FEATURED ARTICLES: ACO
OIG Blames Hospitals For CMS Overpayments
Report from OIG estimates that CMS overpaid hospitals $38.2 million for unnecessary short-stay claims related to cancelled elective surgeries By Greg Bengel, contributing writer
Is The ACO Acceptance Glass Half Full Or Half Empty?
One survey reveals hospital executives reluctant to implement ACO models; another says momentum around ACOs is growing. Which one is right? By John Oncea, editor, Health IT Outcomes
Insights Into Implementing A Patient-Centered Medical Home
Considering a move to a patient-centered medical home environment? Read what providers making the transition have to say.
Onward And Upward – Predictions For 2014
It’s hard to believe we are already closing out another year! With 2014 upon us, I took some time to reflect on what progress the healthcare industry made in 2013, and to contemplate what’s to come in the year ahead. This year, we saw increased investment in technologies to support gains in the efficiency and quality of patient care, and I really think that 2014 will be a year of continued evolution. By Terry Edwards, president and CEO, PerfectServe
CASE STUDIES & WHITE PAPERS
Providing Accountability: Accountable Care Concepts For Healthcare Providers Healthcare expenditures in the United States totaled $2.5 trillion in 2009. Researchers estimate as much as 30 percent of those costs, or $750 billion, may have been due to overuse, underuse, misuse, and/or inefficiencies of healthcare services. By RelayHealth
Enhance The Quality Of Care, While Reducing Costs
Read this analyst white paper, Sophisticated Solutions to Optimize Healthcare Delivery, and see how enterprise content management solutions can enable your organization to optimize patient care, reduce the cost of healthcare, and improve clinician satisfaction and overall organizational productivity.
Even A 60-Year-Old Multi-Specialty Practice Can Succeed With EHR
After 60+ years in operation, The Veranda multi-specialty practice wanted a solution that would include an integrated electronic health record (EHR)/practice management (PM) solution, as well as one that could support multiple specialties as the practice considered growing outside of its OB/GYN roots.
IT Infrastructure: A Foundation For Accountable Care Organizations The advent of healthcare reform will require a health information technology infrastructure that integrates all the “moving parts” of an ACO, including hospitals, physicians, labs, outpatient centers, claims and analytics.
FROM THE EDITOR'S DESK
The Problem With Consumerism In Healthcare
Many industry leaders championed a free market approach to healthcare during the 12th Annual World Health Care Congress last week. Here are a few key reasons why I don’t think this model is “the fix” our industry so desperately needs.
ABOUT ACCOUNTABLE CARE ORGANIZATIONS (ACO)
An Accountable Care Organization (ACO) utilizes a payment and care delivery system that bases payments to providers on quality metrics and seeks to reduce the total cost of care for a certain population of patients. ACOs use a range of payment models and consist of groups of coordinated healthcare providers that provide care to groups of patients. ACOs are accountable to a third-party payer and the group of patients for the appropriateness, quality, and efficiency of the health services they provide.
In 2011, the Department of Health and Human Services (DHHS) set forth initial guidelines for ACOs to be created under the Medicare Shared Savings Program. These guidelines contained all necessary steps required for a physician, health care provider, or hospital to voluntarily participate in ACOs.
The quality measures used to evaluate an ACO's performance as defined by the Center for Medicare and Medicaid Services (CMS) fall into five domains. These domains are patient/caregiver experience, care coordination, patient safety, preventative health, and at-risk population/frail elderly health.
The three stakeholders in an ACO are the providers, payers, and patients. Providers are a network of hospitals, physicians, and other healthcare professionals. The primary payer is the federal government, Medicare, but also includes other payers such as private insurances or employee-purchased insurance. The patient population of an ACO will primarily consist of Medicare beneficiaries, but in larger ACOs can also include those who are homeless and uninsured.
ACOs Face Interoperability Barriers
According to a new report, a lack of out-of-network interoperability is the biggest obstacle facing ACOs today. By Katie Wike, contributing writer
Adverse Event Reporting: Avoiding Common Pitfalls
September 24, 2020
1pm-2:30pm EDT, Online Training
24th World Congress on Pediatrics, Neonatology & Primary Care
October 19 - 20, 2020