Viewing posts categorised under: Accountable Care Organizations

21st Century CURES Act and Post- Acute Care: Are You Aware?

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Accountable Care Organizations, Administration, Clinical Practices, Coding

21st Century CURES Act and Post- Acute Care: Are You Aware?

21st Century CURES Act signed into law.

 
December, 2016 saw the 994 page 21st Century CURES Act signed into law. The primary function was to identify new funding initiatives for the National Institute of Health and to expedite the Food and Drug Administration Drug and Device approval process. However, many other provisions were included; many of which impact post- acute care. There is over $6.3 Billion available in funding. Over $1Billion in grants were made available to fight the opioid epidemic, especially those directed toward improving drug monitoring programs. The Act addresses treatment of mental health and substance abuse, strengthening prior MH regulations such as the Mental Health and Safe Communities Act of 2015. Fortune Magazine stated that families will be helped with this Act through an “increase in availability of psych beds, establishing a new assistant Secretary for Mental Health and Substance Abuse in HHS, and boosting treatment for young MH patients among the other provisions.” This Act is considered by many as the “most significant attempt at MH reform in decades.” Section 4013 of the Act requires CMS to give an annual report to Congress regarding Medicare beneficiaries, “such as those with chronic conditions whose care may be improved most in terms of quality and efficiency through the expansion of telehealth services.” Telehealth is gaining attention. Section 12006 requires an electronic visit verification system for personal care services as well as home health services under Medicaid. States are required to have adopted a system(s) (not required to have a single state system) for personal care services by January 1, 2019 and for home health services by January 1, 2023 or they will face a reduction in payment. Of the other several provisions, two include making Medicare Advantage plan choice available for end-stage renal disease individuals and a provision updating the Medicare Advantage Risk Adjustment Model to account more accurately persons with multiple chronic conditions. Also, under section 17004, CMS is tightening a specific regulation under the “No Payment for Items and Services Furnished by Newly Enrolled Providers or Suppliers Within a Temporary Moratorium Area.”  This provision is meant to address new home health agencies that skirt regulation by establishing an office outside a moratoria radius but provide services within that area. This regulation covers Medicare, Medicaid, and CHIP services. This overall Act is far reaching and multi- dimensional. For more information on this topic or on our USA based Document review and Coding Services or Revenue Cycle Management, please call Select Data at 1.800.332.0555.
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CoPs: Patient Engagement- Start Preparing Now!

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Accountable Care Organizations, Clinical Documentation Improvement, Clinical Practices

Conditions of Participation (CoPs): Patient Engagement - Start Preparing Now!

The majority of newly revised CoP standards become effective in less than four months, July 13, 2017. Have you conducted your gap analysis yet?

 
The new CoPs signal a shift from problem-focused care that CMS acknowledges has had “inherent limits” to quality focused individualized care. CMS wants to “transform” care delivery. The new CoPs (See Select Data ezine February, 2017) promote actively involving the patient in their care. CMS stresses focusing on patient strengths as well as their specific outcome goals. The CoPs also stress using individualized communication methods with patients such as schedules, handwritten notes and charts, etc. How will your agency consistently involve patients, build on their strengths, and work toward mutual outcomes? Some Home Health agencies, in seeking to reduce care fragmentation and improving continuity of care are turning toward integrative models of care. Patient care has changed with greater demands for multi professional teamwork to offering patients collaboration and coordination. More traditional models tend to focus on isolated interventions rather than the total care needs of the patient. Traditional models frequently offer only partial solutions for improving outcomes and coordination of the care process. Integrated Care Models can be central to the patient-centered organizational design and performance. Without integration, health care performance can suffer. This “bottom up” approach to care views patient characteristics and strengths as essential for care plan development. This partnering with patients, families, caregivers, and professional members of the team promotes health literacy and ongoing engaged patient self-management. The cornerstone to integrated care depends on Motivational Interviewing (MI). Motivational Interviewing is a “method that works on facilitating and engaging intrinsic motivation within the client in order to change behavior” (Miller and Rollnick, 2002). MI is goal oriented and patient centered and it is non- confrontational. MI involves developing the ability to ask open-ended questions, to provide affirmations, increase use of reflective listening, and to provide summaries of care provided as well as progress toward goals. Those skills are used strategically reflecting on a typical day and desired change importance. MI is non- argumentative, understanding that knowledge alone disseminated to patients usually will not change behavior. MI requires working with patients to assess their motivators to change behavior which may not be consistent with their personal goals. Motivational Interviewing uses four general processes: Engaging- This means actively involving the patient in talking about their concerns. Engaging requires the clinician to visit with patients and seek their perspective on their health, solicit their interests, and ask about the patient’s desired goals. This is very different than going into the home to “assess” the patient and tell them the plan or to merely “educate” them regarding their disease and its process. Focusing- This process involves narrowing conversation to patterns the patient wants to change. This is a skill that requires practice by the clinician but is highly effective in helping the patient, in a positive manner, to view expressed desired goals and congruence or incongruence with action toward the goals. Evoking- This is a learned technique used to determine the patient’s sense of change readiness. Planning- This process assists in the development of truly collaborative steps to attain goals. One of the key factors learned in using MI in the home health visit process is that structure is essential for visits. Each visit should begin by 1. listening to the patient/caregiver discuss progress or issues encountered since the last visit. Discussion should discuss prior visit assignments; i.e. increasing ambulation steps by 20 each day. 2. Discussing today’s visit activities and goals so they are clear and any questions or comments can be shared. 3. At the conclusion of the visit, the clinician should review what was accomplished during that visit, review any assignments for either the patient or clinician, seek any comments, and discuss the next visit date and time. MI broadens patient/caregiver and clinician perspectives and builds on the momentum for behavior change which can ultimately mean improved outcomes. To learn more about Integrated Care Management consider training and certification at Sutter Center for Integrated Care. Here is a link for more information: http://www.suttercenterforintegratedcare.org/services/Training-Certification.html There are training programs at numerous hospitals including Mass General. For further information contact them at: http://www.umassmed.edu/cipc/icm/overview/ There are numerous books regarding Integrated Care and/or Motivational Interviewing including: Motivational Interviewing by William Miller and Stephen Rollnick.
For more information regarding CoPs or assistance in document review, clinical/coding audits, and Revenue Cycle Management, contact Select Data at 1.800.332.0555.

