This document provides information about an upcoming continuing medical education event on "Meaningful Use" and computerized physician order entry (CPOE). The one-hour online module will discuss the federal incentive program for meaningful use of electronic health records, including the three stages of the HI-TECH Act and penalties for hospitals not meeting goals by 2015. It is free for Saint Luke's Care physicians and qualifies for one credit of Category 1 CME. The module will be presented by experts from the Medical Group Management Association and McKesson Corporation.
1) US hospitals face mounting pressures to implement EMRs to meet meaningful use requirements and qualify for incentive payments, while also dealing with financial pressures like reimbursement cuts.
2) A survey of 15 CIOs from health systems that have successfully implemented EMRs found that navigating the complex environment requires best practices for driving successful EMR utilization.
3) Key lessons from exemplar hospitals include understanding stages of EMR maturity to set priorities, focusing on clinical workflows and usability over just technology, and gaining executive support for a long-term IT strategy.
The document provides a summary of recent healthcare regulatory and legal developments. It discusses:
1) A federal court case that reversed a $44 million jury verdict for Stark Law violations and provided guidance on assessing such violations.
2) A CMS final rule that requires the use of NPI numbers on Medicare claims and enrollment applications.
3) CMS' posting of proposed Stage 2 meaningful use clinical quality measures for eligible professionals and hospitals.
The document discusses Summa Health System, an integrated healthcare delivery system in Ohio. It consists of hospitals, physicians, a health plan, and a foundation. Summa aims to provide high-quality, accountable care through clinical integration and partnerships. It owns Summa Physicians Inc, which employs over 250 physicians. Summa seeks to advance value-based care and reduce costs through its accountable care organization model and patient-centered medical homes.
This document summarizes several key provisions from the Small Business Jobs Act of 2010 that provide tax breaks for small businesses:
1) It increases the maximum amount that can be deducted under Section 179 to $500,000 in 2010-2011 and increases the phase out threshold to $2 million.
2) It expands the definition of qualifying property for depreciation to include certain leasehold improvements, restaurant property, and retail improvement property.
3) It extends additional first year depreciation for 50% of the cost of certain property with recovery periods of 20 years or less, if acquired and placed in service in 2010.
4) It allows self-employed individuals to deduct the cost of health insurance
This document summarizes several key provisions from the Small Business Jobs Act of 2010 that provide tax breaks for small businesses:
1) It increases the maximum amount that can be deducted under Section 179 to $500,000 in 2010-2011 and increases the phase out threshold to $2 million.
2) It expands the definition of qualifying property for depreciation to include certain leasehold improvements, restaurant property, and retail improvement property.
3) It extends additional first year depreciation for 50% of the cost of certain property with recovery periods of 20 years or less, if acquired and placed in service in 2010.
4) It allows self-employed individuals to deduct the cost of health insurance
Stephen Frank - Role of Private Insurance for Prescription Drugs in CanadaPharmacare 2020
Private insurance plays an important role in supplementing Canada's public healthcare system by covering around 14% of total healthcare spending. While private insurers have to navigate a complex system with different provincial rules, they have adopted outsourcing and active plan management strategies to reduce costs and increase efficiency. Going forward, a mixed public-private system is optimal to ensure universal coverage while leveraging the strengths of both sectors in adapting to changes and controlling expenditures.
1) US hospitals face mounting pressures to implement EMRs to meet meaningful use requirements and qualify for incentive payments, while also dealing with financial pressures like reimbursement cuts.
2) A survey of 15 CIOs from health systems that have successfully implemented EMRs found that navigating the complex environment requires best practices for driving successful EMR utilization.
3) Key lessons from exemplar hospitals include understanding stages of EMR maturity to set priorities, focusing on clinical workflows and usability over just technology, and gaining executive support for a long-term IT strategy.
The document provides a summary of recent healthcare regulatory and legal developments. It discusses:
1) A federal court case that reversed a $44 million jury verdict for Stark Law violations and provided guidance on assessing such violations.
2) A CMS final rule that requires the use of NPI numbers on Medicare claims and enrollment applications.
3) CMS' posting of proposed Stage 2 meaningful use clinical quality measures for eligible professionals and hospitals.
