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Health Reform Heats Up for Case Managers By Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN July 23, 2012
Educational Opportunities Proliferate, Shedding Light on Timely Reform Provisions
With the passage of the Affordable Care Act (ACA) in 2010 and the recent decision by the U.S. Supreme Court to uphold the Act, rules such as the implementation of value-based purchasing (VBP) programs are moving forward. The goal of VBP is to revamp how Medicare services are paid to better reward value, outcomes and innovations instead of basing payment merely on volume.
Traditionally, Medicare sets the standard for policy and soon after commercial insurers and self- insured organizations will follow. Value-based purchasing will affect case managers and other members of the care coordination team who work in hospitals but will also affect those who work on the payer side as well. The Case In Point Webinar Boosting Quality Process Measures: Steps to Success for Your Hospital: Become a Leader and Strengthen Your Reimbursement Level that will take place Wednesday, July 25, 2012, is your opportunity to gain insight in this important culture change taking place that will change the way healthcare is delivered and paid for.
The value-based purchasing program initially will impact all short-term acute care hospitals and exclude critical access hospitals, psychiatric, rehabilitation, long-term care, children’s and cancer hospitals. Beginning October 1, 2012, discharge payments will be reduced by 1 percent to create the VBP pool. Reductions will increase by 0.25 percent annually until reaching 2 percent in federal fiscal year 2017. The reduction will be based on operating diagnosis-related groups (DRG) and excludes add-on payments such as indirect medical education, disproportionate share, outlier and low-volume payments.Other settings will be phased in over the next few years.
According to Health Reform Insights:
The overall Three Domain of Care approach methodology, including the Clinical Process of Care & Outcome Measures and Patient Experience of Care Survey, will be used to determine a hospital’s total performance score.
CMS affirmed the initial weights for FFY2013: 70 percent for clinical process of care measures and 30 percent for the patient experience of care survey. Weights may be adjusted in future years, given additional measures or domains such as outcome measures and efficiency domain.
CMS affirmed the definitions and calculations of achievement and improvement standards, as well as achievement thresholds and benchmarks, which were published in the final rule for the baseline period.
The baseline period was confirmed as the period from July 1, 2009, through March 31, 2010, and the performance period was confirmed as the period from July 1, 2011, through March 31, 2012.
CMS affirmed the use of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and its eight dimensions: nurse communication, doctor communication, cleanliness and quietness, responsiveness of hospital staff, pain management, communications about medications, discharge information and overall hospital rating.
VBP incentive payments will be reallocated to hospitals based on the total performance scores ranked in a linear scale, so that hospitals with higher total performance scores will receive larger incentive payments.
If you work in a hospital, I am sure your organization is working to educate case managers and all members of the care coordination team as to the importance of the team effort it will take to revise policies so all understand the purpose and processes needed to make implement changes to ensure you receive incentives vs. as disincentives for the care you provide. Join us on July 25th at 12 noon-1:30pm ET in a program that will reinforce the urgency of this landmark reform effort. to change the delivery and payment across the care continuum.
A Host of Other Learning Opportunities
Other learning activities that we have teed up for your professional development include:
Constructing the Medical Home: Bolstering Care, Outcomes and Transitions with a Multidisciplinary Team- Harness the Strength of the Medical Home Team for Best-Case Outcomes: This webinar will look at how the multidisciplinary team is engaging patients and improving outcomes as critical members of the dynamic medical home. Date: July 31, 2012 from 2:00pm-3:30pm ET. To review the learn more, click here.
The Care Coordination Summit: New Delivery Models Transforming Healthcare: This is our annual Care Summit that will take place in Washington DC on September 14, 2012 at the National Press Club. To review the agenda and register, click here.
Social Media in Healthcare: The Modern Link to Effective Patient Engagement: This is our latest Special Report. To review the table of contents, click here.
Essence of Case Management: If you are new in to the practice of Case Management or preparing for one of the National Certification Examinations, this e-learning program is for you. It will help you get a clear sense of the industry and help those preparing for certificate develop a course of study that will last well past the examination. To view the agenda, click here.
UroHealth: View our award-winning microsite and get up to date on urinary complications that impact patients with spinal cord injuries, spina bifida, neurogenic bladder and multiple sclerosis. There are 12 learning activities approved for 2.0 contacts each for nurses, social workers, case managers and disability management specialists that will inform, educate and raise your level of understanding of the challenges patients with these conditions live with on a daily and what you as a case manager can do to identify and proactively educate patients so that major setbacks to not occur. To view the programs click here.
Case In Point Learning Network: The learning network allows you to receive Case In Point Magazine on a monthly basis directly to your Inbox. In addition, as a subscriber to the Learning Network, you are able to log into our CE Portal and complete the posttest and program evaluation for each issue and then print off your certificate of completion. To learn about the levels of membership click here.
As we develop additional learning activiteis, I will keep you updated. Have a great week and keep cool.
About Case In Point Weekly
Case In Point Weekly is an extension of the award-winning magazine Case In Point. The weekly e-newsletter brings you cutting-edge news and thought-provoking analysis that will keep you abreast of the trends in health care and more...
About the Editor In Chief
Anne Llewellyn joined Dorland Health, a Contexo Media Company (formerly Dorland Healthcare Information), as editor in chief of case management products in March 2006. Prior to joining the company, Ms. Llewellyn was co-founder and...
The Change You Want
By Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN Editor-in-Chief of Case in Point Magazine and the Case Management Resource Guide "Be the change that you want to see in the world." ~ Mohandas Gandhi In its most recent issue...
This e-learning course brings it all together. It explores venues where case managers are practicing; looks at legislative activities that impact the practice; and discusses tools and principles utilized by case managers across the broad healthcare landscape. Earn CEs »