Posts in Category: performance pay

Parts of Obama's Healthcare Legacy Will Likely Continue Under Trump 

President-elect cites popular provisions he'd like to keep

As the dust settles after the presidential election, it appears that Donald Trump is already softening some of his positions, especially his position on Obamacare. Media outlets have speculated that President Obama pushed hard for the continuance of his signature healthcare program when he met with Trump at the White House following the election.

During the presidential campaign, Trump disparaged the Affordable Care Act and called for its repeal, although he didn't spell out what he would put in its place. A wholesale repeal of the ACA could leave as many as 22 million people without health insurance--a prospect that industry insiders consider unlikely.

Healthcare attorney Michael P. Strazzella told FierceHealthcare that Trump will focus on the ACA on the first day of his presidency, but that he doesn't expect anything dramatic to happen immediately. (Strazzella is co-head of Buchanan, Ingersoll & Rooney's District of Columbia office.)

"Repeal is good campaign language, but it's a 2,000-plus page bill and not everything can be repealed," Strazzella pointed out. To actually repeal all of Obamacare would require a 60-vote Senate supermajority, which Trump could not get unless some Democrats crossed party lines.
Other factors to consider:

  • The Republican Party is far from united under Trump, whom some GOP leaders have distanced themselves from, so the new president may not be able to count on the party's backing his every move.
  • Republicans may be wary of taking away well-liked provisions of Obamacare, especially if that doesn't play well with their constituencies.
  • The ACA's mandate that patients must not be denied coverage due to pre-existing conditions is very popular with voters, as is the act's provision for young people to be kept on their parents' insurance plans till age 26.*

What other aspects of healthcare might change under the Trump presidency? The future of pilot programs such as the Accountable Care Organizations under the Medicare Shared Savings Programs--like so many other Obama administration healthcare provisions--is murky. But many in the healthcare industry maintain that value-based care is here to stay. 

The credit ratings and research company Fitch Ratings issued this prediction: "The shift toward linking pricing to patient outcomes will continue as patients and health insurers grapple with the growing burden of healthcare costs over the longer term." 

*UPDATE: Trump recently told "60 Minutes" that he is in favor of keeping at least two provisions of Obamacare: the requirement that insurance companies accept patients with pre-existing conditions, and the provision that allows young adults to stay on their parents' health insurance plans until they reach the age of 26. He also signaled that he would not end Obamacare without having some other program in place.

Will the election of Trump impact your organization? Share your thoughts in our comment section below.

Early Reaction to MACRA Rule Mostly Positive 

Last weekend was a busy one for those trying to parse the new MACRA rule released on Friday. At 2,202 pages, the Medicare Access and CHIP Reauthorization Act rule wasn't exactly beach reading, and it gave the health IT community plenty to talk about on social media and in policy statements.

The dust is still settling, but it appears that early reaction to the rule was mostly positive. Healthcare organizations praised the CMS for being responsive to concerns they had raised during the comment period leading up to the rule's finalization. In fact, about 80 percent of the 2,000+ pages are comments CMS received and its responses.
The American Medical Association was pleased with the permanent elimination of the Sustainable Growth Rate (SGR) formula. "The new law," according to the AMA's press release, "gives many physicians the opportunity to be rewarded for the improvements they make to their practices and for delivering high-quality, high-value care to Medicare patients."
Other features that drew favorable reactions included:

  • The rule's overarching theme that improving the organization and payment models for medical care must stress quality over quantity.
  • Greater reporting flexibility for clinicians, as well as support for innovation in the delivery of care.
  • The formal adoption of a transition year during 2017, which makes major changes to the Quality Payment Program (QPP) reporting requirements, and provides a longer time frame for those transitioning to the QPP.
  • Emphasis on helping clinicians educate themselves about the rule.
  • Easing of the policy defining the Advanced Alternative Payment Model (APM), which will allow additional programs to quality.

But the rule is not without its detractors. "It's disappointing that the flexibility provided for quality reporting in 2017 largely disappears in 2018 and beyond," the Medical Group Management Association said in a policy statement.
Other organizations complained that the nominal risk standard defining the Advanced APM remains too high.

