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A Timely, Transparent Response to Unexpected Harmful Events

November 16, 2016


“We realize mistakes happen, and we can forgive that,” says patient advocate Carol Hemmelgarn, whose nine-year-old daughter died of medical error and a hospital-acquired infection (HAI) in a teaching hospital.  “But you harm us again by not being honest and transparent with us . . . we should be healing and learning together how to prevent this from happening to someone else.”


Data Released on Medicare Bonuses

November 9, 2016


According to federal data released November 1, more than 1,600 hospitals will see bonuses from Medicare in 2017 under the Hospital Value-Based Purchasing (VBP) Program; about 200 fewer than last year.


WikiLeaks, Hackers and Cybercriminals Keep Healthcare IT Stakeholders on Guard

November 2, 2016


You would have to be living completely off the grid to be unfamiliar with WikiLeaks, the multi-national media organization founded by Julian Assange.  WikiLeaks has elevated itself as the most well-known name in hacking, exposing classified, censored or otherwise restricted official materials involving war, spying and corruption.  The organization is despised for uncovering secrets that were not meant for public consumption and applauded by millions who believe that the world’s most persecuted documents should be available to everyone.  Who would have thought that hacking could land someone on the cover of TIME Magazine as the coveted Person of the Year?  Assange held that distinction in 2010.


The Essentials of Emergency Preparedness

October 26, 2016


In slightly less than a year (by November 15, 2017), healthcare entities that participate in Medicare and Medicaid will be required to meet the provisions of the Centers for Medicare & Medicaid Services’ emergency preparedness final rule.


Final MACRA Rule Released by CMS

October 19, 2016


In an e-Alert released last month, we noted that the Centers for Medicare and Medicaid Services (CMS) would soon be issuing a final rule relating to the Medicare Access and CHIP Reauthorization Act (MACRA).  That final rule was issued this past Friday, and includes changes and clarifications responsive to over 4,000 public comments.


Deconstructing Healthcare Consumerism

October 12, 2016


Merriam-Webster defines consumerism as the promotion of the consumer's interests and it states that an increasing consumption of goods is economically desirable. The United States has become a society of increasing consumerism, where individuals are making increasing levels of purchases for a variety of consumer goods.


A Framework for Tackling Health Disparities

October 5, 2016


In the introduction to its new white paper, Achieving Health Equity: A Guide for Health Care Organizations, the Institute for Healthcare Improvement (IHI) tells the story of Tommy Cannon, a black American with type 2 diabetes and no access to preventive healthcare, who died in 1973 at the age of 62. Cannon waited hours in a segregated physician’s office. When the physician finally saw him, he told him to go to a hospital 50 miles away because he was so ill. He died the next day from sepsis due to a ruptured appendix without ever being treated by a physician.


Emergency Preparedness Requirements Finalized for Healthcare Facilities

September 28, 2016


Earlier this month, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to establish consistent emergency preparedness requirements for healthcare providers participating in Medicare and Medicaid, increase patient safety during emergencies and establish a more coordinated response to natural and man-made disasters. Healthcare providers and suppliers affected by this rule must comply with and implement all regulations one year after the effective date of November 15, 2016.


MACRA Flexibility: Set Your Own Pace in 2017

September 21, 2016

The clinician community breathed at least a partial sigh of relief last week. The Centers for Medicare and Medicaid Services (CMS) announced that clinicians would not suffer financial penalties in 2019 based on their performance in 2017 under the new Quality Payment Program (QPP) that implements the Medicare Access and CHIP Reauthorization Act (MACRA).


Improving Patient Satisfaction with Texting

September 14, 2016

On June 19, 1934, President Franklin D. Roosevelt signed the Communications Act of 1934 into law.1 This Act established the Federal Communications Commission (FCC) agency that regulates all interstate and foreign communication by wire and radio, telegraphy, telephone and broadcasts such as Short Message Service (SMS) texting.


Engage Front-Line Clinicians to Drive Down the Costs of Care

September 7, 2016


The Centers for Medicare and Medicaid Services’ 2018 target date for having 50 percent of all Medicare fee-for-service payments made through a value-based model is not far away. The transition to value requires hospitals, physicians and post-acute care providers to unite in delivering a high quality and cost-effective patient experience. Indeed, providers must do so or suffer penalties.


Quantros Study Finds No Correlation Between CMS Star Ratings and Quality

August 31, 2016


As we reported in an earlier briefing, the Centers for Medicare and Medicaid Services (CMS) published hospital quality star ratings on July 27th, despite pressure from industry stakeholders and Congress to delay their release.


