All Entries Tagged With: "accountable care organizations"
Readmission reduction pilot program saves hospital thousands
A recent article in The Miami Herald describes a readmission reduction pilot program at Jackson Memorial Hospital that saved it an estimated $400,000 in readmission charges.
Jackson nurses visit recently discharged heart patients at their homes to ensure that they’ve filled their prescriptions and understand medication instructions. The nurses also leave frozen healthy meals and check in with patients regularly to monitor their conditions and provide more meals.
The article describes Jackson’s pilot program as a predecessor to accountable care organizations (ACO). The ACO model is widely praised, but this article explains the need to address several challenges. Antitrust and anti-kickback healthcare laws require revisions that will allow healthcare providers to refer patients to entities with which they have a financial relationship. However, some groups warn that relaxing antitrust laws could allow healthcare providers to create the monopolies that these laws were enacted to prevent.
Editor’s note: Read the article at http://www.miamiherald.com/2011/08/03/2344316/will-acos-create-a-revolution.html
Senators ask for a new ACO proposed rule
Seven U.S. senators believe the Accountable Care Organization (ACO) proposed rule will not only cost more than estimated but will not accomplish the program’s goals. They want CMS to try again.
CMS published the ACO proposed rule in the April 7 issue of the Federal Register. The ACO program allows groups of providers to work together to manage and coordinate care for Medicare beneficiaries through an ACO, according to CMS. An ACO may receive payments for shared savings if it meets certain quality performance standards.
Senators Tom Coburn (R-OK), Jon Kyl (R-AZ), Mike Crapo (R-ID), Mike Enzi (R-WY), John Cornyn (R-TX), Pat Roberts (R-KS), and Richard Burr (R-NC) wrote a letter to CMS asking the agency to scrap the current proposed rule and write a new one. The Senators say they have heard concerns from several leading healthcare institutions that believe the proposed rule will fail to accomplish the ACO program’s purpose. The senators also cite an American Hospital Association report which says implementing the ACO program will cost 10 times more than the proposed rule estimates.
The Senators acknowledge that the ACO concept is a worthwhile goal, stating “An ACO model that can increase provider coordination and patient accountability would be a step in the right direction.” However, they believe “this proposed rule misses the target.”
Improve relationships with postacute facilities
The creation of accountable care organizations (ACO) and global payment pilot projects are among the more often discussed initiative in the Patient Protection and Affordable Care Act.
Hospitals can begin laying the groundwork for ACOs by developing relationships with postacute facilities in their communities. They should discuss quality initiatives and improving transfers now before ACOs and global payments take effect in 2013.
Because case managers, social workers, and discharge planners are typically those who communicate with postacute providers, they are the ideal candidates for fostering relationships. Unfortunately, many case managers already have much on their plate and cannot devote much time to meeting with postacute representatives to establish strategic initiatives. This is why Baystate Health (BH) in Springfield, MA, created a role in 2006 devoted exclusively to postacute relations.
Meet Susana Hall, RN, BSN, MBA, director of postacute care (PAC) relationships at BH. Hall essentially is the operations part of a PAC team, developing the health system’s relationships with postacute care providers in western Massachusetts. She does that in two ways—ensuring that postacute facilities share and participate in BH’s vision of quality and negotiating with facilities regarding acceptance of difficult and hard-to-place patients.
Hall meets with representatives from the region’s postacute facilities in strategic planning sessions. During those sessions, they talk about improving transitions and discuss any quality lapses. Hall also negotiates with postacute providers that may be reluctant to accept difficult patients. For example, she says it is sometimes difficult to place Alzheimer’s patients because they tend to “act out” when arriving at a new facility.
“I can call and say, ‘We need your help. I need to ask if you will work with us on a challenging case. What can we do together to make this happen?’ ” Hall says. “We have strong clinical teams in our regional SNFs, and when we approach a challenging case as a team and focus on what is in the best interest of the patient, we have great outcomes. We all work for the same person—the patient.”
In some cases, Hall has negotiated to have BH support the cost of one-on-one services for Alzheimer’s patients until they settle into the new location. Because she is a director, Hall works predominately with administrators, so she often negotiates with chief operating officers and CEO.