Want to know more? Healthcare Dive has a great breakdown of the rule changes you need to know. And for even more information on the new rule, click here. 
What's your take on the final MACRA rule? Share your thoughts in our comment section below.

Improving the Business Performance of Your Heart Hospital 

An effective CVIS strategy can improve the business performance of your hospital

The primary goal of any healthcare provider is to improve the lives of patients through effective treatment. However, because they are also businesses, hospitals have concerns that entail much more than this. To be viable in the long term, hospitals must manage their margins to fund their mission.
There are three main pillars of business concern for any hospital:

  • Clinical—health outcomes are measured with the goal of healthier patients leaving the facility.
  • Financial—the dollars must add up to keep the enterprise solvent.
  • Operational—staffing and facilities are measured against cost and need.

Ultimate success for a hospital demands strength in all three areas. It's incumbent upon clinicians and service line managers to work together to seek out efficiencies in each of them.


 

Praveen Lobo, VP Strategic Products

 
New Operational Realities

Payers' shift away from a fee-for-service model toward a value-based payment model demands that clinicians and administrators expand the above-mentioned pillars to include cost, patient outcomes, and patient satisfaction.

These changes aren’t easy. Providers have long been paid based on quantitative measures: the number of procedures performed. New operational realities demand new ways of measuring the qualitative value of those procedures. Reimbursement is linked to these metrics, and hospitals must find ways to leverage their investments in data technology in order to maximize their financial opportunities.


Granular Data Brings Actionable Insights

Data is critical to the shift to VBP. For example, if we know that extubation within six hours improves patient outcomes, it makes sense to monitor that metric internally on an ongoing basis. When outliers crop up, data points gathered from across the treatment spectrum can allow us to understand why. Perhaps a different treatment was needed at the outset, or some other patient health factor influenced that measure.

Over time, granular data can allow us to understand which type of treatment is best for patient outcomes in that circumstance.

It is discrete, granular data that can help providers fine-tune their processes in order to improve patient outcomes—and of course patient satisfaction. This same kind of close analysis can be applied to reducing costs. But for all three new, expanded pillars, efficient data collection, management, and analysis are needed. 

LUMEDX HealthView CVIS collects more than 30,000 discrete data points—from point-of-care devices to physician reporting. The robust analysis and reporting engine provides meaningful insights in the areas of treatment options, clinical evaluation and training, and service line optimization. HealthView CVIS is an important addition to any heart hospital's electronic records system.  

The Best of Cardio and Healthcare News for the Week of 1/4/16 

Did you have a chance to check out the latest news from the cardiology and healthIT communities? Let us help keep you up to date on the stories you won't want to miss.

2016 may bring slower patient growth, higher wages, more expensive drugs

Late 2015 data support health systems' anticipation that the demand surge from patients newly insured under the Affordable Care Act would fade this year. Economists with the Altarum Institute say spending acceleration from the coverage expansion may have peaked last February. 

FDA clears Biotronik's peripheral stent 

The FDA has cleared Biotronik's Astron Peripheral Self-Expanding Nitinol Stent System, a device for improving luminal diameter in patients with iliac atherosclerotic lesions. The stent system is described as a self-expanding stent loaded on an over-the-wire delivery system. 

Patients increasingly turning to mobile health apps

More than 30 percent of consumers last year said they have at least one health app on their smartphones, and 60 percent are willing to have a video visit with a doctor through a mobile device, according to an online survey of 1,000 U.S. adults. An increased use of telehealth apps is one of the predictions for 2016 from the PwC Health Research Institute.

Diagnostic errors, measuring performance among top healthcare quality issues for New Year

Zeroing in on individual doctor performance, reducing diagnostic errors, standardizing performance measures, and rethinking the patient experience may be among the top agenda items for healthcare quality and safety leaders this year. There could also be a greater focus on individual doctor performance as it relates to value-based payment and quality reporting.

Family satisfaction increases when ICUs relax their visiting hours

A survey published in the American Journal of Critical Care shows patients benefit when families visit throughout the day and night. "These findings support open and patient-centered visitation guidelines in critical care settings," the researchers wrote.
 

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