Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Care Quality

Quality Improvement Projects Save Children’s Hospitals Millions

June 21, 2018 - Care quality improvements require hospitals to invest their money, time, and staff. The investment may be large, but for two children’s hospitals it paid off, saving the organizations millions and reducing costly accidents and unnecessary utilization. Children’s hospitals manage a unique population compared to general acute care facilities. But their mission is the same as...“One of the very first things we did was provide asthma control tests, which is a validated tool to screen for asthma control,” he said. “Our goal was to provide that at each visit in which we saw a patient with asthma regardless of the reason why they were in the office.” Addressing asthma control during all primary care visit was key to preventing emergency...“It started by trying to measure harm. We didn’t have any idea how often that was happening. So, the first thing was to create a system for how we were going to categorize harm and then start to measure that,” he said. The hospital started to track not only general harm to patients, but specific errors and patient safety risks, such as central line infections....


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Healthcare Mergers, Consolidation Increase Patient Safety Risks

by Jacqueline LaPointe

Healthcare mergers and acquisitions, institutional affiliations, shared service agreements, and other healthcare consolidation activities may help organizations realize economies of scale and other financial benefits. But a recent JAMA repo...

3 Strategies to Decrease Low-Value Care, Healthcare Costs

by Jacqueline LaPointe

Low-value care, or care for which the potential harm outweighs the possible benefits or there are little to no benefits, is unnecessarily driving up already high healthcare costs and putting providers at risk under value-based reimbursement...The American Hospital Association (AHA) also released a list of low-value services that clinicians should reconsider and discuss with patients, including inpatient blood management, antibiotic prescription, inpatient admissions for ambulato...

Reducing Low-Value Care Key to Value-Based Reimbursement Success

by Jacqueline LaPointe

Value-based reimbursement success hinges on decreasing low-value care across patient populations, explained Scott Weingarten, MD, MPH, Senior Vice President and Chief Clinical Transformation Officer at Cedars-Sinai Medical Center. While hos...“According to the literature and the information we can find, if we’re really going to make a substantial leap forward in our efforts to both improve quality of care and affordability of care, we have to focus on reducing low-va...

Six Characteristics of High-Value Primary Care Practices

by Jacqueline LaPointe

High-value primary care practices that achieved exceptional care quality at reduced costs shared six attributes centered around risk-stratified care management, mindful specialist selections, and care coordination, a new study in the Annals...Researchers stated that the six attributes reflect the value of “care traffic control.” The characteristics demonstrated in the high-value primary care practices help patients with complex or chronic conditions and treatment pla...Researchers intend for the study’s findings to help physician office leaders to engage in care delivery and practice transformations that will help their physicians succeed under value-based reimbursement models, such as MACRA. The Me...

Type of Provider Data Presented Influences Patient Volume, Choice

by Jacqueline LaPointe

Healthcare consumers who initially prioritized appointment availability when choosing a physician were four times more likely to select a physician based on provider data on quality performance and clinical expertise when presented with mor...

Low-Cost, Low-Value Resource Use Drives $586M in Wasteful Spending

by Jacqueline LaPointe

Inexpensive low-value resource use resulted in over $586 million, or $9.09 per beneficiary per month, in unnecessary healthcare spending in Virginia, a new Health Affairs study showed. The total amount spent on low-cost, low-value resource ...Conversely, only 7 percent of low-value resource use stemmed from high-cost services that were priced between $539 and $1,315 and very-high-cost, which cost over $1,315. The only high-cost, low-value services that topped the list for greate...

Driven by Fee-For-Service, Docs Say Up to 30% of Care Unnecessary

by Jacqueline LaPointe

At least 15 percent to 30 percent of medical care is unnecessary, contributing to low-value resource use and wasteful healthcare spending, stated the majority of physicians surveyed in a recent PLOS ONE study. While the survey of over ...

MSSP ACOs Decreased Spending by $1B, Improved Care Quality

by Jacqueline LaPointe

Accountable care organizations (ACOs) participating in the first three years of the Medicare Shared Savings Program (MSSP) reduced Medicare spending, with a net reduction of almost $1 billion, according to a new OIG report. The analysis of ...In the first year, the net spending reduction totaled $234 million and increased to $429 million by the third year. With overall spending declines, about one-third of MSSP ACOs earned shared savings payments in at least one year of particip...A greater portion of ACOs also earned quality scores of 90 or above as the program matured, with 29 percent achieving at least a 90 in 2014 to 74 percent by 2015. Notably, the ACOs advanced their scores on about 82 percent of quality measur...High-performing ACOs notably decreased spending in inpatient hospital and skilled nursing facility care. Spending on inpatient hospital care dropped from $3,872 per beneficiary in 2010 to $3,324 by 2015. Other ACOs only reduced their spendi...

Exploring Quality Measures Under Value-Based Purchasing Models

by Jacqueline LaPointe

CHICAGO – Jason Goldwater, MPA, MA, Senior Director of the National Quality Forum, recently likened the value-based purchasing transition to the evolution of music at Xtelligent Media’s Value-Based Care Summit in Chicago. Music ...In a similar fashion, value-based purchasing has put massive amounts of healthcare data into the hands of providers, patients, and payers. However, the increased access to healthcare data has presented several challenges for quality measure...Additionally, focusing on clinical outcomes under value-based purchasing models allows healthcare organizations to understand and analyze the patient experience. “It has grown in a way that patient-reported outcomes have more importan...The global accountable care organization offers the greatest opportunity for care coordination and physician alignment, but organizations can implement a range of alternative payment models depending on their investment plans. Organizations...

Care Standardization Key to Healthcare Revenue Cycle Excellence

by Jacqueline LaPointe

To be named a top health system by Truven Health Analytics and IBM Watson Health, it takes a range of clinical quality improvements and healthcare revenue cycle efficiencies. But for St. Luke’s Health System, one of 15 top health syst...“When you standardize your processes and you perform consistently, we have seen fewer of those occurrences that ultimately add extra cost without value, such as readmissions, longer lengths of stay, and more complications,” Hill...“By standardizing it, you reduce the variation in care and you can track and measure lengths of stay, readmissions, complications, and all the things that contribute to excessive and non-value-adding costs,” he said. Using a dat...To implement value-adding quality improvement projects across several hospitals, St. Luke’s Health System engaged their clinicians and staff members to put their revenue cycle management and care quality goals literally at the center ...Engaging C-suite level leaders in the quality improvement push also ensured that providers had the resources they needed to achieve clinical and revenue cycle management excellence. “The leadership is very active in supporting us to b...

AMGA: Align Medicare Reimbursement, Measures for High-Value Care

by Jacqueline LaPointe

AMGA recently called on CMS to align quality measures with spending performance as well as Medicare reimbursement policies across Medicare Advantage, fee-for-service models, and accountable care organizations (ACOs). In two letters to CMS A...

How Do Hospital Mergers Lower Costs, Drive Quality Improvement?

by Jacqueline LaPointe

Recent hospital mergers and acquisitions led to significant healthcare costs savings without sacrificing care quality and affordable prices, a recent Charles River Associates and American Hospital Association (AHA) report indicated. Based o...Merged hospitals, on the other hand, experienced significant cost reductions related to scale and capital, healthcare executives stated. The mergers also allowed for more alternative payment model participation. Because a hospital merger in...

AHA Seeks Changes to Post-Acute Care Medicare Reimbursement

by Jacqueline LaPointe

The American Hospital Association (AHA) has called on the Centers of Medicare and Medicaid Services (CMS) to revise proposed Medicare reimbursement reforms for two post-acute care models. In separate letters, the AHA outlined several issues...

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