Three Affordable Care Act Questions Everyone in Healthcare Is Asking

Trump/Republican rhetoric recently met reality when it comes to the Affordable Care Act (ACA). The latest version of the bill that passed in the House is far from a complete repeal and replacement of the ACA. However, the bill includes significant changes to healthcare policy and coverage, from severe Medicaid cuts to shifting financial accountability. ACA uncertainty has healthcare leaders concerned about how to plot a path forward, with three questions on the top of their minds:

1. What will the final bill look like?
2. How do I plan for the changes?
3. What should happen next to fix the problems with the ACA?

Answers to these questions, although helpful, distract the industry from the ultimate goal: delivering on healthcare’s longstanding mission to provide quality, affordable healthcare. In short, health systems need to continue prioritizing patients until the ACA dust settles in Washington.

Preparing for Changes to Medicare Reimbursement—The Latest CMS Proposed Measures

Health systems that aren’t prepared for changes to Medicare reimbursement under a value-based system risk quality penalties and reduced reimbursement. They can protect themselves by following the Centers for Medicare and Medicaid Service’s (CMS) annual Measures Under Consideration List—and not waiting till it’s too late to address gaps in their system. The measures accepted from the list of proposals will help determine the areas of care delivery that Medicare will hold organizations accountable for. It’s never too early for health systems to prepare. CMS selects measures that are already nationally recognized as priority areas for improvement, giving organizations proactive direction in their improvement strategy.

Is Value-Based Healthcare Here to Stay? Looking for Answers in New Policies

Healthcare leaders are eager for a modicum of clarity when it comes to the industry’s shift to value-based healthcare given the uncertainties of Congress and the new Administration. Fortunately, an analysis of three key pieces of information tells us value-based healthcare is likely here to stay:

1. The 21^st Century Cures Act (Cures).
2. The Executive Order on reducing the “burden” of the Affordable Care Act (ACA).
3. Tom Price’s comments at his confirmation hearings.

It is a relatively safe bet that value-based healthcare delivery and payment programs will continue to be supported by federal law and regulation for several reasons:

• Bipartisan support: The success of Cures indicates that bipartisan cooperation will continue on key healthcare issues.
• Market-based innovation: The emerging evidence is that Congress and the Administration will support innovation in payment and delivery models.
• Support for Existing ACA Innovation programs: Although highly uncertain, there are some indications that not all of the ACA will be scrapped.

Introducing Health Catalyst MACRA Measures & Insights—Addresses Top Physician Concern: Capturing Compliance Measures

A recent Health Catalyst®/Peer60 survey revealed that compiling quality metrics is the top concern for physicians—a regulatory burden expected to worsen in 2017 as physicians struggle to report quality metrics for the Medicare Access & CHIP Reauthorization Act (MACRA)—the federal law that changes the way Medicare pays doctors. MACRA Measures & Insights™—Health Catalyst’s new MACRA solution—does so much more than alleviate this reporting burden:

• Helps health systems track and monitor all MACRA measures across multiple departments.
• Helps systems maximize Medicare reimbursement and monitor performance against measures year over year.
• Enables healthcare organizations to tactically and strategically identify the optimal measures to include within multi-year, value-based care contracts with commercial payers.

Powered by the Health Catalyst Analytics Platform™, which can integrate virtually all of the granular data in a healthcare system, including claims and other external data, MACRA Measures & Insights gives health systems deep insight into performance measures at the degree of detail required for measurement and performance improvement.

Are Health Systems Ready for MACRA? Survey Reveals the Number One MACRA Concern and Varying Degrees of Readiness

The Medicare Access and Chip Reauthorization Act (MACRA) replaces a number of value-based reimbursement programs and will use 2017 as its first reporting year. But, despite being right around the corner, a survey of healthcare professionals around the country reveals only one-third are ready. But while only 35 percent of respondents have a strategy and believe they’re prepared for MACRA, most will participate in the new program. A majority of surveyed hospitals believe MACRA will benefit their physicians (or that they’ll at least break even). MACRA is new, complicated, and rife with uncertainties given the new administration. According to the survey, the top concern for health systems is compiling MACRA quality measures. But despite the industry’s slow movement towards MACRA, the bottom line is that it’s right around the corner, so hospitals must start preparing for MACRA today.