The document discusses Summa Health System, an integrated healthcare delivery system in Ohio. It consists of hospitals, physicians, a health plan, and a foundation. Summa aims to provide high-quality, accountable care through clinical integration and partnerships. It owns Summa Physicians Inc, which employs over 250 physicians. Summa seeks to advance value-based care and reduce costs through its accountable care organization model and patient-centered medical homes.
This document summarizes several key provisions from the Small Business Jobs Act of 2010 that provide tax breaks for small businesses:
1) It increases the maximum amount that can be deducted under Section 179 to $500,000 in 2010-2011 and increases the phase out threshold to $2 million.
2) It expands the definition of qualifying property for depreciation to include certain leasehold improvements, restaurant property, and retail improvement property.
3) It extends additional first year depreciation for 50% of the cost of certain property with recovery periods of 20 years or less, if acquired and placed in service in 2010.
4) It allows self-employed individuals to deduct the cost of health insurance
This document summarizes several key provisions from the Small Business Jobs Act of 2010 that provide tax breaks for small businesses:
1) It increases the maximum amount that can be deducted under Section 179 to $500,000 in 2010-2011 and increases the phase out threshold to $2 million.
2) It expands the definition of qualifying property for depreciation to include certain leasehold improvements, restaurant property, and retail improvement property.
3) It extends additional first year depreciation for 50% of the cost of certain property with recovery periods of 20 years or less, if acquired and placed in service in 2010.
4) It allows self-employed individuals to deduct the cost of health insurance
Stephen Frank - Role of Private Insurance for Prescription Drugs in CanadaPharmacare 2020
Private insurance plays an important role in supplementing Canada's public healthcare system by covering around 14% of total healthcare spending. While private insurers have to navigate a complex system with different provincial rules, they have adopted outsourcing and active plan management strategies to reduce costs and increase efficiency. Going forward, a mixed public-private system is optimal to ensure universal coverage while leveraging the strengths of both sectors in adapting to changes and controlling expenditures.
The document summarizes incentives in the American Recovery and Reinvestment Act of 2009 for critical access hospitals to implement electronic health records. It provides details on the incentive program, including that critical access hospitals can receive up to four years of incentive payments based on costs of implementing EHRs, as long as they demonstrate meaningful use of certified EHR systems. Hospitals must achieve meaningful use by 2015 or face reduced Medicare reimbursement rates beginning that year.
Healthcare IT Incentives for Critical Access Hospitalsmckessonparagon
The document summarizes incentives in the American Recovery and Reinvestment Act of 2009 for critical access hospitals to implement electronic health records. It provides details on the incentive program, including that critical access hospitals can receive up to four years of incentive payments based on costs to implement EHRs. Hospitals must achieve meaningful use of certified EHR systems to qualify for incentives and will face reduced Medicare reimbursement rates starting in 2015 if they do not meet meaningful use.
The Centers for Medicare and Medicaid Services published a Final Rule implementing the Medicare Shared Savings Program and Accountable Care Organizations. The Final Rule broadens eligibility and encourages formation of ACOs to coordinate care for Medicare beneficiaries. ACOs must establish legal structures to receive payments, be accountable for costs and quality, and involve participants and beneficiaries in governance. CMS will assign beneficiaries preliminarily based on their use of primary care services from providers in an ACO and reconcile assignments annually based on actual care received. The goal is to drive effective care management programs to improve outcomes under the shared savings model.
1) The document summarizes a policy brief about accountable care organizations (ACOs) and the key issues in designing them.
2) An ACO aims to deliver coordinated, efficient care to a defined population by holding local healthcare providers accountable for quality and costs. It would receive bonuses for meeting targets but penalties for failing.
3) There are open questions about how to design ACs, including what types of providers must participate, how patients will be involved, and what payment methods should be used. The brief discusses these issues and implementation challenges.
A Look Under the Hood: 5 Critical Questions You Should be Asking about ACOsSheri Litchford
The document discusses 5 critical questions about Accountable Care Organizations (ACOs): 1) what an ACO is, 2) whether ACOs are failing, 3) if there is money to be made through ACOs, 4) examples of successful ACOs, and 5) the information technology costs of ACOs. It provides details on these topics, including definitions of ACOs, perspectives on their viability, examples of ACOs that have generated savings, and the types of IT systems needed to support ACO operations and goals such as quality reporting, cost control and care management.
