Lessons Learned From Pioneer ACOs

As previously reported, nine Pioneer ACOs backed out of an experiment aimed at changing the way medical providers are payed. Although the departure of nearly 1/3 of participants occurred, it was expected seemingly because no model may be right for every population in every community. Two takeaways from the model program were that “ACOs will only succeed over the long term if they genuinely engage patients, families and consumers, in a comprehensive way, in both their design and their implementation, Ness and Kramer said.”  Also, patience in the adjustment period and patience in dealing with hardships will ultimately strengthen the delivery of primary care.

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Defining “Full-time”

The Affordable Care Act comes with many new laws and regulations that will affect the nation as a whole.  While the employer mandate was delayed a full year, it has still been a major concern for many.  Business owners as well as employees still remain skeptical about what exactly “full-time” entails. Capitol Hill defines full-time as working more than 30 hours per week, but some lawmakers may push to make it 40.

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State Insurance Exchange Rates Expected To Rise

Monthly premium rates offered by insurance carriers participating in the exchange are predicted to increase both in the individual and small group market.  According to the report, younger age groups will see the biggest increases in premiums while older individuals will see the lowest increased rates. The takeaway is that it is important for individuals and families to know their annual income and the amount of subsidy they will receive before heading into the marketplace in search of an insurance plan.

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CT Health IT Investments

As the Obama Administration threatens to penalize healthcare providers that do not use electronic medical records by 2015, hospital officials say the total costs of investing in technology are straining their bottom lines.  According to the Centers for Medicare and Medicaid Services, CT healthcare providers have been funded $161 million in federal health IT funds since 2011.  While this seems to be a large figure, it does not cover the total costs of investing in technology.

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August 1 Reporting Deadline

Another stipulation of the Affordable Care Act will be effective August 1st.  The Physician Payment Sunshine Act is designed to expose financial relationships between doctors and industry and requires physicians and teaching hospitals to annually report gifts and payments they receive from medical device and pharmaceutical manufacturers. Group purchasing organizations and drug and medical-device manufacturers will have to report any “transfers of value” of $10 or more they make to doctors and teaching hospitals.  Manufacturers must begin collecting data by August 1st, 2013 and reporting the data to CMS by March 31st, 2014.

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Tiptastic Tuesday: Reducing Hospital Readmissions

According to Yale News, hospital readmissions for older patients cost American taxpayers more than $15 billion per year.   Also, one in five Americans end up back in the hospital within thirty days discharge.  Rosalind D’Egenio’s six tips for reducing hospital readmissions include:

  • partnering with community physicians
  • partnering with local hospitals
  • assigning responsibility for medication reconciliation to nurses
  • sending patients home from the hospital with an outpatient follow-up appointment already made;
  • having a process in place to send all discharge or electronic summaries directly to the patient’s primary care physician;
  • assigning staff to follow up on test results after the patient is discharged.

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Deciphering Medicare Spending

A report conducted by the Institute of Medicine researched if Medicare spending patterns largely have to do with geographic variances in post-acute care. The report was conducted by request from Congress to seek whether or not a geographically-based payment index made sense for Medicare.  Ultimately, a push to support accountable care organizations, medical homes and bundled payment groups will achieve better outcomes instead of using geography to determine Medicare rates.

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