Hospital Readmissions Reduction Program: Keys to Success

Avoidable readmissions are a major financial major problem for the healthcare industry, especially for government payers. To tackle this problem, CMS launched the Hospital Readmissions Reduction Program (HRRP). While some hospitals may be able to absorb the financial penalties under HRRP, they still need to track increasingly complex reporting metrics. Most tracking solutions are inadequate for today’s complicated reporting needs. A healthcare enterprise data warehouse and analytics applications, however, are designed to solve the numerous reporting burdens. When used together, they also deliver a robust solution that enables hospitals to track and drive real cost and quality improvement initiatives, all without the need for users to be technical experts.

Preparing for MACRA: A Comprehensive FAQ for Physicians

The Medicare Access and CHIP Reauthorization Act (MACRA) overhauls the payment system for Medicare providers. It’s a complex program that requires careful study so physicians can make the best choice for how they want to report. This choice ultimately impacts reimbursement and the potential bonuses or penalties associated with each reporting option. This FAQ covers both tracks of the new rule, the Merit-based Incentive Payment System (MIPS), and the Advanced Alternative Payment Model (APM), with a background review and a comprehensive list of questions and answers. It’s a practical guide complete with next steps for strategic and tactical planning.

Why the 21st Century Cures Act Is Great News for Healthcare

The 21^st Century Cures Act, approved by the U.S. Senate on December 7, 2016, is perhaps the most significant federal legislation as it relates to health information technology (HIT) in years. What the Cures Act means for HIT companies and providers is two key things:

1. Health information interoperability will be strongly promoted (involves the development of a “trusted exchange framework” which is expected to facilitate the exchange of health information nationally and locally).
2. Information blocking practices will be strongly prohibited (e.g., Implementing HIT in nonstandard ways likely to increase the complexity or burden of accessing, exchanging, or using electronic health information—with fines as much as $1,000,000).

The Act’s impact on the healthcare industry is monumental, with significantly improved provider access to clinical, financial, and operational data to improve outcomes. The Act’s provisions to promote the free exchange of health information will improve care coordination industrywide.

The Who, What, and How of Health Outcome Measures

Even though thousands of health outcome measures have the potential to impact the work we do every day, how well do we really understand them? In this article, we take a close look at the definitions, origins, and characteristics of health outcome measures. We break down the financial relevance of certain measures, the relationship between outcome measures and ACOs, and which measures impede, rather than enhance, a typical healthcare system. We review the role of an enterprise data warehouse and analytics, and we touch on the future of health outcome measures, all in an effort to provide deeper insight into some of the mechanics behind outcomes improvement.

How Physicians Can Prepare for the Financial Impact of MACRA

If all goes according to plan, the first performance period for the new Medicare Access and Chip Reauthorization Act (MACRA) is just around the calendar corner. It’s a complicated reimbursement structure with multiple tracks that are guaranteed to reward with bonuses or inflict pain through penalties in CMS’s new zero sum game. To the physicians and practices that adopt this new program early and position themselves for the best fiscal outcomes, go the spoils. But for many smaller practices and those that consistently underperform, the outlook may be glum regardless. Here are some highlights of the new program and the financial impact it will have on clinicians and practices.

The 7 Best Ways to Prepare for MACRA Today

The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law in 2015, with major impacts starting in 2019. MACRA attempts to prioritize quality over quantity by letting providers choose between two value-based payment tracks: MIPs and APMs. Providers won’t have to choose until 2019; until then, they will receive a .5 percent annual increase. The industry is conflicted about MACRA. On the one hand, many believe it is part of the overall shift to value-based healthcare. On the other hand, many say the administrative burden will overwhelm providers. Another area of MACRA controversy has to do with meaningful use which, contrary to what the CMS Acting Administrator said in 2016, isn’t going away with the introduction of MACRA. Although it seems a ways away, MACRA’s base year will likely be 2017. Armed with the seven best ways to start preparing for MACRA today, and an EDW that provides clinicians with the self-service tools to monitor their performance, health systems can be ready to tackle MACRA when it finally goes into effect.