This document discusses system selection for electronic health records. It compares commercial off-the-shelf (COTS) software to in-house developed systems, outlining advantages and disadvantages of each. COTS software has lower development costs but limits customization, while in-house systems are tailored to needs but have higher costs. The document also describes ONC certification requirements and Meaningful Use criteria to receive federal stimulus incentives for implementing health IT systems.
This document discusses several topics related to healthcare finance and quality reporting systems:
1) It summarizes the goals of the Physician Quality Reporting System (PQRS) and Value-Based Purchasing System (VBPS), including improving quality of care and tying reimbursement to quality metrics.
2) It outlines the roles of Health Information Management professionals in supporting these programs through data analytics and quality reporting.
3) It describes the roles of Quality Improvement Organizations in ensuring accurate medical coding and documentation for reimbursement.
4) It provides an overview of several laws and acts aimed at reducing healthcare fraud, including the Anti-Kickback statute and their effects on providers.
Pharmacy Services and Accountable Care Organizations Discussion.pdfsdfghj21
Pharmacy services can help accountable care organizations (ACOs) improve patient care and outcomes. A 1-page proposal should identify pharmacy services like chronic disease management, medication reconciliation after discharge, or annual wellness visits. These services help with benchmarks like readmissions, adherence to preventive screenings, and management of chronic conditions. Pharmacists can enhance care coordination, patient education, and medication optimization within ACOs.
Pharmacy Services Development within ACO MSO Business Proposal.pdfsdfghj21
The document discusses implementing pharmacy services within an ACO/MSO business proposal. It provides background on ACOs, MSOs, and the evolving healthcare landscape. The proposal should include 1) pharmacy services to implement like medication therapy management, annual wellness visits, or chronic disease management and 2) how these services will improve patient care by impacting benchmarks for quality, care coordination, preventive health, and management of at-risk populations. The literature demonstrates benefits of these pharmacy services including reduced costs and improved outcomes.
This document discusses the implementation of electronic medical records (EMRs) in healthcare as mandated by 2014. It notes that current EMR vendors do not meet federal requirements and standards are still being developed. The costs of implementation are high and there are barriers like funding, IT resources, and provider resistance. It provides answers to questions about costs, funding sources like grants and loans, and the long-term benefits of EMRs like reduced errors and improved care coordination.
The document discusses key points healthcare providers should know about implementing electronic medical records (EMRs) by the 2014 mandate. It notes that current EMR vendors do not fully meet federal requirements and standards are still being developed. EMRs will be very expensive to implement and maintain, though government loans and grants are available to help fund them. Proper implementation requires addressing barriers like costs, unclear returns on investment, training needs, and resistance to change. Non-adoption will result in lower Medicare reimbursements starting in 2015.
A Clinically Integrated Network (CIN) is a selective partnership of physicians collaborating with
hospital(s) and other providers to deliver evidence-based care, improve quality and efficiency,
manage populations and demonstrate value to the market. Once these objectives are met, the network may contract on behalf of participants
This document discusses downcoding and bundling of claims by health insurers, which can reduce physician reimbursement. It provides background on Current Procedural Terminology (CPT) coding, noting that CPT is updated regularly but does not dictate reimbursement amounts. While health insurers must accept CPT codes, they are not required to follow CPT guidelines and can interpret codes differently. The document advises physicians to code correctly but warns that insurers may still improperly downcode or bundle claims as tactics to reduce payments.
Part ONE-1 page AMA format-due 917 by 1000 pm EST Evaluate m.docxdanhaley45372
Part ONE-
1 page AMA format-due 9/17 by 10:00 pm EST
Evaluate meaningful use regulations for recovery audit contractors (RACs) and electronic health records (EHRs), as well as the impact on either case management or performance incentives. What is the purpose of these regulations? How effective are they in meeting the purpose? Support your answer with course resources-attached
Part TWO
In response to your peer-provided below, agree or disagree with their assessments of the effectiveness of RAC and EHR meaningful use regulations. Be sure to justify your answer.
