityfor a minimum of 5,000 Medicare patients. TheACO will manage all the healthcare needs of these Microscopic Auditing May Havebeneficiaries for three years beginning April, 2012. Gone Too FarProviders will have incentives to cooperate and savemoney through the seamless integration and sharing The typical home health agency today is subject toof information. While the original rule mandated the eight different audits; five from the federaluse of electronic health records (EHR), the final rule government and three from state bureaucrats not todoes not. ACOs that save money while also meeting mention those from the generally welcomedquality benchmarks will keep a percentage of the accreditation bodies. Agency personnel aresavings. The quality measures that require reporting operating in a state of fear that the government’sfrom the ACO stands at 33 different measures down zero tolerance for minor, non-patient related error isfrom the original 65 proposed. If the ACO meets the designed purely from a punitive perspective withoutrequired targets, their incentive equates to getting regard for the extraordinary job caregivers do everypaid more for keeping their patients healthy and out day for the millions of patients being served acrossof the hospital verses being paid for services this country.rendered to sick patients. While we agree there should be a zero toleranceSome have said that an ACO sounds and looks like policy for medical error, to withhold thousands ofthe old style HMO concept. There are however, dollars in reimbursement because an agency forgotsome critical differences such as the right of patients to renew a $100.00 local business license is nothingto choose a provider outside the ACO model at no short of wrong. When RAC auditors are paid basedadditional cost. According to Steve Lieberman, on a percent of recovered funds, where is theDeputy Director for Policy and Analysis at the unbiased approach fundamental to good auditNational Governor’s Association, ACOs aim to technique and outcomes? Something that looks likereplicate the performance of the HMO in terms of a conflict of interest is most likely a conflict.holding down costs while avoiding the structuralproblems encountered by controlling the patient and With huge amounts of money being spent on thesetheir choices. audits, why do we still read every day of fraudulent activities amounting to millions by unscrupulousPhysicians and hospitals are in charge of the ACO people? I submit that something is very wrong whenbut insurers also have indicated they want to play. good home health agencies, working very hard toUnited Healthcare, Cigna and Humana already have serve patients must live in fear from multipleannounced plans to form their own ACOs for the unwarranted audits when unscrupulous people canprivate market. Insures believe they are essential to defraud the government and go undetected foran ACO because they already have the years.infrastructure to track and collect data on patientcare and report on the results. ACO development is Editorial by Elaine Davis Jones, COO of CareMinders Home Care, Inc., a national franchise specializing in the long term care of chronicall about what is important to patients: staying and debilitating conditions for people of all ages. Direct linehealthy, out of the hospital and in control of their 770.360.5554 or edavis@careminders.comown health care decisions. 2