Why We Need to Shift Healthcare Quality Measures from Volume to Value

Healthcare quality reporting is integral to achieving the Triple Aim and improving outcomes. But the sheer volume of quality measures has become as much a part of healthcare as healing and prevention. Recently, CMS and AHIP took the unprecedented step of aligning and consolidating measures in seven care categories. This will go a long way toward reducing the amount of time physicians and staff spend every week on quality reporting, but it’s only a beginning. Healthcare’s focus needs to shift from volume to value of quality measures, such as those that concentrate on quality of life and patient-reported outcomes. The International Consortium for Health Outcomes Measurement is setting the right example for quality measures designed to actually improve outcomes rather than just processes.

Two-Midnight Rule: Ready For the Clock to Strike 12?

CMS’s proposed changes to the controversial two-midnight rule that governs short hospital stays, has been met with strong opposition by the healthcare community. While the core of the rule is fairly straightforward, implementation could be anything but. Being classified as an outpatient or inpatient can have a substantial financial impact the patient and the hospital. Adding to the confusion, CMS has also stated this policy won’t override a physician’s judgment. Unfortunately, CMS failed to provide details on what the physician must provide in order to justify their decision. The good news is there is still time to provide feedback to CMS. Take action, understand the new rules, let your voice be heard, and most importantly, be prepared for the new rule in 2016.

Top 7 Healthcare Trends and Challenges from Our Financial Expert

As the healthcare industry moves closer to value-based care, there are a lot of projections about the changes that will occur in the near future. This article discusses seven of the top trends the industry is focused on: (1) physicians start to feel the financial impact of CMS’s rules; (2) the use of technology in healthcare is exploding; (3) financial viability is a key concern for CEOs; (4) reducing exposure to risk performance is becoming more important; (5) interest in population health management continues to grow; (6) outcomes improvements will continue to increase; and (7) collaboration between providers and payers will increase.

5 Strategies to Use Regardless of What Happens to the ACA

Our guest commentator, Dr. Tommy Prewitt from HORNE LLC, believes that the ACA is likely to fail. He has 5 strategies he suggests that hospitals should use, regardless of what happens with the ACA. 1. Rethink your model of care by eliminating waste. 2. Allocate 20% of your financial resources toward care innovation. 3. Get serious about data analytics; in fact, this is a good place to spend your 20%. 4. Avoid buyer’s remorse and be cautious when buying smaller hospitals. 5. Win the race to the bottom; post fixed charges for episodes of care. 

How to Survive CMS’s Most Recent 3% Hospital Readmissions Penalties Increase

Hospital readmissions rates are now at 3 percent, which means that health systems are feeling the financial burden of decreased payments from Medicare. They also need to track two more 30-day readmission rates. While there aren’t any new penalty measures planned for 2016, coronary artery bypass grafts will be added as yet another measure to track in 2017. By using three strategies to reduce readmission rates, health systems will experience better outcomes and decreased penalties. The three strategies include the following: (1) implementing a data warehouse that provides a single source of truth; (2) engaging a multidisciplinary team to lead the improvement efforts; (3) installing a sophisticated analytics platform.

5 Ways to Use the ICD-10 Delay to Create a Competitive Advantage for Your Health System

In April 2014, Congress gave the entire healthcare industry in the U.S. a reprieve — a one-year ICD-10 delay before providers will be required to document care using ICD-10 codes. The new deadline is October 1, 2015. The question now is, what will health systems do with an extra year to make the transition to using ICD-10 codes? My recommendation is to proceed as though the ICD-10 deadline will still happen this year for five reasons: (1) Coders need time to learn how to code. (2) Dual coding early rewriting of reports and the discovery problems. (3) ICD-10 codes can be used to improve analytics and provide a 2014-2015 comparison of data. (4) Health systems will be able to more accurately project the financial impact of the transition. (5) Payers are learning too, opening up new opportunities for improved relationships with providers.

Why You Need to Understand Value-Based Reimbursement and How to Survive It

There are clear signs the healthcare industry is in the midst of a shift to value-based reimbursement. The most noticeable signs are the recent and proposed 2015 rulings from CMS. There are four areas in value-based reimbursement that will be impacted by the end of 2015: the physician payment structure, bundled payments, Inpatient Prospective Payment Systems regulations, and commercial payers. To survive the shift to value-based reimbursement, it’s important for providers and payers to take three steps: provide access to rich data, share knowledge and learn from each other, develop strategies by doing assessments.

