I recently ran across an announcement that I found to be quite interesting. On November 3, 2015, the Department of Health and Human Services (HHS) released proposed requirements for discharge planning for hospitals participating in Medicare and Medicaid. And, the requirements would implement changes from the Improving Medicare Post-Acute Care Transformation Act of 2014. Public comment is open until January 4, 2016. We can expect new rules to go in effect sometime in late 2016 or early 2017.
In caring for patients, collaboration between providers is key to successful outcomes. However, since hospitals and other healthcare providers frequently use multiple, disparate systems, exchanging information and even communicating basic data can often be quite challenging. And when trying to coordinate resources for appointments and medical events, these differences can present insurmountable obstacles that frustrate patients, providers and office staff alike.
When preparing to negotiate payer contracts that establish reimbursement rates, many providers don’t realize that this is also an excellent opportunity to assess and improve their overall financial performance. However, this will require operational insight into key metrics in order to objectively assess your organization’s performance while also managing the payer negotiations from a position of strength.
As providers begin to see the effects of ICD-10, it becomes more important than ever to review your Clinical Documentation Improvement (CDI) program. The increased specificity that ICD-10 demands, along with the productivity concerns, provides the impetus to not only improve your documentation, but also all your processes around CDI. Succeeding now means we need to work smarter, and that reinforces the need for a multi-faceted approach to maximize our CDI results. Whether you have a well-established CDI program, are just getting started or somewhere in between, here are five areas to review to ensure you’re getting the most out of your CDI efforts.
Consumer focus on health records is really heating up. I recently searched Twitter for the phrase “medical records” and found that, between Aug-Sept 2015, the number of news tweets increased by 80% over the previous 6 months. It’s attracting a lot of media attention and people are starting to ask: “Where exactly is my medical record?” and “What kind of information is not included in my medical record?”
Healthcare is moving quickly and irreversibly into a new era of risk-based accountable care. This business model will leverage predictive analytics on big data as a primary conduit to adapting and eventually succeeding in value-based purchasing programs. As such, it’s critically important to bring together traditional clinical and financial data in meaningful ways. However, there are many other sources of data available that can be factored into analysis. If properly collected and processed, this can provide valuable insight into managing care and aligning resources in ways that improve outcomes while also achieving value metrics.
Patient Scheduling is a critical but often underappreciated element of care delivery. Despite the high profile role it plays in influencing everything from the patient experience and financial performance, many organizations often see it as a necessary evil of sorts, relying on dated systems or add-on functionality from their EHR to manage appointments. Whether each department manages its own scheduling or you have a call center, using an Enterprise Scheduling system improves the experience for all stakeholders in care delivery.
We all know that ICD-10 will bring with it a learning curve for coders at provider organizations. Despite all our preparations, training, and dual coding scenarios, there will be an impact to the revenue cycle in terms of higher DNFB due to longer coding times and possibly reduced revenue due to missing specificity.
As provider organizations adapt to the new realities of healthcare delivery in the US, the need has never been greater for an integrated view of not only the care delivery enterprise but also the interdependencies between the financial and clinical operations.