Classmate Chiwaula’s post:
Top of Form
MEANINGFUL USE REGULATIONS FOR RECOVERY AUDIT CONTRACTORS & ELECTRONIC HEALTH RECORDS
IMPACT ON CASE MANAGEMENT OR PERFORMANCE INCENTIVES.
In 2015 the Board of Registration in Medicine introduced a set of regulations requiring physicians to demonstrate proficiency in the use of electronic medical records, as well as the skills to achieve the federal Meaningful Use standard. Under the regulations, physicians are considered to have demonstrated proficiency if they meet any one of the following conditions:
· Participating in the Meaningful Use program as an Eligible Professional
· Having a relationship with a hospital that has been certified as a Meaningful Use participant. This relationship would be satisfied by any oneof the following conditions:
. Employed by the hospital
. Credentialed by the hospital to provide patient care
. Having a “contractual agreement” with the hospital
· Completing at least three hours of accredited CME program on electronic health records. Such a program must, at a minimum, discuss the core and menu set objectives, as well as the clinical quality measures for Meaningful Use.1
The Recovery Audit Contractor, or RAC, program was created through the Medicare Modernization Act of 2003 (MMA) to identify and recover improper Medicare payments paid to health care providers under fee-for-service (FFS) Medicare plans. The United States Department of Health and Human Services (DHHS) is required by law to make the program permanent for all states by January 1, 2010, under section 302 of the Tax Relief and Health Care Act of 2006.2 The main goals for RAC include:
• Minimize Provider Burden
• Ensure Accuracy
• Maximize Transparency
RACs are authorized to investigate claims submitted by all physicians, providers, facilities, and suppliers—essentially, everyone who provides Medicare beneficiaries in the fee for service program with procedures, services, and treatments and submits claims to Medicare (and/or their fiscal intermediaries (FI), regional home health intermediaries (RHHI), Part A and Part B Medicare administrative contractors (A/B/MACs), durable medical equipment Medicare administrative contractors (DME MACs), and/or carriers.2
Benefits of Electronic Health Records (EHRs)
Providers who use EHRs report tangible improvements in their ability to make better decisions with more compreh.
Population Health Management & Meaningful UsePhytel
The government’s EHR incentive program is designed to transform healthcare delivery and dovetails with other healthcare reform initiatives. Population health management, the goal of these initiatives, requires advanced forms of health IT.
White Paper - eCQMs: It's Time to Make Data Quality the No. 1 Priority Q-Centrix
This white paper will examine eCQM data quality issues and their implications. It will raise questions hospitals should consider when developing strategies to improve their eCQM capabilities. Lastly, it will outline how they can benefit from implementing better data quality control practices and present new developments in eCQM data collection and reporting.
MANAGED CARE
CHAPTER 3 LECTURE NOTES
Part 2
NETWORK MANAGEMENT AND REIMBURSEMENT
I. HOSPITALS AND AMBULATORY FACILITIES
A. Reimbursement Methods – there are many reimbursement
methods available when contracting with hospitals. In deciding
which method to use, management must have the internal ability to
manage these financial terms in their information systems and
maintenance will be affected to some degree by the types of health
plans that the hospital or ambulatory facility chooses to contract
with.
Types of Facilities and Contracting Situations
Hospitals
Community-based Single Acute Care Hospitals
Multihospital Systems
For-Profit Hospitals
Specialized Hospitals
Physician-Owned Single-Specialty Hospitals
Government Hospitals
Subacute Care
Hospice
Ambulatory Surgical Centers and Other Ambulatory Facilities
Aka: ASCs
Dialysis Units
Birthing Centers
Endoscopy Suites
Radiation Oncology Centers
Retail Health Clinics
Urgent Care Centers
II. Credentialing of Hospitals and Ambulatory Facilities
Facilities meeting applicable state licensure and accreditation
standards, as well as participation with Medicare and Medicaid.
