October 1 draws ever-closer, meaning now is ICD-10 crunch time for many healthcare providers. At SNFs and other facilities where billers have become accustomed to working with a familiar and relatively limited code set, the change means a lot of studying is underway. Read more
As the ICD-10 countdown continues, coders and billers in physicians’ offices are taking many steps to make sure they’ll be ready. You’re likely attending trainings or using online resources to learn the new codes, and you’re probably also conducting testing with payers. Despite these measures, many in the industry fear that ICD-10 implementation will have a negative effect on their productivity and denial rates. Read more
Experts have projected employment in the long-term care industry will continue to grow through the year 2030, leading to concerns about talent shortages. “Policy makers and educators should redouble efforts to create and sustainably fund programs to recruit, train, and retain long-term care workers,” wrote researchers in a study conducted at the University of California San Francisco. Read more
The recent recommendation from the Medicare Payment Advisory Commission (MedPAC) that the “three-day stay” rule be relaxed is welcome news for many skilled nursing facilities (SNFs). Not only did the commission recommend that up to two outpatient observation days be counted toward the three-day requirement, it also asked Congress to mandate that hospitals communicate better with patients about their status as an outpatient or inpatient and how it might impact their benefits in a skilled nursing facility. (To be clear, the three-day rule is not to be confused with the two-midnight rule, to which CMS has recently proposed changes.)
The June 25 Supreme Court ruling in King v. Burwell brings closure in the latest chapter of legal wrangling over the Affordable Care Act (ACA), and avoids the upheaval that would have resulted if the court had ruled against the federal government. The ruling is significant for commercial payers, whose plan pricing depends on the participation of the young and healthy, and also for providers and patients, for whom the ruling means that business can continue as usual, with eligible patients continuing to receive subsidies to purchase their insurance. Read more
I recently attended the 2015 Health Datapalooza, a national conference presented every year in the Washington, DC, area by the Health Data Consortium. Health Datapalooza has billed itself as “the only event where leaders, across industries, unite to discuss the future of open health data.” The conference brings together a few thousand technology experts, entrepreneurs, policy makers, and other healthcare leaders to talk about “the power of health data.”
It was an exciting and energizing conference. One thing that struck me was just how far we’ve come since the first of these conferences five years ago. That feeling of progress was epitomized by the announcement that CMS – yes, the federal government! – made at this year’s Health Datapalooza. Read more
“Hospitals are seeking to hold post-acute-care providers accountable because they have more at risk under value-based payment models,” according to a May 9 story in Modern Healthcare. The story reports on a growing number of hospital systems moving to evaluate post-acute facilities based on a variety of measures. Read more
Many companies in the healthcare EDI industry are dependent on connecting to the nation’s largest payer, Medicare, to access the critical data needed to provide services to their customers. Much of the data needed sits in an antiquated system that has required vendors to build and maintain systems to programmatically access the data.
But there are challenges with building and maintaining these systems, including trying to keep up with Medicare changes; keeping subject matter experts on staff who understand the home-grown system; and determining how to efficiently and cost-effectively make changes to their system to pull new data as made available. More and more healthcare IT vendors are turning to XML to address the challenges listed above as they refresh an aging technical infrastructure and source new revenue streams to keep up with shifts in healthcare IT. XML has increasingly become a standard in simplifying complex interoperability and clinical data exchange. Read more
Listen to this patient’s story about her “transition of care” experience:
An 85-year-old cognitively intact but frail female is admitted to the hospital for myocardial infarction and heart failure. She is later transferred to an SNF for 3 weeks of rehabilitation on account of her functional limitations, poor balance, and complex medication regimen. During a follow-up visit with her primary care physician after her discharge from the SNF, the patient and her daughter express discontent with the quality of care at the facility. . . . They also express dissatisfaction with the hospital-to-SNF transition, alleging that the hospital team rushed them into selecting an SNF. They claim that on the day of hospital discharge, no relevant information was provided to them other than a list of nine SNFs that were near her home [added emphasis]. The family had chosen this particular SNF based on its close proximity to the home of the patient’s daughter.
There’s clearly a disconnect here. Read more