There’s a lot of buzzing in the health care industry these days, despite the fact that President Obama left health care out of his State of the Union speech! The Affordable Care Act is officially “in process” and all stake holders are scrambling to meet the new requirements that will dictate how much money they make. We believe everyone should know what these terms mean and how it might impact you or your family
1. HIT: Health Information Technology: Whether you know it or not, it is likely your physician has invested a lot of money in health information technology in the past five years. One of the ways health reformers hope to save money is by making the system more efficient and collaborative. By making information clear, standardized and available to multiple providers in multiple settings, the health care system can meet the needs of patients more efficiently. Most Health Information Technology is in the form of an EHR (Electronic Health Record). The features of EHRs vary, but many allow the patients to communicate with their physicians via email and see their own test results and medical records online. While no physician is required to adopt EHRs, there are incentives built in to Medicare payments that make it “a must” for any practice that counts on Medicare reimbursement. Approval is based on a metric called “meaningful use” which means the tool is used for things such as : expediting referrals to specialists, electronic drug prescriptions, documentation of smoking cessation efforts, and built-in reminders to manage specific patients. All of these are designed to gently prod clinicians to do things which have been shown to provide the greatest health benefits to patients and also to minimize risks of such things as overprescribing and dangerous drug interactions. The adoption of HIT has been a bumpy road, but everyone should see the many benefits in the next few years…not the least of which will be data collection and a better understanding of our population’s health.
2. HIPAA 5010 HIPAA stands for the Health Insurance Privacy and Portability Act which was passed by Congress in 1996.. It governs the way health care entities and related business handle private personal health information. However, in the era of electronic health records and other information technology, the standards and practices of HIPAA were due for an overhaul, so as part of the HITECH act, HIPAA 5010 was born in 2009 and goes into effect this year. In conjunction with a new coding system for diagnoses (ICD-10), and the new focus on quality measures, HIPAA 5010 is a new way of doing business for health care providers. Health care entities are working hard to understand the new standards and how to comply because breaches in health care information security incur heavy financial penalites and really bad PR. So, on the one hand, the government is asking the health care system to share more information to create efficiency and higher quality care…but on the other hand, they are asking that information shared electronically be kept private. Can any health care entity do both? Seems unlikely.
3. Patient-Centered Care: The Agency for Health Research and Quality (AHRQ) defines Patient-Centered Care succinctly: “Relationship-based primary care that meets the individual patient and family’s needs, preferences, and priorities.” Another definition of Patient -Centered care focuses of 4 elements:
Dignity and Respect
for the patient: that includes things like the way in which the patient is addressed and the amount of time the patient is kept waiting.
: Educating the patient about their disease and providing anticipatory guidance. Showing the patient how they can impact their own health outcomes.
: Allowing the patient to participate in making decisions about their health care, which means providing more than one choice or allowing a patient to make an informed choice NOT to have treatment.
: Health care leaders will need to show that they have involved patients and the community to collaborate with them on making decisions about programs, design and implementation of health care projects. Health care entities such as physician groups, clinics, and hospitals will be evaluated on all of these elements via patient surveys and audits when it comes time to negotiate contracts with payors. These are the features every consumer should be looking for when deciding where to spend their health care dollars.
4. Value Based Purchasing This term refers to the practice of buying health care products and services using quality and outcomes criteria rather than price alone. Here is a link to some of the criteria used to assess the quality of services provided by hospitals: Value-Based Purchasing Metrics
Hospitals will need to do well in these metrics to maintain their contracts and be fully reimbursed by Medicare. If you or a loved one are hospitalized, you will most certainly perceive efforts to meet these benchmarks.
5. Accountable Care Organization (ACO) Sometimes called “HMOs lite” by skeptics, ACOS are the latest attempt at managed care for the Medicare population. They turn the traditional HMO on its head in that they put the onus on the health care system to keep patients healthy and happy. ACOs will be affiliated groups of doctors, hospitals and other health services like laboratories that will band together to serve a specific patient population (usually a group of 5,000 Medicare patients) ACOs will pay physicians and hospitals “bonuses” if there are demonstrable savings in their group of patients. However, they do not place as many restrictions on patients in terms of where they can get their care, but the providers who are in the ACO will lose money if patients go “out of network”. Using the principles of Value Based Purchasing, ACOs will get paid according to performance on quality metrics (see value based purchasing) and other quality measures designed to assess quality in the outpatient setting. Medicare may assign you to an ACO, but you have to agree to its terms, like sharing your data for quality tracking. You can opt out if you wish, but participating in an ACO might get you better care.
Sources: The American Medical Association Fact Sheet: Preparing for the Next Version of HIPAA Standards: January 2012.
AHRQ: Patient Centered Care
Questions: How can consumers influence how the health care system is changing?
Will these new financial incentives lead to better care or patient
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