Payers do not credential Hospitals and Ambulatory Facilities the
same way that they credential physicians
1
Individual states typically carry out inspections and initial
evaluations of new facilities, after which they accept
accreditation by recognized facility accreditation organizations
o JCAHO
o AAAHC
o CHAP
o HFAP
o DNV
o ACHC
In some cases, a health plan will establish further criteria that
are applicable to certain types of care such are:
o Minimum # cardiac bypass operations performed each
year
o % patients who achieve the defined outcomes following
obesity surgery
o Staffing ratios of nurses and physicians for an intensive
care unit
o Center of Excellence
III. Integrated Delivery Systems (IDS)
A. Types of IDSs
Independent and Hospital-Employed Physicians
Management Services Organizations (MSOs)
Patient Centered Medical Homes
Accountable Care Organizations (ACOs)
A term coined by the MedPAC, adopted by CMS, and
incorporated into the ACA
Similar to a Patient-Centered Medical Home (PCMH) in that it
focuses on patients with significant chronic conditions and high
costs
May different types of provider organizations may be eligible for
designation as ACOs. But can be structured like an IDS
CMS (Centers for Medicare and Medicaid Services) requires
ACOs to meet other standards in governance, management,
etc.
Must also have 5000 traditional Medicare beneficiaries
“assigned” to it by CMS
ACOs contract with CMS for the traditional FFS Medicare
Program and are subject to a specific payment model called
“shared savings”
B. Vertical Integration
The future of the healthcare sector in the U.S.??
2
IV. Ancillary Services
Broadly divided into diagnostics and therapeutic services
o Examples:
Diagnostic: Lab, X-ray, CT scan, MRI, EK ...
A New Payer Model for Medical Management ExecutionCognizant
To combat rising costs and inefficient use of resources, payers can streamline utilization management and optimize care management through medical management delivered as a service.
The Alliance for Healthcare Transformation provides a wide range of services to help healthcare organizations address the changing healthcare landscape and requirements under the Affordable Care Act. These services include population health assessments and best practices, electronic health records evaluations and clinical systems, patient safety programs, financial and revenue cycle management, monetizing healthcare assets, and international healthcare consulting. The goal is to help providers improve quality of care, health outcomes, and cost efficiency through evidence-based programs and recommendations.
The document summarizes incentives in the American Recovery and Reinvestment Act of 2009 for critical access hospitals to implement electronic health records. It provides details on the incentive program, including that critical access hospitals can receive up to four years of incentive payments based on costs of implementing EHRs, as long as they demonstrate meaningful use of certified EHR systems. Hospitals must achieve meaningful use by 2015 or face reduced Medicare reimbursement rates beginning that year.
Healthcare IT Incentives for Critical Access Hospitalsmckessonparagon
The document summarizes incentives in the American Recovery and Reinvestment Act of 2009 for critical access hospitals to implement electronic health records. It provides details on the incentive program, including that critical access hospitals can receive up to four years of incentive payments based on costs to implement EHRs. Hospitals must achieve meaningful use of certified EHR systems to qualify for incentives and will face reduced Medicare reimbursement rates starting in 2015 if they do not meet meaningful use.
The Centers for Medicare and Medicaid Services published a Final Rule implementing the Medicare Shared Savings Program and Accountable Care Organizations. The Final Rule broadens eligibility and encourages formation of ACOs to coordinate care for Medicare beneficiaries. ACOs must establish legal structures to receive payments, be accountable for costs and quality, and involve participants and beneficiaries in governance. CMS will assign beneficiaries preliminarily based on their use of primary care services from providers in an ACO and reconcile assignments annually based on actual care received. The goal is to drive effective care management programs to improve outcomes under the shared savings model.
1) The document summarizes a policy brief about accountable care organizations (ACOs) and the key issues in designing them.
2) An ACO aims to deliver coordinated, efficient care to a defined population by holding local healthcare providers accountable for quality and costs. It would receive bonuses for meeting targets but penalties for failing.
3) There are open questions about how to design ACs, including what types of providers must participate, how patients will be involved, and what payment methods should be used. The brief discusses these issues and implementation challenges.
A Look Under the Hood: 5 Critical Questions You Should be Asking about ACOsSheri Litchford
The document discusses 5 critical questions about Accountable Care Organizations (ACOs): 1) what an ACO is, 2) whether ACOs are failing, 3) if there is money to be made through ACOs, 4) examples of successful ACOs, and 5) the information technology costs of ACOs. It provides details on these topics, including definitions of ACOs, perspectives on their viability, examples of ACOs that have generated savings, and the types of IT systems needed to support ACO operations and goals such as quality reporting, cost control and care management.
