The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.
Much has been written about the Affordable Care Act (ACA) and one of its ongoing experiments is known as Accountable Care Organizations (ACOs). Recently The Wall Street Journal published an opinion with the headline “The Coming Failure of ‘Accountable Care’”. While I agree with the authors that many ACOs will fail, I believe that they will fail for different reasons.
In this time of rapid change and financial challenges in healthcare, there is a need for change management. Process engineering, also called management engineering, can be a valuable resource in negotiating these challenges across the Acute Care Continuum.
Process engineering, an offshoot of industrial engineering, looks at the big picture of an organization and utilizes a number of tools to create improvements that will help the organization operate more efficiently. For example, the Lean process was first devised by the manufacturing industry, used to identify methods to streamline workflow processes. The process engineer uses tools, like Lean, to look at all the people involved and translate their different activities into metrics that can be reviewed, measured, and assigned goals.
This week, we highlight articles that focus on the difficulty hospitals are having in transitioning from a fee-for-service payment system to one that is based on clinical outcomes and patient experience.
Managing an Acute Care Continuum physician services organization that sees approximately five million patient encounters annually requires data. Lots of data. This includes information on meeting defined clinical guidelines, such as the Centers for Medicaid and Medical Services (CMS) performance metrics, resource utilization, practitioner productivity, patient flow, quality metrics and risk are all necessary.
The Centers for Medicare & Medicaid Services (CMS) just published some newly proposed rules that enable States to impose increased cost sharing on Medicaid patients for non-emergency care in the ER. These rules open the door even wider for these States to abuse ER providers and hospitals, and discourage Medicaid patients from seeking needed care. Sadly, CMS did not even bother to consult with the American College of Emergency Physicians before drafting these rules, which makes it a lot more difficult to put some of the more problematic provisions back into Pandora’s box. There is a good article on these proposed rules in the NY Times if you want a thousand foot view. I’ve done a pretty thorough review of these rules, and will try to highlight the pertinent language and possible consequences of the provisions related to emergency care; so lets get into the weeds:
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Nice job Ryan. CEP and Sonra is lucky to have you on our team.
Great tips and guidance!
Great post! Thank you for the insight and suggestions.
Excellent!! Thanks for sharing this valuable information!
What a great example of spanning the differences between groups to arrive at a