Health Insurance Exchanges – Success or Failure?

Written by Gregory M. Adams, FHFMA

Recent headlines, like the one in USA Today, “Health Care Costs to Rise in 2017,” are creating a stir in the world of health insurance exchanges. ....

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The Value Proposition of Long-Term and Post-Acute-Care Coordination

Written by John F. Derr, RPh

This article, the final in a series, summarizes the May 2015 Office of the National Coordinator for Health IT (ONC)brief prepared for Karen DeSalvo, M.D. on the Health Information Technology Use & Value Delivered by the Long Term & Post Acute Care ....

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Feature Stories

Use of Predictive Analytics Drives Outstanding Returns for Your Patients and Your Revenue

Those who try to transition to value-based reimbursement by just working harder are very likely to fail. Changes in the demographics and disease burden are already causing health systems to struggle financially. The population is aging, chronic...Read more...

imgres
The Elephant in the Room: Drug-Induced Disease Diagnosis

One of YouScript’s clinical pharmacists tells a story of his car breaking down in high school. He had it towed to a local mechanic as none of his attempts to get the car going were successful. The gas gauge was showing one quarter of a tank. Read more...

  1. HVBP
  2. IQR
  3. IT
  4. HRRP
  5. HAC
  6. PQRS
  7. OQR
  8. ASCQR
  9. IRFQRP
  10. LTCHQR
  11. PCHQR
  12. IPFQR
  13. HHQRP
  14. HQRP
  15. ESRD
  16. Patient Safety
  17. Finance
  18. ACOs
  19. Process Improvement
  20. Research

Frequently Asked Questions about Comprehensive Care for Joint Replacement

January 12, 2016 / David Glaser, Esq.

On Nov. 24, 2015 the Centers for Medicare & Medicaid Services (CMS) published a final rule changing the reimbursement for certain lower-extremity joint replacement (LEJR) procedures. While the proposed rule referred to “CCJR,” for “comprehensive care for joint replacement,” CMS has elected to drop one “C,” instead referring to the .... Read more...

The Patient Experience: Can You Control the Seemingly Uncontrollable?

July 1, 2015 / Catherine Gormam-Klug, RN/MSN

It is interesting to consider that the value-based purchasing domain, whose scoring is based on criteria tied to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), relies on what in any other circumstance would be considered skewed or flawed data. Unlike any other domain within the program, the scoring cannot be tied directly to fact- and evidence-based documentation...Read more...

Cutting-Edge Quality Strategies Take Center Stage at HIMSS Conference

Written by Mark Spivey VBPmonitor.com Correspondent

The style at the HIMSS 16 Conference & Exhibition in Las Vegas last week was provided by none other than keynote speaker and recent Super Bowl champ Peyton Manning of the Denver Broncos. .. Read more...

The Evolution of CMS Readmission Measures Sparks Movement toward Population Health Management in U.S. Hospitals

July 21, 2015 / Vicky Mahn-DiNicola, RN, MS, CPHQ

While nearly everyone agrees that some readmissions are clinically necessary, the fact is that unplanned 30-day hospital readmissions for high-risk, complex clinical populations afflicted by conditions such as acute MI, heart failure, and pneumonia are not good for patients, nor good for our collective fiscal bottom line. Since 2012, the Centers for Medicare & Medicaid Services (CMS) has sanctioned hospitals economically for what they deem as excess 30-day readmissions (meaning more than expected, given a hospital’s risk-adjusted population), resulting in a significant reduction of Medicare revenue for approximately two...Read more...

Understanding Outcome Measures: Catheter-Associated Urinary Tract Infections and CDI

January 12, 2016 / Maureen Bucci, BSN, RN, CCDS

Everyone take a breath! 2015 has come to an end, and although the healthcare profession in 2016 will continue to be challenged, our focus remains on getting the job done. We are better educated and have gained practical experience in implementing ICD-10. We are also making great efforts to problem-solve the high-priority outcome quality measures that threaten reimbursement, quality scores, and to some degree, the credibility of healthcare facilities. ...Read more...

Developing an Effective PQRS Quality Measures Reporting Strategy for 2016

March 08, 2016 /Gloria Johnston, MBA, RN, RHIT, CCS-P

It’s time for providers to consider a Physician Quality Reporting System (PQRS) quality measures reporting strategy for 2016 PQRS and Value-Based Modifier (VBM) programs in order to avoid heavy penalties in 2018. ... Read more...

Don’t Forget About Hospital Outpatient Quality Measures

Written by Kim Charland, BA, RHIT, CCS

The Tax Relief and Health Care Act of 2006 mandated that the Centers for Medicare & Medicaid Services (CMS) establish the Hospital Outpatient Quality Reporting (OQR) Program. In general, outpatient measures evaluate the regularity with which a healthcare provider administers the outpatient treatment known to provide the best results for the most patients with a particular condition. This program requires acute-care hospitals to submit data on quality-of-care measures furnished in outpatient settings that assess: .. Read more...

Coming Soon!

Thank you for visiting Panacea’s newest monitor - VBPmonitor.com. VBPmonitor will be covering the news for all the VBP initiatives including the Ambulatory Surgery Center Quality Reporting (ASCQR). If you are interested in contributing a relevant article, please read our Writer’s Guidelines.