This document discusses system selection for electronic health records. It compares commercial off-the-shelf (COTS) software to in-house developed systems, outlining advantages and disadvantages of each. COTS software has lower development costs but limits customization, while in-house systems are tailored to needs but have higher costs. The document also describes ONC certification requirements and Meaningful Use criteria to receive federal stimulus incentives for implementing health IT systems.
This document discusses several topics related to healthcare finance and quality reporting systems:
1) It summarizes the goals of the Physician Quality Reporting System (PQRS) and Value-Based Purchasing System (VBPS), including improving quality of care and tying reimbursement to quality metrics.
2) It outlines the roles of Health Information Management professionals in supporting these programs through data analytics and quality reporting.
3) It describes the roles of Quality Improvement Organizations in ensuring accurate medical coding and documentation for reimbursement.
4) It provides an overview of several laws and acts aimed at reducing healthcare fraud, including the Anti-Kickback statute and their effects on providers.
Pharmacy Services and Accountable Care Organizations Discussion.pdfsdfghj21
Pharmacy services can help accountable care organizations (ACOs) improve patient care and outcomes. A 1-page proposal should identify pharmacy services like chronic disease management, medication reconciliation after discharge, or annual wellness visits. These services help with benchmarks like readmissions, adherence to preventive screenings, and management of chronic conditions. Pharmacists can enhance care coordination, patient education, and medication optimization within ACOs.
Pharmacy Services Development within ACO MSO Business Proposal.pdfsdfghj21
The document discusses implementing pharmacy services within an ACO/MSO business proposal. It provides background on ACOs, MSOs, and the evolving healthcare landscape. The proposal should include 1) pharmacy services to implement like medication therapy management, annual wellness visits, or chronic disease management and 2) how these services will improve patient care by impacting benchmarks for quality, care coordination, preventive health, and management of at-risk populations. The literature demonstrates benefits of these pharmacy services including reduced costs and improved outcomes.
This document discusses the implementation of electronic medical records (EMRs) in healthcare as mandated by 2014. It notes that current EMR vendors do not meet federal requirements and standards are still being developed. The costs of implementation are high and there are barriers like funding, IT resources, and provider resistance. It provides answers to questions about costs, funding sources like grants and loans, and the long-term benefits of EMRs like reduced errors and improved care coordination.
The document discusses key points healthcare providers should know about implementing electronic medical records (EMRs) by the 2014 mandate. It notes that current EMR vendors do not fully meet federal requirements and standards are still being developed. EMRs will be very expensive to implement and maintain, though government loans and grants are available to help fund them. Proper implementation requires addressing barriers like costs, unclear returns on investment, training needs, and resistance to change. Non-adoption will result in lower Medicare reimbursements starting in 2015.
A Clinically Integrated Network (CIN) is a selective partnership of physicians collaborating with
hospital(s) and other providers to deliver evidence-based care, improve quality and efficiency,
manage populations and demonstrate value to the market. Once these objectives are met, the network may contract on behalf of participants
This document discusses downcoding and bundling of claims by health insurers, which can reduce physician reimbursement. It provides background on Current Procedural Terminology (CPT) coding, noting that CPT is updated regularly but does not dictate reimbursement amounts. While health insurers must accept CPT codes, they are not required to follow CPT guidelines and can interpret codes differently. The document advises physicians to code correctly but warns that insurers may still improperly downcode or bundle claims as tactics to reduce payments.
Part ONE-1 page AMA format-due 917 by 1000 pm EST Evaluate m.docxdanhaley45372
Part ONE-
1 page AMA format-due 9/17 by 10:00 pm EST
Evaluate meaningful use regulations for recovery audit contractors (RACs) and electronic health records (EHRs), as well as the impact on either case management or performance incentives. What is the purpose of these regulations? How effective are they in meeting the purpose? Support your answer with course resources-attached
Part TWO
In response to your peer-provided below, agree or disagree with their assessments of the effectiveness of RAC and EHR meaningful use regulations. Be sure to justify your answer.
Classmate Chiwaula’s post:
Top of Form
MEANINGFUL USE REGULATIONS FOR RECOVERY AUDIT CONTRACTORS & ELECTRONIC HEALTH RECORDS
IMPACT ON CASE MANAGEMENT OR PERFORMANCE INCENTIVES.
