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
My uncle was recently in need of post-acute care after a hospital stay. During discharge planning, he was given a short list of facilities, with names and addresses. He was pressed to make a decision, because the discharge staff needed time to check where his insurance would be accepted and check on who might be available to take him. Then they would get back to him with a new list of options. It all had to happen pretty quickly.
Did my uncle really get a meaningful choice? Read more
Healthcare in the U.S. seems to be in a constant state of hand-wringing, not the least of which concerns how complicated it is to bill and pay for care. It is hard to imagine that something so straightforward could be so complex. Curiosity about this, or more of a desire to learn, has always driven me.
Complex, confusing, disorganized, unprofitable, duplicative, wasteful — pick your negative adjective and it’s been applied to the administrative side of healthcare. Thinking about unraveling all the complicated systems can be daunting. Where to start? Read more
ABILITY Network Inc, a leading healthcare technology company, announced today that it has entered into an agreement to receive a significant strategic investment from Summit Partners, a global growth equity investor. Read more