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Top 5 Challenges Facing Home Health Care Agencies

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Accountable Care Organizations, Clinical Documentation Improvement, Healthcare, The Affordable Care Act (ACO), Value-Based Purchasing

Top 5 Challenges Facing Home Health Care Agencies

Guiding The Home Healthcare Industry to Value-Based Purchasing Thru Clinical Documentation Improvement (CDI)

 
It’s no secret that growth in the home care industry is on the rise. More new agencies emerge on the scene every day. In fact, it’s one of the largest growing trades nationwide, with individual and franchise businesses popping up from coast to coast.  But, it’s also one for the most difficult business opportunities to get a handle on.  Partly because of the tremendous growth and partly because of the numerous fundamental changes occurring simultaneously, the home healthcare industry could be classified as particularly volatile (Kenyon Homecare Consulting, 2014). But despite the challenging nature of the industry, there are some bright spots on the horizon. Most of you agree, for example, that the movement to value, the rise of consumerism, and the use of new technologies could transform the industry for the better—it's just a matter of turning that potential into reality (Brown, 2014). Here are five of the heaviest hitters: Increasing Demand America is home to an aging population. By 2020, an estimated 17% of the entire population will be 65 or older. That’s 50 million men and women who will be increasing their reliance on the healthcare industry as a whole (Halvorson, 2013). With more aging individuals preferring to receive care in the comfort of home, many home care agencies will struggle to meet the growing demand with qualified staff and capable caregivers (Kenyon Homecare Consulting, 2014). Advances in Technology The home health care industry is in the middle of a tremendous technological revolution. In fact, figures released by Lucintel predict over $29 billion in growth by 2017. Older, outdated systems are being replaced with faster, less-intrusive and more powerful equipment. And the home health care industry is struggling to keep up.  Learning how to correctly and effectively use these new gadgets takes a considerable investment of time and effort.  While some agencies are leading the pack, others are lagging behind – put off by either the added cost of the added hassle (Halvorson, 2013). Political Pressure With the ongoing debate about who is right and who is wrong in Washington raging, healthcare is a big fat target for political movers and shakers (Halvorson, 2013). With a Trump Presidency political pressure is at an all-time high. President Trump has promised a repeal of the Affordable Care Act (Obamacare) but, has not outlined how or when. In a debate Tuesday night, Senator Ted Cruz made it clear that nothing is happening yet (Newkirk, 2014). Accountable Care Organization (ACO) Establishing an accountable care arrangement with a payer means entering into a total-cost-of-care system that rewards or penalizes based on the total cost of a patient population. These complex arrangements are growing even faster than bundled payments. There were approximately 500 ACOs as of year-end 2013. CMS announced 123 new ACOs that would start in January 2014. According to a Premier survey, ACO participation has almost quadrupled since spring 2012, and should continue to grow with participation projected to double by the end of 2014 to 50 percent of all hospitals participating (Brown, 2014). Home health agencies should be encouraging discussions among provider leaders of all levels of the care continuum. Patient ultimate outcomes should be shared by all providers. Establishing those mutual patient outcomes is a primary step in a strategic alliance between ACOs and PCMHs. It may be wise for some organizations to ease into the ACO world incrementally by starting with P4P and bundled payments. Entering into shared savings agreements is one of the main strategies hospitals must pursue to survive in this environment. Value-Based Purchasing However, the number one most challenging factor impacting Home Health Care agencies is the transition to value-based purchasing. Moving to value-based reimbursement continues to be a top challenge, according to our survey. While most respondents said their organization has at least started shifting its operations toward value, nearly one out of every five said they have not yet started transitioning and are "waiting to see what works for other organizations." How does Select Data improve your Agency's quality? Select Data improves your Agency's quality through our Clinical Documentation Improvement (CDI) system. Clinical documentation is at the core of every patient encounter (Ahima, 2017). Consider Select Data as a partner in achieving the best patient plan of care for the diagnoses to be coded and the goals needed to achieve those high quality goals and succeed with the CMS quality measures. Select Data improves your clinical documentation and provides a clear picture of your patient's health. Don’t wait, if you are an agency in one of the 41 states not yet officially affected. VBP is here to stay. Payors other than CMS are also looking at patient outcomes by diagnoses and using that factor as a guide as to whether or not they wish to contract with a provider. For a small Medicare certified agency, a 3% reduction in payment will be painful and a 5% reduction could be unsustainable. You need to be active in VBP education NOW! You may need to designate a position only for data analytics. You need to have strong partners whether in your EMR, your coding and document review, or in analyzing and providing the best plan of care for the patient in order to meet the VBP outcome level goals. Call Select Data at 1.800.332.0555 for more information. References Ahima (2017). Clinical Documentation Improvement: Overview. Retrieved from: http://www.ahima.org/topics/cdi Brown, Bobbi (2014) Healthcare Payers and Providers: The Best System for Process Improvement. Retrieved from: http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/top-5-industry-challenges-2016 Top 5 industry challenges of 2016 Halvorson, Chad (2013). Top 7 Challenges Facing Home Health Care Agencies in 2013. Retrieved from: https://wheniwork.com/blog/top-7-challenges-facing-home-health-care-agencies-in-2013/ Kenyon Homecare Consulting (2014). Top 5 Challenges Facing Home Care Agencies in 2014. Retrieved from: http://www.kenyonhcc.com/top-5-challenges-facing-home-care-agencies-2014/ Newkirk, Vann (2017). Republicans Don't Know How or When to Repeal Obamacare. Retrieved from: https://www.theatlantic.com/politics/archive/2017/02/nobody-knows-when-obamacare-repeal-is-happening/515955/
Related articles https://www.selectdata.com/value-based-purchasing-glance/ https://www.selectdata.com/home-health-value-based-purchasing-model-one-year-old-growing/

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Value-Based Purchasing At A Glance

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Accountable Care Organizations, Clinical Documentation Improvement, The Affordable Care Act (ACO), Value-Based Purchasing

Value-Based Purchasing At A Glance

Successfully Navigating the Home Healthcare Industry to Value-Based Purchasing Through Clinical Documentation Improvement (CDI)