In 2015 the Board of Registration in Medicine introduced a set of regulations requiring physicians to demonstrate proficiency in the use of electronic medical records, as well as the skills to achieve the federal Meaningful Use standard. Under the regulations, physicians are considered to have demonstrated proficiency if they meet any one of the following conditions:
· Participating in the Meaningful Use program as an Eligible Professional
· Having a relationship with a hospital that has been certified as a Meaningful Use participant. This relationship would be satisfied by any oneof the following conditions:
. Employed by the hospital
. Credentialed by the hospital to provide patient care
. Having a “contractual agreement” with the hospital
· Completing at least three hours of accredited CME program on electronic health records. Such a program must, at a minimum, discuss the core and menu set objectives, as well as the clinical quality measures for Meaningful Use.1
The Recovery Audit Contractor, or RAC, program was created through the Medicare Modernization Act of 2003 (MMA) to identify and recover improper Medicare payments paid to health care providers under fee-for-service (FFS) Medicare plans. The United States Department of Health and Human Services (DHHS) is required by law to make the program permanent for all states by January 1, 2010, under section 302 of the Tax Relief and Health Care Act of 2006.2 The main goals for RAC include:
• Minimize Provider Burden
• Ensure Accuracy
• Maximize Transparency
RACs are authorized to investigate claims submitted by all physicians, providers, facilities, and suppliers—essentially, everyone who provides Medicare beneficiaries in the fee for service program with procedures, services, and treatments and submits claims to Medicare (and/or their fiscal intermediaries (FI), regional home health intermediaries (RHHI), Part A and Part B Medicare administrative contractors (A/B/MACs), durable medical equipment Medicare administrative contractors (DME MACs), and/or carriers.2
Benefits of Electronic Health Records (EHRs)
Providers who use EHRs report tangible improvements in their ability to make better decisions with more compreh.
Population Health Management & Meaningful UsePhytel
The government’s EHR incentive program is designed to transform healthcare delivery and dovetails with other healthcare reform initiatives. Population health management, the goal of these initiatives, requires advanced forms of health IT.
White Paper - eCQMs: It's Time to Make Data Quality the No. 1 Priority Q-Centrix
This white paper will examine eCQM data quality issues and their implications. It will raise questions hospitals should consider when developing strategies to improve their eCQM capabilities. Lastly, it will outline how they can benefit from implementing better data quality control practices and present new developments in eCQM data collection and reporting.
MANAGED CARE
CHAPTER 3 LECTURE NOTES
Part 2
NETWORK MANAGEMENT AND REIMBURSEMENT
I. HOSPITALS AND AMBULATORY FACILITIES
A. Reimbursement Methods – there are many reimbursement
methods available when contracting with hospitals. In deciding
which method to use, management must have the internal ability to
manage these financial terms in their information systems and
maintenance will be affected to some degree by the types of health
plans that the hospital or ambulatory facility chooses to contract
with.
Types of Facilities and Contracting Situations
Hospitals
Community-based Single Acute Care Hospitals
Multihospital Systems
For-Profit Hospitals
Specialized Hospitals
Physician-Owned Single-Specialty Hospitals
Government Hospitals
Subacute Care
Hospice
Ambulatory Surgical Centers and Other Ambulatory Facilities
Aka: ASCs
Dialysis Units
Birthing Centers
Endoscopy Suites
Radiation Oncology Centers
Retail Health Clinics
Urgent Care Centers
II. Credentialing of Hospitals and Ambulatory Facilities
Facilities meeting applicable state licensure and accreditation
standards, as well as participation with Medicare and Medicaid.
Payers do not credential Hospitals and Ambulatory Facilities the
same way that they credential physicians
1
Individual states typically carry out inspections and initial
evaluations of new facilities, after which they accept
accreditation by recognized facility accreditation organizations
o JCAHO
o AAAHC
o CHAP
o HFAP
o DNV
o ACHC
In some cases, a health plan will establish further criteria that
are applicable to certain types of care such are:
o Minimum # cardiac bypass operations performed each
year
o % patients who achieve the defined outcomes following
obesity surgery
o Staffing ratios of nurses and physicians for an intensive
care unit
o Center of Excellence
III. Integrated Delivery Systems (IDS)
A. Types of IDSs
Independent and Hospital-Employed Physicians
Management Services Organizations (MSOs)
Patient Centered Medical Homes
Accountable Care Organizations (ACOs)
A term coined by the MedPAC, adopted by CMS, and
incorporated into the ACA
Similar to a Patient-Centered Medical Home (PCMH) in that it
focuses on patients with significant chronic conditions and high
costs
May different types of provider organizations may be eligible for
designation as ACOs. But can be structured like an IDS
CMS (Centers for Medicare and Medicaid Services) requires
ACOs to meet other standards in governance, management,
etc.
