FEATURED ARTICLES: ACO
Final Countdown To HIPAA Rule Implementation Begins
The final HIPAA omnibus rule holds healthcare providers responsible for the security of patient information, even after it has been transferred to a vendor; impact on providers as covered entities will be “significant” By Katie Wike, contributing writer
Disparities In Incentive Payments May Foreshadow Penalties9/10/2013
A recent study found that small, rural, nonteaching hospitals are lagging behind in meeting meaningful use requirements and are at risk for electronic record penalties By Greg Bengel, contributing writer
Guest Column: Fight Healthcare Fraud With Analytics7/13/2011This article highlights how a pre-pay claims processing system that leverages claims review, predictive modeling, and linking analytics technologies can help healthcare payers save the billions of dollars lost annually to fraud. By Bill Fox, JD, MA, and Senior Director of Healthcare for LexisNexis
Contractor To Recover Improper Bonuses Paid For Incentive Program10/8/2013
Medicare hires Arch Systems to verify the accuracy of provider data submitted to the Electronic Prescribing Incentive Program (eRx) and Physician Quality Reporting System (PQRS) By Greg Bengel, contributing writer
CASE STUDIES & WHITE PAPERS
Take Your EMR From Good To Great12/29/2011Good EMRs help you improve operational efficiencies, reduce costs, meet meaningful use requirements and better serve patients. Great EMRs are a digital lifeline, critical to saving lives and preventing medical errors. This white paper outlines why this is such a critical distinction.
Even A 60-Year-Old Multi-Specialty Practice Can Succeed With EHR6/1/2012
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.
The Direct Evolution: Why It Will Change How You Communicate5/1/2013
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?
ACO Efficiently Manages Population Health With The Help Of Gateway EDI10/2/2012
With a local network currently uniting more than 150 providers and 250,000 patients, United Medical is well on its way to changing the health care landscape in Delaware.
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 Barriers2/8/2016
According to a new report, a lack of out-of-network interoperability is the biggest obstacle facing ACOs today. By Katie Wike, contributing writer