 
On April 29, 2011, the healthcare industry changed forever. It’s on that date that the Centers for Medicare and Medicaid Services (CMS) released its Hospital Value-Based Purchasing (VBP) Final Rule, required under the Patient Protection and Affordable Care Act (StuderGroup, 2016). What is Value-Based Purchasing? The Hospital Value-Based Purchasing (VBP) Program is a Centers for Medicare & Medicaid Services (CMS) initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide to Medicare beneficiaries. How does Hospital VBP Work? CMS rewards hospitals based on:
  • The quality of care provided to Medicare patients;
  • How closely best clinical practices are followed; and
  • How well hospitals enhance patients’ experiences of care during hospital stays.
Hospitals are no longer paid solely on the quantity of services they provide. The Affordable Care Act of 2010 established the Hospital VBP Program, which applies to payments beginning in Fiscal Year (FY) 2013 and affects payment for inpatient stays in more than 3,000 hospitals across the country (cms.gov, 2016). How to improve your Agencies quality?
  • You must build a solid foundation...
  • Great field clinicians are not necessity
How does Select Data improve your Agencies quality? Through Clinical Documentation Improvement (CDI). Clinical documentation is at the core of every patient encounter (Ahima, 2017). Consider Select Data as a partner in achieving the best patient plan of care for the diagnoses to be coded and the goals needed to achieve those high quality goals and succeed with the CMS quality measures. Select Data improves your clinical documentation and provides a clear picture of your patients health. Don’t wait, if you are an agency in one of the 41 states not yet officially affected. VBP is here to stay. Payors other than CMS are also looking at patient outcomes by diagnoses and using that factor as a guide as to whether or not they wish to contract with a provider. For a small Medicare certified agency, a 3% reduction in payment will be painful and a 5% reduction could be unsustainable. You need to be active in VBP education NOW! You may need to designate a position only for data analytics. You need to have strong partners whether in your EMR, your coding and document review, or in analyzing and providing the best plan of care for the patient in order to meet the VBP outcome level goals. Call Select Data at 1.800.332.0555 for more information. References Ahima (2017). Clinical Documentation Improvement: Overview. Retrieved from: http://www.ahima.org/topics/cdi CMS.gov (2016). Hospital Value-Based Purchasing. Department of Health and Humans Services: Centers for Medicare & Medicaid Services. Retrieved from: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf Studer Group (2016). VALUE-BASED PURCHASING AT A GLANCE:Fiscal Year 2016 and Your Organization. Studergroup.com. Retrieved from: https://www.studergroup.com/industry-impact/value-based-purchasing
Select Data is committed to a strong compliance program that includes educating all personnel on mitigating HIPAA breaches. For more information about Select Data and their commitment to quality in Home Health and Hospice, call 1.800. 332.0555. Click here to contact us.

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ACOs, Transitions of Care, Patient Centered Medical Homes, Care Transitions: What Do They Mean for Home Health?

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Accountable Care Organizations, Slideshow

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Care Transitions Patient Centered Models ACOs Homecare Practical Approach

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Accountable Care Organizations, Patient Centered Medical Homes, Slideshow

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ACOs and Patient Centered Medical Homes: Home Health, Have You Prepared?

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Accountable Care Organizations, Patient Centered Medical Homes

