Top 12 Uncertainties Hovering Over Healthcare

Cheryl Clark, for HealthLeaders Media , November 21, 2011

Expanded criteria may include making sure, for example, that a certain percentage of a physician's patients actually see their electronic health records, rather than just making those records available to them, as well as thresholds for secure messaging between patients and physician.

Protocols for having patients sign advance directives are expected as well.  All of this costs money, and hospitals as well as physician groups have expressed concerns about where they'll find the money to implement EMR, and what other needed improvements they'll have to delay.

10.  Accountable Care Organizations
Regardless whether large numbers of hospitals choose one of the approved options under the Medicare Shared Savings Plan, hospitals and providers throughout the country will eagerly want to know who becomes an approved ACO, a Pioneer ACO, or an Advance Payment ACO, and what their competitors do in response.  Increasingly important will be ACOs as defined by private payers, how that impacts physician integration and employment, and how these organizations are ultimately defined.  Will there be shared savings?

Equally of interest will be how CMS, along with the Federal Trade Commission and the Anti-Trust Division of the Department of Justice, work together to assure that ACOs don't dominate their markets, don't skimp on services, and don't pressure enrollees to influence their choice of providers.

11. Physician Payments Sunshine Act
To limit influence of manufacturers of drugs and medical equipment and supplies on physician or hospital practice, the Affordable Care Act requires those manufacturers to report payments or "transfers of value" to physicians or academic medical centers and teaching hospitals by Jan. 1, 2012.

However, the legislation gave little guidance on what information was to be provided and how. And both providers and industry leaders are worried about how it will all be interpreted by payers and the public. To clarify the intent, CMS was required to issue regulations specifying what was needed and in what format no later than Oct. 1, but it has yet to do so.

"Everyone is eagerly awaiting these details," said Richard Bankowitz, MD, chief medical officer for Premier Inc., a quality and purchasing cooperative for hospitals and healthcare systems.

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6 comments on "Top 12 Uncertainties Hovering Over Healthcare"

Janice (11/30/2011 at 1:52 PM)
I agree with Lanay - having coded and reviewed thousands of records in my career, patient non-compliance is a major reason especially for CHF readmissions. Patients are adequately trained during the admission but it is too easy to slip back into old habits when they go home. What makes non-compliance easy is that many of the CHF patients may be on low incomes, and eating appropriately, which is a major player in CHF, may be next to impossible. Patient non-compliance should be excluded from the readmissions for CHF (there is a ICD-9-CM code for it).

Kandi O'Brien (11/29/2011 at 10:59 PM)
It is great to see that the government wants to [INVALID] measures to prevent harm. However, the affects of some of these measures excludes a lot of common situations. Ex: 30 day rule. Most of these PTA have multiple chronic issues and they have totally separate issues that land them in the hospital. The entire visit /week stay shouldn't be denied when there was no wrong doing in relation to the initial treatment. There also should be more regulation on insurance companies. They are making money every year while everyone else faces cuts. Increases for our tax rates have to be approved, maybe the increase for premiums should have a similar plan. Having worked on both sides I am confident that there is a middle ground, however, the wrong people aren't usually at the table to make those decisions.

Lanay (11/29/2011 at 5:48 PM)
In addition to that which is listed regarding readmission for selected illnesses they need to consider patient non-compliance with treatment that directly leads to the readmission.




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