cmonfils | April 3, 2012
CHICAGO—Insurers and health care organizations need to devise detailed policies on how they and their employees use social media to reduce their risks of violating medical privacy law and damaging their reputations, experts say.
http://www.businessinsurance.com/article/20120401/NEWS06/304019985#crit=sheena
cmonfils | February 29, 2012
Self-Insurer January 2012 Issue, Volume 39
By Jason Kimpel, Baker & Daniels LLP and Nick Manetto, B&D Consulting
When it comes to reviving patients from near-death experiences, the Medicare Shared Savings Program (MSSP), or Accountable Care Organization (ACO) initiative, may rival even the most herotic examples of medicine. (more…)
cmonfils | February 9, 2012
Accountable care organizations (ACOs) are networks of physicians and other providers that are held accountable for the cost and quality of the full continuum of care delivered to a group of patients.
cmonfils | February 9, 2012
There are serious issues with our health care system and even more question as how to fix it. Accountable care organizations aim to directly address the problems plaguing health care, including cost, quality and satisfaction. They’re also an integral component to health care reform. But are ACOs the way to go?
For years, the U.S. health care system has been called broken. Health care costs continue to spiral upward, outpacing inflation, and the quality of care has been lacking, even among primary care physicians. Given these issues, health care consumers are struggling to get the care they need at an affordable rate.
cmonfils | February 8, 2012
Chuck Weller, Cleveland–As a health care old timer who lived with the HMO Act of 1973 and a lawyer, ACOs seem much like HMOs under another name and will not succeed as much as the country needs for many of the same reasons. Eg, state regulation of insurance cripples interstate innovation and competition (the US is the only major country in the world that bars national insurance competition in effect creating state insurer and HMO monopolies), capitation and provider risk theory vs the complexity of patients having vastly different health status, lobbyists that understandably protect their clients and undermine needed innovation, and more.
The best hope for ACOs and Medicare/Medicaid reform generally is a two step process that taps what everybody in health care knows from Dr Wennberg’s work on variations is on the order of $750 billion annual savings. The first step avoids lobbyists and government having to devise enormously complex and ever changing payment innovations. The first step takes advantage of a legal opportunity many don’t know and is not just theory, as it resulted in what the CBO reported was “the slowest rate of growth in over 30 years” in public and private health benefit costs in the early 1990s. The first step is to have a few self-insured employer and union plans adopt Michael Porter and Elizabeth Teisberg’s idea of paying providers as a team by disease, what I call “Patient Value Organzaiations.” As legal matter, that is not insurance and thus payment innovation (excluding capitation) is not regulated by 50 states. There are 110 million people with self-insured benefits, and success at one employer or union plan triggers adoption by others at great speed. The second step is for government programs to adopt the new creations, PVOs. Think horse and buggies in 1890–that’s our health care system now. Let the first step of innovation begin–so we all can be in jet planes soon.
cmonfils | February 8, 2012
It’s often said that the main method of paying health-care providers—with a fee for each service—results in increased and wasteful spending. Such a system, its critics say, rewards providers just for doing more procedures, rather than for providing efficient and high-quality care.
cmonfils | February 3, 2012
One of the lesser publicized provisions of the Affordable Care Act creates “accountable care organizations” or “ACOs” ACOs are a new healthcare delivery model for Medicare beneficiaries that attempts to address the well known problem with the current , procedure-based Medicare billing system, which encourages multiple (and sometimes redundant and unnecessary) medical tests and procedures. It also organizes the delivery of medical care around a particular diagnosis or condition, as opposed to addressing the patient’s overall physical and mental well-being. Medicare has already limited reimbursements for multiple procedures but reports of unnecessary duplicate treatments – particularly with regards to imaging services .
cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
Sponsors and administrators of employer-sponsored health plans will spend lots of 2012 in implementing the health reform law, because there’s still a lot of uncertainty that will decide the fate of self-funded health plans in particular. Plans will have to raise annual limits on essential benefits (as defined by reform rules) to $2 million starting next Sept. 23. Plans won’t have to pay new fees to fund comparative effectiveness research in 2012. But 2012 will be the year plans learn the payment frequency of and the method used to calculate the fees they will start paying in 2013. Similarly, plans won’t have to start issuing summaries of benefits and coverage (SBCs) to all participants, but they will be waiting and watching for rules about the SBC to develop, so they know how to satisfy that requirement. (more…)
cmonfils | January 8, 2012
www.myhealthguide.com
MyHealthGuide Source: Chris Dimick, American Health Information Management Association (AHIMA), 1/4/2012, AHIMA Field Guide
CHICAGO — The healthcare industry has been inundated with change in recent years and health information management (HIM) professionals are being challenged to re-evaluate and prioritize initiatives that will have the most impact on the profession. Seven of the nation’s top initiatives will be monitored throughout the year by AHIMA’s HIM experts and are discussed in this month’s Journal of AHIMA cover story, “Field Guide: Seeing the Trees Through the Forest in 2012.” (more…)
cmonfils | January 8, 2012
On Thursday, October 20, 2011, The Centers for Medicare & Medicaid Services (CMS) released the long-awaited final rule regarding the formation of accountable care organizations (ACOs). The new rule makes a number of changes from the proposed rule discussed in our prior alert. Generally, the changes increase the financial incentives, reduce financial risks, and mitigate some compliance burdens for ACOs.
cmonfils | November 14, 2011
This issue paper examines the latest developments in accountable care organizations (ACOs), including a look at the final regulations on ACOs issued in October 2011 by the Centers for Medicare & Medicaid Services (CMS). Written by the Urban Institute’s Bob Berenson and Rachel Burton, this paper provides an overview of ACOs, the key complaints about CMS’ proposed regulations and their resolution in the final regulations, and the status of adoption of this new model for delivering health care by both Medicare and private health insurance plans. This paper is supported by the Robert Wood Johnson Foundation.
cmonfils | November 7, 2011
The U.S. Department of Health and Human Services (HHS) released the final rules governing Accountable Care Organizations (ACOs) on October 20, 2011, to be published in the Federal Register on November 2, 2011. As one of the value-based purchasing models authorized by the Affordable Care Act, the ACO shared savings program encourages health care providers to work together to redesign care processes in order to deliver high-quality and efficient care by offering to share the savings achieved for the Medicare program.
cmonfils | October 26, 2011
The Obama administration on Thursday bowed to health industry concerns about its plans for Medicare accountable care organizations, making it easier for doctors and hospitals to participate in the program designed to lower medical costs.
cmonfils | September 11, 2011
Modern Healthcare September 5, 2011-09-09
Melanie Evans
Norton Healthcare, Humana already seeing results in first year of pilot project
One year into an accountable care organization, Norton Healthcare and Humana officials can point to results—which is more than anyone expected at the outset.
As hospitals, medical groups and commercial insurers grapple with how to launch an accountable care network and Medicare officials debate final rules for ACO shared-incentive payments, Norton, which owns four Kentucky hospitals, and insurer Humana have a year’s worth of results from a limited pilot. (more…)
cmonfils | August 30, 2011
www.modernhealthcare.com By Rich Daly August 1, 2011
CMS’ actuaries: Healthcare spending will continue to increase, despite reform law promises
The landmark 2010 healthcare law will not slow the nation’s ballooning healthcare spending in the coming decade, and it will drive spending away from hospitals and toward physicians and pharmaceuticals, according to projections from the government’s healthcare actuaries. (more…)