CMS has, for years, suggested to healthcare providers across the care continuum that they must refine old and create new methods of providing care. Providers are expected to collaborate and coordinate to minimize the fragmentation in healthcare. They need to work together to improve care delivery, efficiency, and effectiveness. Home health care providers should be aware of the new Chronic Care Management Models that include Accountable Care Organizations (ACOs) (see Select Data ezine, January, 2012 ) and Patient Centered Medical Homes (PCMH). Through collaboration amongst stakeholders, with coordination of expensive chronic care, and with partnership developments, strategic alliances are being encouraged. Is your home health agency ready? What specific programs do you have in operation? Are they evidenced-based? What have been the outcomes? Do you have reliable statistics? As stated in the January, 2012 ezine: “Home health agencies should be paying VERY close attention to the latest requirement for home health found in the Affordable Care Act. The Act encourages development of Accountable Care Organizations (ACOs) and provides for “incentives to enhance quality, improve beneficiary outcomes and increase value of care.” (CMS Q&As Section 1899 of Title XVIII)  The ACO becomes a type of managed care organization that may use fee-for- service or capitation payment, and is accountable to patients and the third party payor for the quality, appropriateness, and efficiency of the care provided. Because of the Affordable Care Act, CMS must have an ACO in place by January, 1, 2012. Some home health agencies have begun aligning with physician offices, hospitals, rehabilitation facilities, and long term care providers to coordinate care across the health care continuum. Home health agencies are becoming members of hospital teams in both general and specialty areas. Agencies which cannot seem to form the alliances may find themselves with declining referrals in the near future. Home health needs to demonstrate their personalized approach to care so they may be appealing to the PCMH team. Home health agencies should be encouraging discussions among provider leaders of all levels of the care continuum. Patient ultimate outcomes should be shared by all providers. Establishing those mutual patient outcomes is a primary step in a strategic alliance between ACOs and PCMHs. Hospitals know that the bundled payment pilot begins January, 2013. It is expected that hospitals will be responsible for the patient three days prior to hospitalization, during hospitalization, and 30 days after hospitalization. They will more likely want to work with agencies with proven hospital reduction programs, quality care clinical programs, and positive patient outcomes. Agencies with those types of programs are already aligning to form care transition models to be ready to bill the new CMS ACO.” (Select Data ezine, 1/2012) Hospitals are also expected to be working closely with primary care practices which have the PPC- Patient Centered Medical Home Recognition. Many practices approved using the 2008 Standards have now applied to meet the 2011 National Committee for Quality Assurance (NCQA) Standards. The PCMH is defined by NCQA as an innovative program for improving primary care using clear and specific criteria centered around patients and their care needs, working in teams coordinating and tracking care over time. The PCMH program is for practices that “provide first contact, continuous, comprehensive, whole-person care for patients across the practice.” (NCQA, 2011) Per the NCQA: “The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.” The PCMH is being touted as an excellent way to improve healthcare in this country by “transforming how primary care is organized and delivered. The Agency for Healthcare Research and Quality (AHRQ) defines the PCMH as a model of the organization of primary care that delivers the core functions of primary health care.” The Patient Centered Medical Home must encompass five core functions and attributes:

