The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.
Medicare is fighting hard to remain a financially viable program in an era of austerity. On July 8, 2013, The Centers for Medicare & Medicaid posted several proposed changes to its rules surrounding outpatient facility coding and invited public comment. Because this proposal could impact patient care and the financial viability of emergency departments around the country, it’s important that hospitals review the proposed changes, understand the implications, and voice any concerns to CMS.
Under its Hospital Outpatient Prospective Payer System (OPPS), CMS currently uses a five-level system for coding, billing and reimbursing emergency department care at the facility level. The lower evaluation and management (E/M) levels (which carry smaller reimbursements) typically involve less complex complaints such as rashes, earaches, musculoskeletal injuries, and minor cuts. The higher levels cover more significant and complex problems that require more testing and intervening, such as chest pain, abdominal pain, vomiting, headache and stroke.
Our biweekly news updates are designed to keep you up to date with current developments relating to the Acute Care Continuum. Feel free to share your perspective on these stories or link to articles that you have found relevant to today’s healthcare environment.
Medicare Considering a Star Rating System for Hospitals
Following the likes of Yelp, Centers for Medicare & Medicaid Services (CMS) is considering implementing a more easily understood “star rating system” to assist patients in comparing quality between hospitals and health systems. In its recently released proposed rules to hospitals, CMS asked for suggestions on "how we may better display this information on the Hospital Compare Web site. One option we have considered is aggregating measures in a graphical display, such as star ratings." The current Hospital Compare website has been criticized as being too difficult for patients to navigate as more and more quality information has been added. Both medical groups and policymakers question CMS’ ability to convert large amounts of patient and quality data into a simple and accurate rating system.
The Obama Administration’s announcement that it will delay the employer mandate for one year brought the rhetoric surrounding the Affordable Care Act (ACA) to a fever pitch.
Republicans see this development as proof that the entire concept is doomed to failure and promptly introduced a House bill to delay the individual mandate. Representative Louise Slaughter (D-NY) decried the bill as "the height of irresponsibility and nihilistic obstruction." Her party is quick to play up the delay as a temporary setback, an opportunity to iron out inevitable kinks in ACA implementation.
As I watch this spectacle unfold, I can’t help but feel a little pessimistic about the fate of healthcare reform. I fear that the intense partisanship surrounding the ACA (and everything else in Washington) is interfering with our ability to make difficult but necessary choices. It also begs a fundamental issue: Is healthcare in our country a right or a benefit?
When I am at a gathering and someone finds out I am a physician, they inevitably ask how I feel about healthcare reform.
I typically tell them that reform is here now, whether I like it or not. I opine on ACOs and bundled payments. And by the time I reach Medicaid expansion and insurance exchanges, they either have a glossy-eyed look or are actively working out a way to ditch me.
This is good for me, because I am truthfully not sure how I feel about Medicaid expansion and insurance exchanges. As a doctor, I know I’m looked at as something of an expert in this area. But I don’t yet feel able to explain the impact to patients, much less curious laypeople. And with nearly half of the states expected to opt out of the Medicaid expansion — or leaving exchanges to the federal government — others clearly share my doubts.
The recent Healthcare Financial Management Association (HFMA) conference held in Orlando offers some great insights into the hospital-C-suite world. From my perspective, one of the most important lessons is that there is a direct opportunity for emergency medicine (EM).
As EM professionals, we are all subject to rules set forth by both the Centers for Medicare & Medicaid Services and the payer community. But ultimately, when push comes to shove, the C-suite holds the trump card for every emergency medicine physician — in the form of control over employment or contract renewal.
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Great article! Thank for the resources too.
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