Thank You,
Kim Charland
VBPmonitor Editor

CMS Releases More Final 2016 PPS Rules: Quality Continues to Be a Major Component

August 11, 2015 / Kim Charland, BA, RHIT, CCS

Below are some excerpts from the 2016 final rules related to value-based purchasing (VBP) and quality for inpatient psychiatric facilities (IPFs) and inpatient rehabilitation facilities (IRFs). We will be following up with additional articles over the next few weeks featuring industry reaction, so please stay tuned. Background on the IPFQR Program: The IPFQR Program is a pay-for-reporting program... Read more...

Duration and its Role in Valued Quality Coordination of Care


December 17, 2015 / John F. Derr, RPh

This is the third article in a series on the value of long-term, post-acute care providers (LTPACs) and health IT vendors. These articles are based on the LTPAC Health IT Collaborative Brief written in May 2015 for Karen B. DeSalvo, M.D., M.PH., M.Sc., national coordinator for health information technology and acting assistant secretary for health with the U.S. Department of Health and Human Services (HHS); the brief is titled Health Information Technology Use and Value Delivered By The Long-Term & Post-Acute Care (LTPAC) Sector. ... Read more...

Coming Soon!

Thank you for visiting Panacea’s newest monitor - VBPmonitor.com. VBPmonitor will be covering the news for all the VBP initiatives including the PPS-Exempt Cancer Hospital Quality Reporting Program (PCHQR). If you are interested in contributing a relevant article, please read our Writer’s Guidelines.

Thank You,
Kim Charland
VBPmonitor Editor

CMS Releases More Final 2016 PPS Rules: Quality Continues to Be a Major Component

August 11, 2015 / Kim Charland, BA, RHIT, CCS

Below are some excerpts from the 2016 final rules related to value-based purchasing (VBP) and quality for inpatient psychiatric facilities (IPFs) and inpatient rehabilitation facilities (IRFs). We will be following up with additional articles over the next few weeks featuring industry reaction, so please stay tuned. Background on the IPFQR Program: The IPFQR Program is a pay-for-reporting program... Read more...

Coming Soon!

Thank you for visiting Panacea’s newest monitor - VBPmonitor.com. VBPmonitor will be covering the news for all the VBP initiatives including the Home Health Quality Reporting Program (HHQRP). If you are interested in contributing a relevant article, please read our Writer’s Guidelines.

Thank You,
Kim Charland
VBPmonitor Editor

Coming Soon!

Thank you for visiting Panacea’s newest monitor - VBPmonitor.com. VBPmonitor will be covering the news for all the VBP initiatives including the Hospice Quality Reporting Program (HQRP). If you are interested in contributing a relevant article, please read our Writer’s Guidelines.

Thank You,
Kim Charland
VBPmonitor Editor

Coming Soon!

Thank you for visiting Panacea’s newest monitor - VBPmonitor.com. VBPmonitor will be covering the news for all the VBP initiatives including the End-Stage Renal Disease Initiative (ESRD). If you are interested in contributing a relevant article, please read our Writer’s Guidelines.

Thank You,
Kim Charland
VBPmonitor Editor

Coming Soon!

Thank you for visiting Panacea’s newest monitor - VBPmonitor.com. VBPmonitor will be covering the news for all the VBP initiatives including Patient Safety. If you are interested in contributing a relevant article, please read our Writer’s Guidelines.

Thank You,
Kim Charland
VBPmonitor Editor

Price Transparency in a Value-Based Payment World

January 12, 2016 / Gregory M. Adams, FHFMA

As the healthcare industry adapts to the new reality of value-based payments, the issue of how best to implement price transparency continues. Given the complexity of how prices historically have been developed by hospitals, it is no surprise that developing rational prices using a methodological approach based on cost and market data can be no easy task. In fact, it could be argued that in order to implement price transparency, hospitals need to start with revamping the way they develop their prices. To focus on the publishing of current prices with.. Read more...

ACOs: The Evolving Frontier

December 8, 2015 / Kai Tsai

Recently, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) unveiled its formal Work Plan for the 2016 fiscal year (which began on Oct. 1, 2015), and it outlines the new and ongoing activities the OIG plans to focus on during the current fiscal year and beyond. Created in 1976, the OIG is responsible for providing independent and objective oversight of HHS programs, including Medicare and Medicaid, in order to combat system fraud, waste, and abuse.... Read more...

Strategies to Improve Quality and Financial Outcomes

Kim Charland, BA, RHIT, CCS

In the Dec. 9 edition of VBPmonitor e-news, I wrote about bundled payments and what we can do to start preparing for them. I’d like to expand on that article and leave you with some thoughts at the end of 2015 on what we need to start thinking about for 2016 to help you prepare with what needs to happen next year with regard to quality measures. ...Read more...

Leveraging Evidence-Based Medicine in the Hospital Setting

March 20, 2015 / Ronald Hirsch, M.D.

When caring for a patient, doctors use many resources to determine what care to provide. They first perform a thorough history and physical examination to help them develop a differential diagnosis – the list of possible conditions that may be present. For example, if the patient has chest pain, the differential diagnosis could range from simple heartburn or a pulled muscle to a blood clot in the lungs or a life-threatening tear in the aorta. They may develop this differential from memory or make use of a textbook, a medical journal such as the New England Journal of Medicine, or an authoritative, evidence-based resource, the best known of ... Read more...

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Sepsis - Are Quality, CDI and Coding Working Together to Get It Right?

With quality, CDI, and coding usually under different department management, are you sure they are all on the same page when it comes to how the new ICD-10 coding rules impact how sepsis codes are assigned now and reported for core measures?

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