Three Research Studies Indicate Early Discharge Puts Patient Lives at Risk

August 24, 2016


Today hospitals operate under a microscope. Consumerism has motivated healthcare leaders to become more transparent in publically sharing their pricing, quality and performance data. In addition, they must comply with a barrage of new reporting requirements thrust upon them by governmental mandates. These trends along with other operational challenges have forced providers to operate in a financial pressure cooker.


How Hospitals Can Avoid the Risks of Moving to the Cloud

August 17, 2016


Eighty-three percent of healthcare organizations have systems in a cloud environment, and an additional nine percent are in the planning phase, according to a 2014 survey by the Health Information Management Systems Society (HIMSS). Other research shows that 55 percent of hospitals have already migrated mission-critical and sensitive data to a cloud, and that 77 percent plan to move more of their information technology (IT) systems there in 2016.


Improving the Patient Experience Drives Superior Patient Satisfaction

August 10, 2016


Anyone who has followed the healthcare industry over the past few years understands the transition that is underway moving from the traditional fee-for-service (FFS) model of reimbursing providers for delivering care where physicians and organizations are incentivized to do more and provide more services. Under this economic model, a provider can make more money by ordering more tests, see more patients and perform more procedures.


MiraMed Global Services' Subsidiary Company, Plexus Technology Group’s Anesthesia Touch Becomes First Mobile AIMS Solution to Achieve Full KLAS Rating

August 9, 2016


MiraMed Global Services' subsidiary company and trusted Anesthesia Information Management Systems (AIMS) partner, Plexus Technology Group, LLC (Plexus TG), is pleased to announce Anesthesia Touch™ is now a fully-rated AIMS solution as scored by providers and recorded by KLAS research with a score of 891.


Where the Rubber Meets the Road – Correcting Improper Payments

August 3, 2016


Health plans and care providers need to open the lines of communication with each other in ways that they have never done before.  In order to maintain compliance and receive accurate payment from the Centers for Medicare and Medicaid Services (CMS) that reflects the severity of illness, utilization of resources and the increasing number of chronic conditions requires ongoing management of care documentation by providers.  The silos that exist between payers, providers and other enterprises must play ball together, or they will become their own besetting evil.  Frankly, this decision to communicate and collaborate will be the very process that will separate the “Men from the Boys; and the Women from the Girls.”  This article will delve into four areas that affect improper payments and will offer strategies to mitigate them.  They are:


Overall Hospital Quality Star Ratings

July 27, 2016

As part of their continuing efforts to make quality of care information more readily available, the Centers for Medicare & Medicaid Services (CMS) has developed a rating system that reflects comprehensive quality information about the care provided at our nation’s hospitals.  The ratings are intended to convey a hospital's overall quality with a single, composite metric of one to five stars, with five being the best.  The CMS originally planned to publish those ratings on its Hospital Compare website in April but delayed doing so after 60 senators and 225 representatives wrote letters urging it to hold off.  The CMS already publishes hospital star ratings based on patient experience; however, the Overall Hospital Quality Star Rating (Star Rating), which was developed through a public and transparent process, takes 62 existing quality measures already reported on the Hospital Compare website and summarizes them into a unified rating of one to five stars.  The rating includes quality measures for the routine care an individual receives when being treated for heart attacks and pneumonia to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections.  Key measures included in the Star Rating ask questions such as:


The Hospital’s Role in the Opioid Epidemic

July 20, 2016

According to the U.S. Centers for Disease Control, 44 people die every day in the United States from overdose of prescription painkillers.1 In order to combat the devastating effects of the growing epidemic, the American Hospital Association (AHA) and the Centers for Disease Control (CDC) have joined forces to educate the public about the issue. With the help of various experts from within the healthcare industry, the organizations formed a document entitled, Prescription Opioids: What You Need to Know, detailing the risks and side effects of opioids. In light of this release and the current national focus on opioid prescription use and abuse, it is important to understand what facilities and hospital systems can do to assist in curtailing this rapidly growing epidemic.


Changes Proposed to Medicare Appeals Process

July 13, 2016


Every year, Medicare Administrative Contractors process an estimated 1.2 billion fee-for-service claims on behalf of the Centers for Medicare & Medicaid Services (CMS) for more than 33.9 million Medicare beneficiaries.  When beneficiaries or providers disagree with a coverage or payment decision made by Medicare, they have the right to appeal and the Social Security Act established five levels to the Medicare appeals process:


CMS-HCC Risk Adjustment Auditing—A Necessary Evil

July 6, 2016


The Centers for Medicare and Medicaid Service’s (CMS) Hierarchical Condition Category (HCC) risk adjustment model is used to calculate risk scores, which will adjust capitated payments made for aged and disabled beneficiaries enrolled in Medicare Advantage (MA) and other plans.


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