The Unintended Consequences of Electronic Clinical Quality Measures

Many quality reporting programs are being to shift to the use of electronic clinical quality measures (e-measures).  There are good reasons and benefit for accelerating this shift and reducing the labor and effort associated with previous manual approaches.  However, there are some potential unintended consequences to this shift.  Healthcare providers must pay even more attention to reviewing the integrity of their clinical data.  Failure to do so could result in inaccurate reporting and create financial risk.  By tightly combing quality reporting efforts with strong data governance practices, however, healthcare organizations will not just survive, but also benefit from, the move to electronic quality measure reporting.

4 Ways to Reduce Penalties Under the Hospital-Acquired Condition Reduction Program

Hospitals with high rates of hospital-acquired conditions face steep financial penalties if they can’t adhere to CMS’ new rule. But by following these four tips, hospitals will decrease their risk of penalty for HACs: (1) Proactively evaluate, measure, and optimize critical care processes and outcomes.  (2) Put the right coding processes in place to accurately capture your patients’ POA data.  (3) Apply what you’ve learned to create a culture of safety. (4) Consider active surveillance systems to identify HACs and potential patient harm.

CMS Reporting Requirements – 4 Changes Hospitals Need to Know for 2014

Hospitals need to be proactive to avoid the penalties from CMS’ reporting measures. In specific, there are 4 changes to be aware of: 1) Value based purchasing will include two additional outcome measures: CLABSI and PSI. 2) The Readmissions Reduction Program will be expanded to include COPD and THA/TKA, plus there’s a proposed 3 percent penalty for readmission. 3) Under the new proposed HAC Reduction Program, hospitals with the highest rate of HACs will receive a 1 percent reduction in Medicare inpatient payments. 4) Medicare proposes to align reporting for the Electronic Health Record and Inpatient Quality Reporting.

Simplifying the Meaningful Use Stages: The Case for Eliminating Stages 2 and 3

Meaningful use is a federal program with good intentions, but it fails to produce meaningful results for clinicians and patients. A recent study found no correlation between quality of care and observance of meaningful use requirements. Stage 1 was a much-needed prod for the industry, but it’s time to let organizations drive themselves to fully use their EMRs. The core principles of EMR utilization include guidelines around: Encounters, Medications, Problem Lists, Allergies, Orders, Progress Notes, and In Basket. Stages 2 and 3 of meaningful use should be eliminated.

Meaningful Use and ACO Reporting: Why an EMR Is Only a Partial Solution

Meaningful Use and ACO reports are just two of a plethora of ever-increasing external healthcare reporting requirements. An EMR is only a partial solution due to limitations in data turnaround time, data and logic multi-purposing, and being relegated to single-vendor, homogenous environments. Learn about a solution that helps you streamline your Meaningful Use and reporting requirements and can be leveraged for clinical quality improvement, population health and predictive analytics.

The Medicare Sustainable Growth Rate Repeal: Implications for Your Health System

The Sustainable Growth Rate (SGR) Repeal and Medicare Provider Payment Modernization Act of 2014, introduced to Congress on February 6, 2014, is a bipartisan attempt to address perceived failings of the current Medicare physician payment system, the so-called “Doc Fix.” Below, two industry experts provide commentary on the bill’s proposed changes and the implications for health systems and providers.

From Meaningful Use to Meaningful Analytics

Guest contributor, Brian Ahier, describes the transition from “meaningful use” to meaningful analytics and achieving high-quality care. Since meaningful use is requiring greater interoperability and data sharing, there is now much greater opportunity to aggregate data at a community level and have an even broader data set than just the EHR to mine for clinical intelligence. One benefit from HIE, besides improved care coordination, is the ability to perform queries and apply analytical tools to those data that were not previously available. The five health outcomes policy priorities included in meaningful use are: 1. Improve quality, safety, efficiency and reduce health disparities 2. Engage patients and families 3. Improve care coordination 4. Improve population and public health 5. Ensure adequate privacy and security protections for personal health information