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Forecast Roundup

Year of the healthcare cuts? By Fauzia Khan, M.D., FCAP, co-founder, CMO, DiagnosisOne

CMS has been threatening to cut its

programs, but those changes continue to get pushed off. The proposed changes could have a very negative impact on the availability and quality of care for anyone on Medicare, and physicians will not be able to afford to treat Medicare patients. Knowing that private insurance typically follows Medicare reimbursement leads, the

total compensation for physicians will be slashed drastically. If these cuts become reality, the industry could eventually see an even greater decrease in people becoming physicians. With the volume of medical school debt they typically accrue and the prospect of signifi cantly lower income, it will not be a lucrative career path for many.

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The reimbursement for care must be focused on the patient and outcomes rather than on services rendered. The ACO concept is a start, but it needs to be adapted. Bundled payments are on the right track, and they can be implemented without the massive overhead and legal structure required for an ACO. Improving quality and effi ciency, rather than just reporting on it, places a heavy reliance on the ACO-wide sharing of clinical and cost data. Modernizing processes will enable healthcare organizations to provide effi cient workfl ows throughout the system, while also providing a higher quality of care for the patient. However, most physicians will not enter into an ACO agreement due to the lack of return on investment. Regardless, the mechanism to analyze clinical outcomes based on actual data and improve measures accordingly will likely be worth the upfront investment. Structured vocabularies for the healthcare industry will empower continuity of care and communication across multiple clinical-care settings. With the migration to a universal code, translating into ICD-10 from ICD-9 will pose a challenge and require resources, both

human and IT, but the result will be better quality of care. This transition will become the next hot topic, as it is already looming on the horizon. Additionally, the shift to ICD-10 could create thousands of jobs as hospitals and other healthcare facilities adjust to an initial delay in claims submissions. There is an increased focus on the patient at the core of the plan of treatment. To truly impact care, the patient must be engaged, educated on all options and able to help choose the best course of action along with the allied care professionals responsible for treating the patient. Engaging the patient is also at the crux of the patient- centered medical home, which is becoming increasingly signifi cant as an emerging model of healthcare delivery. Coordination of care can reduce duplicate tests and prevent errors in confl icting treatment when patients have several doctors.

32 February 2012

Practices will begin implementing the features of 5010

By Ken Bradley, VP of strategic planning, Navicure

In my opinion, 2012 promises to be a year marked by growing awareness of how the effective use of data can be used to transform the medical revenue cycle that is only possible with full implementation of the HIPAA Version 5010 electronic transaction standards. One of my greatest worries, in fact, is that most

healthcare organizations – providers and payers alike – will have rushed to meet the bare minimum 5010 requirements by Jan. 1, 2012. Then, on Jan. 2, they’ll move straight into planning for ICD-10 without first ensuring maximum 5010 functionality. That could prove costly.

The effective use of data is becoming the undisputed driver for improving administrative healthcare processes, and 5010 will definitely start streamlining and replacing many manual processes this year. But without fully and correctly implemented 5010 standards, we won’t be able to take advantage of tons of good data. Eligibility is the perfect example. Under 5010, the eligibility response has been greatly enhanced to include patient demographic information and financial responsibility amounts. But if that valuable data never makes it back to the practice – because either an IT or clearinghouse vendor hasn’t appropriately updated its software, for instance – everyone loses the ability to report, benchmark and make business decisions based on it. This year, I think we’ll begin to see forward- thinking practices examining how to implement the features of 5010 in order to update business processes to reduce operational costs. As they’re doing so, they will begin to analyze ICD-9 code data in much the same way. (We can’t forget, of course, that 5010 sets the framework to ensure even better data mining capabilities once ICD-10 is implemented.)

Make no mistake: 5010 is worth the effort. You just need to make sure all the benefits of 5010’s standardized and more robust data are put to work to help you reap the highest reward.

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HEALTH MANAGEMENT TECHNOLOGY

www.healthmgttech.com

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