Must also have 5000 traditional Medicare beneficiaries
“assigned” to it by CMS
ACOs contract with CMS for the traditional FFS Medicare
Program and are subject to a specific payment model called
“shared savings”
B. Vertical Integration
The future of the healthcare sector in the U.S.??
2
IV. Ancillary Services
Broadly divided into diagnostics and therapeutic services
o Examples:
Diagnostic: Lab, X-ray, CT scan, MRI, EK ...
A New Payer Model for Medical Management ExecutionCognizant
To combat rising costs and inefficient use of resources, payers can streamline utilization management and optimize care management through medical management delivered as a service.
The Alliance for Healthcare Transformation provides a wide range of services to help healthcare organizations address the changing healthcare landscape and requirements under the Affordable Care Act. These services include population health assessments and best practices, electronic health records evaluations and clinical systems, patient safety programs, financial and revenue cycle management, monetizing healthcare assets, and international healthcare consulting. The goal is to help providers improve quality of care, health outcomes, and cost efficiency through evidence-based programs and recommendations.
Similar to Meaningful use and cpoe cme presentation (20)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
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• Equipping health professionals to address questions, concerns and health misinformation
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1. Saint Luke's Care
presents
"Meaningful Use" and CPOE
1 credit hour of Category 1 CME
Free CME for Saint Luke's Care physicians
Upon completion of the online learning module, the participant will
List three required portions of the Electronic Health Record that must be completed for a hospital to reach “Meaningful Use”.
List the three required areas for electronic quality measure documentation and reporting by hospitals.
Know that 30% of unique hospitalized patients must have more than one medication entered via CPOE
Know that only physicians working primarily in the outpatient environment are eligible for incentives to use an Electronic
Health Record.
List the three stages of the HI-TECH Act
Know that hospitals will begin incurring penalties if they are not meeting Meaningful Use goals by 2015.
Target Audience: All SL Care physicians
Content: The federal EHR incentive program: Achieving ‘meaningful use’,
Robert Tennant, MA, Senior Policy Advisor, Medical Group Management Association (MGMA), Washington, D.C.
&
Healthcare IT and Stimulus Readiness: The American Recovery and Reinvestment Act of 2009,
Melody Kolb, MBA, Director, Business Analysis-McKesson Corp, Alpharetta, GA
Planning Committee:
Brent W. Beasley, MD, FACP - Medical Director, Saint Luke's Care, Saint Luke’s Health System, Kansas City, MO
John Yeast, MD – Vice President of Medical Affairs, Saint Luke’s Health System, Kansas City, MO
Carl Dirks, MD – Chief Medical Information Officer, Saint Luke’s Health System, Kansas City, MO
Shauna Todd, RN, BSN - Quality and Implementation System Analyst, Saint Luke’s Care, Kansas City, MO
Sharon Hoffarth, MD, MPH, FACPM – Medical Director, Primaris, Columbia, MO
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of
Primaris and Saint Luke's Care. Primaris is accredited by the Missouri State Medical Association to provide continuing medical education for physicians.
Primaris designates this educational activity for a maximum of 1 hours AMA PRA Category 1 Credit™. Physicians should claim credit commensurate with the extent of their participation in the activity.
For questions please contact Shauna Todd (stodd@saint-lukes.org)
or Brent Beasley (bbeasley@saint-lukes.org)
5. Copyright of MGMA Connexion is the property of Medical Group Management Association and its content
may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express
written permission. However, users may print, download, or email articles for individual use.
Reprinted with permission from the Medical Group Management Association, 104 Inverness Terrace East,
Englewood, Colorado 80112. 877.275.6462. www.mgma.com. Copyright 2010.