Calling the ACA ‘part of the fabric of middle-class recovery,’ Obama promises to veto changes to law. By Christine Kern, contributing writer
Now, patients can find ratings and reviews of their physicians directly on many hospital websites. By Katie Wike, contributing writer
The outlook for ICD-10 implementation is bleak if the results of the National Pilot Program are any indication By Katie Wike, contributing writer
Despite the constant buzz around electronic records and MU requirements, 25 percent of hospitals have made no EMR progress in half a decade By Katie Wike, contributing writer
What is Direct? Does it replace a HIE? Is it redundant with HL7 or XDS functionality? If I use email rather than Direct am I out of compliance with HIPAA?
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.
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.
According to a new report, a lack of out-of-network interoperability is the biggest obstacle facing ACOs today. By Katie Wike, contributing writer