Harmony Healthcare Blog

Data, Data, Data - You Cannot Make Bricks Without Clay

Posted by Kris Mastrangelo on Mon, Aug 12, 2013


Edited by Kris Mastrangelo

Uncertainty.  That is the word that best defines our country at the present time.  The Supreme Court upheld Obamacare in June 2012, which again magnifies the significance of healthcare decisions for providers. Think about it.  This decision continues to impact every organization, employer, employee, i.e., person in the United States.  This impacts one of the largest sectors of the world’s largest economy.  

This decision influences the growth and success of Accountable Care Organizations (ACO).  To date, there are approximately 220 ACO’s that have signed up to participate in the “Medicare Shared Savings Program.”  This equates to more than 2.4 million Medicare beneficiaries that will be receiving care under the new model which allows for ingenuity, but still requires each entity to meet a set of 33 quality measures and outcomes.  Many non-Medicare beneficiaries are experiencing some of the practices that are being applied within the HMO framework today.  Are you? Is your dentist taking your blood pressure? Is your orthopedic surgeon asking you if you scheduled your mammogram? Two examples of practices seen in the ACO model in an effort to extricate solo physician focus and merge patient centered practice.

The outlook of the economy is more uncertain today than it has been over the last 20 years.  Owners, executives and healthcare leaders are specifically concerned and unclear on “governmental policy.”  Will changes impact their business and how should they forecast.

Traditional Medicare payments to skilled nursing facilities will increase by 1.3 percent in Fiscal Year 2014 (effective October 1, 2013).  CMS estimates the total impact of the FY 2014 SNF payment rate update to be an increase of approximately $500 million.  The last two years have been filled with complex changes to MDS, PPS and the Medicare Reimbursement System.  Staff members are inundated with rule changes that necessitate larger focus on MDS Completion, ARD Selection and Therapy Service Delivery.  All this attention has distracted healthcare providers in viewing the overall management of the patient’s clinically anticipated stay.  ACO implementation arouses fear that stays in the Skilled Nursing Facility (SNF) will be compressed in an effort to decrease costs.

This fear combined with global distraction warrants a review of length of stay practices.  The national average for Medicare Part A Length of Stay calculates at approximately 34 days.  Are you tracking yours? Facility level comparison and discharge destination data provide a font of information.

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Tags: ACOs, CMS, MDS

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