Advanced Revenue Cycle Analytics: An Overview
Now that the election season has come to a close, what does that mean for us in healthcare?
Will Legislation Change?
HITECH Act – No change, unless budgets are overturned; includes Meaningful Use, HIPAA Security, and Health Information Exchanges (HIE). The funding for these programs is relatively secure with either party having a majority. Adopting an EHR for Meaningful Use has incentives now, but will transition into a penalty if you fail to have one by 2015.
Affordable Care Act, aka ObamaCare – Some would say is now here to stay, others argue the contrary. Many states have proposed amendments against it. Programs and statutes resulting from ObamaCare are Health Insurance Exchanges (HIX), elimination of insurers’ ability to refuse or limit coverage based on pre-existing conditions, mandated coverage for both employers and citizens, rise of Accountable Care Organizations (ACOs), and an increase in Medicare funding. ACOs will share risks with the payor (may result in a bonus or a loss). In CMS terms, it is a shared savings program.
Patient Centered Medical Home (PCMHs)—No Legislation Attached: Although no legislation or government funding is attached, certification through the National Committee for Quality Assurance (NCQA) is a major industry trend and the PCMH is the cornerstone of an ACO. PCMH status is an influence for negotiating payor contracts and providers earn incentives for maintaining their certification and reporting important quality-based information (quality measures, HEDIS data) to the payors. Not to mention that the certification standards for a PCMH lays the foundation for lower costs with improved health which, in the end, is the over-arching goal for all this legislation.
Industry Reactions to Election
Healthcare Finance News gave a summary of industry reactions to the election results.
Healthcare Informatics summarized reactions into suggesting “Healthcare IT will regain momentum.”
The American Academy of Family Physicians (AAFP) reached out to the president to “implement a permanent fix to the flawed Medicare physician payment formula that rewards volume over quality and discourages growth of primary care.”
Capretta and Levin of the Wall Street Journal opined that “ObamaCare Is Still No Sure Thing,” pointing to the impact that individual state decisions may have on the new laws.