This post was originally published at Triple-Tree.
The passage of the Affordable Care Act empowered CMS to encourage the healthcare market to refine or in some cases develop new delivery models through changing reimbursement structures as the market evolves from pay for volume to a pay for quality.
These two reimbursement models are at odds as volume keeps the lights on for providers, but new incentives and penalties related to quality are challenging their profitability. This is an important point as the new initiatives encouraged by CMS can carry both a carrot and a stick but often just a stick.
- Hospital Acquired Conditions (HAC) and Readmission Reduction Programs are mandatory programs that penalize lower performing hospitals.
- HAC’s focus on patient safety and infection measures will force hospitals to evaluate their operating room workflow and their ability to ensure proper sterilization. Surgical instrument tracking solutions will play a critical role in supporting these efforts (see my colleague Elliot Amundson’s recent blog on that topic); and readmissions in the context of the current pay-for-volume reimbursement model can be challenging as hospitals have received additional reimbursement for readmissions.
- With the Readmission Reduction Program, hospitals may weigh the loss of revenue through readmission reduction efforts against the potential penalty for those with higher readmission rates than the national average. At what point does the penalty outweigh the investment to reduce readmissions plus the incremental revenue that it provides?
- In the case of bundled payments, a participating provider selects a specific condition or procedure and accepts a capitated payment. This arrangement with CMS gives the provider an opportunity to bear the risk and reward for the cost of delivering care for a particular condition or procedure. Providers can capture the financial rewards by finding and correcting current inefficiencies in the delivery of care and redesigning the care coordination efforts across multiple parties for that particular condition or procedure.
- Value-Based Purchasing also creates an opportunity for providers to participate in both risk and reward based on three key areas: clinical process, patient experience and mortality. Depending on a hospital’s score against the industry average and its individual performance over time, a hospital will receive either an increase or decrease in reimbursement. Value-Based Purchasing attempts to ensure that hospital efforts to decrease the cost of care do not sacrifice efforts to provide quality care.
The graphic below adds some additional context for these four programs:
Hospitals continue to invest time and money to meet ever-changing regulatory focus and requirements, and many are consumed with the ambitious goals of the Meaningful Use provisions in the HITECH Act. With the functionality and investment now taking shape, hospitals will be able to address CMS’s ultimate goals of increased patient safety, improved care coordination and better overall outcomes. Companies positioned to support hospitals in these new endeavors will find increased interest and engagement from the provider community.
Let us know what you think.
ORLANDO, Fla., Feb. 24, 2014 /PRNewswire/ — (HIMSS Booth #8244) – ClinicSpectrum, leaders in hybrid workflow solutions consisting of both an innovative software suite and back-office operations, today announced the introduction of its latest offering, AutoCollectSpectrum. The patent-pending solution is designed specifically to assist physician practices with the growing amount of deductible collection that will be necessary with the huge influx of eligible patients under the Affordable Care Act (ACA). AutoCollectSpectrum is being unveiled at the Healthcare Information and Management Systems Society (HIMSS) annual conference & exhibition in Orlando, Fla., February 24-27, and is expected to be widely available to physician offices in March.
“Our goal is to support physicians and their practices by enabling them to focus on medicine and maximize profitability while ClinicSpectrum’s solutions automate their billing and collection processes,” explained Vishal Gandhi, chief executive officer, ClinicSpectrum. “With AutoCollectSpectrum, we can readily help practices benefit from the changes brought on from healthcare reform.”
AutoCollectSpectrum is an automated program to expedite the collection of deductibles and other balances owed. The patent-pending and proprietary collection method uses automated secure text, patient portals and other messaging channels in place of traditional phone calls, and hard copy, mailed letters. By eliminating the representative involvement and automating the process, physicians reduce the cost and time involved with retrieving payments.
Other products in the ClinicSpectrum portfolio that also help enhance efficiency and maximize revenue include EligibilitySpectrum, as well as the patent-pending ProductivitySpectrum, InvoiceSpectrum and CredentiallySpectrum.
EligibilitySpectrum – With the enormous influx of patient deductibles in the health insurance market place, EligibilitySpectrum enables practices to readily manage the complete eligibility of all patients by combining software and back-office operations resources. The options include using a real-time connection with a clearing house, insurance companies’ websites, or live calls conducted by ClinicSpectrum’s eligibility team. This product interfaces via an API with any EHR / scheduling system.
ProductivitySpectrum – Focused on benchmarking on various tasks and instilling self-accountability through daily reporting, this product calculates employee desk time and reduces ideal time or non-productive time. It provides comparative analysis with respect to industry and / or office benchmarks, and expected weekly or monthly productivity.
InvoiceSpectrum – By using a unique payment and invoice processing rule setup for auto-fax, auto-email, auto-credit card processing and auto-paper statement processing, practices will benefit from saving time on template creation, follow-up and more. Additionally the product provides monthly forecast management, receivable management and sales force productivity examination for better cost/profit analysis.
CredentialingSpectrum – CredentialingSpectrum is an automated tool for the credentialing of providers’ profiles and insurance participation, as well as for contract management. It allows users to import CAQH summaries for faster data entry of a provider’s profile, and also auto populates participation application forms from most insurances. It also has a built in document management, task management, milestone management, and reminder functionality for expiration of various documents and credentials, as well as communication templates and messaging solutions for automated calls, secure email, secure text and fax. For more information about ClinicSpectrum or any of their physician practice products, please visitwww.ClinicSpectrum.com.
ClinicSpectrum is a healthcare services company providing outsourcing/back-office and technology solutions for 17+ medical billing companies, 600+ medical groups/healthcare facilities including hospitals, and hospital medical records departments.
The company is promoted by technical experts from diversified industries. In a span of 12 years, ClinicSpectrum has been able to transform several billing companies and healthcare facilities nationwide with unprecedented efficiency. The company’s strategy is to build productivity through the use of technology, highly trained personnel who deliver results in a timely fashion, and customized consulting services. ClinicSpectrum has created a solution for all the problems in running a medical billing company and medical practice resulting in better clinical records, revenue cycle, and administrative task management. For more information, e-mail Vishal@Clinicspectrum.com or visit www.ClinicSpectrum.com.
For media inquiries, contact:
Kate Ottavio, KNB Communications for ClinicSpectrum