Can you believe there is a bill in Congress right now, ‘To prohibit the Secretary of Health and Human Services from replacing ICD-9 with ICD-10 in implementing the HIPAA code set standards. Yes, despite all the hard work already completed by the healthcare industry, it is believed that scrapping ICD-10 entirely could be the way to go! Can that really happen?
Mediware Rehabilitation Blog
Healthcare quality and performance improvement work is not sexy . It is expensive, painfully time consuming and highly detailed with focus upon improving service in meeting the needs of patients. And, it usually occurs long after the patient encounter. Technology exists to acquire the information needed to accomplish quality and performance objectives but healthcare infrastructures and behaviors are not prepared to take advantage. When costs are excessive and money is limited, the investment decisions in improving quality and performance will always favor short term dollars.
Now is the time to pay attention to detail. If you have kept an untidy watch on the comparability of your operations to local or national benchmarks then it's time to pull out the microscope to examine every type of data that streams from your organization daily. Science 101 has returned with a vengeance to the world of health care and the numbers, even though not understood by most laypeople, will lay at consumers' feet to make a decision. Will you be a star or a sinking ship based on those numbers?
Last week, Mediware hosted its annual conference for respiratory and rehabilitation professionals focusing on “Reaching Peak Performance” with Population Based Healthcare. Coincidentally, Frank Cohen posted a piece on the RACmonitor eNews site about the futility of healthcare compliance and its similarity, and differences, to game playing theory by Dr. John Forbes Nash: The Nash Equilibrium: A Study in the Futility of Striving for Healthcare Compliance. While some will argue that our healthcare system and its operation is not a game, there certainly are many winners and losers in the healthcare environment. All participants are challenged with the accountability for transparency of cost and effectiveness of their participation in the game. I immediately saw the analogy with Cohen’s paper.
If you are like most, hitting the “delete” button as you course through the daily dose of email offerings has become a common housekeeping chore. The “open” button is hit only when the message title strikes a purposeful note or curiosity factor and followed by a click-read-drilldown sequence of analysis.
Population health is a term that is widely used in healthcare, but not universally understood. The concept of population health was introduced after the turn of the century when David Kindig and Greg Stoddart defined it as “the health outcome of a group of individuals, including the distribution of such outcomes within the group.” Since then, we have come to appreciate the role health care providers must take to impact those outcomes. Accountability to assume responsibility for health outcomes must include the behaviors of the population.
The Sustainable Growth Rate formula replaced through the Medicare and CHIP Reauthorization Act (MACRA), may not have been thought of much lately since Congress acted in April. However, this and the therapy caps exceptions process was reinstated April 1, with redefined manual medical review to begin July 1st and therefore the Act is worth reviewing once more. Exactly what happened with MACRA? If you're paid based on the physician fee schedule, it's time to review!
Every year at this time, CMS issues its proposed rules for how providers will operate and get paid under Medicare. Changes are inevitable and this year’s issue continues to drive home the requirement to submit additional information to feed Congress and policy makers the data needed to figure out exactly what they are paying for in post-acute care.
Each year, Inpatient Rehabilitation Hospitals/Units (IRH/U) can be presented with a new set of regulatory challenges and presented those with a relatively short time to prepare yourself and staff to meet those requirements. Fortunately, CMS publishes a 'PROPOSED RULE' when they plan to implement change. During that time, facilities and knowledgeable persons are invited to comment on the proposals made in order to help mold a FINAL RULE expectation. If you are the type to wonder how your facility is always caught up in these changes, you may be the type that wants to review the proposed changes and make comments to CMS so your ideas are considered in addition to or instead of a present proposal. IF SO, please join us for the Inpatient Rehabilitation Hospital/Unit Proposed Rule review...
Non-Participation in quality reporting in an IRF reduces the standard payment by two percent in a future payment year. The deadline for quarter 4 CAUTI data and Influenza vaccination of your healthcare personnel are due THIS WEEK (May 15) ! There is no time to spare; validate your submissions have or will occur before May 15 to the National Health Safety Network on these two items!
This is so disturbing, CMS has created a new MedLearn Matter on the subject, along with the course of events for how the 2% reduction and appeals can occur.
If you haven't heard much about 'Alternative Payment Models' at all, or all until recently, it is a concept that all healthcare workers need to embrace, acknowledge and understand as soon as possible. Bundled Payment and Accountable Care Organizations have been referenced as Alternative Payment Models (APMs); however, this concept is just beginning and CMS, in their quest to guide payment away from fee-for-service toward 'paying providers based on the quality, rather than the quantity of care they give patients', is entering on a whole new horizon. It's time to take a peek and define when, where and how you feel APM fits into your book of business.
If the Sustainable Growth Rate formula for physician payment in the Medicare program has been the object of criticism for unacceptable value-based methodologies, its repeal is certainly a positive step to providing some rationale for paying for needed healthcare. The Merit-based Payment Incentive System (MIPS), announced last month, will change Medicare payments under Part B. Could this new legislation provide insight to how outpatient therapy providers could be paid in the future?
The Senate left for spring break without many extension package decisions being made; Therapy Cap exceptions process being one of those. Without the exceptions process, CMS will not pay for therapy services beyond the Cap amount for PT and SLP combined and OT individually. What next?
Each year, healthcare brings new challenges as regulations change; documentation requires more specificity and the push to do more with less climbs to even higher levels. If you work in healthcare, you are certainly feeling the pinch. This year, as I attended the AMRPA Spring Executive Forum at the end of February in Washington, D.C., and learned more information on the multitude of changes facing healthcare executives and workers, I could not but wonder how many people are truly keeping up with the possibilities and how those areas will affect their daily routine.
In an effort to place some urgency into your sails, I want to present a short list of the blueprints being worked into our healthcare models at top-notch speeds. DO NOT think you will not be affected. Change is occurring and you need to lace up your marathon sneakers because a simple hike will not get you to the milestones you need to reach right now! This is what we are facing in the very near future...
A big push from the House of Representatives to present the first possible permanent fix to the Sustainable Growth Formula and avoid a 21 percent reduction in payment to the Physician Fee Scheduled as early as April 1, 2015, came to a grinding halt when S. 810 was left to discuss after the Senate's spring break. Having all possibilities covered, CMS acted early and released a statement on what they were prepared to do should a final vote not be completed in time.