  1. Comprehensive Care: The PCMH is accountable for meeting “the large majority of each patient’s physical and mental health needs, including prevention and wellness, acute care, and chronic care.” To meet required standards, comprehensive care must include a patient-centered team that may include physicians, nurses, PAs, pharmacists, social workers, and care coordinators. Large primary practices may have large teams while smaller practices may “link themselves and their patients to providers and services in the community” (NCQA, 2008).
  2. Patient Centered: The PCMH must provide “primary care that is relationship-based with an orientation toward the whole person.”  The standards require a partnering with patients and families that demonstrates an understanding of their unique needs, values, and preferences. The PCMH primary physician and team are expected to assist patients to manage and organize their own care.
  3. Coordinated Care: Care is required to be coordinated across “all elements of the health care system.” This care is considered critical during transition between levels of care with clear and open communication.
  4. Accessible Services: The PCMH is expected to deliver care in shorter timelines with individualized hours of care and 24/7 phone or electronic access to a member of the PCMH team demonstrating responsiveness to patient needs.
  5. Quality and Safety: The PCMH is committed to quality and quality improvement with ongoing evidence-based medicine and “clinical decision-support tools to guide shared decision making with patients and families.
CMS believes that for too long patients have been provided care by disparate systems; a hospital here, a home health agency there, and yet long term care over there. An ACO (created by health care reform law) is expected to include a broad network that will share responsibility for providing care. The ACO must be able to show they can provide care better than the singular services. Home health agencies should consider establishing patient populations of mutual interest and present evidence-based practice interventions that are likely to improve quality, diminish decline, and improve patient satisfaction not merely in one level of care but across that continuum.  NCQA released its ACO Accreditation Standards in 2011.The NCQA approach to ACOs emphasize patient-centered primary care; use of measurement techniques that improve health care, and high standards for care coordination. The CMS ACO initiatives were launched January 1, 2012, but ACOs were already being explored not only for Medicare but for other payor sources as well.  ACOs, theoretically, would make the providers jointly responsible for care and offer incentives to achieve quality outcomes yet, make a profit. There would need to be a seamless way to share information.  They would encourage standardizing care to reduce variable clinical practices. It is expected that those who would achieve the quality and financial goals would retain a portion of the savings.  The amount or percentage is yet to be determined. To work together with agencies with like values, goals, and evidenced-based processes could challenge present regulation. Would this mean the regulation regarding the hospitals discharge policy involving a referral list of local agencies would be changed? It would seem that would be needed since the hospital would be working with agencies that were a part of their ACO. Also, under a hospital led bundled payment, hospitals it would seem, would want to transition patients to agencies with specific programs in place to prevent readmissions. Agencies should be developing programs NOW that can significantly reduce emergent and inpatient care. Outcomes will play a larger role as to which agencies will be chosen as ACO members. NCQA views primary care as the foundation of the health care system. The primary care physician/team is frequently the first point of contact. The NCQA new standards require a patient survey to help drive quality improvement. It also requires involvement of patients and family in quality improvement. In addition, tracking care over time is necessary. Reducing fragmentation, involving patients and families actively, while transitioning through levels of care is a primary goal of the PCMH and the ACOs. Home health agencies should be prepared to statistically present outcomes and be ready to participate actively in devising a plan for sharing information. The need to dramatically alter home health care delivery is upon us. Agencies need to be prepared for this change. Be open and receptive to collaborative practices. Be prepared to assist in standardizing teaching and discharge planning instruction. And one other point: CMS is subtly suggesting that discharge planning will soon evolve into transitional planning as the patient moves from one level of the care continuum to another. Be prepared for that transition or face the potential consequences. Before and after home health care could well be the PCMH. Home health agencies may need to blend into that model. No matter what, data, statistics, and analytical analysis will be vital and an integral part of any Chronic Care Management Model. Are you prepared…or preparing?

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